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Abstract
Perforations of the nasal septum have many etiologies and occasionally result from intranasal medicated spray use. This case report describes a perforation related to the use of desmopressin nasal spray, which has not been previously reported in the literature. Clinical considerations presented in this article include appropriate technique of nasal spray application, appropriate monitoring of patients on intranasal sprays, and indications for evaluation by an otolaryngologist. Septal perforation treatment success is improved with an early diagnosis.
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Affiliation(s)
- Daniela A Brake
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Grant S Hamilton
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Stephen F Bansberg
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
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2
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Tumlin P, Assi S, Armeni M, Ramadan HH, Reyes C, Makary CA. Outcome of Endoscopic Repair of Nasal Septal Perforation. Ann Otol Rhinol Laryngol 2023; 132:1617-1620. [PMID: 37246364 DOI: 10.1177/00034894231176610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The anterior ethmoidal artery (AEA) flap has been demonstrated to be a reliable option for endoscopic repair of symptomatic nasal septal perforations. The purpose of this study is to study the outcome of this technique. METHODS A retrospective case series of all consecutive patients who underwent repair of nasal septal perforation utilizing the AEA flap among 2 institutions from August 2020 to July of 2022 was conducted. Demographics and comorbidities were collected preoperatively and postoperatively. The main outcome of this study was to identify the risk factors for surgical failure. RESULTS Forty-one patients were included. Mean perforation size was 2.2 cm (range 0.5-4.5 cm). Mean age was 42.5 years (range 14-65 years), 53.6% were female, 39% were active smokers, mean body-mass-index (BMI) was 31.9 (range 19.1-45.5), 20% with history of CRS and 31.7% had diabetes mellitus (DM). Etiologies of the perforation included idiopathic (n = 12), iatrogenic (n = 13), intranasal drug use (n = 7), trauma (n = 6), and secondary to tumor resection (n = 3). Overall success rate for complete closure was 73.2%. Active smoking, history of intranasal drug use, and DM were significantly associated with surgical failure (72.7%vs 26.7%, P = .007; 36.4%vs 10%, P = .047; and 63.6%vs 20%, P = .008 respectively). CONCLUSION The endoscopic AEA flap is a reliable technique for closure of nasal septal perforation. It may not work when the etiology is intranasal drug use. Close attention to diabetes and smoking status is also needed.
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Affiliation(s)
- Parker Tumlin
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Sahar Assi
- American University of Beirut, Beirut, Lebanon
| | - Mark Armeni
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Camilo Reyes
- Department of Otolaryngology, Augusta University, Augusta, GA, USA
| | - Chadi A Makary
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
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3
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Matti E, Maiorano E, Nacu B, Luceri A, Sovardi F, Siragusa V, Ferrauto A, Spinozzi G, Olivieri C, Benazzo M, Pagella F. Silicone septal splint for recurrent epistaxis in HHT patients: experience of a national referral centre. Acta Otorhinolaryngol Ital 2023; 43:S28-S33. [PMID: 37698097 PMCID: PMC10159634 DOI: 10.14639/0392-100x-suppl.1-43-2023-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 09/13/2023]
Abstract
Objective To report our experience in the use of silicone septal splint for recurrent severe epistaxis in hereditary haemorrhagic telangiectasia patients (HHT). Methods This is a descriptive analysis carried out at the Otorhinolaryngology Department of Fondazione IRCCS Policlinico San Matteo in Pavia, a reference centre for the treatment and diagnosis of HHT. We retrospectively evaluated HHT patients who underwent silicone septal splint positioning after the endoscopic surgical treatment of epistaxis from 2000 to 2022. Results Of the 506 patients surgically treated in the period of analysis, 74 patients underwent silicone septal splint positioning and 37 were post-operatively interviewed. With a mean of 2.4 previous surgical treatments and a mean epistaxis severity of 7.38, the majority of patients presented with septal perforation (71.6%). On average, patients maintained the splint in place for 54.5 months, with a good tolerability and a significant reduction in epistaxis severity, need for blood transfusion and improvement of haemoglobin levels. Conclusions In HHT patients with recurrent severe epistaxis and with septal perforation, the placement of septal splints offers a useful additional strategy in the management of nosebleeds.
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Affiliation(s)
- Elina Matti
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eugenia Maiorano
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Bogdan Nacu
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Andrea Luceri
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Fabio Sovardi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vera Siragusa
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
| | | | - Giuseppe Spinozzi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carla Olivieri
- Molecular Medicine Department, General Biology and Medical Genetics Unit, University of Pavia, Pavia, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Fabio Pagella
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
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Garaycochea O, Rodríguez Van Strahlen C, Rojas-Lechuga MJ, Alobid I. How to Improve the Outcomes of Anterior Septal Perforations Repair With Combined Flaps. Laryngoscope 2022. [PMID: 36317778 DOI: 10.1002/lary.30447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
The combination of a partial inverted edges with an either extended anterior ethmoidal flap or greater palatine artery flap, in which the anterior incision includes contralateral mucosa (ZigZag anterior flap-incision). Laryngoscope, 2023.
