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2.
Laryngoscope ; 132(12): 2301-2306, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36370085

RESUMO

OBJECTIVES/HYPOTHESIS: Reconstruction of mucosal defects using free mucosal grafts has become a common procedure during endoscopic sinus surgery. Epithelialization of mucosal grafts affects postoperative complications and outcomes, which could be influenced by different recipient tissue. However, morphological changes occurring in the grafts transplanted over different tissues remain unexplored. STUDY DESIGN: An animal study. METHODS: Free mucoperichondrial grafts were prepared from the nasal septum of rabbits; the cartilage group had reconstruction on the nasal septal cartilage, and the perichondrium group had reconstruction on the contralateral perichondrium. The nasal septum was removed after 1 and 4 weeks of reconstruction, and the graft was histologically evaluated. RESULTS: After 1 week of reconstruction, the mucosal epithelium of grafts in the cartilage group disappeared, whereas the columnar epithelium of grafts was preserved in the perichondrium group. After 4 weeks of reconstruction, the mucosal defect site was covered with mucosal epithelium in both groups. However, while squamous epithelium was mostly observed in the cartilage group, columnar epithelium containing the healthy ciliary and goblet cells was observed in the perichondrium group. Statistically significant differences were detected in the parameters of epithelial morphology between the two groups, which were higher in the perichondrium group. CONCLUSIONS: In the reconstruction of mucosal defects using free mucosal grafts, difference in recipient tissue affects the graft epithelial morphology. LEVEL OF EVIDENCE: NA Laryngoscope, 132:2301-2306, 2022.


Assuntos
Septo Nasal , Transplantes , Animais , Coelhos , Septo Nasal/transplante , Endoscopia , Cartilagem , Mucosa Nasal/transplante
3.
Ear Nose Throat J ; 100(5_suppl): 618S-623S, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31914815

RESUMO

OBJECTIVE: This study describes a surgical approach wherein a lobulated pedicled nasal mucosa flap technique was employed for endoscopic dacryocystorhinostomy (EDCR) as a means of treating nasolacrimal duct obstructions. This study also assessed the long-term outcomes of this EDCR approach when implemented without stenting. METHODS: This was a retrospective study of a total of 63 patients (67 eyes) treated for nasolacrimal duct obstructions between January 2011 and November 2016. All patients had undergone ophthalmic diagnosis followed by EDCR treatment using a lobulated pedicled nasal mucosa flap without stenting. Patients were then monitored for both anatomical patency and sustained symptom relief during the follow-up period in order to assess objective and subjective study outcomes. RESULTS: Patients were followed for a mean of 25.3 ± 1.2 months (range: 24-28 months), with a 100% anatomical patency success rate (67/67) and a 94.03% symptomatic cure rate (63/67). There were no instances of complications. CONCLUSIONS: The use of a lobulated pedicled nasal mucosa flap technique for EDCR without stenting is a straightforward, effective, and safe approach that keeps bone exposure to a minimum while offering a high rate of satisfactory outcomes, making it a procedure worthy of consideration as a means of treating patients suffering from nasolacrimal duct obstructions.


Assuntos
Dacriocistorinostomia/métodos , Obstrução dos Ductos Lacrimais/terapia , Mucosa Nasal/transplante , Ducto Nasolacrimal/cirurgia , Retalhos Cirúrgicos , Adulto , Dacriocistorinostomia/instrumentação , Endoscopia/métodos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
4.
Ann Otol Rhinol Laryngol ; 130(1): 98-103, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32578449

RESUMO

BACKGROUND: Reconstruction of full thickness nasal defects usually requires different donor sites for the external skin envelope, structural elements, and internal nasal lining. In this paper we present a novel single site method for dual inner lining and skeleton repair for full thickness nasal defects with a composite nasoseptal flap and extended pedicle dissection. METHODS: A 72-year-old male presented with a T4b melanoma involving the nasal dorsum and left upper lateral cartilage. Following full thickness resection, reconstruction was performed with a nasoseptal flap (NSF) with attached septal cartilage and vomer in conjunction with a paramedian forehead flap. Extended pedicle dissection into the pterygopalatine fossa allowed the NSF to fully cover the defect. RESULTS: The nasal defect was fully corrected. There was no evidence of flap compromise or nasal valve stenosis at 1 month, 2 month, and 1 year follow-up visits. CONCLUSIONS: We present here the first successful application of a composite cartilage-osseous-mucosal NSF for multilayered nasal reconstruction. In appropriate patients, this technique may obviate the need for flaps or grafts from extranasal sources, limiting donor site morbidity.


