Correção de fissura palatina com retalho músculo mucoso de bucinador: resultados de 6 casos após 27 anos / Correction of palatine fistulas with a musculo-mucosal buccinator flap: results of 6 cases after 27 years

Introdução: O retalho miomucoso de músculo bucinador, descrito em 1989, pode ser utilizado para corrigir fístulas palatinas, fissuras com alongamento do palato mole ou cobrir áreas cruentas após ressecções de tumores. Métodos: Trata-se da análise do resultado após 27 anos de 6 casos de pacientes operados no Hospital de Base e na Santa Casa de São José do Rio Preto, no período de 1984 a 1989, e reavaliados em 2016, nos quais foram realizados retalhos miomucosos de bucinador para correção de fissura palatina. Resultados: Dos 36 casos operados, 6 foram reavaliados após 27 anos, dos quais 5 trataram-se de correção primária e 1 de correção secundária (fístula após fechamento de fissura palatina). Todos os casos obtiveram resultados satisfatórios no crescimento maxilar, na correção da fistula palatina e na função da fala. Conclusão: Apesar de estatisticamente não significativo, o presente estudo demonstrou que o retalho miomucoso de músculo bucinador para correção e alongamento do palato é um procedimento adequado, com resultados de crescimento maxilar normal ou próximo disso e fala praticamente normal, mesmo sem adequado tratamento fonoaudiológico.

Introduction: The buccal musculo-mucosal patch, described in 1989, can be used to correct palatine fistulas and fissures with stretching of the soft palate, or to cover bloody areas after tumor resection. Methods: This is an analysis of the 27-year postoperative results for 6 patients who underwent operation at Base Hospital and Santa Casa de São José do Rio Preto between 1984 and 1989, and reassessed in 2016, when a myo-buccinator mucosa was used for cleft palate correction. Results: Of the 36 operated cases, 6 were reevaluated after 27 years, of which 5 had primary correction and 1 had a secondary correction (fistula after cleft palate closure). All the cases had satisfactory results in terms of maxillary growth, correction of the palatine fistula, and speech function. Conclusion: Although not statistically significant, the present study demonstrated that the buccal musculo-mucosal flap is an adequate procedure for correction and stretching of the palate, with normal or near-normal maxillary growth and practically normal speech even without adequate phono-audiological treatment.

Long-term oral intake through a salivary bypass tube with chronic pharyngocutaneous fistula.

Pharyngocutaneous fistulae (PCFs) are a common complication after total laryngectomy. Patients with persistent PCFs are often kept nil by mouth and are dependent on feedings via a gastric tube. Our patient is a 65-year-old man who presented to our clinic in 2008 having a persistent PCF after a total laryngectomy who failed numerous attempts at reconstruction. We inserted a salivary bypass tube as a method of spanning the PCF and advanced his oral diet. He has been able to tolerate a regular diet 30 months postoperatively with no dysphagia and has gained weight. This is a demonstration of salivary bypass tubes as a useful adjunct to maintain oral intake in the presence of a persistent PCF.

Traumatic perilymphatic fistula with pneumolabyrinth: diagnosis and management.

A perilymphatic fistula (PLF) is an abnormal communication between the inner and middle ear resulting in vestibular or cochlear symptoms. We review three pediatric traumatic temporal bone fractures with pneumolabyrinth, confirmed radiologically by the presence of air within the cochlea (pneumocochlea) or vestibule (pneumovestibule). Patients were treated conservatively with complete resolution of vestibulopathy. Hearing outcome was variable and worse in two patients with pneumocochlea. A pneumolabyrinth on radiologic imaging confirms a PLF and obviates the need for exploration to reach a diagnosis. We suggest exploration be reserved for patients with persisting cerebrospinal fluid leakage, progressive sensorineural hearing loss, or vestibular symptomatology.

Tratamento não-cirúrgico de lesão periapical de origem endodôntica associada à fístula extra-oral / non-surgical treatment of periapical lesion of endodontic origin associated with extraoral fistula

É rara a ocorrência de fístula extra-oral de origem dentária. Neste relato de caso, a paciente apresentou-se com uma fístula na região do mento, queixando-se da freqüente exsudação purulenta e do marcante comprometimento estético. Diagnosticou-se necrose pulpar no dente 31 associada à radiolucidez periapical. Simultaneamente à limpeza e anti-sepsia da fístula, realizou-se o tratamento endodôntico mediante instrumentação, seguido de renovação mensal de pasta à base de hidróxido de cálcio, por três meses, com ulterior obturação do canal radicular. Não foram prescritos antibióticos. A ferida cutânea cicatrizou-se num período de dez dias. Em 20 meses de preservação não houve recidiva da fístula e, radiograficamente, ocorreu completa reparação periapical. Esteticamente, não houve necessidade da cirurgia plástica no mento.

Extraoral fistula of dental origin is a rare occurrence. In the present case report, endodontic treatment was performed in a patient presenting with a periapical radiolucent area associated with fistula at the chin region, which often exhibited purulent exudate with severe esthetic impairment. Endodontic instrumentation was performed simultaneously to cleaning and antisepsis of the fistula with saline and triclosan soap; following, a calcium hydroxide and CPMC paste was applied and changed monthly for 3 months, when the root canal was filled. No antibiotics were prescribed. The fistula healed after 10 days. After 20 months, there was complete repair of the periapical lesion. Moreover, no surgical procedures were required to improve the esthetics at the chin region.

