Repair of frontal sinus fractures: clinical and radiological long-term outcomes.

OBJECTIVE: The long-term clinical and radiological outcomes of patients surgically treated for frontal sinus fracture were assessed. METHODS: A retrospective, single-centre analysis was conducted of patients treated for frontal sinus fracture in a tertiary trauma centre between 2000 and 2017. Patients who underwent surgical repair for frontal sinus fracture followed by clinical and radiographical evaluation for at least six months were included. RESULTS: Of 338 patients admitted with frontal sinus fracture, 77 were treated surgically. Thirty patients met the inclusion criteria for long-term follow-up. The average follow-up duration was 37 months (range, 6-132 months). Reconstruction, obliteration and cranialisation of the frontal sinus fracture were performed in 14, 9 and 7 patients, respectively. Two patients with a reconstructed frontal sinus and one with an obliterated frontal sinus developed mucoceles. One patient developed forehead disfigurement following obliteration. CONCLUSION: Long-term complications of frontal sinus repair using the chosen repair techniques are rare, but patients need to be made aware of these potential complications.

Closed-suction compared with Penrose drainage after free flap reconstruction in the head and neck.

Microsurgical free flaps are common in head and neck reconstruction, and their techniques and outcomes have continuously improved during the past decades. However, there are variations in practice among surgeons between the use of closed-suction drainage systems and Penrose drains. The proponents of Penrose drains propose that the negative pressure generated by the closed-suction drainage system may harm the microvascular anastomosis. We know of no previous studies that have compared the two drains for microvascular free flap reconstruction, so our aim was to compare them in a single-centre, retrospective review of all patients who had microvascular free flap reconstruction of the head and neck region in our department between 1 November 2010 and 1 September 2017. During this period 84 patients had 87 free flap reconstructions in the head and neck, 43 of which had Penrose, and 44 closed-suction, drainage. We compared the number of complications between the groups including haematomas, seromas, wound infections, anastomostic thrombosis, anastomotic revision, and need for re-exploration. There were no significant differences between the groups, despite a trend toward fewer negative explorations in the closed-suction group. There were no differences in complications between suction and passive drainage systems after microvascular free flaps, which suggests that closed suction drainage could be safely used after free flap reconstruction in the head and neck.

The significance of Computed Tomography in invasive paranasal mucormycosis.

INTRODUCTION: Early diagnosis of acute invasive fungal rhinosinusitis (AIFR) is crucial for patients prognosis and may reduce the extent of surgical debridement. Initial evaluation usually includes paranasal Computed Tomography (CT), with an emphasis on bony erosion which is considered a specific but insensitive radiologic sign. Most studies made no distinction between Aspergillus and Mucor species while addressing CT findings. In this study, we seek to evaluate whether bony erosion on paranasal CT is a significant and reliable finding in the initial evaluation of invasive paranasal mucormycosis. METHODS: A retrospective review of pre-operative non-contrast craniofacial CT scans of patients diagnosed with acute invasive fungal rhinosinusitis (AIFR) caused by Mucor species for the presence of bony erosion. RESULTS: A total of 13 patients (9 males, 4 females) were included. Twelve patients were immunosuppressed due to various hematological malignancies. Six patients underwent debridement due to gross intraoperative findings of bony fungal invasion, but only one patient had evidence of bony erosion on the pre operative paranasal CT. CONCLUSION: Bony erosion on paranasal CT is an exceptionally insensitive radiologic sign for establishing or rejecting the diagnosis of Mucor induced AIFR. The mainstay of confirming or rejecting the diagnosis of AIFR is by physical examination, endoscopy and oriented biopsy of suspicious mucosal lesions.

Predicting outcome in tracheal and cricotracheal segmental resection.

The aim of this study was to analyze prognostic factors of successful tracheal and cricotracheal segmental resection (TR/CTR), the type of revisions performed in cases of failure, and the outcome of revisions. The study is designed as case series with chart review. Between 1995 and 2011, 122 adult patients underwent TR/CTR. Forty-six patients (38 %) had concomitant airway pathologies and 59 patients (48 %) failed previous interventions. Forty-six patients (38 %) were aphonic with a complete obstruction. Cricotracheal, tracheotracheal, and thyrotracheal anastomosis was performed in 78 (64 %), 24 (20 %) and 20 (16 %) patients, respectively. Subglottic involvement, higher grade of obstruction, preoperative tracheostomy, presence of any concomitant airway pathology and impaired vocal cord movement were all associated with poorer outcome. Initially, 85 patients (68 %) achieved primary goal with no need for further intervention. Thirty-six patients underwent one or more revision surgeries (laser, dilatation, tracheostomy, stent or T-tube, laryngoplasty, segmental resection, posterior cordotomy) with a success rate of 69 %. Overall success rate, after revisions, was 88.5 %. Segmental tracheal resection for tracheal stenosis is highly successful in non-tracheotomized, cricoid sparing incomplete tracheal stenosis patients, without secondary airway pathologies. Initial failures of TR/CTR can be managed with revision surgery.