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Affiliation(s)
- Octavio Garaycochea
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain
| | - Camilo Rodríguez Van Strahlen
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain
| | - María J Rojas-Lechuga
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain.,Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain
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Li Q, Dai W, Fang D, Ma W, Lin C, Lu C, He D, Liu X, Guo C. Occurrence of ventricular septal perforation in patients with permanent left bundle branch pacing followed up using echocardiographic and computed tomography images. Ann Noninvasive Electrocardiol 2022; 27:e13002. [PMID: 36087037 DOI: 10.1111/anec.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore short-term changes after left bundle branch pacing (LBBP) using echocardiography and computed tomography (CT), especially for postoperative ventricular septal perforation. METHODS Between January and September 2019, 33 patients with atrioventricular block underwent LBBP at Beijing Anzhen Hospital. All the patients were evaluated using electrocardiography, pacing, parameters and echocardiographic measurements, including for major complications, during the 1, 3, 6, 12 and 24-month follow-up. Interval perforations were examined during a 1-month follow-up echocardiogram and CT. RESULTS Left bundle branch pacing was successfully performed in 100% (33/33) of patients. The mean seizure threshold was stable and unchanged postoperatively at the 1, 3, 6, 12 and 24-month follow-up. The paced QRS duration of the LBBP was 119.72 ± 2.53 ms and <130 ms in all patients. Unipolar impedance during the procedure was higher than 500 Ω (662.00 ± 181.50 Ω). No ventricular septal perforation occurred at the end of the procedure. At the 1-month follow-up, two patients reported transthoracic echocardiography, with CT revealing septal lead perforation. Through CT, two other patients were found to have septal lead perforation, and echocardiography indicated that the pacing lead had penetrated the interventricular septum and entered the left subendocardium. At the 1, 3, 6, 12 and 24-month follow-up, these four patients exhibited no significant increase in pacing threshold or impedance (p > .05). No ventricular thrombus or stroke was detected. CONCLUSION Permanent LBBP is safe and feasible in patients with bradycardia. Echocardiography and/or CT can more accurately evaluate changes in cardiac structure and function after LBBP.
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Affiliation(s)
- Qiaoyuan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenlong Dai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dongping Fang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weili Ma
- Department of Cardiology, Chaoyang Central Hospital, Chaoyang, China
| | - Cancan Lin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chunshan Lu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dongfang He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chengjun Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Chang SW, Kim JH. Extranodal nasal-type natural killer/T-cell lymphoma with nasal septal perforation. Ear Nose Throat J 2022:1455613221092206. [PMID: 35392686 DOI: 10.1177/01455613221092206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There are very few reports of extranodal nasal-type NKTL with septal perforation, as seen in our patient. In addition, extranodal nasal-type NKTL is often diagnosed as chronic inflammation on histopathological examination. Therefore, if nasal septal perforation does not improve with appropriate conservative treatment, clinicians should consider a malignant disease such as extranodal nasal-type NKTL.
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Affiliation(s)
- Suk Won Chang
- Department of Otorhinolaryngology, 91577Jeju National University School of Medicine, Jeju, Korea
| | - Jeong Hong Kim
- Department of Otorhinolaryngology, 91577Jeju National University School of Medicine, Jeju, Korea
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Jastrzębski M. Left bundle branch area pacing lead implantation using an uninterrupted monitoring of endocardial signals. J Cardiovasc Electrophysiol 2022; 33:1055-1057. [PMID: 35229383 DOI: 10.1111/jce.15427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/27/2022]
Abstract
An 82-year old woman with third degree atrioventricular block underwent left bundle branch area pacing (LBBAP) lead implantation - as is the routine pacing strategy for such indication in our institution This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
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Fermin JM, Bui R, McCoul E, Alt J, Avila-Quintero VJ, Chang BA, Yim MT. Surgical repair of nasal septal perforations: A systematic review and meta-analysis. Int Forum Allergy Rhinol 2022; 12:1104-1119. [PMID: 34978162 DOI: 10.1002/alr.22965] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/10/2021] [Accepted: 12/24/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND A wide variety of techniques for the surgical repair of nasal septal perforations (NSPs) have been described. Surgical management of NSPs can be broadly divided into open versus endonasal approaches, with additional variables involving unilateral or bilateral flaps, use of grafts, and placement of splints. The objective of this study was to compare surgical approaches and their outcomes. METHODS PubMed, EMBASE, and CINAHL Plus databases were examined for patients undergoing NSP repair. English-language studies reporting surgical management of patients with the primary diagnosis of NSP were included. Outcome measures of interest included perforation size, surgical approach characteristics, and success rate defined as complete closure assessed by surgeon postoperatively. The quality of articles was assessed with the methodological index for nonrandomized studies (MINORS) criteria. A random-effects model was used to calculate pooled proportions for the different outcomes. RESULTS The electronic database search yielded 1076 abstracts for review. A total of 64 articles met the inclusion criteria, with 1591 patients: 1127 (71%) underwent an endonasal approach and 464 (29%) an open approach. The median (range) MINORS score was 10 (5-12) out of 16 points. Overall, 91% of patients had total closure (95% confidence interval [CI], 0.89-0.93, p < 0.01), with moderate heterogeneity between studies (I2 = 42.03%). There was no difference in closure success between open and endonasal approaches. Use of bilateral versus unilateral flaps, interposition grafts, and intranasal splints and packing were not associated with differences in outcomes. CONCLUSION Nasal septal perforation surgical repair success rates are comparable regardless of technique.
