The complications of external rhinoplasty.

An analysis of complications of 867 consecutive external rhinoplasties over a 14-year period is presented. The most common intraoperative complication was excessive bleeding. Transient epiphora, bleeding, excessive and/or prolonged edema, septal dematoma, transient anosmia and various problems with packing were observed in the early postoperative period. Late complications included hypertrophic scar, localized periostitis, skin telangiectasia, etc. The complications of external rhinoplasty are comparable in incidence and severity of standard endonasal rhinoplasty.

Surgical treatment of laryngeal stenosis.

In this study of the surgical treatment of acquired definite stenoses and atresia of the larynx, the author made the following classification: (i) stenoses due to bilateral paralysis of the recurrent nerve; (ii) stenoses caused by cicatrization of endolaryngeal structures, complete atresia of the larynx with obliteration of the lumen (a) the cartilaginous skeleton of the larynx is still preserved, (b) cases in whom for various reasons the cartilaginous skeleton had been destroyed and the lumen of the larynx assumed the shape of a narrow fissure covered with mucosa; and (iii) cases without cartilaginous skeleton or mucosa where only a cicatricial tissue has remained. As a basis for this research 120 cases were used. Two surgical techniques in bilateral paralysis of the recurrent nerve are described in detail. A combined extra- and intralaryngeal method of submucosal exenteration of the larynx and arytenoidectomy on one half, and cordopexy and disarticulation of the arytenoid was carried out on 30 patients. The second technique, which is still in a clinically experimental phase, is called arytenoidectomy and cordopexy via intercricothyroidolaryngotomy. It was used on only two patients, while greater experience has been gained through experiments carried out on animals (horses and dogs). In 22 patients treated for cicatricial stenoses and atresia various kinds of plastic reconstructive procedures were used. In all 22 patients treated for cicatricial stenoses and atresia various kinds of plastic reconstructive procedures were used. In all 120 cases the respiratory function of the larynx was satisfactorily restored. The voice of all these patients was altered and the phonatory function in 65 per cent of cases remained significantly impaired.

Functional evaluation after partial resection in patients with carcinoma of the larynx.

This paper presents the results of conservative operations on patients with laryngeal carcinoma in the ENT Department of the University Hospital "Dr. Mladen Stoianovic," Zagreb, Yugoslavia, during the last 20 years. The authors have evaluated the functional results after partial vertical and horizontal surgical interventions on the larynx and after the reconstruction of the larynx following these operations. Functional analysis of the voice was performed by stroboscopic, indirect microlaryngostroboscopic and sonagraphic examinations of the laryngeal function, as well as by the spirometric analysis of the respiratory potential of these patients, especially the degree of obstruction of the upper respiratory tract and changes on the cardiovascular system. Attention has been given likewise to the examination of the act of swallowing, especially after horizontal partial resections of the larynx. Radiography and radiocinematography was used for these examinations. Based on this research the authors have formulated new conceptions and opinions about the voice generator.

Combination of extranasal and intranasal approach in surgery of the nasal pyramid and nasal septum (decortication).

Decortication of the nose is a combination of the extranasal and intranasal approach to the surgery of the nasal pyramid and nasal septum. It consists of temporary removal (decortication) of the skin from the infrastructure of the tip and dorsum of the nose through a columellar and slot incision. This method makes it possible to perform very precisely a wide spectrum of surgical interventions under visual inspection and thus guarantees the basic surgical postulate of good surveillance over the operative field. We have used this method in 500 cases and evaluated the esthetic and functional results of the operation in all of these patients. This modified technique meets all the requirements of functional rhinosurgery.