223 research outputs found
Update on the Evidence for Functional Rhinoplasty Techniques
Purpose of review: Functional rhinoplasty is a term that is commonly used to describe any technique used to address nasal obstruction in the nasal valve region. The cause of nasal valve collapse differs based on the site. Internal valve collapse may be idiopathic or associated with previous rhinoplasty, trauma, or weakened cartilage in older patients. External valve collapse is usually idiopathic and less likely to be associated with previous surgery. Various techniques have been developed over time, and the data in support of functional rhinoplasty continue to increase.
Recent findings: This article discusses popular techniques currently in use, as well as newer techniques that have been described over the past several years. In addition, there is a trend toward utilizing objective testing and validated assessment scales to assess postoperative changes.
Summary: Functional rhinoplasty utilizes a multitude of techniques to address nasal valve collapse. Although high-level data are lacking, the current literature is in support of nasal valve correction to improve nasal breathing. Most importantly, the technique employed is unique for each patient
Facing Facts: Facial Injuries from Stand-up Electric Scooters
Background Stand-up electric scooters (SES) are a popular public transportation method. Numerous safety concerns have arisen since their recent introduction. Methods A retrospective chart review was performed to identify patients presenting to the emergency departments in Indianapolis, who sustained SES-related injuries. Results A total of 89 patients were included in our study. The average patient age was 29 ± 12.9 years in a predominantly male cohort (65.2%). No patient was documented as wearing a helmet during the event of injury. Alcohol intoxication was noted in 14.6% of accidents. Falling constituted the leading trauma mechanism (46.1%). Injuries were most common on Saturday (24.7%) from 14h00 to 21h59 (55.1%). Injury types included: abrasions/contusions (33.7%), fractures (31.5%), lacerations (27.0%), or joint injuries (18.0%). The head and neck region (H&N) was the most frequently affected site (42.7%). Operative management under general anesthesia was necessary for 13.5% of injuries. Nonoperative management primarily included conservative orthopedic care (34.8%), pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) (34.8%) and/or opioids (4.5%), bedside laceration repairs (27.0%), and wound dressing (10.1%). Individuals sustaining head and neck injuries were more likely to be older (33.8 vs. 25.7 years, p=0.003), intoxicated by alcohol (29.0% vs. 3.9%, p=0.002), and requiring CT imaging (60.5% vs. 9.8%, p <0.001). Conclusion Although SESs provide a convenient transportation modality, unregulated use raises significant safety concerns. More data need to be collected to guide future safety regulations
Reconstruction of midface defect from idiopathic destructive process using Medpor implant
Importance
Reconstruction of the midface remains a challenging task for even the most experienced surgeon, with a host of reconstructive options including free tissue transfer, allografts, or prosthetic implants. Presented here is a case of idiopathic bony destruction of the right midface in a 19 year old female, creating a unique defect requiring repair.
Objective
Demonstrate a unique case of severe maxillary degeneration and discuss the associated reconstructive challenges and final repair with a prosthetic implant.
Design
Case report.
Results
The patient presented with a 7 month history of an idiopathic progressive deformity of the right cheek. Computed tomography of the paranasal sinuses revealed extensive bone loss of the right midface and orbit. The patient underwent facial reconstruction using a customized Medpor (Stryker Corp, Kalamazoo, MI) implant. At 6 month follow-up the patient and physician were both pleased with the patient's overall appearance. The patient did have some residual lower lid retraction present as well as some lateral pull at the lateral canthus outward from the orbit itself.
Conclusions
Preoperative planning for midface reconstruction requires a deep understanding of the aesthetic, functional, and supportive roles this structure holds. Computer assistance allows the creation of custom made implants, providing the reconstructive surgeon with innovative options for reconstruction with minimal morbidity to the patient. As the technology around the design and creation of the custom implants continues to improve, the role of computer assistance in reconstruction will become more prominent
Sinonasal Chondromyxoid Fibroma: Case Report and Literature Review
Chondromyxoid fibroma (CMF) is a rare, benign neoplasm of the chondroid, myxoid, and fibrous tissue. It characteristically affects the lower extremity long bones, although it may rarely arise within the craniofacial skeleton. We report the diagnosis and management of a 31-year-old male with a large, incidentally discovered CMF originating from the sphenoid sinus. A subsequent review of the literature reveals the need to differentiate from more aggressive neoplasms, such as chondrosarcoma and chondroma, which share radiographic features. A histopathologic examination is crucial for proper diagnosis and treatment. We discuss clinical sequelae, highlight the importance of a thorough pre-operative evaluation, and summarize previously suggested treatment paradigms
In-office Functional Nasal Surgery
Nasal airway obstruction is a common complaint encountered by the otolaryngologist. In-office nasal procedures are becoming increasingly popular, and should be considered for patients desiring immediate treatment without the adverse effects of general anesthesia, operating room costs or scheduling delays. In this paper, we discuss the factors in patient selection, room set-up, and other considerations. We discuss the options available for in-office treatment for nasal valve repair including turbinoplasty, septoplasty, and nasal valve repair/functional rhinoplasty-type techniques described in our literature
Three-Dimensional Printing and Its Applications in OtorhinolaryngologyâHead and Neck Surgery
Objective
Three-dimensional (3D)-printing technology is being employed in a variety of medical and surgical specialties to improve patient care and advance resident physician training. As the costs of implementing 3D printing have declined, the use of this technology has expanded, especially within surgical specialties. This article explores the types of 3D printing available, highlights the benefits and drawbacks of each methodology, provides examples of how 3D printing has been applied within the field of otolaryngologyâhead and neck surgery, discusses future innovations, and explores the financial impact of these advances.
