RESUMO
BACKGROUND: Tumours of nasal skin or mucosa are common, and can usually be treated with limited surgical excision or radiotherapy. This paper highlights a subset of high risk tumours which require rhinectomy for complete oncological clearance. METHOD: Retrospective case note review of 14 patients undergoing rhinectomy for nasal tumours. Clinical and histological findings, treatment and outcome are reviewed and discussed. RESULTS: Forty-three per cent of patients had recurrent disease and underwent rhinectomy as a salvage procedure following previous surgery or radiotherapy. Most tumours (79 per cent) were basal cell carcinoma or squamous cell carcinoma. After a mean follow up of 30.1 months (range, zero to 96 months), seven patients (50 per cent) were alive and disease-free. Reconstruction was most commonly with a prosthesis. CONCLUSION: Rhinectomy is an oncologically sound procedure for the management of high risk nasal malignancies. Prosthetic rehabilitation can be an excellent alternative to surgery, particularly in those patients unsuitable for major reconstruction.
Assuntos
Procedimentos Cirúrgicos Nasais/métodos , Neoplasias Nasais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Carcinoma Basocelular/reabilitação , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/reabilitação , Carcinoma de Células Escamosas/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Nasais/estatística & dados numéricos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/reabilitação , Recidiva Local de Neoplasia/cirurgia , Neoplasias Nasais/patologia , Neoplasias Nasais/reabilitação , Próteses e Implantes , Implantação de Prótese/métodos , Procedimentos de Cirurgia Plástica/métodos , Procedimentos de Cirurgia Plástica/reabilitação , Reoperação , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/reabilitação , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
METHODS: A retrospective case-note study of immediate breast reconstruction using the pedicled latissimus dorsi flap with a silicone implant and a patient-satisfaction survey were carried out. RESULTS: Fifty-four reconstructions were performed in 52 patients between March 2001 and October 2006. Major complications included capsular contracture requiring capsulotomy (7.4%); minor complications included donor-site seroma (20.4%) and superficial wound problems (13%). The average score out of 10 for the appearance of the reconstructed breast whilst wearing a bra was 8.35; score for appearance whilst out of a bra was 7.0 and overall symmetry was 6.6. On the basis of the scores, 16 patients were grouped as excellent; 15 as good; seven as fair and two as poor. Significantly, more of the patients without a contralateral matching procedure graded their reconstruction as good or excellent (p=0.024). CONCLUSIONS: The pedicled latissimus dorsi flap with a silicone implant gives the majority of patients a satisfying reconstruction, without necessarily requiring a contralateral matching procedure, whilst minimising postoperative complications.