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Affiliation(s)
- Janmaris Marin Fermin
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University (LSU)-Health Sciences Center, Shreveport, Louisiana, USA
| | - Roger Bui
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University (LSU)-Health Sciences Center, Shreveport, Louisiana, USA
| | - Edward McCoul
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.,Ochsner Clinical School, University of Queensland, New Orleans, Louisiana, USA
| | - Jeremiah Alt
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Brent A Chang
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Michael T Yim
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University (LSU)-Health Sciences Center, Shreveport, Louisiana, USA
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9
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Hwang JW, Han MS, Kang SH, Kwak JW, Kim HK, Kim TH, Lee SH. Long-Term Outcomes of Naso septal Perforation Repair Using Anterior Maxillary Sinus Wall as an Interpositional Graft. Am J Rhinol Allergy 2021; 36:238-244. [PMID: 34636626 DOI: 10.1177/19458924211049608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Various graft materials have been used to repair nasoseptal perforation, but there is no standardized treatment method. The anterior maxillary sinus wall is flattened in appearance and can be easily obtained in a sufficient amount for a large-sized nasoseptal perforation. OBJECTIVES The aim of this study is to determine whether the anterior maxillary sinus wall is suitable as an interpositional graft in the surgical repair of septal or nasoseptal perforation. METHODS This is a retrospective review of 21 patients who underwent repair of nasoseptal perforation using anterior maxillary sinus wall as an interpositional graft. The etiology, pre- and post-operative NOSE and GBI score, and perforation size were reviewed. The surgical outcome was considered successful if total closure was achieved after postoperative follow-up. RESULTS 19 of the 21 perforations were successfully repaired with anterior maxillary sinus wall. Failure of the repair was found in 2 patients. Causal etiology of perforation was previous septoplasty in 10 patients, and electrocautery in 1 case, but not identified in 10 cases. The largest size was 2.7 × 2.2 cm. The most common symptoms were epistaxis, crusting, and nasal obstruction. Closure of septal perforation resulted in improved subjective symptoms and quality of life which were evaluated with NOSE and GBI score. CONCLUSION Anterior maxillary sinus wall as interpositional graft between mucoperichondrial flaps can be used to reliably repair nasoseptal perforations.
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Affiliation(s)
- Jae Woong Hwang
- College of Medicine, 36899Korea University, Seoul, South Korea
| | - Mun Soo Han
- College of Medicine, 36899Korea University, Seoul, South Korea
| | - Sung Hoon Kang
- College of Medicine, 36899Korea University, Seoul, South Korea
| | - Ji Won Kwak
- College of Medicine, 36899Korea University, Seoul, South Korea
| | - Hyun Keun Kim
- College of Medicine, 36899Korea University, Seoul, South Korea
| | - Tae Hoon Kim
- College of Medicine, 36899Korea University, Seoul, South Korea
| | - Sang Hag Lee
- College of Medicine, 36899Korea University, Seoul, South Korea
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Woodard TD, Yappel-Sinkko KB, Wang X, McCrae KR, Parambil JG. Sclerotherapy Versus Cautery/Laser Treatment for Epistaxis in Hereditary Hemorrhagic Telangiectasia. Laryngoscope 2021; 132:920-925. [PMID: 34160081 DOI: 10.1002/lary.29701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/21/2021] [Accepted: 06/13/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Surgical interventions for epistaxis management in hereditary hemorrhagic telangiectasia (HHT) demonstrate short-term success and require repeated procedures for disease control. Although electrocautery and/or laser photocoagulation (C ± L) are most frequently performed, sodium tetradecyl sclerotherapy (STS) is emerging as a promising newer treatment. We hypothesized that in a 24-month time period, STS would require fewer treatments than C ± L to maintain epistaxis severity within the mild range. STUDY DESIGN Retrospective study. METHODS We retrospectively assessed 67 patients with HHT with moderate and severe epistaxis that were treated periodically with C ± L (34 patients) versus STS (33 patients). The primary outcome was the number of procedures needed to maintain the epistaxis severity score (ESS) as mild. Secondary outcomes assessed for differences in postoperative complications, hemoglobin levels, iron stores, hematologic support, and quality-of-life (QoL) scores. RESULTS To maintain ESS in the mild range, 1.6 STS procedures (range, 1-4) were performed versus 3.6 C ± L procedures (range, 1-8) (P = .003). Significant postoperative differences included reduction in nasal crusting (3% vs. 32%, P = .001), foul odor (3% vs. 35%, P < .001), and septal perforation (3% vs. 29%, P = .006) after STS. There were no significant differences between the two treatments in hemoglobin levels, iron stores, hematologic support, or QoL scores. CONCLUSION STS is able to attain satisfactory epistaxis control with significantly fewer procedures and lower postoperative complications than C ± L. STS should be considered as the initial surgical intervention for epistaxis in patients with HHT. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Troy D Woodard
- Head and Neck Institute, Cleveland Clinic, Department of Otolaryngology-Head and Neck Surgery, Cleveland, Ohio, U.S.A
| | - Kathleen B Yappel-Sinkko
- Head and Neck Institute, Cleveland Clinic, Department of Otolaryngology-Head and Neck Surgery, Cleveland, Ohio, U.S.A
| | - Xiaofeng Wang
- Lerner Research Institute, Cleveland Clinic, Department of Quantitative Health Sciences, Cleveland, Ohio, U.S.A
| | - Keith R McCrae
- Taussig Cancer Institute, Cleveland Clinic, Department of Hematology and Medical Oncology, Cleveland, Ohio, U.S.A
| | - Joseph G Parambil
- Respiratory Institute, Cleveland Clinic, Department of Pulmonary Medicine, Cleveland, Ohio, U.S.A
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Zocchi J, Russo F, Volpi L, Elhassan HA, Pietrobon G, Arosio A, Bignami M, Castelnuovo P. Long Term Outcomes of Naso septal Perforation Repair With an Anterior Ethmoidal Artery Flap. Am J Rhinol Allergy 2021; 36:18-24. [PMID: 33878936 DOI: 10.1177/19458924211012120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nasoseptal perforation repair is a challenging condition with no standard technique for repair recognized. METHODS A case series of consecutive patients who underwent nasoseptal perforation repair with an anterior ethmoidal artery flap was conducted. Demographic data, preoperative features of the perforation and postoperative outcomes were analyzed. Closure rate, complications and persistence of nasal symptoms were documented. RESULTS Thirty-two patients were included in the study. The average perforation diameter was 1.48 cm (range: 0.4-3 cm). Iatrogenic trauma was the most common cause (56% of patients). Nine cases ended up being idiopathic. The overall closure rate was 81%, but 87.5% when perforation had a 2-cm diameter or less. Of the six failures, 2 were due to flap necrosis and 4 to a residual anterior perforation. Despite the persistence, 2 patients solved their symptoms. One patient underwent revision surgery. CONCLUSION The anterior ethmoidal artery flap is a reliable and minimal invasive technique for closure of symptomatic perforations. For defects larger than 2 cm, a lower success rate and additional reconstructive measures should be considered. Objective questionnaires are needed in order to evaluate functional outcomes.
