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Cardín AA, Pereira A, Mendes A, Duarte J, Pereira A. Maxillary reconstruction with horizontally oriented scapular tip free flap: outcomes in orbital support and palate closure. J Plast Reconstr Aesthet Surg 2024; 95:221-230. [PMID: 38936333 DOI: 10.1016/j.bjps.2024.05.042] [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: 03/19/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Current indications of maxillary reconstruction with scapular tip free flap (STFF) are palatoalveolar defects associated with zygomaticomaxillary buttress and/or orbital floor defects. STFF can be placed either horizontally or vertically. Horizontal placement usually allows ideal palatal conformation, preventing oronasal communication, but has been argued to compromise orbital support and projection of the midface, whereas vertical placement is advocated for midface support but may be insufficient for the complete closure of the palate. The present study focuses on the horizontal placing of STFF to allow complete palate reconstruction and fistulae prevention while still obtaining optimal midface projection and orbital support. MATERIALS AND METHODS This study included 21 case complex maxillary reconstructions with this flap, in which the horizontally placed scapular tip component replaced the palate, a muscular flap component was included for midface volume restoration, and an alloplastic implant was utilized for supporting the orbital content when needed. RESULTS None of the patients presented palatal fistulas or alterations in the orbital support. CONCLUSION A multilevel approach was proposed according to the maxillectomy defect. This experience supported the horizontal insetting of STFF to allow palatal fistulae prevention while still obtaining an optimal midface projection and orbital support.
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Affiliation(s)
- Adrián A Cardín
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Donostia, San Sebastián, Spain.
| | - André Pereira
- Department of Stomatology, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal.
| | - Ana Mendes
- Department of Plastic and Reconstructive Surgery, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal.
| | - José Duarte
- Department of Plastic and Reconstructive Surgery, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal.
| | - Alberto Pereira
- Department of Plastic and Reconstructive Surgery, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal; Department of Plastic and Reconstructive Surgery, Hospital da Luz Lisboa, Lisbon, Portugal.
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Pitak-Arnnop P, Subbalekha K, Meningaud JP, Sirintawat N, Auychai P, Tangmanee C, Wunsch A, Neff A. Factors associated with epiphora following orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty. J Surg Oncol 2021; 123:1246-1252. [PMID: 33523470 DOI: 10.1002/jso.26408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE The aims of the study were to estimate the frequency of epiphora and to identify factors associated with epiphora after orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty (OSOSM-MWFILB). METHODS We performed a retrospective cohort study enrolling a sample derived from the patient population undergoing OSM-MWFILB over a 7-year period. The predictor variables were grouped into demographic, related health status, anatomic, tumor-specific, and therapeutic categories. The primary outcome variable was the presence of postmaxillectomy epiphora (PME). Descriptive, univariate, and multivariate regression mixed-effect models were computed. RESULTS The study sample was composed of 134 patients (46.3% females; 71.6% squamous cell carcinomas) with a mean age of 64.7 ± 12.2 years. There were 23 (17.2%) PME events, which were significantly associated with eight variables: male gender, poor general health (ASA III-IV), large vertical defect (Brown and Shaw's class III-IV), squamous cell carcinoma tumor type, big tumor size (T3-4), cervical lymph node metastasis (N1-2), long operating time > 3 h, and adjuvant radio(chemo)therapy in both univariate mixed regression and multivariate Cox hazards analyses. Healing of PME in irradiated patients was significantly delayed. CONCLUSIONS Ophthalmologic consequences in patients undergoing OSM-MWFILB require particular attention, especially in case of advanced tumors, multiple comorbidities, or long surgery with postoperative radio(chemo)therapy. This emphasizes the importance of appropriate cooperation between the surgeons and ophthalmic colleagues.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, Campus Marburg, UKGM GmbH, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Esthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Prim Auychai
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
| | - Annette Wunsch
- Department of Otolaryngology/Head and Neck Surgery, Division of Oral and Maxillofacial Surgery, Faculty of Medicine Campus Trier, Klinikum Mutterhaus der Borromäerinnen Mitte, Johannes Gutenberg University of Mainz, Trier, Germany
