RESUMO
Congenital and traumatic disorders of the nose and ear in children and adolescents must be dealt with on an individual basis. The indications for surgical correction must be guided by functional, psychologic, and aesthetic considerations.
Assuntos
Orelha Externa/anormalidades , Rinoplastia/métodos , Cirurgia Plástica/métodos , Adolescente , Criança , Pré-Escolar , Orelha Externa/cirurgia , Humanos , Nariz/anormalidades , Nariz/cirurgiaRESUMO
Since 1959, we have used a superior extension of the anterior approach to the cervical spine of Robinson and Smith in a consecutive series of seventeen patients. This approach provided anterior access to the neural elements from the clivus to the body of the third cervical vertebra, without the need for posterior dissection of the carotid sheath or entrance into the hypopharynx or oral cavity. It also provided adequate exposure for the insertion of iliac or fibular strut grafts, which was necessary in thirteen patients. The approach gave excellent exposure for anterior intralesional excision of a tumor in ten patients, marginal excision of an osteochondroma, two corpectomies of the second cervical vertebra combined with removal of the odontoid process, corpectomy of the second cervical vertebra for the treatment of fixed atlanto-axial subluxation, removal of a bullet anterior to the clivus, reduction of a dislocation of the second on the third cervical vertebra secondary to an unstable fracture of the pedicles of the second cervical vertebra, and anterior débridement for treatment of pyogenic vertebral osteomyelitis. In contrast to the reported results of transmucosal approaches to the atlas and axis, there were no infections or iatrogenic neurological deficits of the spine in the present series. Twelve patients who were followed for two years or more had a solid anterior fusion and no subsequent loss of cervical stability. Pain in the neck was relieved in all of the patients who had had a pathological or traumatic fracture.
Assuntos
Vértebras Cervicais/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adolescente , Adulto , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Faringe/cirurgia , Radiografia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Traumatismos da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/secundárioRESUMO
A transcervical extraoral approach was utilized to achieve exposure to the upper cervical spine in five patients, four of whom required bone graft placement. Excellent exposure was achieved in all patients, and the postoperative course was uncomplicated. The anterior extraoral approach is a reliable technique in treatment of pathology of the atlas and axis.
