ABSTRACT
In rhinoplasty, diced cartilage with fascia (DC-F) is a commonly used technique to enhance dorsal projection and achieve a smooth dorsum. We have developed a modified technique by dissecting the thickness of the fascia along its width, called "Mini DC-F". This method allows for effective camouflaging of dorsal irregularities and provides a slight increase in dorsal height. This simplified and less invasive technique not only reduces operative time but also enhances the surgeon's ability to achieve a refined aesthetic result. This technique offers an intermediate option in the surgical arsenal, bridging the gap between pure camouflaging methods and those aimed at significant dorsal augmentation.
ABSTRACT
In spite of the ever-increasing hyper-specialization of gastro-intestinal surgeons, some surgical emergency procedures, such as tracheotomy, need to be mastered. The need for tracheotomy is sometimes so urgent that one cannot wait for a specialized surgeon to arrive or to transport the patient elsewhere. Even though percutaneous tracheotomy, as performed by intensive care physicians, represents an alternative to surgical tracheotomy, it is not always possible.
Subject(s)
Emergencies , Tracheotomy , HumansSubject(s)
COVID-19/prevention & control , COVID-19/surgery , Respiratory Protective Devices/standards , Surgeons , Tracheotomy/instrumentation , Equipment Design/standards , Equipment Design/statistics & numerical data , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Military Personnel/statistics & numerical data , Respiratory Protective Devices/virology , Tracheotomy/methods , Tracheotomy/trendsABSTRACT
BACKGROUND: Blast injuries in modern warfare are common, and the ear is often affected as it is an effective pressure transducer. This study aimed to evaluate military blast injuries of the ear. METHODS: From May 2002 to October 2014, all patients referred to two military hospitals near Paris, France following exposure to massive explosions were analysed. RESULTS: Among the 41 patients (82 ears), 36 of them reported tinnitus, 25 hearing loss, 14 earache and 8 vertigo. It was noted that 44% of the patients had tympanic membrane perforations and that this was bilateral in two-thirds of the cases. The hearing loss in 29% of the cases was pure sensorineural, in 55% it was mixed and in 15% it was a pure conductive hearing loss. There was no correlation between the impact of middle ear lesions and the severity of the inner ear injury. Three patients had a pharyngolaryngeal blast injury detected on the battlefield associated with blast lung injury, but only two of them had tympanic perforations. Nine tympanoplasty procedures were performed, of which 44% succeeded in sealing the perforation. CONCLUSIONS: Blast injuries of the ear are characterised by significant functional signs and are not correlated to otoscopic examinations. Sensorineural hearing loss is almost immediately final. When deciding on initial management, the status of the tympanic membrane does not provide any information about the risk of a primary blast injury of the lung; laryngeal nasofibroscopy seems a more relevant screening test.
Subject(s)
Blast Injuries/epidemiology , Ear/injuries , Explosions , Hearing Loss/epidemiology , Tympanic Membrane Perforation/epidemiology , Adult , Female , France , Hospitals, Military , Humans , Male , Middle Aged , Military Personnel , Retrospective Studies , Tinnitus , Young AdultABSTRACT
AIMS: The aim of the current study was to report the learning curve for endoscopic septoplasty for a senior surgeon already trained in endonasal sinus surgery. MATERIAL AND METHODS: From November 2011 to September 2012, 100 patients were prospectively included and grouped in 5 consecutive groups of 20 by date of surgery. The primary endpoint was operative time. Intra- and postoperative complications and functional assessment were also analyzed. RESULTS: Operative time decreased with the surgeon's experience and became stable after 60 procedures. Operative time saving was about 10min per 20 procedures. Mean operative time was stable between groups 4 (21.1±9.6min) and 5 (19.2±8.2min). There was a 2% rate of conversion to conventional surgery for technical problems. The number of procedures free of accidental mucosal lesion increased and became stable after 40 procedures. There was a 4% rate of residual postoperative perforation. Nasal Obstruction and Septoplasty Effectiveness (NOSE) score improved postoperatively in each group (P<0.05). CONCLUSION: After 60 endoscopic septoplasty procedures, a senior surgeon masters the surgical technique with satisfactory operative times, and a decreasing rate of intra- and postoperative complications.
Subject(s)
Endoscopy/education , Learning Curve , Nasal Septum/surgery , Clinical Competence , France , Humans , Intraoperative Complications , Operative Time , Postoperative Complications , Prospective StudiesABSTRACT
The aim of this review of literature was to compare conventional and endoscopic septoplasty in terms of operating time, functional efficacy and perioperative morbidity. A systematic review of the scientific literature was performed on the PubMed database, Google and Google Scholar, searching for randomized prospective trials comparing endoscopic and conventional septoplasty. The primary endpoint was operating time, and the secondary endpoints were intra- and postoperative complications, postoperative pain, hospital stay and functional result. Twenty-nine articles published between 1991 and 2012 compared conventional and endoscopic septoplasty, five of which were prospective randomized trials. Operating time was shorter with endoscopic surgery (P<0.001), with less mucosal damage (P<0.01); there was less synechia (P<0.01) and residual deformity (P<0.05); and postoperative pain was milder. Endoscopic septoplasty thus shortened surgery time and reduced perioperative complications, but the functional result was the same as with conventional septoplasty.
Subject(s)
Endoscopy , Nasal Septum/surgery , Humans , Intraoperative Complications , Length of Stay , Operative Time , Postoperative ComplicationsABSTRACT
The authors report a case of invasive aspergillosis of a sphenoid sinus mucocele revealed in a patient with diabetes in Djibouti by homolateral palsy of the 3rd, 4th, 5th and 6th nerves. This rare condition occurs preferentially in immunodeficient subjects. Because of its clinical polymorphism, its diagnosis is difficult and is often not made until complications develop. Endonasal surgery with anatomopathological and mycological examination is both a diagnostic and therapeutic procedure. It must be performed early, to avoid functional or even life-threatening complications.
Subject(s)
Cranial Nerve Diseases/microbiology , Neuroaspergillosis/complications , Sphenoid Sinus , Djibouti , Humans , Male , Middle AgedSubject(s)
Endometrial Stromal Tumors/diagnosis , Endosonography , Magnetic Resonance Imaging , Rare Diseases , Ultrasonography, Doppler , Adult , Diagnosis, Differential , Endometrial Stromal Tumors/pathology , Endometrial Stromal Tumors/surgery , Endometrium/pathology , Female , Humans , HysterectomyABSTRACT
INTRODUCTION: Facial palsy (FP) is a feared complication of parotidectomy. Facial nerve monitoring (FNM) has been poorly evaluated since it was created at the beginning of the 90's. The authors described a retrospective series and discussed it reviewing the literature data. SUBJECTS AND METHOD: From January 2002 to January 2009, 75 parotidectomies were performed in 72 patients (34 males, 38 females), without FNM in 28 cases (group 1) and with FNM in 47 cases (group 2). RESULTS: In group 1, 9 FP were noted, 5 were transient and 4 were definitive. In group 2, 12 FP were noted, 9 were transient and 3 were definitive. Both one month and six months after parotidectomy, the FP rate was significatively higher in group 1 than in group 2 for the reoperations. CONCLUSIONS: Facial nerve monitoring is an adjunctive method available to a surgeon during parotid surgery to assist with the functional preservation of the facial nerve. It did not allow to improve the facial prognosis in benign tumours removal but it improved the facial prognosis in reoperations. Its interest should be tested for malignant tumour removal.