Assuntos
Cartilagens Nasais/transplante , Mucosa Nasal/transplante , Neoplasias Nasais/cirurgia , Retalhos Cirúrgicos , Vômer/transplante , Idoso , Testa/cirurgia , Humanos , Masculino , Melanoma/cirurgia , Fossa Pterigopalatina/cirurgia
5.
Genes (Basel) ; 11(6)2020 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-32485957

RESUMO

We describe a human nasal epithelial (HNE) organoid model derived directly from patient samples that is well-differentiated and recapitulates the airway epithelium, including the expression of cilia, mucins, tight junctions, the cystic fibrosis transmembrane conductance regulator (CFTR), and ionocytes. This model requires few cells compared to airway epithelial monolayer cultures, with multiple outcome measurements depending on the application. A novel feature of the model is the predictive capacity of lumen formation, a marker of baseline CFTR function that correlates with short-circuit current activation of CFTR in monolayers and discriminates the cystic fibrosis (CF) phenotype from non-CF. Our HNE organoid model is amenable to automated measurements of forskolin-induced swelling (FIS), which distinguishes levels of CFTR activity. While the apical side is not easily accessible, RNA- and DNA-based therapies intended for systemic administration could be evaluated in vitro, or it could be used as an ex vivo biomarker of successful repair of a mutant gene. In conclusion, this highly differentiated airway epithelial model could serve as a surrogate biomarker to assess correction of the mutant gene in CF or other diseases, recapitulating the phenotypic and genotypic diversity of the population.


Assuntos
Regulador de Condutância Transmembrana em Fibrose Cística/genética , Fibrose Cística/terapia , Terapia Genética , Mucosa Nasal/transplante , Células Cultivadas , Fibrose Cística/genética , Fibrose Cística/patologia , Células Epiteliais/metabolismo , Humanos , Mucosa Nasal/metabolismo , Organoides/metabolismo , Organoides/transplante , Fenótipo
6.
Laryngoscope ; 130(12): 2795-2801, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32324280

RESUMO

OBJECTIVES: To review our experience with secondary surgery for persistent nasal obstruction following successful septal perforation repair and describe the potential contribution of the nasal swell body (NSB) to obstruction. STUDY DESIGN: Retrospective chart review. METHODS: IRB-approved retrospective chart review of perforation repairs utilizing bilateral mucosal flaps performed by the senior author from October 2008 through April 2019 was performed. Patients who underwent secondary surgery for persistent nasal obstruction were identified. Data regarding patient demographics, perforation characteristics, primary closure technique, and secondary surgical procedures for persistent postoperative obstruction were analyzed. Nasal Obstruction Symptom Evaluation (NOSE) scores were assessed pre and post revision surgery. RESULTS: Thirty-four patients (14.7% of 232 successful repairs) met study criteria. Of those, 30 patients underwent revision septal surgery. An inferiorly advanced NSB was surgically reduced in 9.9% (23/232) of patients following successful closure to improve persistent obstruction. There was no incidence of reperforation. All patients undergoing NSB reduction reported improved nasal airflow postoperatively and 13 completed the NOSE questionnaire. The mean preoperative NOSE score (95% CI) was 52.7 (42.2-63.2; median, 50). The mean postoperative NOSE score (95% CI) was 19.2 (12.8-25.6; median, 15). The difference between the preoperative and postoperative NOSE scores was statistically significant (P < .001). CONCLUSIONS: Repair of a septal perforation using a superior bipedicle flap carries the potential for the NSB to contribute to persistent postoperative nasal obstruction. The swell body can be surgically reduced, without re-perforation, to relieve obstructive symptoms in the patient with a successful perforation repair. LEVEL OF EVIDENCE: IV Laryngoscope, 2020.


