1,721,010 research outputs found
Managing the severe septal deviation using dorsal preservation
No full text: Severe septal deviations are a constant challenge for rhinosurgeons. As the septum is the most important pillar of the nasal framework, septal deformities require correction to insure a straight nose. The septum should be on the midline without any tension to ensure a correct healing of the external nasal pyramid. In certain cases, the association of a correct septoplasty and dorsal preservation allows the treatment of the crooked nose and at the same time gives natural results with rapid postoperative recovery. The aim of this article was to underline the versatility of the dorsal preservation technique for the correction of severe septal deviation
Northern Mediterranean nose correction: Italian experience: preservation approach
No full textSevere septal deviations are a constant challenge for rhinosurgeons. As the septum is the most important pillar of the nasal framework it is mandatory its correction. The septum should be on the midline without any tension to ensure a correct healing of the external nasal pyramid.
In certain cases, the association of a correct septoplasty and dorsal preservation allow the treatment of the crooked nose and at the same time gives natural results with rapid post-operative recovery. The aim of this chapter is to underline the versatility of the dorsal preservation technique for the correction of severe septal deviation
Diced cartilage and fluid cartilage in the nasal dorsum deficit
No full textThe saddle nose is a deformity of the nasal pyramid characterized by a reduction of the dorsal height due to an osteocartilaginous deficit.
Most saddle noses are acquired, even though there are congenital causes, such as syphilis or intrauterine traumas. The acquired deformities are caused by previous traumas at the level of the septum or the nasal pyramid, from pathologies such as Wegener's granulomatosis and recurring polychondritis, cocaine abuse or the outcome of previous septorhinoplasties. An iatrogenic origin, due to the removal of an excessive quantity of osteocartilaginous hump during a previous operation, is the most frequent.
The saddle nose is one of the morpho-functional alterations of the nose most difficult to correct.
The correction does not aim only to camouflage the deformity with a graft but consists of an anatomical reconstruction plan of all the inadequate structures. After reconstructing a solid cartilaginous support framework of the nasal pyramid, a better definition and height of the dorsum can be obtained by making use of various types of graft for the purpose of obtaining functional and aesthetic results that are stable over time.
Of the numerous autologous and heterologous materials described in the literature, each with advantages and disadvantages, autologous cartilage is currently the first choice.
Heterologous materials, such as Medpor, are habitually used for refilling certain areas of the face, such as the zygoma or chin, but their application in the nose is often associated with serious complications of an infective nature, including long-term.
Autologous cartilage “block” grafts, that is, used as a single segment, were used for many years, enabling creating even significant deformities to be corrected. However, over time the skin thins and adheres to them, making them visible in many cases, even when they were well modelled in order not to leave superficial irregularities. In the case of costal cartilage block grafts, moreover, there is also the problem of “warping”.
The use of “crushed” (morselized) autologous or “diced” (cut into cubes) cartilage can prove invaluable for the purpose of preventing these complications, both to regularize and to raise the nasal dorsum.
Diced cartilage (fig. 1) can be prepared by cutting it into larger cubes (1) or smaller ones (less than 0.2 mm) (2) wrapped or otherwise in the muscular fascia (DCF) (deep temporal, fascia lata or rectus abdominis) or otherwise in Surgicel (oxidized regenerated cellulose – polyanhydroglucuronic acid, commonly used as a hemostatic agent, reabsorbable in 48 hours) or in the acellular matrix (Allorderm, LifeCell Corp., Branchburg, N.J.).
Sometimes, to aggregate the cartilage cubes, fibrin glue or the venous blood of the patient is used.
It has been demonstrated in various studies that the vitality of the chondrocytes is greater than the "crushed” or “morsellised” cartilage. For many small defects, crushed cartilage still remains a valid alternative, if obtained with the right degree of morsellisation, known as "crocodile skin", that enables minimum reabsorption (fig. 2) (3). However, it must always be borne in mind that the degree of reabsorption of this cartilage is inversely proportional to the degree of morsellisation and the predictability of the long-term result is not so high as in diced cartilage (3)
Pisa Tower Concept and swinging door septoplasty: a winning combination in the most complex dorso-septal deviation
No full textThe crooked nose – that is, the deviation of the nasal pyramid from the median line of the frontal plane – is a constant challenge for rhinosurgeons.
The types of dorsal deviation can be many and often also involve the nasal tip. There are multiple causes of the deviation of the nasal pyramid and include, in the first instance, traumas, followed by iatrogenic or congenital factors.
All faces present an asymmetry but most people do not notice this if it is less than 3-4 mm.
However, it is very important to show the patient their facial asymmetry before performing the operation since the level of attention to each little detail will in- crease the post-operative period.
A careful analysis becomes essential for planning the operation. Each of the ana- tomical components (upper lateral cartilages and alars, the septum, the osseous vault, the nasal spine, the soft tissues and the ligament must be assessed since each can contribute to creating this deformity.
Even though, in structured rhinoplasty, various nasal osteotomy techniques have been described for the correction of osseous nasal deformities, so far surgical strategies have not been described that would be compatible with the dorsal pres- ervation philosophy.
The three main pillars of the dorsum are made up of the nasal bones (in conjunc- tion with the upright branch of the maxillary bone) and the nasal septum. There- fore, the correction of a crooked pyramid must involve the evaluation and, where necessary, management of one or more pillars
Hemifacial microsomia treated by total joint reconstruction (TJR) and orthognathic surgery: all-in-one approach
No full textTemporomandibular joint surgery: open discopexy and "Functional Arthroplasty"
No full textTMJ open surgery is reserved in patients with chronic pain, irreversible TMJ damage and/or a perforation supposed.
