1/45. A previously unreported surgical technique utilizing five different grafting materials to successfully achieve simultaneous alveolar regeneration and closure of a large oronasal defect.This case report describes the successful surgical and restorative management of an unusual cyst-granuloma combination that had expanded to perforate the labial and nasal parts of the maxillary bone. Enucleation and curettage of the lesions resulted in a large oronasal communication that presented a reconstructive challenge. Five different graft and/or barrier materials were used to close the oral and nasal openings and to regenerate the alveolus for implant placement and for aesthetic prosthetic restoration.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/45. Surgical technique for reconstruction of the nasal septum: the pericranial flap.BACKGROUND: We describe a new technique for the surgical reconstruction of large-sized anterior septal perforations based on the pericranial flap. methods: The technique requires a standard open rhinoplasty combined with a pericranial flap harvested after a bicoronal approach and tunnelled to the nasal cavity. We present the case of a man with complete destruction of the nasal septum as a result of chronic cocaine abuse. RESULTS: Surgery resulted in a permanent and complete closure of the perforation. CONCLUSIONS: The main advantage of this technique is the use of well-vascularized autogenous tissue and the minimal donor site morbidity. This technique provides a new method to close large nasal perforations.- - - - - - - - - - ranking = 0.25keywords = closure (Clic here for more details about this article) |
3/45. Oronasal fistula repair with three layers.We present an innovative method for closure of oronasal fistulas involving a three-layer repair, consisting of septal mucosa flap, bone or cartilage graft, and palatal mucosa flap. The septal mucosa flap closes the nasal side of the defect. This is an inferiorly based flap along the nasal floor and consists of septal mucosa from the side opposite the oronasal fistula. A slit is created in the remaining layers of the nasal septum, allowing the flap to be delivered into the defect. When the septal flap is folded down in this fashion, it exposes nasal septal bone and cartilage. The bone and cartilage are harvested and are used to create the middle layer of the three-layer fistula repair. The oral layer of the repair is provided by a palatal mucosa transposition flap. This method allows the bone/cartilage graft to be sandwiched between two vascular layers. We have successfully used the three-layer repair on three patients. All of the oronasal defects were 2 cm in size. All patients are at least 1 year after repair with 100 percent closure; thus, no oronasal leakage. The flaps both septal and palatal resulted in no morbidity once healed. Specifically, the surgically created slit in the nasal septum is well mucosalized and barely discernible. Also, no nasal obstruction occurs from the septal flap on the floor of the nose. We perform the procedure on an outpatient basis. The three-layer repair can be used in adult patients with oronasal fistulas of the middle and posterior hard palate up to 3 cm in size. This technique is not recommended for children.- - - - - - - - - - ranking = 0.5keywords = closure (Clic here for more details about this article) |
4/45. Team approach for closure of oroantral and oronasal fistulae.Oroantral and oronasal fistulas present with a broad range of causation, size, duration, and extent of infection involving the nose and paranasal sinuses. Accurate diagnosis of the extent of the disease with appropriate radiographic evaluation will guide the surgeon to select an approach that addresses all of the infected sites. When significant sinus disease is found, an endoscopic approach to restoring drainage in all of the involved sinuses can promote predictably successful closure of oroantral and oronasal fistulas. The multispecialty team approach to this disease, with the concomitant management of the sinusitis and fistula closure, is a significant advance in the successful management of this chronic condition.- - - - - - - - - - ranking = 1.5keywords = closure (Clic here for more details about this article) |
5/45. Recovery of anaerobic bacteria from 3 patients with infection at a pierced body site.We describe 3 adolescents who developed infections due to anaerobes at pierced body sites: the nipple, the umbilicus, and the nasal septum. Anaerobes (prevotella intermedia and peptostreptococcus anaerobius) were recovered from pure culture of specimens obtained from 1 patient with nipple infection and were mixed with aerobic bacteria in cultures of specimens obtained from 2 patients (Streptococcus aureus, peptostreptococcus micros, and prevotella melaninogenica were recovered from a patient with nasal septum infection, and bacteroides fragilis and enterococcus faecalis were recovered from a patient with umbilical infection). The infection resolved in all patients after removal of the ornaments and use of antimicrobial drug treatment.- - - - - - - - - - ranking = 0.03719387755102keywords = drug (Clic here for more details about this article) |