Assuntos
Perfuração do Septo Nasal/diagnóstico por imagem , Perfuração do Septo Nasal/cirurgia , Adulto , Idoso , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/transplante , Reoperação , Estudos Retrospectivos , Retalhos Cirúrgicos/transplante , Tomografia Computadorizada por Raios X
7.
Acta Otolaryngol ; 139(8): 701-706, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31107127

RESUMO

Background: Many techniques have been proposed to close an oroantral fistula (OAF), with most of them involving transoral repairs with oral soft tissue flaps. An additional Caldwell-Luc approach or endoscopic sinus surgery (ESS) is required to address coexisting maxillary sinusitis. Objectives: This study presents the endonasal closure of an OAF through modified endoscopic medial maxillectomy (MEMM) with a free nasal mucoperichondrial-osteal graft. Materials and methods: Sixteen OAF patients who underwent closure operations in our department from May 2013 to June 2018 were retrospectively reviewed. Results: The main cause of OAF was maxillary dental cysts (56.25%). The OAF size ranged from 2 × 2 to 10 × 15 mm. The first molar (62.5%) was the most frequently involved tooth. All closures were made via MEMM, using nasal mucoperichondrial-osteal grafts harvested from the septum or nasal base. All patients were followed up for at least six months. Successful closure after a single procedure was achieved in 93.75% of cases. No obvious complications or recurrences were observed. Conclusions: Endonasal repair of OAFs via MEMM with free nasal mucosal grafts is feasible and promising. The approach preserves the normal oral and nasal physiology after surgery. It could be used alone for the closure of small to medium-sized OAFs.


Assuntos
Endoscopia/métodos , Cistos Maxilomandibulares/complicações , Fístula Bucoantral/cirurgia , Adulto , Feminino , Humanos , Cistos Maxilomandibulares/patologia , Masculino , Maxila/cirurgia , Seio Maxilar/cirurgia , Sinusite Maxilar/complicações , Pessoa de Meia-Idade , Mucosa Nasal/transplante , Septo Nasal/transplante , Fístula Bucoantral/etiologia , Estudos Retrospectivos
8.
Can J Ophthalmol ; 54(2): 258-264, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30975351

RESUMO

OBJECTIVE: To report the long-term outcomes of the conjunctivo-rhinostomy surgery with labial mucosal graft performed for the patients of proximal lacrimal drainage system disorders. METHODS: Retrospective, single surgeon (KB), non-comparative study including patients having complete obstruction of the superior and inferior proximal lacrimal drainage system. All patients underwent conjunctivo-rhinostomy with labial mucosal graft insertion. Preoperatively, tear film break-up time and a fluorescein dye disappearance test was performed for each patient. A phaco aspiration tubing segment was used for supporting the mucosal graft for first 4 weeks followed by its removal. Minimum follow-up was 12 months. fluorescein dye disappearance test and nasal endoscopy were performed at each follow-up visit. Total resolution of epiphora and negative fluorescein dye disappearance test was defined as complete success. RESULTS: Eighteen patients (12 males, 6 females) with a mean age of 39.94 years (range 7-76 years) all had a unilateral presentation. The indication for surgery was trauma (n = 11), failed dacryocystorhinostomy (DCR) with canalicular obstruction (n = 4), chronic ocular inflammation with complete punctal occlusion (n = 2), and post-radiotherapy (n = 1). At a mean follow-up of 5.38 years, complete success was observed in 12 (66.67%), partial success in 4 (22.22%) while in 2 (11.11%) patients, the procedure failed. CONCLUSION: Labial mucosal graft in conjunctivo-rhinostomy is a successful adjunct which provides satisfactory long-term outcomes. Our surgical technique of directly suturing the mucosal graft to surrounding muscle provides better functionality to the system with eyelid blinking.


