Patients undergoing complex rhinoplasty, following previous trauma or cartilage deteriorating disease processes, present a surgical challenge. The availability of septal cartilage maybe limited, and alternative graft materials should be considered.
A retrospective study of our experience using the porous polyethylene (Medpor®) implant in nasal reconstruction was conducted. The indications for surgery are reviewed and the surgical outcomes noted. We also review the literature on available nasal implants and discuss their advantages and disadvantages.
A total of 22 Medpor® nasal implants were used for augmentation rhinoplasty over a 6 and half years period. Three patients experienced a surgical complication, including one slipped dorsal implant, and two patients with graft extrusion. Both of these two patients had concomitant disease processes that would have resulted in a poor tissue microenvironment, which may have contributed to their graft failures.
In our experience, the Medpor® implant has proved very successful in patients requiring complex rhinoplasty, in a normal host tissue microenvironment.
DOI: 10.5005/jp-journals-10013-1076 |
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Mohindroo N, Sharma D, Thakur J, Diwana V, Chauhan D. Nasofacial Cutaneous Cancer at High Altitude: Patients Awareness and Surgical Outcome. Clin Rhinol An Int J 2011; 4 (2):71-74.
Nose has anatomical variation from other facial units. Nasal skin surgery needs experience due to limited skin mobility for postsurgical defect. MMS is the preferred method for facial skin cancers but it is available in only few advanced centers of the country. We performed retrospective study to evaluate the results of traditional surgery and reconstruction in our hospital lacking frozen section facility.
A total of 129 lesions of the face were excised in 87 patients. Thirty-six skin cancers were found in 31 patients. 21 postoperative defects were repaired with full thickness skin graft and seven cases needed local or distant flap. The recurrence occurred in two patients (one lesion each) in 1 year follow-up.
Nasal cutaneous cancers need utmost surgical expertise and experience in reconstruction. Health awareness campaign is needed to avoid skin cancers, especially people living at higher altitude.
To evaluate and compare the efficacy of endoscopic-assisted (EA) adenoidectomy with the conventional adenoidectomy (CA) with an aim to reduce rates of residual adenoid tissue after adenoidectomy.
A prospective randomized study involving 32 patients in which 16 underwent EA and 16 underwent CA. The outcomes compared were residual adenoid tissue after 3 months of surgery, operative blood loss, operative time and complications.
A tertiary care teaching hospital.
EA was significantly better in terms of residual tissue left behind as compared to CA (p < 0.05), similar operative blood loss and operative time with no difference in complications.
EA makes for a safe and efficacious way to do an adenoidectomy which has a significant advantage over CA.
To evaluate the effect of tranexamic acid, an antifibrinolytic agent, in reduction of surgical hemorrhage during endoscopic nasal surgery.
Comparative analysis of the use of tranexamic acid in 200 patients undergoing endoscopic nasal surgery and its demonstrable reduction of hemorrhage and improvement of visibility of operative field.
Around 200 patients with varied indications underwent endoscopic nasal surgery; 100 were given tranexamic acid perioperatively and 100 did not receive tranexamic acid and were used as a control. Selection of patients was done on random basis. We used the following parameters to measure intraoperative blood loss: Visibility of field of surgery, weight of blood swabs postoperatively and amount of blood from suction machine.
Patient who received tranexamic acid showed reduction of blood loss amounting to 72.48% (p < 0.05). This reduction was compared with results published by other authors using various kinds of anesthesia.
Tranexamic acid is an antifibrinolytic agent which inhibits the action of plasmin. There is also reduction in blood level of D-dimer. It is seen to significantly reduce intraoperative blood loss during endoscopic nasal surgery. Additionally, there seems to be no alteration of coagulation parameters or untoward systemic effects. The consequent improvement in surgical field visibility is of great benefit which is encouraging and should prompt further trials.
A legal duty exists whenever a hospital or health care provider undertakes treatment to a patient. The duty is breached when the provider is failed to conform to the standard care. The breach of duty is a proximate cause of injury. Without damages there is no basis for a claim, regardless of whether the medical provider was negligent. Likewise, damage can occur without negligence, e.g., when someone dies from a fatal disease.