6/45. Modified retrograde intubation in a patient with difficult airway.We report a modified technique of retrograde endotracheal intubation in a patient with limited motility at the atlanto-occipital joint, temporomandibular joint, and cervical spine, presenting for closure of a large oronasal fistula. Despite more recent advances in intubation techniques and technology, retrograde intubation still deserves a place in the anesthetist's armamentarium for the management of the difficult airway.- - - - - - - - - - ranking = 0.25keywords = closure (Clic here for more details about this article) |
7/45. Fatal rhino-orbito-cerebral mucormycosis in an apparently normal host: case report and literature review.Fungal infections of the central nervous system (CNS) are fortunately rare but remain challenging problems occurring mostly in immunocompromised individuals, with protean manifestations, unpredictable course and unfavorable outcome in many cases despite aggressive neurosurgical intervention and recent antifungal drugs. Rhino-orbito-cerebral mucormycosis is a potentially lethal opportunistic fungal infection with rapid progression and high mortality. Its pathogenic nature becomes evident when the patient's general resistance is compromised. We present a case of an invasive rhino-orbito-cerebral mucormycosis in an apparently normal adult who initially developed mild paranasal sinusitis and later developed status epilepticus and despite an aggressive management died. Interesting clinical, neuroimaging and histological findings are described, and the possibility of fatal mucormycosis in an apparently normal host is highlighted.- - - - - - - - - - ranking = 0.03719387755102keywords = drug (Clic here for more details about this article) |
8/45. Complications of intranasal prescription narcotic abuse.The abuse of drugs via an intranasal route is an increasingly prevalent pattern of behavior. In the past year, a number of patients received care at our institution for complications resulting from the previously unreported phenomenon of intranasal prescription narcotic abuse. This report describes the clinical manifestations of this form of drug abuse in 5 patients. Their symptoms consisted of nasal and/or facial pain, nasal obstruction, and chronic foul-smelling drainage. Common physical findings were nasal septal perforation; erosion of the lateral nasal walls, nasopharynx, and soft palate; and mucopurulent exudate on affected nasal surfaces. In addition, 2 of the 5 patients had invasive fungal rhinosinusitis, which appears to be a complication unique to intranasal narcotic abuse.- - - - - - - - - - ranking = 0.074387755102041keywords = drug (Clic here for more details about this article) |
9/45. Simultaneous cortex bone plate graft with particulate marrow and cancellous bone for reliable closure of palatal fistulae associated with cleft deformities.OBJECTIVE: The purpose of this study was to evaluate the effectiveness of simultaneous cortex bone plate (CBP) graft with particulate marrow and cancellous bone (PMCB) graft for reliable closure of palatal fistulae associated with alveolar clefts. DESIGN: Following standard secondary bone graft preparation of the cleft site, CBP harvested from the medial iliac crest was inserted into the palatal deficiency. This was followed by suturing the palatal mucosa. PMCB was then packed between the cortical bone and the reconstructed nasal floor. SETTING: Ten consecutive patients with palatal fistula were operated on at tokyo Medical and Dental University Hospital from 1998 to 2000. Primary palatal repair was performed in 7 out of 10 patients at our center and in 3 out of 10 patients at other hospitals. patients: Ten patients (6 boys and men, 4 girls and women) with a palatal fistula associated with an alveolar cleft were studied. Ages ranged from 12 to 26 years. INTERVENTIONS: All patients underwent simultaneous CBP graft with PMCB graft for closure of palatal fistula under general anesthesia. RESULTS: Complete closure of palatal fistulae were obtained in 8 out of 10 cases. A very small asymptomatic fistula remained in one patient. Total necrosis of the labial flap with a residual palatal fistula occurred in one patient. CONCLUSIONS: Simultaneous CBP graft with PMCB graft could be more reliable than PMCB alone for closure of a cleft associated palatal fistula.- - - - - - - - - - ranking = 2keywords = closure (Clic here for more details about this article) |
10/45. Microsurgical tissue transfer for rehabilitation of the patient with cleft lip and palate.OBJECTIVE: Three case reports of microsurgically revascularized tissue transfer for secondary closure of complex oronasal fistulae in cleft lip and palate patients are reported. One scapular and two radial forearm flaps were used in that respect; the scapular flap was transferred without a skin paddle and was left for secondary epithelialization whereas iliac crest bone was transplanted in the two patients with the forearm flaps in a further surgical step. CONCLUSIONS: These microsurgical flaps represent solutions in selected cases of oronasal fistulae in patients with cleft lip and palate with extensive scarring, large defects, or both. Alternative free flaps of the vast spectrum available today, however, also deserve consideration.- - - - - - - - - - ranking = 0.25keywords = closure (Clic here for more details about this article) |
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