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Affiliation(s)
- Jacopo Zocchi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Russo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Luca Volpi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | | | - Giacomo Pietrobon
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Alberto Arosio
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Department of Otorhinolaryngology, Head and Neck Surgery, Ospedale di Sant'anna, Como, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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12
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Köycü A, Hızal E, Erol O, Büyüklü AF. Effect of Suture Type and Suture Distance on Holding Strength in Nasal Septal Laceration Model. Turk Arch Otorhinolaryngol 2021; 59:1-7. [PMID: 33912854 PMCID: PMC8054927 DOI: 10.4274/tao.2021.6100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/15/2021] [Indexed: 12/01/2022] Open
Abstract
Objective: Septal mucosal-perichondrial flaps can be lacerated during the elevation of the flaps. Appropriate repair of the lacerations is essential to prevent the development of septal perforation during the healing process. We aimed to determine the superior suture type and suture distance to use in repairing the lacerations of nasal septal mucosal-perichondrial flaps. Methods: The study used 128 nasal septal mucosal-perichondrial flaps prepared from sheep heads. Experimentally induced lacerations on the mucosal-perichondrial flaps were sutured with two interrupted sutures using one of four suture materials (4-0/5-0 Polyglactin 910, 4-0/5-0 Polydioxanone) and leaving either 5 mm or 10 mm distance between the sutures. Maximum tissue holding strength (HSmax) was measured for each suture material and suture distance used. Results: Mean HSmax values were higher for Polyglactin 910 sutures (p<0.001) and 10 mm suture distance (p=0.008) when the groups were compared in terms of suture material and suture distance, respectively. There was no statistically significant difference between the mean HSmax values of sutures with 4-0 and 5-0 diameters (p=0.057). Conclusion: Polyglactin 910 suture material with 10 mm space between two adjacent sutures may be more durable than the other suture materials when repairing nasal septal mucosal lacerations.
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Affiliation(s)
- Alper Köycü
- Department of Otolaryngology, Head and Neck Surgery, Başkent University, Ankara, Turkey
| | - Evren Hızal
- Department of Otolaryngology, Head and Neck Surgery, Başkent University, Ankara, Turkey
| | - Ozan Erol
- Department of Otolaryngology, Head and Neck Surgery, Başkent University, Ankara, Turkey
| | - Adnan Fuat Büyüklü
- Department of Otolaryngology, Head and Neck Surgery, Başkent University, Ankara, Turkey
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Chen X, Wei L, Bai J, Wang W, Qin S, Wang J, Liang Y, Su Y, Ge J. Procedure-Related Complications of Left Bundle Branch Pacing: A Single-Center Experience. Front Cardiovasc Med 2021; 8:645947. [PMID: 33869306 PMCID: PMC8044788 DOI: 10.3389/fcvm.2021.645947] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Although left bundle branch pacing (LBBP) has emerged as a novel physiological pacing strategy with a low and stable threshold, its safety has not been well-documented. In the present study, we included all the patients with procedure-related complications at our centre to estimate these LBBP cases with unique complications. Methods: We enrolled 612 consecutive patients who received the procedure in Zhongshan Hospital, Fudan University, between January 2018 and July 2020. Regular follow-ups were conducted (at 1, 3, and 6 months in the first year and every 6-12 months from the second year), and the clinical data of the patients with complications were collected and analyzed. Results: With a mean follow-up period of 12.32 ± 5.21 months, procedure-related complications were observed in 10 patients (1.63%) that included two postoperative septum perforations (2/612, 0.33%), two postoperative lead dislodgements (2/612, 0.33%), four intraoperative septum injuries (4/612, 0.65%), and two intraoperative lead fractures (2/612, 0.33%). Pacing parameters were stable during follow-up, and no major complications were observed after lead repositioning in the cases of septum perforation and lead dislodgement. Conclusion: The incidence of procedure-related complications for LBBP, namely postoperative septum perforation, postoperative lead dislodgement, intraoperative septum injury, and intraoperative lead fracture, were low. No adverse clinical outcomes were demonstrated after successful repositioning of the lead and appropriate treatment.
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Affiliation(s)
- Xueying Chen
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lanfang Wei
- Department of Cardiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Jin Bai
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wei Wang
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shengmei Qin
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jingfeng Wang
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yixiu Liang
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
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14
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Abdel-Aty Y, Cain RB, Taylor C, Marino MJ, Lal D, Bansberg SF. Outcomes of Septal Perforation Repair With Concurrent Endoscopic Sinus Surgery. Otolaryngol Head Neck Surg 2021; 165:370-374. [PMID: 33494646 DOI: 10.1177/0194599820982912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study reviews a cohort of patients in whom septal perforation repair was performed concurrently with endoscopic sinus surgery. We present an endonasal perforation repair technique using bilateral mucosal flaps with an autogenous interposition graft. Intraoperative and postoperative management of the combined surgical patient is discussed and perforation closure outcomes are reported. STUDY DESIGN Case series. SETTING Tertiary care center. METHODS In this institutional review board-approved retrospective chart review, adult patients who underwent concurrent bilateral mucosal flap septal perforation repair and endoscopic sinus surgery from March 1992 to March 2020 were identified. Data on demographics, clinical presentations, perforation size, surgical techniques, and outcomes were extracted and analyzed for patients with a minimum of 3 months of follow-up. RESULTS Fifty-six patients met study inclusion criteria. Nasal obstruction/congestion was the most frequent symptom reported (80.4%), followed by crusting and epistaxis. Mean perforation size measured at the time of surgery was 14.7 (range, 3-41) mm in length by 9.3 (range, 2-23) mm in height. Temporalis fascia was the most frequent (57.9%) interposition graft material used. Complete perforation closure at the time of the last follow-up was noted in 51 (91.1%) patients. Only 1 failure was noted in the last 48 attempted repairs. CONCLUSION Patients with a perforated septum may have coexistent chronic sinusitis. The feasibility of attempting concurrent sinus surgery and perforation repair has been questioned. Our review demonstrates a high perforation closure rate when a bilateral mucosal flap procedure is performed after sinus surgery is performed at the same setting.
