1,720,971 research outputs found
Repair of cocaine-related oronasal fistula with forearm radial free flap.
No full textBACKGROUND: Cocaine snorting may cause significant local ischemic necrosis and the destruction of nasal and midfacial bones and soft tissues, leading to the development of a syndrome called cocaine-induced midline destructive lesion. A review of the English-language literature reveals only a few articles describing the treatment of hard and/or soft palatal perforation related to cocaine inhalation. Described here are 4 patients with a history of cocaine abuse showing palatal lesions. MATERIALS AND METHODS: From 2010 to 2013, a total of 4 patients affected by cocaine-related midline destructive lesions were referred to our department. They all presented signs of a cocaine-induced midline destructive lesion. They showed wide midfacial destruction involving the nasal septum as well as the hard and soft palates causing an ample oronasal communication. RESULTS: In 3 patients, oronasal communication has been treated successfully using a personal technique based on a partially de-epithelialized forearm free flap. The fourth patient had been treated only with local debridement because, when she came to our attention, her abusive habits were still unsolved. DISCUSSION: Different surgical options have been reported such as local, regional, and free flaps for hard and soft palate reconstruction. However, because of an unpredictable vascularization of the palatal tissues and owing to the scarceness of the local soft tissues, local flaps are at high risk for partial and complete failure. The transfer of free vascularized tissue, however, seems to be the most reliable and logical solution for medium- to large-sized fistulas. Among the various free flaps, we choose the radial forearm type because of the pedicle length and the flap thickness
New Tunneled Buccal Fat Pad Flap for Palatal Reconstruction
No full textIn the palatal defects due to surgical resection, flap selection is very important for a correct reconstruction. Different methods have been suggested over the time, however the pedicled buccal fat pad is a simple, effective, reliable flap for reconstruction after palate tumor resection. The aim of the present study is to introduce a new surgical technique for palate reconstruction with pedicled buccal fat pad flap exposing the advantages. The Authors performed this procedure in 17 patients in order to treat medium-sized oncologic surgical defect of palate region in the period between 2016 and 2019. Complete wound healing after only 4 weeks without complication after 12 months follow-up was observed. This is the first cases series described with this new technique
Surgical access to condylar fractures in panfacial traumas. [L’accesso chirurgico al condilo nei fracassi facciali]
No full textObiettivo. L’accesso al condilo nel contesto delle fratture panfacciali è un argomento particolarmente complesso e dibattuto. Il presente lavoro propone un protocollo applicabile nei fracassi facciali dove è necessario accedere al condilo.
Metodi. Lo studio comprende 10 pazienti (8 maschi e 2 femmine) con fratture panfacciali comprendenti 16 fratture extracapsulari di condilo associate a 3 fratture sinfisarie, 7 parasinfisarie, 1 frattura di angolo mandibolare, 6 fratture mascellari tipo LeFortII, 3 fratture orbito-maxillo-zigomatiche e 5 fratture zigomatiche. La riduzione e sintesi delle fratture di condilo veniva effettuata mediante accesso mini-retromandibolare in 6 pazienti per un totale di 10 fratture di condilo mentre in 4 pazienti per un totale di 6 fratture extracapsulari veniva effettuato attraverso un accesso tipo lifting come estensione caudale di un accesso emicoronale o coronale necessario per il trattamento delle fratture coesistenti.
Risultati. In tutti i pazienti venivano ottenuti buoni risultati morfo-funzionali. Nessuna complicanza relativa agli accessi ed al trattamento delle fratture di condilo.
Conclusioni. Il protocollo che proponiamo potrebbe guidare nella scelta dell’accesso chirurgico al condilo mandibolare nelle fratture panfacciali.AIM:
Surgical access to the condyle in panfacial fractures is a delicate and debated issue. The aim of the study was to propose a protocol which would apply in the treatment of panfacial fractures requiring access to the condyles.
METHODS:
A case series of 10 patients (8 males and 2 females) with panfacial fractures consisting of 16 extracapsular mandibular condylar fractures associated with 3 symphyseal, 7 parasymphyseal, 1 mandibular angle, 6 Le Fort II, 3 orbitomaxillomalar, 5 zygomatic arch fractures were included in this study. Reduction and fixation were achieved using the mini-retromandibular access in 6 patients with 10 extracapsular condylar fractures while in 4 patients with 6 extracapsular condylar fractures access to the condyles consisted in a face-lift-type preauricular access, as a caudal extension of a coronal or hemicoronal incision required for the reduction and fixation of other fractures of the upper and middle thirds.
RESULTS:
A good morphological and functional outcome was achieved in all patients. No surgical complication associated with access to the condyles or treatment of the condylar fractures was registered.
CONCLUSION:
The proposed protocol could be used as a guide in choosing access to the condyles in panfacial traumas
Surgical access to condylar fractures in panfacial traumas
No full textSurgical access to the condyle in panfacial fractures is a delicate and debated issue. The aim of the study was to propose a protocol which would apply in the treatment of panfacial fractures requiring access to the condyles. A case series of 10 patients (8 males and 2 females) with panfacial fractures consisting of 16 extracapsular mandibular condylar fractures associated with 3 symphyseal, 7 parasymphyseal, 1 mandibular angle, 6 Le Fort II, 3 orbitomaxillomalar, 5 zygomatic arch fractures were included in this study. Reduction and fixation were achieved using the mini-retromandibular access in 6 patients with 10 extracapsular condylar fractures while in 4 patients with 6 extracapsular condylar fractures access to the condyles consisted in a face-lift-type preauricular access, as a caudal extension of a coronal or hemicoronal incision required for the reduction and fixation of other fractures of the upper and middle thirds. A good morphological and functional outcome was achieved in all patients. No surgical complication associated with access to the condyles or treatment of the condylar fractures was registered. The proposed protocol could be used as a guide in choosing access to the condyles in panfacial traumas
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
O-0705 TOTAL NASAL RECONSTRUCTION WITH OR WITHOUT SKELETAL SUPPORT: OUR PROTOCOL
No full textThe reconstruction of nasal skin is relatively easy when the defect involves one to two subunits. These cases are effectively managed with local flaps. However, when an extensive defect involves more than two subunits or the entire nose, a global nasal reconstruction must be consid- ered.