Assuntos
Túnica Conjuntiva/cirurgia , Dacriocistorinostomia/métodos , Doenças do Aparelho Lacrimal/cirurgia , Mucosa Nasal/transplante , Ducto Nasolacrimal/cirurgia , Adolescente , Adulto , Idoso , Criança , Endoscopia , Feminino , Seguimentos , Humanos , Doenças do Aparelho Lacrimal/diagnóstico , Masculino , Pessoa de Meia-Idade , Nariz , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
9.
World Neurosurg ; 126: e165-e172, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30794981

RESUMO

OBJECTIVE: At our institution, skull base reconstruction using a free mucosal graft from the nasal cavity floor has been the standardized technique after pituitary adenoma resection via transsellar approach. In this study, the expected appearance of the reconstruction on postoperative magnetic resonance imaging (MRI) scans is described and its integrity and impact on the sinonasal cavity are assessed. METHODS: Fifty patients were selected, and their electronic medical records were reviewed for postoperative course, Sino-Nasal Outcome Test-22 (SNOT-22) scores, and nasal endoscopy reports. A total of 116 postoperative MRI scans were available to evaluate 1) the appearance and thickness of the graft, 2) the enhancement of the graft, and 3) the T2 signal in sphenoid sinus as a potential indication for inflammatory disease. RESULTS: There was no significant change in the thickness of the graft over time. Except for the 7 scans that were obtained without intravenous contrast, all scans showed enhancement of the graft. About half of the patients showed persistent T2 hyperintense signal at 12 and 24 months. However, this finding was not clinically significant, because postoperative SNOT-22 scores showed minimal sinonasal impact. CONCLUSIONS: Postoperative MRI surveillance scans showed a stable appearance of the graft that mimics the native mucosa, with enhancement through time, reflecting its robust vascularization and integration to the skull base. Although persistent T2 hyperintense signal was detected in the sphenoid sinus, clinical evidence based on nasal endoscopy reports and SNOT-22 scores indicated minimal sinonasal morbidity.


Assuntos
Endoscopia/métodos , Cavidade Nasal/cirurgia , Mucosa Nasal/transplante , Procedimentos Neurocirúrgicos/métodos , Procedimentos de Cirurgia Plástica/métodos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Base do Crânio/anormalidades , Resultado do Tratamento , Adulto Jovem
10.
World Neurosurg ; 122: e506-e511, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30368014

RESUMO

BACKGROUND: Cerebrospinal fluid (CSF) leak is a common complication after surgeries involving sellar reconstruction. Various techniques, including the nasoseptal flap, have been developed to limit postoperative CSF leak. However, the nasoseptal flap causes complications owing to donor site morbidity. A free mucosal graft may be just as effective in reducing CSF leaks as well as reducing postoperative nasal discomfort. This study aimed to assess operative outcomes of free mucosal graft after pituitary resection. METHODS: A retrospective chart review was performed for patients who underwent endoscopic endonasal resection of pituitary adenomas. The following data were collected: demographic data, intraoperative CSF leak, postoperative CSF leak, other complications, and mucosal graft healing at 1 month. Also, the Sinonasal Outcome Test-22 was administered preoperatively and 1 month and 3 months postoperatively. RESULTS: Charts of 158 patients were reviewed, including patients who underwent no mucosal reconstruction, free mucosal graft reconstruction, and nasoseptal flap reconstruction. There was a 7.4% postoperative CSF leak rate in patients who underwent no reconstruction (n = 27), whereas postoperative CSF leak rate was 0.82% in patients undergoing free mucosal graft reconstruction (n = 122) (P < 0.05). Sinonasal Outcome Test-22 scores for patients with free mucosal graft reconstruction showed no significant worsening postoperatively. CONCLUSIONS: The free mucosal graft is a simple and effective means of sellar reconstruction in patients undergoing endonasal endoscopic pituitary resection, and its efficacy is similar to nasoseptal flaps. The free mucosal graft technique does not worsen sinonasal morbidity postoperatively.