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Affiliation(s)
- Yassmeen Abdel-Aty
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Rachel B Cain
- Southwestern Colorado Ear, Nose, and Throat Associates, Durango, Colorado, USA
| | - Cullen Taylor
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Michael J Marino
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Devyani Lal
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Stephen F Bansberg
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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15
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Miglani A, Taylor C, Bansberg SF. Septal Perforation Repair Using Bilateral Mucosal Flaps With a Temporalis Fascia Interposition Graft. Laryngoscope 2020; 131:1277-1280. [PMID: 33038276 DOI: 10.1002/lary.29109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/28/2020] [Accepted: 09/05/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Amar Miglani
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
| | - Cullen Taylor
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
| | - Stephen F Bansberg
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
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16
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Pendolino AL, Unadkat S, Zhang H, Pendolino M, Bianchi G, Randhawa PS, Andrews PJ. The role of surgery in antineutrophil cytoplasmic antibody-associated vasculitides affecting the nose and sinuses: A systematic review. SAGE Open Med 2020; 8:2050312120936731. [PMID: 32676189 PMCID: PMC7340348 DOI: 10.1177/2050312120936731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/29/2020] [Indexed: 01/28/2023] Open
Abstract
Background: The ear, nose and throat region has been reported to be one of the commonest sites involved in antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis diseases and often precedes the diagnosis of ANCA–associated vasculitis by many months. Although treatment for ANCA–associated vasculitis primarily requires systemic immunosuppressive therapy, there are specific indications for sinonasal surgery during the course of the disease process. The three major roles for surgery in sinonasal vasculitis are to aid diagnosis through biopsy, enable symptom relief and nasal reconstructive surgery consideration when in remission. Purpose: The aim of this systematic review is to provide an overview of the surgical procedures which can be performed in patients with ANCA–associated vasculitis presenting with sinonasal involvement. Materials and methods: A systematic literature search was performed for scientific articles on MEDLINE (PubMed Advanced MEDLINE Search) and EMBASE. The search included all articles up to April 2020. Conclusion: Surgical intervention during the active phase of ANCA–associated vasculitis disease can improve the patient’s symptoms and enable histological diagnosis. The surgical decision to manage the nose requires a multidisciplinary approach involving the vasculitis specialist and the ear, nose and throat surgeon. Nasal reconstruction can be performed to restore form and function but only when the disease is in remission so as to maximise success and minimise complications.
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Affiliation(s)
- Alfonso Luca Pendolino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK.,Ear Institute, University College London (UCL), London, UK
| | - Samit Unadkat
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Henry Zhang
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Monica Pendolino
- Division of Rheumatology, Department of Locomotor System, ASL 3, Genoa, Italy
| | - Gerolamo Bianchi
- Division of Rheumatology, Department of Locomotor System, ASL 3, Genoa, Italy
| | - Premjit S Randhawa
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Peter J Andrews
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK.,Ear Institute, University College London (UCL), London, UK
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17
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Lu GN, Eytan DF, Desai SC. Simultaneous Septal Perforation and Deviation Repair with a Chondromucosal Transposition Flap. OTO Open 2020; 4:2473974X20924332. [PMID: 32500113 PMCID: PMC7243391 DOI: 10.1177/2473974x20924332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/14/2020] [Indexed: 11/15/2022] Open
Abstract
Nasal septal perforations can cause issues of epistaxis, whistling, crusting, saddle deformity, and obstruction, which motivate patients to seek surgical repair. Numerous methods of septal perforation repair have been described, with surgical success rates ranging from 52% to 100%, but few studies address situations with concomitant septal deviation. In treating patients with septal perforation and deviation, both issues should be addressed for optimal outcomes. While routine septoplasty involves the removal of septal cartilage, septal perforation repair involves the addition of interposition grafts. The composite chondromucosal septal rotation flap harmoniously combines these seemingly conflicting goals as an effective and efficient technique for septal perforation repair. We present 3 patients successfully treated for their septal perforation and septal deviation concurrently with this technique.
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Affiliation(s)
- G Nina Lu
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Danielle F Eytan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Shaun C Desai
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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18
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Rusetsky Y, Mokoyan Z, Spiranskaya O, Arutyunyan S. Cross-septal returned flap: modified endoscopic technique for bilateral closure of septal perforation. Int J Oral Maxillofac Surg 2020; 49:1260-3. [PMID: 32088131 DOI: 10.1016/j.ijom.2020.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/31/2020] [Indexed: 11/20/2022]
Abstract
Endoscopic approaches for septal perforation closure have achieved a certain popularity. Many of the flaps described provide unilateral closure of the perforation. Thus, complete restoration of the normal multilayer septal anatomy is still challenging, particularly in children. This article presents a modified technique for endoscopic bilateral surgical repair of nasal septal perforations. A novel cross-septal returned flap was performed in nine patients with nasal septal perforations. The mean size of the perforation was 17.7mm in the sagittal axis and 16.9mm in the vertical axis. All patients were followed up for a minimum of 12 months (range 12-31 months). There was only one case of residual septal perforation during the follow-up period, but with a significant decrease in the severity of symptoms. The results of the surgical technique presented show its high efficacy. We believe that the best indication for this technique is non-epithelized perforation edges that cannot be used as a reliable bridge for the preparation of any cross-over flaps. Use of the cross-septal returned flap allows the complete bilateral repair of nasal septal perforations to be achieved.
