RESUMEN
The surgical management of cerebrospinal fluid (CSF) rhinorrhoea has changed significantly after the introduction of functional endoscopic sinus surgery in the management of sinusitis. The clear anatomical exposure of the roof of the nasal and the sinus cavities by the endoscope offers the surgeon an opportunity to identify the area of the CSF leak, which enables one to adequately plan the treatment. The incidence of iatrogenic CSF rhinorrhoea has also increased, especially after the introduction of endoscopic sinus surgery. This study and presentation will analyze the various medical and surgical decisions that can be offered in the management of CSF rhinorrhoea from the authors' combined 10-year experience. The early identification of high-risk patients prior to surgery will be stressed including the various diagnostic options which are currently available in isolating the leak. The technique of endoscopic repair in the surgical management of the various leaks and the timing of the repair will be discussed in detail.
Asunto(s)
Rinorrea de Líquido Cefalorraquídeo/cirugía , Adolescente , Adulto , Anciano , Rinorrea de Líquido Cefalorraquídeo/diagnóstico , Toma de Decisiones , Endoscopía , Femenino , Adhesivo de Tejido de Fibrina/uso terapéutico , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The purpose of this study was to apply a quantitative approach to augmentation mentoplasty with Silastic implants to achieve consistently accurate results. A Silastic extension wafer was introduced for custom contouring implants as part of this technique. DESIGN: Case series. SETTING: Private practice. PATIENTS: One hundred patients undergoing elective facial cosmetic surgery. For the main outcome measure, ideal profile augmentation was defined as projecting the most anterior point of the patient's chin on profile to within 2 mm of a vertical line dropped from the lower lip. RESULTS: Using a quantitative approach, 98 of 100 patients were able to achieve ideal profile augmentation. CONCLUSIONS: A quantitative approach to augmentation mentoplasty can provide consistently accurate results. Easy intraoperative customization of Silastic implants is necessary for this type of technique. A Silastic extension wafer is an effective method for intraoperative customization of implants.
Asunto(s)
Aumento de la Cresta Alveolar/métodos , Prótesis e Implantes , Elastómeros de Silicona , Párpados/cirugía , Femenino , Humanos , Rinoplastia , RitidoplastiaRESUMEN
Facial defects created by removal of various types of skin cancer are usually closed primarily. There are some areas of the face where primary closure produces less than optimal results. We have utilized a non-reactive collagen sponge (Collagen Matrix) to enhance closure by secondary intention following removal of skin cancers. This presentation describes the properties of Collagen Matrix as well as the technique we utilized for closure of facial defects following tumor removal.
Asunto(s)
Carcinoma Basocelular/cirugía , Colágeno , Neoplasias Faciales/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nariz/cirugíaRESUMEN
The compressive mechanical properties of untreated and chemically and physically treated nasal septum homografts were determined. Mechanical properties of control, saline-, thimerosal (Merthiolate)- and Alcide-treated specimens were similar. At high strains, the stiffness of treated cartilage ranged from 12.8 to 22.5 MPa and was unaffected by storage time. In comparison, irradiated and freeze-dried nasal septum exhibited stiffnesses of 35 and 37.5 MPa, respectively, after approximately 1 month of storage. These values of stiffness were significantly different from controls at a 0.95 confidence level. On the basis of these results, it was concluded that Alcide and Merthiolate treatment did not alter the compressive mechanical properties of cartilage and that a combination of these treatments may adequately sterilize and preserve nasal septum homografts.