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Calvert JW, Kruayatidee A, Shakoori P, Rovelo M. Immediate Nasal Reconstruction in Management of Infected Nasal Alloplast and Allografts: A Case Series. Aesthetic Plast Surg 2024; 48:689-701. [PMID: 37395793 DOI: 10.1007/s00266-023-03397-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/29/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The use of alloplastic and allogenic nasal implants is widely popular in rhinoplasty. However, the use of these materials is accompanied by a risk of infection and extrusion. Traditionally, management of these complications is performed in a dual-staged fashion. First, the implant is removed and infection is controlled, then a delayed reconstruction is performed. However, scarring and soft tissue contracture make a delayed reconstruction challenging, and optimal aesthetic outcomes are difficult to achieve. This study was designed to evaluate the outcomes of immediate nasal reconstruction following removal of an infected nasal implant. METHODS A retrospective chart review was performed of all patients who had infected nasal implants and underwent simultaneous removal and immediate nasal reconstruction with autologous cartilages (n = 8). Data collected included patient age, race, pre-operative presentation, intraoperative surgical maneuvers, and post-operative outcomes and complications. Post-operative results were used to measure success of the single-staged method. RESULTS Follow-up ranged from 12 to 156 months with mean 84.4 months of the eight patients who were evaluated in the study, none had any major post-operative complications that required revision or reconstruction. All of the patients had marked improvement in nasal form and function. Six of the eight (75%) patients reported excellent aesthetic outcomes; two (25%) requested revisional surgeries for aesthetic concerns. CONCLUSION Low complication rates and excellent aesthetic outcomes are possible in immediate autologous reconstruction following removal of an infected nasal implant. This is an alternative approach that obviates the inherent problems of a traditional delayed reconstruction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ..
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Affiliation(s)
- Jay W Calvert
- Roxbury Clinic and Surgery Center, 465 North Roxbury Drive, Suite 1001, Beverly Hills, CA, 90210, USA.
| | - Adira Kruayatidee
- Roxbury Clinic and Surgery Center, 465 North Roxbury Drive, Suite 1001, Beverly Hills, CA, 90210, USA
| | - Pasha Shakoori
- Roxbury Clinic and Surgery Center, 465 North Roxbury Drive, Suite 1001, Beverly Hills, CA, 90210, USA
| | - Millicent Rovelo
- Roxbury Clinic and Surgery Center, 465 North Roxbury Drive, Suite 1001, Beverly Hills, CA, 90210, USA
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Richards E, Qamar N, Naik P, Ahmed S. Use of tobramycin-impregnated antibiotic beads in frontal sinus osteomyelitis. J Laryngol Otol 2023; 137:934-937. [PMID: 36597831 DOI: 10.1017/s0022215122002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Osteomyelitis of the frontal bone is a rare but devastating complication of frontal sinusitis. Treatment involves aggressive surgery to remove all sequestra in combination with long-term antibiotic therapy. However, systemic antibiotics may struggle to penetrate any remaining infection in devascularised areas, and the morbidity associated with surgical resection of some areas of the skull base is too high. In contrast, locally implanted antibiotics provide a reliable, high concentration of treatment to these areas while also minimising potential systemic side effects. The clinical application of tobramycin beads has primarily been used in orthopaedics as an adjunct to the treatment of tibial osteomyelitis or prosthetic joint infection. CASE REPORT To the best of the authors' knowledge, the two cases discussed here represent the first use of tobramycin antibiotic beads in frontal sinus osteomyelitis secondary to chronic rhinosinusitis. CONCLUSION These cases show promising use of tobramycin beads in recalcitrant frontal osteomyelitis.