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19
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Rusetsky YY, Spiranskaya OA, Sergeeva NS, Lipsky KB, Sadikov IS. [Endoscopic closure of septal perforation in children with a vascularized flap on the ethmoidal artery]. Vestn Otorinolaringol 2019; 84:25-27. [PMID: 31579053 DOI: 10.17116/otorino20198404125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the article, a new method of septal perforation closing in children with a flap on the ethmoid artery under endoscopic control is described. Unlike conventional endoscopic procedures described technique allows to close the perforation bilaterally. Using the author's technique, 6 children with septal perforation aged from 13 to 17 years (mean age 15.2±2.1) were operated on. In all patients, the perforation was completely closed. Thus, the method has shown high efficiency and safety, which allows it to be widely used in pediatric practice.
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Affiliation(s)
- Yu Yu Rusetsky
- National Medical Research Center for Children's Health, Moscow, Russia, 119991
| | - O A Spiranskaya
- National Medical Research Center for Children's Health, Moscow, Russia, 119991
| | - N S Sergeeva
- Sechenov First Moscow State Medical Univesity, Moscow, Russia, 119992
| | - K B Lipsky
- Sechenov First Moscow State Medical Univesity, Moscow, Russia, 119992
| | - I S Sadikov
- Private clinic 'K+31', Moscow, Russia, 119415
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20
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Lou ZC, Jin KF. Randomized Comparative Study of Microwave Ablation and Electrocautery for Control of Recurrent Epistaxis. Ear Nose Throat J 2019; 100:509-515. [PMID: 31597530 DOI: 10.1177/0145561319879238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare the outcomes of adult patients with recurrent epistaxis treated intraoperatively with either bipolar electrocautery or microwave ablation (MWA). STUDY DESIGN Prospective randomized control study. MATERIALS AND METHODS One hundred ten patients with idiopathic recurrent epistaxis who met the inclusion criteria were randomly assigned into MWA group and bipolar electrocautery group. Primary outcomes were the proportion of patients in each group whose bleeding had stopped within 24 hours after treatment and time to achieve successful hemostasis. Secondary outcomes were the rebleeding rate after 3 days, 1 and 12 weeks, and 6 months and complications. RESULTS Successful immediate arrest of epistaxis was achieved in all patients. The times to achieve successful hemostasis were 2.13 ± 1.04 minutes in the MWA group and 6.60 ± 2.68 minutes in the bipolar electrocautery group (P = .000). The rates of recurrent bleeding were similar in patients treated with the different approaches (P = .231). However, secondary crusting was observed endoscopically in 59 patients in the bipolar electrocautery group, while pseudomembrane of the ablation zone was seen in 19 (36.5%) patients in the MWA group. Nevertheless, there were no severe postoperative complications, including septal perforation and orbit and brain complications, in either group at the 6-month follow-up. CONCLUSION Bipolar electrocautery and MWA had similar outcomes for the treatment of adult patients with recurrent epistaxis. However, MWA resulted in rapid hemostasis with less local nasal pain and less crust. Thus, MWA could be a favorable treatment option for patients with idiopathic recurrent epistaxis.
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Affiliation(s)
- Zheng-Cai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, Zhejiang, China
| | - Kan-Feng Jin
- Department of Otorhinolaryngology, Yiwu Central Hospital, Zhejiang, China
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21
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Jackson MWP, Lee D, Egred M. Septal Hematoma: A Rare But Potentially Serious Complication of Retrograde CTO-PCI. J Invasive Cardiol 2019; 31:E47-E48. [PMID: 30819978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The uptake of CTO-PCI and the use of the hybrid approach have increased widely; this has resulted in a new set of complications, some of which are unusual, particularly with the retrograde approach. We present a case of a rare complication of septal collateral perforation resulting in the formation of septal hematoma that fortunately on this occasion did not result in any significant clinical deterioration, and was managed conservatively with a successful outcome. However, on other occasions, the outcome can be more serious.
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Affiliation(s)
| | | | - Mohaned Egred
- Cardiac Department, Freeman Hospital, Newcastle-upon-Tyne, NE7 7DN, United Kingdom.
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22
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Benzer M, Biceroglu H, Ates MS, Kaya I, Ozgiray E, Midilli R, Karcı B, Gode S. Comparison between Rescue Flap and Double Flap Technique. J Neurol Surg B Skull Base 2018; 80:431-436. [PMID: 31316889 DOI: 10.1055/s-0038-1673695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/08/2018] [Indexed: 10/27/2022] Open
Abstract
Objectives Endoscopic techniques in pituitary surgery lead to inevitable mucosal loss of the sphenoethmoidal recess and posterior nasal septum in the nasal cavity. There is no other comparative study between primary reconstruction of septal perforation and secondary healing in the literature. The aim of this study is to evaluate postoperative patient morbidity with or without posterior septal perforation in endonasal pituitary surgery by comparing two commonly used techniques: rescue and double nasoseptal flaps. Design Prospectively randomized study. Setting Tertiary academic center. Participants Sixty patients underwent endoscopic endonasal pituitary surgery. Main Outcomes and Measures Functional results (breathing) using visual analog scale (VAS), sphenoid sinusitis, presence of synechia, perforation in the posterior septum, and crusting in the sphenoethmoidal recess were assessed. Results Pre- and postoperative mean VAS scores were 71.67 ± 11.47 and 67.67 ± 9.71 mm in the intact septum group and 77.67 ± 14.06 and 62.67 ± 10.48 mm in the posterior septal perforation group. There was a significant difference between pre- and postoperative VAS values in all groups. There was significant worsening in both groups; worsening in VAS values was much higher in the posterior septal perforation group. In the posterior septal perforation group, much more crusting was seen. Conclusions This is the first study to compare the postoperative patient morbidity in endoscopic endonasal pituitary surgery with and without a posterior septal perforation. Reconstruction of the posterior septum along with less mucosal loss yields better postoperative nasal symptom score.