Assuntos
Adenoma/cirurgia , Mucosa Nasal/transplante , Neoplasias Hipofisárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Adenoma/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Septo Nasal/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Estudos Retrospectivos , Transplante de Tecidos/métodos , Resultado do Tratamento
11.
PLoS One ; 13(12): e0208122, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30517163

RESUMO

Delivering therapeutics across the blood-brain barrier (BBB) for treating central nervous system (CNS) diseases is one of the biggest challenges today as the BBB limits the uptake of molecules greater than 500 Da into the CNS. Here we describe a novel trans-nasal mucosal drug delivery as an alternative to the intranasal drug delivery to overcome its limitations and deliver high molecular weight (HMW) therapeutics efficiently to the brain. This approach is based on human endoscopic skull base surgical techniques in which a surgical defect is repaired by engrafting semipermeable nasal mucosa over a skull base defect. Based on endoscopic skull based surgeries, our groups has developed a trans-nasal mucosal rodent model where we have evaluated the permeability of ovalbumin (45 kDa) as a model protein through the implanted mucosal graft for delivering HMW therapeutics to the brain. A thermo sensitive liposome-in-gel (LiG) system was developed for creating a drug depot allowing for a sustained release from the site of delivery to the brain through the implanted nasal graft. We would like to report this as an exploratory pilot study where we are using this novel surgical model to show that the implanted nasal mucosal graft and the LiG delivery system result in an efficient and a sustained brain delivery of HMW proteins. Hence, this study demonstrates that the trans-nasal mucosal engrafting technique could overcome the limitations for intranasal drug delivery and enable the uptake of HMW protein therapeutics into the CNS for the treatment of a wide range of neurodegenerative diseases.


Assuntos
Barreira Hematoencefálica/metabolismo , Encéfalo/metabolismo , Sistemas de Liberação de Medicamentos/métodos , Lipossomos/farmacocinética , Mucosa Nasal/metabolismo , Ovalbumina/farmacocinética , Animais , Encéfalo/cirurgia , Carbocianinas/química , Craniotomia/métodos , Corantes Fluorescentes/química , Lipossomos/química , Lipossomos/metabolismo , Masculino , Mucosa Nasal/transplante , Ovalbumina/sangue , Ovalbumina/química , Permeabilidade , Ratos , Ratos Sprague-Dawley , Coloração e Rotulagem/métodos , Técnicas Estereotáxicas , Transplante Autólogo
12.
J Plast Reconstr Aesthet Surg ; 71(9): 1352-1361, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30007536

RESUMO

OBJECTIVE: The risk of sight-threatening complications related to facial paralysis makes palpebral fissure management a priority. Surgery must take account of and adapt to the clinical signs of paralytic lagophthalmos. This therefore presupposes that a sufficient therapeutic arsenal is available. In this report, we propose a technique for palpebral lengthening (lower and/or upper), reconstructing the posterior lamella using a chondromucosal graft harvested from the nasal septum, combined with anterior lamellar repositioning. PATIENTS AND METHOD: A 5-year single center retrospective study was conducted, including sixteen patients for a total of nineteen septal chondromucosal grafts. The only inclusion criterion was paralytic lagophthalmos. Functional ophthalmic deficits were recorded (main outcome measure), first preoperatively, then postoperatively. Additionally, the degree of lagophthalmos was measured in order to infer palpebral fissure elongation gain. Surgical consequences and complications were recorded. RESULTS: A rapid regression in functional ophthalmic deficits was observed in 87% of patients, improving in stability over time (mean follow-up interval of 34 months). Mean palpebral fissure elongation gain was 3 mm. 53% of patients suffered from complete occlusion of the palpebral fissure. Surgical consequences were uncomplicated. 38% of patients eventually underwent revision surgery. CONCLUSION: Palpebral fissure lengthening using septal chondromucosal grafts serves as an alternative to existing treatment methods for paralytic lagophthalmos. Robust functional and cosmetic results, combined with very low morbidity, make this a simple and efficient technique whose indications may be extended.


Assuntos
Blefaroplastia/métodos , Doenças Palpebrais/cirurgia , Pálpebras/cirurgia , Paralisia Facial/cirurgia , Mucosa Nasal/transplante , Septo Nasal/transplante , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
13.
J Laryngol Otol ; 132(1): 83-87, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29151373