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, Campus Marburg, UKGM GmbH, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Rotsides JM, Franco A, Albader A, Casiano RR, Lieberman SM. Nasolacrimal Duct Management During Endoscopic Sinus and Skull Base Surgery. Ann Otol Rhinol Laryngol 2019; 128:932-937. [PMID: 31088142 DOI: 10.1177/0003489419848454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate rates of epiphora after transection and marsupialization of the nasolacrimal duct (NLD) during endoscopic sinus and skull base surgery. INTRODUCTION The nasolacrimal canal forms part of the medial wall of the maxillary sinus. Transecting the NLD is sometimes necessary for tumor resection or surgical access to maxillary sinus and infratemporal fossa pathology. There is no consensus for the endoscopic management of the NLD when only the duct is transected without involving the nasolacrimal sac. METHODS Medical records of 29 patients from 2 academic institutions who underwent endoscopic sinus and skull base surgery with transection of the NLD were retrospectively reviewed. Whether the duct was marsupialized or simply transected was recorded, and the postoperative rate of epiphora was calculated. RESULTS Mean age was 59 years (range, 14-86 years). Mean follow-up was 10.5 months (range, 1-33 months). The NLD was marsupialized in 16 (55%) and simply transected in 13 (45%) patients. Six patients underwent postoperative radiation. No patients in the marsupialization group had epiphora postoperatively, all with Munk score of 0. One patient in the transection group developed postoperative epiphora with Munk score of 1. Pathology included inverted papilloma (8), acute on chronic inflammation (6), B-cell lymphoma (3), juvenile nasopharyngeal angiofibroma (2), squamous cell carcinoma (2), Schneiderian papilloma (2), metastatic melanoma (1), HPV-related carcinoma (1), adenocarcinoma (1), benign epithelial cyst (1), adenoid cystic carcinoma (1), and erosive chronic sinusitis without nasal polyposis (1). CONCLUSION Management after transection of the NLD varies widely. The duct may be simply transected or marsupialized, or a formal dacryocystorhinostomy can be performed. The surgeon must also choose whether to place a stent. Based on our small series and review of the literature, marsupialization or simple transection of the NLD results in a low rate of postoperative epiphora in the setting of endoscopic sinus and skull base surgery.
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Affiliation(s)
- Janine M Rotsides
- 1 Department of Otolaryngology-Head and Neck Surgery, New York University Langone Health, NY, USA
| | - Alexa Franco
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Abdullah Albader
- 3 Department of Otolaryngology-Head and Neck Surgery, Zain Hospital-AlSabah Medical Area, Kuwait City, Kuwait
| | - Roy R Casiano
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Seth M Lieberman
- 1 Department of Otolaryngology-Head and Neck Surgery, New York University Langone Health, NY, USA
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Transection of Nasolacrimal Duct in Endoscopic Medial Maxillectomy: Implication on Epiphora. J Craniofac Surg 2016; 26:e616-9. [PMID: 26468843 DOI: 10.1097/scs.0000000000002115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Management of the nasolacrimal system is usually recommended during medial maxillectomy via external approach because of reported higher rates of postoperative epiphora. Association of the endoscopic medial maxillectomy (EMM) with epiphora, however, is not clearly stated. In this study, we attempted to evaluate whether patients develop epiphora after simple transection of the nasolacrimal duct during EMM. PATIENTS AND METHODS Medical records of 26 patients who underwent endoscopic tumor resection for inverted papilloma (IP) were retrospectively reviewed. Patients who underwent EMM with nasolacrimal canal transection were included and recalled for lacrimal system evaluation. Twelve patients were eligible for inclusion and fluorescein dye disappearance test (FDDT) was performed for each patient. Patient demographics, tumor data, surgical procedures, and follow-up time were recorded. RESULTS Of the 12 patients included in the study, 6 underwent canine fossa transantral approach concurrently with EMM. The mean duration of follow-up was 21.1 months (range, 6-84 months). Eight patients were graded as 0, whereas 4 patients were graded as 1 according to FDDT. All test results were interpreted as negative for epiphora. All patients were completely symptom free of epiphora. CONCLUSIONS Epiphora after EMM with nasolacrimal canal transection among patients with sinonasal tumors appears to be uncommon. Therefore, prophylactic concurrent management of nasolacrimal system including stenting, dacryocystorhinostomy (DCR), or postoperative lacrimal lavage are not mandatory for all patients.