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Affiliation(s)
- Murat Benzer
- Department of Otorhinolaryngology, Ege University School of Medicine, Izmir, Turkey
| | | | - Murat Samet Ates
- Department of Otorhinolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Isa Kaya
- Department of Otorhinolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Erkin Ozgiray
- Department of Neurosurgery, Ege University, Izmir, Turkey
| | - Rasit Midilli
- Department of Otorhinolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Bulent Karcı
- Department of Otorhinolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Sercan Gode
- Department of Otorhinolaryngology, Ege University School of Medicine, Izmir, Turkey
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23
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Helman S, Kadakia S, Guthrie A, Mourad M, Mashkevich G. Temporoparietal Fascia Free Flap for Naso septal Perforation Repair. Craniomaxillofac Trauma Reconstr 2017; 11:238-241. [PMID: 30087755 DOI: 10.1055/s-0037-1604425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022] Open
Abstract
Nasoseptal perforations can be a challenging defect for the reconstructive surgeon, with repair limited by the surrounding tissue availability and the defect size. In patients with a history of cocaine use, often the integrity of surrounding vasculature is questionable and large defects may not be well suited for local reconstruction. In the otolaryngology literature, several reconstructive options using local tissue and synthetic materials have been described, but there have been no reports of microvascular free flaps utilized in this regard. We present a unique case of a 37-year-old woman with a 3.0 cm × 3.5 cm nasoseptal perforation secondary to cocaine use successfully reconstructed with a temporoparietal fascia free flap anastomosed to the facial artery and vein. Postoperatively, the patient had a well-healed septal defect from the free flap reconstruction This new technique shows promise as a feasible option for patients with large defects and for those with limited local reconstructive options. The ease of harvest and low donor-site morbidity make the temporoparietal fascia flap a suitable option for repair of complex nasoseptal defects.
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Affiliation(s)
- Samuel Helman
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Sameep Kadakia
- Department of Otolaryngology, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Ashley Guthrie
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Moustafa Mourad
- Department of Otolaryngology, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Grigoriy Mashkevich
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
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24
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Sazgar AA. The bony cartilaginous unit: the missing graft in septorhinoplasty. Int J Oral Maxillofac Surg 2016; 45:1006-8. [PMID: 27261165 DOI: 10.1016/j.ijom.2016.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/06/2016] [Accepted: 05/11/2016] [Indexed: 11/16/2022]
Abstract
To achieve the desired nasoseptal refinements in septorhinoplasty, sufficient septal cartilage is needed. There are many cases in which septal cartilage is insufficient, especially in revision surgery. To obtain an optimal outcome, a bony cartilaginous unit is proposed as a versatile graft for various parts of the nose. This bony cartilaginous unit is extracted using the open septorhinoplasty approach in which the bilateral septal flaps are elevated over the entire cartilaginous and bony part; however, the cartilaginous septum and posterior bony part are not separated and are removed as an integrated unit. These bony cartilaginous units can be used as various types of grafts at different sites in the nose. In the present study, the bony cartilaginous units were used as caudal extension grafts, spreader grafts, lateral crural strut grafts, and for the closure of septal perforations. This research has shown the advantage of using septal bone in conjunction with cartilage as an integrated unit to correct external nose and septal deformities, especially in cartilage-depleted patients.
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Affiliation(s)
- A A Sazgar
- Department of Otolaryngology, Head and Neck Surgery, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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25
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Williams R, Lee MK, Most SP. Large Septal Perforation Repair with Pericranial Flap and Intraoperative Fluorescence Angiography. Craniomaxillofac Trauma Reconstr 2015; 9:181-4. [PMID: 27162579 DOI: 10.1055/s-0035-1570073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/28/2015] [Indexed: 10/22/2022] Open
Abstract
Septal perforations present a challenging dilemma for surgical intervention when medical therapy fails. Multiple techniques have been described in the literature to address perforations using numerous techniques; however, there have been varying rates of success and reproducibility reported. The use of a large, pericranial flap was previously described to repair large septal perforation. The objective of this case report is to describe the use of a pedicled pericranial flap in combination with intraoperative fluorescence angiography to quantify vascular perfusion. This article presents a 31-year-old man with an idiopathic, septal perforation measuring 1.7 × 1.7 cm who previously failed medical therapy and surgical repair. He underwent a combined, coronal incision and external rhinoplasty approach with a tunneled pericranial flap resulting in a successful repair. This case report illustrates robust reconstructive capability of pericranial flaps for repair of septal perforations, as well as the potential value of intraoperative fluorescence angiography in determining the likelihood of a successful outcome.
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Affiliation(s)
- Ryan Williams
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Matthew K Lee
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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26
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Binar M, Arslan F, Tasli H, Karakoc O, Kilic A, Aydin U. An unusual cause of necrosis and nasal septum perforation after septoplasty: Enterobacter cloacae. New Microbes New Infect 2015; 8:150-3. [PMID: 27257495 PMCID: PMC4877400 DOI: 10.1016/j.nmni.2015.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/02/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022] Open
Abstract
A 20-year-old man with nasal obstruction underwent septoplasty due to nasal septal deviation. Nasal packs were inserted at the end of surgery and removed 48 hours after surgery. Twenty-four hours after removal of nasal packs, there was necrosis in both sides of septal mucosa and in bilateral inferior turbinates. Nasal swab culture was performed from both nasal cavities. Enterobacter cloacae was isolated from samples. Two weeks after surgery, nasal septum perforation was unavoidable. To our knowledge, this is the first case in literature describing septal mucosal necrosis caused by this pathogen after septoplasty. Mucosal necrosis and perforation as septoplasty complications should be kept in mind, the result of causes both common and, as in the present case, unusual.
