Gracilis Muscle-Free Flap Objective Improvement of Oral Commissure Excursion in Facial Palsy Reanimation Surgery: Systematic Review and Meta-Analysis

Background: Facial palsy patients face significant challenges. Gracilis free flap transfer is a key procedure in facial reanimation. Objective: This study aims to analyze oral commissure excursion improvement after gracilis free flap transfer and the differences regarding donor nerve: cross-facial nerve graft (CFNG), hypoglossal or spinal accessory nerves, motor nerve to masseteric (MNTM), and most recently, double anastomosis using both the MNTM and CFNG. Methods: A systematic review and meta-analysis were conducted of studies reporting oral commissure excursion improvement after free gracilis muscle transfer. Pooled proportions were calculated using a random-effects model. Results: Eighteen studies, 453 patients, and 488 free gracilis flaps were included. The mean change in perioperative oral commissure excursion was 7.0 mm, for CFNG 7.2 mm, for MNTM 7.7, and for double anastomoses 5.5 mm. Conclusions: There is a significant improvement in oral commissure excursion after gracilis muscle-free flap. Unfortunately, we could not make definitive conclusions regarding the optimal choice of donor nerve.

Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document

INTRODUCTION

Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes.

OBJECTIVES

The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery.

MATERIAL AND METHODS

Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects.

RESULTS

We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts.

CONCLUSIONS

We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.

Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document

INTRODUCTION

Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes.

OBJECTIVES

The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery.

MATERIAL AND METHODS

Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects.

RESULTS

We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts.

CONCLUSIONS

We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.

Computation and visualization of regional-scale forest disturbance and associated dissolved nitrogen export from Shenandoah National Park, Virginia

Long-term watershed research conducted in Shenandoah National Park (SNP) in Virginia and elsewhere in the eastern U.S. indicates that annual export of dissolved nitrogen (N) from gaged forested watersheds to surface waters increases dramatically in response to vegetation disturbances. Dissolved N leakage is a common, well-documented response of small forested watersheds to logging in the larger region, while recent defoliation outbreaks of the gypsy moth ( Lymantria dispar) larva in the deciduous forests of SNP have been shown to generate similar biogeochemical responses. A recent modeling analysis further suggests that a parsimonious, empirical, unit N export response function (UNERF) model can explain large percentages of the temporal variation in annual N export from a group of small gaged forested watersheds in the years following disturbance. The empirical UNERF modeling approach is completely analogous to the unit hydrograph technique for describing storm runoff, with the model representing annual N export as a linear deterministic process both in space and in time. The purposes of this analysis are to (1) test the applicability of the UNERF model using quarterly streamwater nitrate data from a group of ungaged watersheds in SNP; (2) demonstrate a park-wide application of a regional UNERF model that references the geographic distributions of bedrock geology and the timing and extent of gypsy moth defoliation over the entire SNP area; and (3) visualize the temporal and spatial patterns in vegetation disturbance and annual dissolved N export through the use of computer animation software. During water year 1992, the year of peak defoliation, our modeling study suggests that park-wide export had transiently increased by 1700% from a baseline rate of about 0.1 kg/ha/year. SNP forests appear to be characteristic of other N-limited second-growth forests in the eastern U.S. that leak little N under undisturbed conditions, despite receiving relatively large inputs of N from atmospheric deposition sources. Vegetation disturbances can apparently cause major changes in N input-output balances with potentially important ramifications for low-order forest streams and downstream receiving waters.

Astra blue and basic fuchsin double staining of plant materials

Methods for double staining plant materials using astra blue and basic fuchsin are described here. These methods can be applied to free hand and microtome sections embedded in paraffin, paraplast or historesin. Also, they can be used to study isolated epidermal peels and pollen preparations. Temporary, semipermanent and permanent preparations were studied. Astra blue stained polysaccharides of the cell wall such as cellulose and pectins. Basic fuchsin showed an affinity for lignified, suberized or cutinized walls. The easy preparation of the reagents, excellent color contrast of the histological preparations, and brief staining times of some methods makes them useful for both routine research and didactic purposes. Also, excellent color or black and white photomicrography can be obtained after the double staining described here.