Factors associated with postrhinoplasty mucous cyst in cleft lip patients.

PURPOSE: The purpose of this study was to identify risk factors associated with postrhinoplasty mucous cyst (PMC) among adult cleft patients undergoing rhinoplasty. PMC has been reported sporadically in the literature. Its aetiology is uncertain. The purpose of this study was to determine whether three factors, (1) patient age, (2) surgical trauma, and/or (3) use of a nasal septal cartilage graft (NSCG), were risk factors for PMC. METHODS: We organized a retrospective, single-center study and enrolled cleft rhinoplasty patients treated between January 2003 and December 2008. The predictor variables included age at surgery, use of a NSCG, and length of surgery. The primary outcome was presence of PMC. Other study variables included demographic, surgical, and postoperative data. Appropriate descriptive and univariate statistics were calculated, and P < 0.05 was regarded as indicative of statistical significance. RESULTS: The sample comprised 314 cleft rhinoplasty patients (118 females; 37.6 %) with a mean age of 14.9 ± 10.7 years (range 0-65). Three patients had a PMC after secondary cleft rhinoplasty. Average time to disease was 26 ± 19.3 months after surgery (range 12-48). There was no significant association between the presence of the PMC and the three predictor variables-patient's age, NSCG transplantation, and protracted surgery (P > 0.05). CONCLUSIONS: These study findings suggest that young age, use of a NSCG, and protracted surgery are not risk factors for PMC. The prevalence of PMC is greater for cleft patients after rhinosurgery than for noncleft patients.

Intracranial extension of Schneiderian inverted papilloma: a case report and literature review.

Inverted papilloma is an uncommon primary nasal tumor. Despite its benign nature, this tumor represents three typical characteristics: a high propensity of recurrence, local aggressiveness and association with malignancy. Inverted papilloma can reduce the patient's quality of life due to compromised nasal function, extension to the orbit and brain. The authors reported the unusual case of a 72-year-old male patient with inverted papilloma, which fatally extended to the intracranial temporal fossa after multiple recurrences. To the authors' knowledge, this is the twelfth case in the literature of inverted papilla extending into the temporal fossa. The current and pertinent literature in English, French and German was reviewed, and an algorithm for managing inverted papilloma was also proposed.

The saxon bisphosphonate register - therapy and prevention of bisphosphonate-related osteonecrosis of the jaws.

In 2009, a study group of three Saxon hospitals set up a Saxon register with the aim of including all patients with bisphosphonate (BP) medication. In addition, specific concepts for surgical approach were developed. The target is to define relevant treatment and prevention strategies of bisphosphonate-related osteonecrosis of the jaws (BRONJ) based on high patient population statistics. Since July 2009, all patients with oral or intravenous BP medication have been registered in the 3 Saxon hospitals. Data was systematically acquired in detailed forms. Totally, 258 patients (♂: 83, ♀: 175) were registered by October 2010. 100 patients out of this already had BRONJ which preferably affected the mandible (70%) and was mostly associated with intravenous medication. In 54 cases, treatment was carried out by surgery according to the strategy developed. The criterion for success was absence of symptoms at least for 3 months after surgery. The following stage-dependent success rates were obtained: stage I (13 patients) - 84.6%, stage II (22 patients) - 95.5%, stage III (14 patients) - 85.7%, stage IV (5 patients) - 80%. Under preventive aspects, teeth were extracted after a predefined scheme in 68 of all patients registered as being asymptomatic. No BRONJ was observed in 98.5%; the criterion also being absence of symptoms for a minimum period of 3 months after surgery. Surgical treatment is the treatment of choice in cases of BRONJ. Tooth extractions are rather unproblematic in asymptomatic patients if the predefined scheme is followed.

The role of surgical therapy in the management of intravenous bisphosphonates-related osteonecrosis of the jaw.

OBJECTIVES: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) seems resistant to conventional treatment approaches. We report a study with a surgical concept characterized by resection of the necrotic bone followed by sufficient wound closure. STUDY DESIGN: In a clinical study of 24 patients with 33 sites of BRONJ, the surgical basis of the treatment was as follows: (1) conservative treatment with antimicrobiological rinsing, (2) resection of the entire necrotic bone and smoothening of any sharp bone edges, and (3) coverage of the remaining bone by use of a bilayered wound closure. RESULTS: In 88% of cases, BRONJ could be treated with success by use of this surgical therapy. Median follow-up was 60 weeks. There was no statistically significant difference between treatment results irrespective of whether or not bisphosphonate treatment was continued. CONCLUSION: Because of the high success rate of this surgical technique it seems that patients with BRONJ may benefit from this approach.