Data Sources
Articles were identified from PubMed and Ovid MEDLINE.
Review Methods
PubMed and Ovid Medline were queried for English articles published between 2011 and 2016, including a few articles prior to this time as relevant examples. Search terms included 3-dimensional printing, 3D printing, otolaryngology, additive manufacturing, craniofacial, reconstruction, temporal bone, airway, sinus, cost, and anatomic models.
Conclusions
Three-dimensional printing has been used in recent years in otolaryngology for preoperative planning, education, prostheses, grafting, and reconstruction. Emerging technologies include the printing of tissue scaffolds for the auricle and nose, more realistic training models, and personalized implantable medical devices.
Implications for Practice
After the up-front costs of 3D printing are accounted for, its utilization in surgical models, patient-specific implants, and custom instruments can reduce operating room time and thus decrease costs. Educational and training models provide an opportunity to better visualize anomalies, practice surgical technique, predict problems that might arise, and improve quality by reducing mistakes
Extra-ocular movement restriction and diplopia following orbital fracture repair
Purpose
To report a series of patients with extra-ocular movement restriction and diplopia after orbital fracture repair, and determine the effect of timing of repair and the type of implant used.
Methods
A chart review was conducted identifying all patients > 18 years of age at our institution between June 2005 and June 2008 who underwent orbital fracture repair, and presented with clinically significant diplopia and extra-ocular movement restriction persisting longer than one month after repair. Data collected included timing of repair, implant used within the orbit, and need for revision.
Results
Ten patients were identified with a mean time to primary orbital fracture repair at 9 days (range 1â48). Seven patients underwent revision of their orbital fracture repair with removal of the previously placed implant and replacement with non-porous 0.4 mm Supramid Foil, whereas one patient underwent lateral and inferior rectus recessions without revision of primary fracture repair. Titanium mesh was the intra-orbital implant found in all patients requiring revision of orbital fracture repair. All revisions resulted in resolution of clinically significant diplopia.
Conclusions
Clinically significant diplopia and extra-ocular movement restriction is not an uncommon complication after orbital fracture repair. In our series, there was a strong association between these complications and the use of porous titanium mesh implants. Revision of fractures significantly improved diplopia in all but one patient. This suggests that meticulous fracture repair and the use of non-porous implants primarily or secondarily may preclude the need for strabismus surgery after orbital trauma
Parentsâ Beliefs Regarding Shared Reading with Infants and Toddlers
Parent beliefs about reading to young children- and factors related to such beliefs- affect a childâs reading skill. But, little is known about parent beliefs about reading to infants and toddlers. To fill this gap, three University Centers of Excellence in Developmental Disabilities (UCEDDs) studied 43 English and Spanish speaking parents of children aged 9-18 months. The three UCEDDs were working on a project to create a childrenâs book that had tips for parents about how their one year-old learns and grows. The UCEDD study survey asked about parent beliefs about reading to young children (4 questions) and factors related to those beliefs (2 questions). Parents were also asked to give feedback about the book. Nearly all parents agreed that children should be read to as infants and that this helps children develop reading skills. Most (62%) parents said it was âvery commonâ for friends and family to read with children of this age (62%). Parents said that reading the board-book together was: useful for âpromot[ing] language,â âhelp[ing] my babyâs development,â and âhelp[ing] my child speak.â More research like this can identify ways to help parents of young children develop reading skills
Pediatric Midface Fractures: Outcomes and Complications of 218 Patients
Objective
To analyze management, outcomes, and complications of pediatric midface fractures.
Methods
Retrospective cohort study at an urban, singleâinstitution, multispecialty surgical teams, at two level 1 pediatric trauma centers. Query included subjects aged 0â17 diagnosed with midface fractures between 2012 and 2016.
Results
A total of 218 pediatric patients presented with 410 total midface fractures. The most common etiologies included motor vehicle collisions (MVC) (n = 56, 25.7%), sportârelated (n = 35, 16.1%), and assault/battery (n = 32, 14.7%). Fracture site distribution included: 125 maxillary (34 with exclusively the nasal/frontal process), 109 nasal, 47 ethmoid, 40 sphenoid, 33 zygoma, 29 frontal sinus, 21 lacrimal, and 6 palatal. Among these, there were 105 orbital, 17 nasoâorbitoâethmoid, and 12 Le Fort fractures. Oneâquarter of patients received at least one midfaceârelated operation during the initial encounter. Operative intervention rates for specific midface fracture subsites were not significantly different (X2 = 6.827, P = .234). One hundred thirtyâfive patients (63.4%) attended followâup, thus known complication rate was 14.6% (n = 31). Complication rates between midface fracture subsites were not significantly different (X2 = 5.629, P = .229). Complications included facial deformity (n = 18), nasal airway obstruction (n = 8), diplopia (n = 4), hardwareârelated pain (n = 3), and paresthesias (n = 3).
Conclusions
The most common sites of pediatric midface fractures involved the maxilla, and nasal bones. Three quarters of pediatric midface fractures were treated conservatively, with low rates of complications. Facial deformity was the most common complication; as such, proper management and followâup are important to ensure normal growth and development of the pediatric facial skeleton.
Level of Evidence
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