RESUMO

OBJECTIVE: Palatal reconstruction following maxillectomy is a surgical challenge, and a nasoseptal flap is a feasible approach. This paper reports the first known successful clinical case of a nasoseptal pedicle flap applied for the reconstruction of maxillary bone following hemi-maxillectomy. CASE REPORT: This report describes hemi-maxillectomy in a 60-year-old Italian male diagnosed with stage IV squamous cell carcinoma of the left maxilla. Endoscopic transnasal extended medial maxillectomy was performed, followed by a transoral modified midfacial degloving technique for removal of the maxillary bone. The contralateral nasoseptal pedicle flap was used to reconstruct the defect. The case was followed up prospectively for the assessment of flap reception and healing. CONCLUSION: The locally accessible nasoseptal flap is a viable alternative for palatal reconstruction; therefore, a second surgical procedure with its associated donor site morbidity can be avoided. Large-scale studies may help in establishing the cosmetic and functional outcomes.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Retalhos de Tecido Biológico , Maxila/cirurgia , Neoplasias Maxilares/cirurgia , Mucosa Nasal/transplante , Palato/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Carcinoma de Células Escamosas/diagnóstico , Endoscopia , Humanos , Imageamento por Ressonância Magnética , Masculino , Maxila/diagnóstico por imagem , Neoplasias Maxilares/diagnóstico , Pessoa de Meia-Idade , Septo Nasal/cirurgia , Reoperação
14.
J Laryngol Otol ; 132(1): 79-82, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29151381

RESUMO

BACKGROUND: Re-stenosis and a consequent need for revision surgery are the most common problems in the follow-up period following endoscopic modification of the Lothrop procedure. METHOD: This paper reports a new technique for reconstructing and resurfacing of the posterior frontal recess bone for prevention of re-stenosis. RESULTS: A 46-year-old man presented with a frontal sinus osteoma, and treatment featured an endoscopic modification of the Lothrop procedure. A vascularised, posteriorly based, septal mucosal flap was used in reconstruction. There have been no reported issues over 24 months of follow up. CONCLUSION: The use of a nasoseptal flap seems feasible to reduce scarring and recurrence of (common) frontal recess stenosis after a Draf III operation.


Assuntos
Neoplasias Ósseas/cirurgia , Endoscopia/métodos , Osteoma/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Neoplasias dos Seios Paranasais/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Retalhos Cirúrgicos , Neoplasias Ósseas/diagnóstico , Estudos de Viabilidade , Seguimentos , Seio Frontal , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/transplante , Neoplasias dos Seios Paranasais/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Recidiva , Reoperação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
15.
Am J Otolaryngol ; 39(2): 253-256, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29279249

RESUMO

This report describes a bilateral sphenoid sinus mucosal flap for the repair of a sellar floor defect and CSF leak following endoscopic endonasal skull base surgery. The key advantage of this technique is enabling the sphenoid mucosal flaps to remain vascularized, which reduces postoperative complications including CSF leakage, recurrent sinusitis, meningitis, encephalitis and pneumocephalus. The use of this technique is a viable and possibly favorable alternative to free grafts in the reconstruction of small to medium sized sellar defects with low flow or absent CSF leaks base surgery.


Assuntos
Mucosa Nasal/transplante , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Neoplasias Hipofisárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/cirurgia , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Adulto , Humanos , Imageamento por Ressonância Magnética , Masculino , Nariz , Neoplasias Hipofisárias/diagnóstico , Reoperação , Base do Crânio/diagnóstico por imagem , Seio Esfenoidal/cirurgia , Tomografia Computadorizada por Raios X
16.
Laryngoscope ; 128(4): 794-797, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28786234

RESUMO

OBJECTIVE: Obstruction of the nasolacrimal duct is a relatively common condition that affects patients of all ages, races, and sexes. The surgical gold standard for complete nasolacrimal duct obstruction and dacryocystitis is dacryocystorhinostomy (DCR). The purpose of this study was to describe a novel, bipedicled interlacing mucosal sparing flap technique for endoscopic DCR (eDCR). METHODS: A posteriorly based mucosal flap over the fundus is combined with a novel, anteriorly based mucosal flap over the intraosseus portion of the nasolacrimal duct (NLD). This exposes a wide area of the maxillary bone, allowing for exposure and identification of the NLD/sac complex in a safer, more inferior position. The interlacing mucosal flaps may be replaced at the conclusion of the procedure, thereby minimizing bone exposure and maintaining excellent long-term patency. RESULTS: The authors have utilized this technique in 55 procedures with 100% positive identification of the NLD and lacrimal sac, 0% complication rate, 100% anatomical patency rate, and 96.4% success rate after a minimal follow-up of 6 months. DISCUSSION: The bipedicled interlacing flap technique for eDCR provides for safe and reproducible identification of the NLD and lacrimal sac while minimizing bone exposure and restenosis rate. CONCLUSION: The bipedicled interlacing flap technique for eDCR provides for safe and reproducible identification of the NLD and lacrimal sac while minimizing bone exposure and restenosis rate. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:794-797, 2018.