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Flam JO, Brook CD, Sobel R, Lee JC, Platt MP. Nasal epithelial myoepithelial carcinoma: An unusual cause of epiphora, a case report and review of the literature. ALLERGY & RHINOLOGY 2015; 6:133-7. [PMID: 26302736 PMCID: PMC4541636 DOI: 10.2500/ar.2015.6.0127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction: Epithelial myoepithelial carcinoma (EMC) of the nasal cavity is a rare tumor, and here we describe the first case of EMC of the nasal cavity presenting with epiphora. A case presentation and review of the literature is provided. Methods: A case report is described of a 63-year-old man who presented with unilateral epiphora and was found via a thorough history and physical examination to have a nasal tumor. The physical examination consisted of an ocular examination, including probing and irrigation, and a detailed nasal examination (anterior rhinoscopy, nasal endoscopy). The nasal examination was prompted by the patient's report of concurrent nasal symptoms during history taking. Immunohistochemistry subsequently identified the nasal tumor as EMC. A literature search was performed to gain insights into similar malignancies of the nasal cavity. Results: Eight cases of EMC of the nasal cavity were identified in the literature, none of the patients presented with epiphora. The case presented here resulted in resolution of the patient's symptoms and no evidence of disease after surgical excision. Conclusion: Epithelial myoepithelial is a rare salivary gland malignancy that can arise in the nasal cavity. Unilateral epiphora with concurrent nasal symptoms should prompt nasal cavity examination for the possibility of an obstructive tumor.
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Affiliation(s)
- Juliette O Flam
- Boston University School of Medicine, Boston, Massachusetts, USA
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Outcomes of endonasal endoscopic dacryocystorhinostomy after maxillectomy in patients with paranasal sinus and skull base tumors. Eur Arch Otorhinolaryngol 2013; 271:1513-8. [DOI: 10.1007/s00405-013-2706-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
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Sadeghi N, Joshi A. Management of the nasolacrimal system during transnasal endoscopic medial maxillectomy. Am J Rhinol Allergy 2012; 26:e85-8. [PMID: 22487283 DOI: 10.2500/ajra.2012.26.3737] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND During transnasal endoscopic medial maxillectomy (TEMM) for sinonasal tumors, the nasolacrimal duct (NLD) is resected as it forms part of the medial wall of the maxillary sinus. This disrupts the nasolacrimal drainage system. To ensure that epiphora does not develop after such resection, an endoscopic dacryocystorhinostomy (DCR) is traditionally performed. This is based primarily on prior experience with open medial maxilloethmoidectomy. It is unclear whether a concurrent DCR during endoscopic medial maxillectomy is necessary, however. This study was designed to compare patients undergoing TEMM with or without concurrent DCR for postoperative patency of the NLD. METHODS This is a prospective cohort study comparing12 patients undergoing TEMM, 5 with concurrent DCR and 7 without, to assess for patency of the NLD system. In the group that underwent a concurrent DCR, a Jones silastic stent was inserted for 2-3 months. Patients were followed for a minimum of 1 year for assessment of epiphora. The patency of the NLD was judged by clinical and qualitative evidence for epiphora. RESULTS None of the patients in either group developed epiphora. All were completely symptom free for epiphora during the follow-up period. CONCLUSION It appears that after TEMM, patients do not develop epiphora, whether or not a concurrent DCR is performed. Hence, a concurrent DCR does not seem necessary during TEMM.