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Affiliation(s)
- M Binar
- Department of Otolaryngology, Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - F Arslan
- Department of Otolaryngology, Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - H Tasli
- Department of Otolaryngology, Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - O Karakoc
- Department of Otolaryngology, Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - A Kilic
- Department of Medical Microbiology, Gulhane Military Medical Academy, Ankara, Turkey
| | - U Aydin
- Department of Otolaryngology, Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
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Sharma A, Janus J, Diggelmann HR, Hamilton GS. Healing septal perforations by secondary intention using acellular dermis as a bioscaffold. Ann Otol Rhinol Laryngol 2014; 124:425-9. [PMID: 25533508 DOI: 10.1177/0003489414565002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Several techniques are described in the literature for nasal septal perforation repair. Most of these involve interposition grafts in conjunction with local pedicled mucosal flaps. The following article describes our experience using acellular dermis as a bioscaffold to support the regrowth of nasal septal mucosa by secondary intention. METHODS Retrospective chart review of all patients who underwent repair of nasal septal perforations by the senior author using acellular dermis placed between the 2 sides of the perforation and covered with silastic splints to allow for mucosalization. RESULTS Thirteen patients underwent nasal septal perforation repair using this technique. All perforations repaired were under 2 cm in greatest dimension. Two-thirds of patients had complete closure of the perforation upon initial use of bioscaffolding technique. The remaining third achieved near-total closure with bioscaffolding technique and were able to be completely closed with a single additional procedure. CONCLUSIONS Acellular dermis offers an alternative to most currently described complex flaps. The method can be used in patients with defects less than 2 cm, but initial data suggest caution when using in those with wound healing impediments. This technique is also an excellent choice for patients with multiple small septal perforations.
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Affiliation(s)
- Ayushman Sharma
- Department of Otorhinolaryngology, Division of Facial Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey Janus
- Department of Otorhinolaryngology, Division of Facial Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Henry R Diggelmann
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Grant S Hamilton
- Department of Otorhinolaryngology, Division of Facial Plastic Surgery, Mayo Clinic, Rochester, MN, USA
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Vosler PS, Ferguson BJ, Contreras JI, Wang EW, Schaitkin BM, Lee S. Clinical and pathologic characteristics of intranasal abuse of combined opioid-acetaminophen medications. Int Forum Allergy Rhinol 2014; 4:839-44. [PMID: 25137346 DOI: 10.1002/alr.21355] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/22/2014] [Accepted: 04/29/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The nonmedical abuse of prescription opioids via intranasal administration is a growing problem. The objective of this study is to investigate of the typical presentation of intranasal opioid-acetaminophen abuse and outline optimal therapy. METHODS This study was a retrospective chart review. Patients with intranasal pathology from inhalation of combined opioid-acetaminophen medications (COAMs) from 3 academic otolaryngology practices in western Pennsylvania from January 2012 to October 2012 were included in the review. RESULTS Seven adults ranging in age from 23 to 46 years were identified with nasal complaints from the intranasal inhalation of COAMs. All patients presented with nasal pain and were found to have fibrinous necrotic nasal mucosa involving the posterior nasal cavity and nasopharynx. Of the 7 patients, 6 (85.7%) presented with a septal perforation. Pathology and culture revealed fungus in 85.7% of the patients; however, no invasive fungal disease was noted in any of the specimens. Patients did not improve with either systemic or topical antifungal therapy. Polarizable material characteristic of talc used as a tablet binder was present in the histopathology of 4 of 7 (57.1%) patients. Patients who abstained from intranasal drug use along with serial debridement demonstrated the greatest improvement. CONCLUSION Intranasal COAM abuse causes nasal pain, tissue necrosis with potential septal and palatal perforation, and noninvasive fungal colonization. Antifungal therapy was of no benefit in the current series of patients. Current therapy should focus on recognition of the etiology of patients' pathology and encourage abstinence from intranasal use of these drugs along with serial debridements.
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Affiliation(s)
- Peter S Vosler
- Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
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Flavill E, Gilmore JE. Septal perforation repair without intraoperative mucosal closure. Laryngoscope 2013; 124:1112-7. [PMID: 24114624 DOI: 10.1002/lary.24386] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/16/2013] [Accepted: 08/08/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To report a technique for septal perforation repair that does not rely on intraoperative mucosal closure of the perforation defect. STUDY DESIGN Case series with prospective and retrospective data collection. METHODS Nine patients received multilayer interposition grafts and no attempt at intraoperative mucosal closure for repair of septal perforations. Eight patients received multilayer interposition grafts consisting of temporoparietal fascia on one side, polydioxanone plate in the middle, and deep temporal fascia on the other side. One patient received a variant graft consisting of acellular dermal matrix, polydioxanone plate, and full-thickness temporal fascia. Silastic or silicone sheets were placed bilaterally for at least 12 weeks to protect the septum during healing. This technique was applied to a variety of challenging surgical candidates. RESULTS The eight patients who received interposition grafts with bilateral temporal fascia had complete repair of septal perforation sites. The variant interposition graft had complete loss on the acellular dermal matrix side but good integration of temporal fascia on the contralateral side. CONCLUSIONS This tension-free technique does not rely on intraoperative mucosal closure of the septal perforation. It has been used to successfully obtain complete repair in a variety of challenging surgical candidates when combined with temporal fascia autografts.
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Affiliation(s)
- Eric Flavill
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
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