From January 2009 to December 2011 we have treated 10 patients who needed a total nasal reconstruction. In 5 patients the reconstruction involved the external skin only after extensive tumour removal. The remaining 5 patients needed a total nasal reconstruction including internal and external lining and the osteocartilaginous support. In detail we reconstructed 2 cases of congenital arhinia, 2 cases of nasal destruction secondary to cocaine abuse and one case of total nasal loss owing to a squamous cell carcinoma.
In all cases the nasal external skin was reconstructed with a paramedian forehead flap. In those patients where the hard tissue support was intact we only used cartilaginous grafts to support the alae.
In the cases of arhinia we performed a two-step surgery. In the first session we created a new nasal fossa by a LeFort Osteotomy and a skin graft; at the same time we posi- tioned a forehead expander. In the second intervention we: removed the skin expander; created an internal lining with local flaps; created a skeletal framework with osteocarti- laginous grafts; rotated a forehead flap to create the exter- nal lining.
In the two cocaine addicted we used the nasal remnants, deepithelialized, to create the internal lining, a costo- chondral graft to build the hard tissue framework and a paramedian forehead flap to create the external skin.
The patient who had his nose lost for oncological reasons was reconstructed with a prelaminated forehead parame- dian flap. In a second surgical session the flap was mod- elled and a costochondral graft positioned to build the skeletal support.
We have observed very good results in all cases with minimal donor site morbidity.
While the technique is by itself not new, we believe that our protocol, that we here present, is ideal if we look at the results and applicable to different conditions that lead to major nasal defects
Contemporary management of vascular malformations.
No full textPURPOSE: To review the literature on vascular malformations and to clarify their diagnosis, clinical presentation, and treatment options. MATERIAL AND METHODS: The authors reviewed the current literature on vascular malformations looking for more innovative and credited diagnostic criteria and treatment protocols. RESULTS: The review is divided in 4 sections (capillary, venous, arteriovenous, and lymphatic malformations). In each section, the clinical presentation, radiologic features, and treatment options for each kind of vascular malformation are described. The experience and results of the authors also are presented. CONCLUSIONS: Vascular malformations are a heterogeneous group of diseases. Each type of malformation has unique features that make it largely different from the others. Only a clear and correct diagnosis can lead to optimal results
O-2207 THE NEED FOR TRACHEOSTOMY IN VASCULAR ANOMALIES: A LITERATURE META ANALYSIS
No full textVascular anomalies encompass an extremely wide spec- trum of pathologies. There are simple single angiomas which do not pose any diagnostic and therapeutic diffi- culty.
On the other hand, there are extremely severe conditions such as congenital gigantic lymphatic malformations involving the upper respiratory tract that can require an Ex Utero Intrapartum Therapy (EXIT).
In general, when a vascular anomaly affects the airways, there could be the risk of asphyxia spontaneously, during certain physiological conditions such as the Valsalva manoeuvre, during intubation or during the surgical man- agement of the vascular anomaly.
The aim of the present paper was to extensively review the literature in the search for indications and techniques to see if a guideline can be proposed to protect the upper airways of patients affected by haemangiomas and vascu-
lar malformations.
In detail we tried to investigate the conditions that suggest a surgical airway versus a conservative management.
As to what pertains to haemangiomas we have thoroughly reviewed the literature regarding subglottic haemangiomas treated before and after the advent of propranolol.
For the vascular malformation we have considered the various clinical conditions that can suggest a surgical airway.
Eventually we try to see if a guideline can be proposed
A new operative open-wings technique to correct the frontoforehead unit in metopic synostosis
No full textThe technology adoption and creation of a multidisciplinary team have helped to overcome the complexity associated. Craniofacial surgery has thus emerged from the valuable contributions of neurosurgery, maxillofacial surgery, plastic surgery, eyes, nose, and throat as well as head and neck surgery. A patient with trigonocephaly may present a prominent "keel" forehead, accompanied by recession of the lateral orbit rims, hypotelorism, and constriction of the anterior frontal fossa when the metopic suture fuses before 6 months of age. In a period between 2007 and 2011, in the Salesi Children's Hospital, were treated for nonsyndromic variety of metopic synostosis 11 infants; their ages ranged from 6 months to 9 months, and 7 were males and 4 females. The most important aims of our new surgical technique are the achievement of symmetry as well as normal proportion and reconstruction of the frontoforehead unit but remaining in a very conservative treatment. The morphology and position of the supraorbital ridge-lateral orbital rim region are key elements of upper facial esthetics. This new "open-wings" technique for the reconfiguration of the bilateral emisupraorbital bar requires a midline incomplete osteotomy that involves only the internal cortex of the frontonasal region. Hence, both lateral orbital walls are bent inwardly and tilting forward, as in computed tomographic scan planning, with a greenstick fracture pivoting on the preserved medial frontonasal region. This open-wings conservative technique allows the avoidance of the most important complication that may result in the traditional way such as dead space in the anterior cranial fossa, infections, and blood loss but with an achievement of satisfactory craniofacial form and aesthetic result
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