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Affiliation(s)
- Nader Sadeghi
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University, Washington, DC, USA.
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Outcomes of dacryocystorhinostomy in patients with head and neck cancer treated with high-dose radiation therapy. Ophthalmic Plast Reconstr Surg 2012; 28:196-8. [PMID: 22460683 DOI: 10.1097/iop.0b013e31824c11df] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the outcomes of dacryocystorhinostomy (DCR) in patients with head and neck cancer treated with high-dose radiation therapy. METHODS The clinical records of 43 consecutive patients with head and neck cancer who underwent DCR after high-dose external beam radiation therapy plus ablative surgery and/or chemotherapy between December 2001 and April 2011 were retrospectively reviewed. RESULTS There were 23 men and 20 women. The median age was 56 years (range, 2-92 years). Thirty-one patients were Caucasian, 6 Hispanic, 4 Asian, and 2 African American. Thirty patients (70%) presented with epiphora, 3 (7%) with dacryocystitis, and 10 (23%) with both epiphora and dacryocystitis. Symptoms were unilateral in 34 patients (79%) and bilateral in 9 patients (21%). The most common primary cancer diagnoses were squamous cell carcinoma (n = 14), sarcoma (n = 8), adenoid cystic carcinoma (n = 4), and basal cell carcinoma (n = 4). The most common primary tumor locations were the sinonasal cavity (n = 16), maxillary sinus (n = 9), palate (n = 3), and ethmoid sinus (n = 3). Thirty-seven patients (43 eyes) had DCR with silicone tube placement, and 6 patients (7 eyes) had DCR with Pyrex glass tube placement. Following DCR, 31 patients (72%) had resolution of their symptoms, and 12 patients (28%), 9 with silicone tubes and 3 with Pyrex glass tubes, had persistent or recurrent epiphora (DCR failure). The most common reason for failure was significant residual canalicular and nasal mucosal scar tissue. Eight of these 12 patients underwent additional surgery, most commonly with placement of a Pyrex glass tube. Seven (35%) of the 20 patients who underwent DCR less than 12 months after radiation therapy and 5 (21%) of the 23 patients who underwent DCR at least 12 months after radiation therapy had recurrent symptoms. CONCLUSIONS Dacryocystorhinostomy in patients with head and neck cancer previously treated with high-dose radiation therapy is generally successful, especially when delayed until at least 12 months after the completion of radiation therapy. A common reason for DCR failure after high-dose radiation therapy is severe canalicular and nasal mucosal scarring.
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Blackmore KJ, Ainsworth G, Robson AK. Epiphora: an evidence based approach to the 12 minute consultation. Clin Otolaryngol 2010; 35:210-4. [PMID: 20636740 DOI: 10.1111/j.1749-4486.2010.02138.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Epiphora is the presence of a watering eye which may be due to reflex tearing or defective drainage of tears. Whilst most cases present to the ophthalmologist the otolaryngologist has a key role to play in both assessment and management of these patients. METHODS This review was based on a literature search last performed on 21st October 2009. MEDLINE and Cochrane databases were searched using the subject headings 'epiphora' or 'functional epiphora' in combination with diagnosis, investigation, management, treatment, intervention and surgery. Results were limited to English language articles. The personal biographies of the senior authors were also used. CONCLUSION An accurate assessment of the site and degree of obstruction is important to ensure the correct management is undertaken. Medical treatment with nasal steroid spray may be effective but the majority of obstructed cases will require surgical intervention in the form of dacryocystorhinostomy (DCR). There is increasing evidence that powered endoscopic DCR has outcomes comparable with the 'gold standard' procedure of external DCR.
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Affiliation(s)
- K J Blackmore
- Department of Otolaryngology-Head and Neck Surgery, Cumberland Infirmary, Carlisle, UK.
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