Assuntos
Dacriocistite/cirurgia , Dacriocistorinostomia/métodos , Endoscopia/métodos , Mucosa Nasal/transplante , Retalhos Cirúrgicos/transplante , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ducto Nasolacrimal/cirurgia , Resultado do Tratamento
17.
J Craniofac Surg ; 28(3): 734-737, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28277475

RESUMO

Full-thickness defects of the entire nasal ala, including the rim, can be challenging to reconstruct. A forehead flap may provide a more imperceptible and natural-appearing reconstructed nasal ala. Previously, many authors have insisted adding cartilaginous infrastructural support for an entire, full-thickness defect to keep the postoperative alar structure symmetrical. They finally use a forehead flap after thinning of the distal covering portion subcutaneously, possibly for a Caucasian-type nasal ala. However, Asian skin has a thicker and more compact dermis than that of Caucasian skin, and the Asian ala is rounder and thicker. There may be another approach for an Asian-type nasal ala. The authors propose the possibility of nasal alar reconstruction for an entire, full-thickness defect in Asians using a forehead flap without structural support. Six patients with entire full-thickness nasal alar defects treated with full-thickness forehead flaps above the periosteum without structural support were reviewed. Five patients demonstrated esthetically good to excellent outcomes in color, texture, and symmetry. Their nasal linings were reconstructed using mucoperiosteal flaps or mucosal grafts. One patient treated with a nasal lining using a local flap showed a fair result esthetically. Asians forehead above the periosteum has adequate thickness and supportability to reconstruct the entire full-thickness nasal ala in Asians. No cartilage support is necessary.


Assuntos
Povo Asiático , Deformidades Adquiridas Nasais , Nariz , Rinoplastia/métodos , Retalhos Cirúrgicos , Idoso , Estética , Testa , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/transplante , Nariz/patologia , Nariz/cirurgia , Deformidades Adquiridas Nasais/etnologia , Deformidades Adquiridas Nasais/cirurgia , Periósteo/transplante , Dobras Cutâneas , Resultado do Tratamento
18.
World Neurosurg ; 101: 180-185, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28185972

RESUMO

BACKGROUND: Postoperative cerebrospinal fluid leak after endoscopic pituitary surgery ranges from 1.9% to 10% in different series. Vascularized flaps have reduced the incidence of leak; however, this carries nasal morbidity. This study presents a technique for sellar reconstruction with free mucosal graft from the nasal cavity floor including inferior meatus mucosa. This technique aims to standardize sellar reconstruction without the use of the nasoseptal flap and to keep the advantage of mucosal coverage of the defect in all cases. METHODS: Fifty consecutive patients who had endoscopic surgery for pituitary tumors and reconstruction with nasal cavity floor free mucosal graft were retrospectively reviewed. There were a total of 50 patients with postoperative follow-up from 3 to 16 months. Collagen dural graft was used inlay and free mucosal graft overlay to cover the sellar defect. No fat grafts or lumbar drains were used. A Sinonasal Outcome Test-22 (SNOT-22) was performed before, 1 and 3 months after surgery. RESULTS: There were 40% detected intraoperative leaks and no postoperative leaks. Nasal endoscopy performed at 1 month follow-up showed complete healing of the graft to the skull base and near total or complete mucosalization of the donor site. No significant difference was found in the SNOT-22 comparing the total preoperative and 1-month scores. CONCLUSIONS: The nasal cavity floor free mucosal graft is an easy and safe technique, with minimal nasal morbidity. There were no postoperative cerebrospinal fluid leaks, despite aggressive tumor resection. No lumbar drains or fat graft were used. The harvest of mucosal graft does not worsen the quality of life measured with the SNOT-22 test.