Time sparing and effective procedure for dural closure in the posterior fossa using a vicryl mesh (Ethisorb®) / Cierre de duramadre en cirugía de fosa posterior con una malla de vicryl (Ethisorb®): un procedimiento simple y efectivo

Introduction. Dural defects and cerebrospinal fluid (CSF) leaks are a common problem following posterior fossa surgery. The management includes either nonoperative management (e.g. external lumbar drainage) or surgical re-exploration. Objectives. We present our surgical, clinical and histopathological experience of dural closure in the posterior fossa. In order to avoid CSF leaks we developed a simple but effective and time-sparing method using a well-cut sheet of a vicryl-poly-pdioxanone mesh (Ethisorb®) covering the whole defect of the craniectomy. Additional fibrin glue or sealant is not necessary. Special attention was focused upon the frequency of postoperative complications, in particular infection rate and CSF leaks. Patients. 85 patients were treated with vicryl mesh as dural substitute after posterior fossa surgery due to distinct pathologies. An illustrative case is presented. Results. In none of the patients a postoperative infection was observed. Four patients presented postoperative CSF leakage and were treated by percutaneous lumbar drainage. Three of the patients improved completely, requiring no additional treatment. Only in one case defect covered by a vicryl mesh, a surgical reexploration became necessary. Conclusion. We consider the vicryl mesh (Ethisorb®) as an ideal dural substitute especially for the dural closure of the posterior fossa (AU)

Introducción. Los defectos en el cierre de duramadre y por consiguiente fístulas de líquido cefalorraquídeo son comunes en cirugía de fosa posterior. El tratamiento incluye manejo conservador o no quirúrgico como drenaje lumbar externo de líquido cefalorraquídeo, cuando éstas medidas fallan se requiere de una nueva cirugía. Objetivos. Con el propósito de evitar fístulas de líquido cefalorraquídeo en cirugía de fosa posterior desarrollamos un método simple, pero efectivo, que permite ahorrar tiempo quirúrgico utilizando una malla de viyril-poly-p-dioxanone (Ethisorb®) para cubrir por completo el defecto de la craniectomía. No se requiere del uso adicional de adhesivo de fibrina. Nuestra experiencia clínica, quirúrgica y hallazgos histopatológicos con ésta técnica de cierre dural se discuten en el presente artículo así como las complicaciones, en particular infección y presencia de fístulas de líquido cefalorraquídeo. Pacientes. En 85 pacientes sometidos a cirugía de fosa posterior debida a diferentes patologías, se utilizó una malla de vicryl (Ethisorb®) como sustituto de duramadre. Se presenta un caso que ilustra nuestra técnica. Resultados. En ninguno de los casos se presentó infección postoperatoria. Cuatro casos presentaron fístula de líquido cefalorraquídeo y fueron tratados con drenaje lumbar externo; tres pacientes mejoraron por completo sin requerir otras medidas. Sólo en un caso se requirió de exploración quirúrgica. Conclusiones. De acuerdo con los resultados y complicaciones, consideramos que la malla de vicryl (Ethisorb®) es un sustituto de duramadre ideal, en particular para cirugías de fosa posterior (AU)

The use of overdentures in children with cleft lip and palate: a report of two cases.

The treatment of children with cleft lip and palate is complex. Advances in primary surgery and the advent of alveolar bone grafting have resulted in the reduction of prosthetic intervention. However, in patients where surgery is contraindicated or has been unsuccessful, an alternative treatment is required. Overdentures are a simple, conservative and reversible non-surgical alternative for children with cleft lip and palate. We present two cases with severe complete bilateral cleft lip and palate that were managed in this way.

Pharyngocutaneous fistulae in laryngectomy patients: the Toronto Hospital experience.

OBJECTIVE: The purpose of this study was to determine the rate of post-laryngectomy pharyngocutaneous fistulae and its association with age, gender, preoperative radiation, TNM staging, patients comorbidity factors, choice of ablation, choice of reconstruction, modality of postoperative feeding, and whether or not a primary tracheoesophageal puncture was performed. DESIGN: Retrospective clinical study. SETTING: The Toronto Hospital/Princess Margaret Hospital, University of Toronto, Toronto, Ontario. METHOD: One hundred and twenty-five consecutive laryngectomy procedures performed between July 1, 1992, and October 1, 1996, were reviewed. RESULTS: There was an overall fistula rate of 22%. No association found was between fistula rates and age, gender, patient comorbidity factors, TNM stage, choice of ablation, choice of reconstruction, modality of postoperative feeding, or whether a primary tracheoesophageal puncture was performed or not. CONCLUSIONS: At this tertiary care head and neck oncology centre, pharyngocutaneous fistulae remain an unpredictable and serious complication with an estimated economic cost of Cdn $400,000 per year.

Aerodynamic estimates of induced anterior orifice openings in human subjects.

This study first examined the accuracy of pressure-flow area estimates of experimental openings in anterior palatal obturators of three adult subjects. Second, we evaluated pressure-flow measures of the same experimental openings using a model. Results indicated that percent error in orifice estimates was slightly higher for induced openings in human subjects (13%) versus those in the model (11%). Results for our human subjects were similar to those reported by previous investigators.