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Affiliation(s)
- E Richards
- ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Qamar
- ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Naik
- ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Ahmed
- ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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Arany P, Papp I, Zichar M, Csontos M, Elek J, Regdon G, Budai I, Béres M, Gesztelyi R, Fehér P, Ujhelyi Z, Vasvári G, Haimhoffer Á, Fenyvesi F, Váradi J, Miklós V, Bácskay I. In Vitro Tests of FDM 3D-Printed Diclofenac Sodium-Containing Implants. Molecules 2020; 25:E5889. [PMID: 33322100 PMCID: PMC7764218 DOI: 10.3390/molecules25245889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 01/29/2023] Open
Abstract
One of the most promising emerging innovations in personalized medication is based on 3D printing technology. For use as authorized medications, 3D-printed products require different in vitro tests, including dissolution and biocompatibility investigations. Our objective was to manufacture implantable drug delivery systems using fused deposition modeling, and in vitro tests were performed for the assessment of these products. Polylactic acid, antibacterial polylactic acid, polyethylene terephthalate glycol, and poly(methyl methacrylate) filaments were selected, and samples with 16, 19, or 22 mm diameters and 0%, 5%, 10%, or 15% infill percentages were produced. The dissolution test was performed by a USP dissolution apparatus 1. A 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide dye (MTT)-based prolonged cytotoxicity test was performed on Caco-2 cells to certify the cytocompatibility properties. The implantable drug delivery systems were characterized by thermogravimetric and heatflow assay, contact angle measurement, scanning electron microscopy, microcomputed tomography, and Raman spectroscopy. Based on our results, it can be stated that the samples are considered nontoxic. The dissolution profiles are influenced by the material properties of the polymers, the diameter, and the infill percentage. Our results confirm the potential of fused deposition modeling (FDM) 3D printing for the manufacturing of different implantable drug delivery systems in personalized medicine and may be applied during surgical interventions.
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Affiliation(s)
- Petra Arany
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Körút 98, H-4032 Debrecen, Hungary; (P.A.); (P.F.); (Z.U.); (G.V.); (Á.H.); (F.F.); (J.V.); (V.M.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Nagyerdei St. 98, H-4032 Debrecen, Hungary
| | - Ildikó Papp
- Department of Computer Graphics and Image Processing, Faculty of Informatics, University of Debrecen, Kassai út 26, H-4028 Debrecen, Hungary; (I.P.); (M.Z.)
| | - Marianna Zichar
- Department of Computer Graphics and Image Processing, Faculty of Informatics, University of Debrecen, Kassai út 26, H-4028 Debrecen, Hungary; (I.P.); (M.Z.)
| | - Máté Csontos
- Department of Physical Chemistry, Faculty of Science and Technology, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary;
| | - János Elek
- Science Port Kft., Varró utca 21, H-5300 Karcag, Hungary;
| | - Géza Regdon
- Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, Eötvös u. 6, H-6720 Szeged, Hungary;
| | - István Budai
- Faculty of Engineering, University of Debrecen, Ótemető utca 2-4, H-4028 Debrecen, Hungary;
| | - Mónika Béres
- Department of Medical Imaging, University of Debrecen, Nagyerdei Krt. 98, H-4032 Debrecen, Hungary;
| | - Rudolf Gesztelyi
- Department of Pharmacology and Pharmacotherapy, University of Debrecen, Nagyerdei Körút 98, H-4032 Debrecen, Hungary;
| | - Pálma Fehér
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Körút 98, H-4032 Debrecen, Hungary; (P.A.); (P.F.); (Z.U.); (G.V.); (Á.H.); (F.F.); (J.V.); (V.M.)
| | - Zoltán Ujhelyi
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Körút 98, H-4032 Debrecen, Hungary; (P.A.); (P.F.); (Z.U.); (G.V.); (Á.H.); (F.F.); (J.V.); (V.M.)
| | - Gábor Vasvári
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Körút 98, H-4032 Debrecen, Hungary; (P.A.); (P.F.); (Z.U.); (G.V.); (Á.H.); (F.F.); (J.V.); (V.M.)
| | - Ádám Haimhoffer
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Körút 98, H-4032 Debrecen, Hungary; (P.A.); (P.F.); (Z.U.); (G.V.); (Á.H.); (F.F.); (J.V.); (V.M.)
| | - Ferenc Fenyvesi
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Körút 98, H-4032 Debrecen, Hungary; (P.A.); (P.F.); (Z.U.); (G.V.); (Á.H.); (F.F.); (J.V.); (V.M.)
| | - Judit Váradi
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Körút 98, H-4032 Debrecen, Hungary; (P.A.); (P.F.); (Z.U.); (G.V.); (Á.H.); (F.F.); (J.V.); (V.M.)
| | - Vecsernyés Miklós
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Körút 98, H-4032 Debrecen, Hungary; (P.A.); (P.F.); (Z.U.); (G.V.); (Á.H.); (F.F.); (J.V.); (V.M.)
| | - Ildikó Bácskay
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Körút 98, H-4032 Debrecen, Hungary; (P.A.); (P.F.); (Z.U.); (G.V.); (Á.H.); (F.F.); (J.V.); (V.M.)
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