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1.
Int J Oncol ; 39(5): 1193-8, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21822536

RESUMO

Exposure to tobacco carcinogens is causally associated with head and neck squamous cell carcinoma (HNSCC), but the underlying molecular mechanisms remain unclear. Here, we reported that AKT is activated at a higher frequency in both HNSCC tumors and the adjacent mucosa from HNSCC patients who are smokers than those from HNSCC patients who are non-smokers. Adding physiologically relevant concentrations of 4-(methylnitrosamino)-1-(3-pyridyl)-1-1butanone (NNK), a major tobacco carcinogen, to normal head and neck epithelial cells and HNSCC cell lines, rapidly and constitutively activated AKT through phosphorylation in a dose- and time-dependent manner. AKT phosphorylation was associated with activation of downstream signaling mediators BAD, MDM2, GSK-3ß, mTOR. These alterations correlated with increased proliferation and decreased etoposide-induced apoptosis in NNK-exposed cells. Finally, NNK exposure to mouse head and neck epithelia resulted in epithelial hyperproliferation and reduced apoptosis, which is correlated with AKT activation. Our results suggest that AKT activation is an early event and plays a pivotal role in mediating tobacco-induced HNSCC carcinogenesis.


Assuntos
Carcinógenos/farmacologia , Carcinoma de Células Escamosas/enzimologia , Neoplasias de Cabeça e Pescoço/enzimologia , Nicotiana/química , Nitrosaminas/farmacologia , Proteínas Proto-Oncogênicas c-akt/metabolismo , Animais , Apoptose/efeitos dos fármacos , Carcinoma de Células Escamosas/patologia , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Ativação Enzimática/efeitos dos fármacos , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Fosforilação/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos , Carcinoma de Células Escamosas de Cabeça e Pescoço
2.
Otolaryngol Head Neck Surg ; 144(3): 353-6, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21493195

RESUMO

OBJECTIVE: In the setting of known facial nerve sacrifice or injury, patients require precautions to prevent exposure keratitis and the morbidity that follows. One recommended treatment is surgical placement of a gold weight with or without lateral tarsal strip. In patients in whom the facial nerve has been sacrificed, it is unknown whether rehabilitation should be simultaneous or in the perioperative period. STUDY DESIGN AND SETTING: Case series with chart review of patients who underwent immediate rehabilitation of the eye (gold weight and lateral tarsal strip) following facial nerve resection. SUBJECTS AND METHODS: From 1998 to 2009, 52 patients were studied. Postoperative ophthalmologic complications and the need for revision surgeries were measured. RESULTS: A gold weight was placed in all patients, and 48 of 52 (92%) simultaneous lateral tarsal strips were performed. The facial nerve was sacrificed in 51 of 52 (88%) patients, and the remaining patient had a known preoperative facial nerve paralysis. Thirty-six of 52 (69%) required free tissue transfer for reconstruction, underscoring the extensive resections performed. A 1.2-g gold weight was placed in 50 of 52 (96%) patients. Three (6%) patients required gold weight revision with a larger weight and 3 (6%) for extrusion. Eight (16.7%) patients underwent revision of the lateral tarsal strip for ectropion. CONCLUSIONS: No patients developed ophthalmologic complications. Patients undergoing radical surgical resections with known or suspected injury of the facial nerve should be considered for simultaneous rehabilitation of the upper and lower eye.


Assuntos
Paralisia Facial/cirurgia , Ouro , Procedimentos Cirúrgicos Oftalmológicos/métodos , Próteses e Implantes , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Neoplasias Oculares/cirurgia , Pálpebras/cirurgia , Nervo Facial/cirurgia , Paralisia Facial/etiologia , Feminino , Ouro/uso terapêutico , Humanos , Ceratite/prevenção & controle , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/reabilitação , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Glândula Parótida/cirurgia , Complicações Pós-Operatórias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos
3.
Arch Facial Plast Surg ; 13(1): 57-9, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21242433

RESUMO

The rib is a generous source of donor cartilage. Thus, costal cartilage harvest is a frequently performed adjunctive procedure in facial plastic and reconstructive surgery. Pneumothorax is an uncommon complication of rib graft harvest but is potentially highly morbid. Although chest radiography is the current diagnostic study of choice to rule out air in the chest, there is growing evidence that ultrasonography is less expensive and more sensitive. Furthermore, the portability of the ultrasonographic unit allows for immediate evaluation and more rapid diagnosis. The use of ultrasonography also precludes exposing the patient to ionizing radiation. We present a case in which ultrasonography was used to rapidly confirm the absence of pneumothorax after costal cartilage harvest and review the literature associated with use of ultrasonography for detection of this uncommon but serious complication.