Assuntos
Adenoma/cirurgia , Mucosa Nasal/transplante , Neoplasias Hipofisárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Sela Túrcica/cirurgia , Transplantes/transplante , Adenoma/diagnóstico por imagem , Adulto , Idoso , Vazamento de Líquido Cefalorraquidiano , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem
19.
Aesthetic Plast Surg ; 41(2): 346-351, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28204937

RESUMO

BACKGROUND: Reconstruction of large defects of the upper eyelid is challenging because of its complex anatomy and specialized function. The aim of this work is to develop a single-stage reconstruction procedure based on a new approach. The technique consists of the advancement of an orbicularis oculi myocutaneous flap designed within the blepharoplasty skin excision pattern. METHODS: After the tumor's excision is completed with clear margins, the borders of the flap are incised down to the submuscular plane inside the classical pattern of upper eyelid blepharoplasty. Two myocutaneous triangles are excised on both sides of the flap to allow its advancement to cover the defect. When it is necessary to repair the posterior lamella, we harvest a mucochondral graft. RESULTS: From 2012 to 2015, we performed upper eyelid reconstruction with this technique on six patients. The flap survived in all the patients, without total or partial necrosis. No patient required surgical revision. The results were aesthetically satisfying, and no tumor recurrence was noted. CONCLUSIONS: Our new approach to upper eyelid reconstruction maximizes the cosmetic outcome respecting the principles of radicality. This flap is better suited for lesions involving the median or paramedian eyelid border from the marginal zone up to the palpebral crease. The approach we propose is safe and versatile, and it ensures either a functional or a good aesthetic reconstruction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Blefaroplastia/métodos , Neoplasias Palpebrais/cirurgia , Pálpebras/cirurgia , Retalho Miocutâneo , Procedimentos de Cirurgia Plástica/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Cartilagens Nasais/transplante , Mucosa Nasal/transplante , Septo Nasal/transplante
20.
Clin Otolaryngol ; 42(3): 514-520, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27662629

RESUMO

BACKGROUND: Historically dacryocystorhinostomy (DCR) has been performed externally with very good outcomes. Current literature shows comparable success rates between endonasal and external approaches. A common reason for the failure of a DCR is the reclosure of the nasolacrimal stoma by granulation tissue and synechiae. OBJECTIVE OF REVIEW: A systematic review and critical evaluation of the evidence relating to the preservation of nasal mucosal flaps in DCR surgery. TYPE OF REVIEW AND EVALUATION METHOD: A systematic review using the consort guidance for review of randomised control trials. SEARCH STRATEGY: A search of the following evidence-based medicine databases was performed: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, Ovid, Medline, EMBASE and PubMed. The search was limited to English language articles, and the following key words were used: Endonasal, Endoscopic, Dacryocystorhinostomy, DCR, Mucosal Flaps, between years 1970 and 2015. RESULTS: The best available evidence was level 1B, comprising two randomised control trials and three comparative studies included in the review. The main outcome measures used were lacrimal irrigation and absence of epiphora. Two of the studies demonstrated a statistically significant benefit of mucosal sparing either with nasal mucosal flaps or with lacrimal flaps. More debridement was needed, and granulation tissue was also seen in the groups without mucosal preservation. There was no difference in surgical complications between a mucosal and non-mucosal-sparing technique. CONCLUSIONS: The overall quality of current evidence is poor, and there does however appear to be a trend towards improved outcomes and reduced granulation in groups where nasal mucosal and lacrimal flaps were preserved, but this is not clear-cut. There was no evidence of increased complication rates with mucosal-sparing techniques. We recommend that until further good quality research is available we should be performing a mucosal-sparing technique when performing DCR routinely.


Assuntos
Dacriocistorinostomia/métodos , Doenças do Aparelho Lacrimal/cirurgia , Aparelho Lacrimal/transplante , Mucosa Nasal/transplante , Cirurgia Endoscópica por Orifício Natural/métodos , Retalhos Cirúrgicos , Humanos , Resultado do Tratamento
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