Complications of paranasal sinus infection most often involve the orbit and periorbita. Because of widespread use of antibiotics, intracranial extension of paranasal sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the potential of these complications, as late recognition of this condition and delay in treatment can increase morbidity and mortality rates. An interesting case series of sinusitis with orbital and intracranial complication is presented, which was radiologically evaluated, and was managed by endoscopic sinus surgery with drainage of subdural empyema by appropriate neurosurgical technique. The radiological tools played a very important role in both assessment and timing of surgical intervention. Unparallel role of radiological investigations cannot be overemphasized. The key to successful treatment is aggressive management and the timing for surgical intervention should not be deferred. The patients made full recovery at the time of discharge.
Jagveer Singh Yadav,
Ashok K Gupta
Aneurysmal bone cysts are vascular tumors that cause expansion and erosion of bone. We present this rare entity involving maxillary, ethmoid and frontal sinuses along with orbit. Computed tomography and histopathology showed typical features of aneurysmal bone cyst. We discuss clinical, radiological and histological details along with endoscopic management and literature review. The rarity of tumor makes this case interesting for head and neck surgeons.
Mukesh Kumar Singh,
Congenital choanal atresia has been recognized for over 200 years, first described by Roederer in 1775. Choanal atresia is an uncommon congenital anomaly. Choanal atresia is strongly suspected on the clinical sign and symptoms and confirmed with radiographs. CA repair in teenagers is not as common as it is in babies, but it still takes place and with good result. Transnasal endoscopic repair of CA is a safe and successful technique.
DOI: 10.5005/jp-journals-10013-1083 |
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Sonkhya N, Mittal P, Sonkhya D. Transnasal Endoscopic Repair of Post-traumatic Cerebrospinal Fluid Fistula and Meningoencephalocele: Successful Closure of a Big Breach (18 × 15 mm) with Septal Cartilage and Temporalis Fascia. Clin Rhinol An Int J 2011; 4 (2):101-104.
Transnasal endoscopic repair of cerebrospinal fluid fistula is recommended for patients with post-traumatic cerebrospinal fluid leaks who do not respond to conservative treatment. It is a safer and more successful alternative to transcranial surgery.
We present our experience of using septal cartilage and temporalis fascia in this transnasal endoscopic approach for the repair of the large defect of anterior skull base cerebrospinal fistula and meningoencephalocele. Use of microdebrider is highlighted in the technique for the debridement of the encephalocele and complete exposure of the defect.
Rupender K Ranga,
Foreign body in the nasopharynx is very uncommon. Authors report a curious case of mutton piece in a 2-year-old child which got lodged consequent to removal try by the mother. The child presented with foul smell, bilateral nasal obstruction and mouth breathing. Mutton piece was removed by nasal endoscopy.
Somanath B Megalamani,
Sunil Kumar Saxena
Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. The disease is endemic in the Middle East, the South Asia and South America. The larvae usually cause cystic lesions in the lung and liver. Hydatid cysts are known to affect the head and neck region. The presence of this cyst in the maxillary sinus is extremely rare and should be suspected in cases presenting from endemic countries.
A 66-year-old male presented with right-sided facial pain and headache since one year. MRI brain showed a large bony lesion in right side of maxillary sinus. CT scan of the paranasal sinuses revealed maxillary sinus osteoma. The tumor was excised through an opening made in anterior wall of maxilla along with endoscopic guidance through nasal cavity. Postoperative period was uneventful. The pathogenesis and various treatment modalities for maxillary sinus osteomas have been discussed.
Hemangiomas are a benign vascular tumor and are of two types: capillary and cavernous. Isolated cavernous hemangiomas of paranasal sinuses are rare. We report a case of hemangioma involving the left maxillary and ethmoid sinus managed endoscopically.
Jagveer Singh Yadav,
Uma Nahar Saikia
Paranasal sinuses are normally lined by respiratory mucosa which is pseudostratified ciliated columnar epithelium. Cholesteatoma of paranasal sinus is a condition where respiratory mucosa is either partially or totally replaced by hyperkeratotic squamous epithelium which lead to formation of lamellar sheet of keratin and this condition is known as cholesteatoma. We report one such rare occurrence of maxillary sinus cholesteatoma managed endoscopically.