Problems with tracheoesophageal puncture for a laryngeal voice rehabilitation: how to manage?

The tracheoesophageal puncture [TEP] technique and the application of its associated voice prostheses may give rise to adverse events. We present our experience with this technique with special attention to the incidence and management of these adverse events. Retrospective clinical analysis. 75 laryngectomized patients underwent TEP for voice restoration; they were included into two groups; Group 1, 43 patients with secondary TEP and Group II, 32 patients with primary TEP. Charts were reviewed regarding the incidence, management, and outcome of the adverse events encountered during their follow-up. Problems arose in the study patients, were itemized as either early or late problems. The same patient may develop one or more problems in either group. Management of the problems concerned the creation and maintenance of the TEP and the prostheses are presented. By an intensive and consequent multidisciplinary approach to problems, most of the inevitable adverse events can be solved adequately, minimizing the discomfort for the patient who has undergone laryngectomy and uses indwelling voice prosthesis

Static reanimation of the paralyzed face with polypropylene mesh facial suspension and auricular cartilage upper eyelid implantation

To study the technical feasibility and efficacy of the polypropylene mesh facial suspension [PMFS] along with auricular cartilage upper eyelid implantation in the rehabilitation of the paralyzed face. Prospective study of a case series. The study was carried out in 17 patients with unilateral facial paralyses [6/6 House-Brackmann score]. The parameters evaluated were: restoration of nasal breathing, improvement of drooling, restoration of normal speech, degree of eye closure and cosmetic results. 12 months after intervention, patient evaluation of the outcome parameters was as follows: 14 patients [82%] reported significant improvement and 3 [18%] reported modes drooling improvement, 12 patients [71%] reported significant improvement and 5 [29%] reported modes improvement of speech, 13 patients [76%] had complete eye closure, and 4 patients [24 5] had partial closure with adequate corneal coverage, 13 patients [76%] reported complete satisfaction and 4 [24%] reported moderate satisfaction with cosmoses. Two revisions were required for suspension failure. This technique is a simple and reversible method of facial reanimation that can be performed under local anesthesia, thereby reducing morbidity and cost. It provides improved function and cosmoses

Prevalence of Helicobacter pylori DNA in recurrent aphthous ulcerations is predominantly. Limited to mucosa-associated lymphoid tissues of the pharynx

To determine the presence of H. pylori and, if detected, its potential prevalence in the etiology of recurrent aphthous ulcers [RAS], confined to mucosa-associated lymphoid tissues [MALTs] of the pharynx. A prospective, controlled clinical trial. The study population comprised 146 patients with recurrent multiple aphous ulcers of the oral cavity and pharynx, and 20 normal subjects, that were used as controls. Patients were assigned to [Group A, n=58] in whom the ulcers were strictly limited to the lymphoid tissues, or [Group B, n=88] in whom the ulcers were randomly distributed in the oral cavity and pharynx. H. pylori DNA was extracted from 3-mm-diameter tissue samples and PCR amplifications were performed for the 16S ribosomal RNA [rRNA] gene. In examining all the samples; Group A, 39 [68%] patients were shown to be positive for H. pylori DNA, while in Group B, 9 [10%] patients were shown to be positive for H. pylori DNA, but it was not detected in any of the 20 control samples [Chi test, P<0.001]. Our results support a possible etiological role for H. pylori in recurrent aphthous ulcerations with a characteristic distribution and affinity to mucosa-associated lymphoid tissues of the pharynx

One stage aesthetic reconstruction of the nasal tip using lateral fronto-nasal flap

To review and report our experience with the lateral frontonasal flap in the reconstruction of nasal tip defects. Retrospective review. Review our results in 27 consecutive patients who underwent nasal reconstruction using the lateral frontonasal flap. The flaps were viable in all patients and the outcome was rated; excellent in 19 patients, good in 5, mediocre in 2 and poor in only one patient. The lateral frontonasal flap is an ideal option for reconstruction of nasal tip defects. It provides a sizable amount of skin similar in texture and color for aesthetic reconstruction

Combined triple approach for management of persistent oro - antral fistula

Fourteen patients with persistent oro-antral fistula following dental extraction were managed by a combined endonasal, sublabial and per-oral approach, under cover of antibiotic and metronidazole therapy. Endoscopic endonasal ethmoidectomy with middle meatal antrostomy, modified Caldwel-Luc approach and per-oral closure of the fistula mouth by a posteriorly based palatal flap was our surgical technique. Results were very satisfactory without any major complications