“Functional Arthroplasty” (FA) is a surgical procedure including upper compartment arthroscopy, access to the lower compartment with condyle condylar shaving, retrodiscal perforations repair, disc repositioning and its stabilization through a resorbable anchor.
The disk has to be repositioned from its pathologic position to a more correct position over the condylar head and the posterolateral side of the disk sutured above the condyle.
The patient generally discharged the day after the operation with painkiller therapy (NSAID) and the prescription of a semi liquid diet
Grande rialzo di seno mascellare e chirurgia endoscopica funzionale rinosinusale: (FESS & Maxillary Sinus Lift): due tecniche combinate nel trattamento contestuale delle atrofie mascellari associate alle patologie rinosinusali
No full textLa tecnica di grande rialzo di seno mascellare è ormai pratica routinaria, predicibile e sempre più richiesta data l'esigenza di eseguire riabilitazioni implanto-protesiche di pazienti affetti da edentulie dei settori posteriori dei mascellari superiori. Spesso ci si imbatte in seni mascellari patologici e quindi è pratica comune far trattare questi pazienti prima per la patologia rino-sinusale e poi, dopo la risoluzione di tali problematiche, sottoporli agli interventi di incremento osseo dei seni mascellari con contestuale o differita all'applicazione d'impianti endossei. L'esperienza maturata in questi ultimi dieci anni nella risoluzione delle patologie disventilatorie contestuali alle atrofie mascellari, insieme con i notevoli passi in avanti della chirurgia endoscopica rinosinusale e con i nuovi biomateriali da innesto, hanno permesso l'esecuzione di questa tecnica e, quindi, la stesura di questo volume. Da parte del paziente, questa procedura chirurgica è mini-invasiva, rapida e rispettosa dei principi biologici; se in passato erano necessari tre diversi interventi chirurgici, con la necessità dei tempi biologici di guarigione tra le diverse procedure, oggi, il tutto si riduce ad un unico intervento chirurgico. Il libro esamina singolarmente le tecniche chirurgiche per poi consigliare le diverse strategie terapeutiche variabili a seconda delle indicazioni cliniche. Volutamente è stato dato risalto all'iconografia per agevolare la comprensione dei passaggi chirurgici anche per i neofiti della disciplina
Floating bone phenomenon in Pierre Robin Sequence
No full textAfter a failed mandibular osteodistraction, the wrong positioned mandible of a few patients with Pierre Robin sequence returned in the most functional position and regained a proper symmetry, without external intervention. The study aims to explain this self-adjustment and introduce the floating bone phenomenon.The inclusion criteria were severe micrognathia, Fast and Early Mandibular Distraction Osteogenesis protocol, postoperative mandibular wrong positioning, presurgery, immediate postsurgery, and long-term computed tomography scan. Five patients were included. The considered parameters were the distance between mandibular dental centerline and midsagittal facial axis, the rotation of the mandibular body, the magnitude of elongation, and the lowering of the mandibular body.Three patients went from a decentralization >4 mm in the activation phase to a normalization of the said value in the follow-up. In the same period, the interincisal point of 2 patients moved respectively from 0.5 mm on the left and 0.8 mm on the right to 1.2 mm and 1.6 mm on the right, respectively. The rotation of the mandibular body was meanly 25.6° among all patients. The mean value of the distraction was 14.1 mm. A difference of about 4.4 mm between the left and the right side was measured. The lowering of the mandible varied between 2.8 and 12.6 mm.All patients improved their symmetry. Four of them improved in all the measured parameters, while 1 patient presented a worsening in the decentralization of the interincisal point.The floating bone phenomenon could break new grounds in the management of patients with Pierre Robin sequence
The caudal septum pivot technique for short nose correction
No full textThe short nose represents one of the greatest challenges in rhinoplasty. It is characterized by a reduced distance from the nasal radix to the tip-defining points, often associated with inadequate tip projection. Several techniques have been described for correction of short nose with the common objective of replacing and rebuilding the osteocartilaginous framework. One of the most effective method to correct the short nose is the septal extension graft. The authors describe the caudal septum pivot (CSP) technique, a simple method to elongate short noses by using a graft inserted in the dorsal septum after its division using as pivot the caudal portion, without detaching it from its natural anchorage to the anterior nasal spine. A retrospective analysis was performed reviewing the clinical charts and the operative records of 315 patients who underwent revision rhinoplasty from January 2015 to June 2019; among this group, 34 were considered eligible for the study. The patients (8 men, 26 women; mean age: 25.4 years; age range: 22-53 years) were divided into two groups: in 12 patients (Group 1) the CSP technique was performed, while Group 2 was composed of 22 patients who received a more classic treatment with a septal extension graft. To evaluate the outcomes, nasal length, tip projection, and tip rotation were measured pre- and 1 year postoperatively on digital photographs of each patient. Nasal anthropometric measurements revealed, at 12-month visit follow-up, an improvement in nasal length, tip projection, and nasolabial angle was achieved in all the patients. The comparison of the pre- and postoperative values showed a statistically significant reduction in the nasolabial angle ( p <0.05) and an increase in the tip projection ( p <0.05) and in the nasal lengthening ( p <0.05) in both groups. In authors' experience, the CSP technique could be considered a safe, reliable, and effective alternative technique in selected patients
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