Assuntos
Cartilagem/cirurgia , Pneumotórax/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Costelas/cirurgia , Adulto , Feminino , Humanos , Rinoplastia , Ultrassonografia
4.
J Oral Maxillofac Surg ; 69(1): 237-41, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21055861

RESUMO

The needs of patients with a cleft lip and/or palate (CL/P) extend beyond surgical repair. A multidisciplinary approach to the care of patients with CL/P is the widely accepted standard in most regions of the developed world. Patients with CL/P in developing countries have needs similar to those of patients in industrialized nations. However, the existing shortages of healthcare resources have precluded provision of the most basic care to those with a CL/P. Innovative applications of technology can facilitate the delivery of speech therapy, evaluation of audiometric data, and limited dental evaluation for these patients with a modest financial investment. One method by which this care might be provided is with the use of Internet-based modalities. This represents a near universally available method to fill a conspicuous gap in the preoperative evaluation and postoperative care of patients with CL/P in the developing world. With rapidly expanding access to the Internet, particularly with wireless-3G connectivity worldwide, it is time to expand our delivery of humanitarian care beyond surgery alone in treating patients with CL/P in medically underserved areas.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Países em Desenvolvimento , Equipe de Assistência ao Paciente , Altruísmo , Audiometria , Fenda Labial/reabilitação , Fissura Palatina/reabilitação , Periféricos de Computador , Assistência Odontológica , Seguimentos , Recursos em Saúde , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Internet , Ciência de Laboratório Médico , Missões Médicas , Área Carente de Assistência Médica , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Fonoterapia , Padrão de Cuidado , Resultado do Tratamento , Comunicação por Videoconferência
5.
Facial Plast Surg Clin North Am ; 19(1): 163-73, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21112518

RESUMO

Nasal reconstruction has been refined to the point that its goals should include full restoration of form and function in addition to providing an aesthetically-pleasing result. Contemporary facial plastic surgeons have all the tools available in their armamentarium to repair the complex composite structure of nasal lining, structure, and skin cover. Nasal defects most often result from oncologic surgery or, less commonly, nasal trauma. While defects of nasal cover are more prominent, the impact of unrepaired nasal lining defects should not be underestimated. Meticulous repair of lining, structure and cover are all required for functional, stable and aesthetic nasal reconstruction.


Assuntos
Mucosa Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Rinoplastia/métodos , Retalhos Cirúrgicos , Humanos , Cirurgia de Mohs/efeitos adversos , Deformidades Adquiridas Nasais/etiologia , Deformidades Adquiridas Nasais/patologia
6.
Ear Nose Throat J ; 89(4): E27-32, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20397134

RESUMO

Laryngeal adenoid cystic carcinoma (ACC) is a rare clinical entity that poses a number of diagnostic and therapeutic challenges. We present a case of ACC of the subglottic larynx, and we review its diagnosis and management. We also discuss the workup of submucosal masses of the subglottic larynx, with an emphasis on clinical and radiologic diagnosis, surgical treatment, radiotherapy, and emerging therapies. The presence of a submucosal mass in the subglottic larynx should raise suspicion for the presence of ACC.


Assuntos
Carcinoma Adenoide Cístico/diagnóstico , Neoplasias Laríngeas/diagnóstico , Laringoscopia , Tomografia Computadorizada por Raios X , Biópsia , Carcinoma Adenoide Cístico/patologia , Carcinoma Adenoide Cístico/cirurgia , Progressão da Doença , Intervalo Livre de Doença , Secções Congeladas , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringectomia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prega Vocal/patologia
7.
Clin Plast Surg ; 37(2): 253-64, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20206743

RESUMO

The alar cartilages provide the contour and structural support of the nasal tip. Current rhinoplasty concepts support preservation of alar structure with suture techniques or judicious cephalic trim indicated for tip deformities. In many primary cases and some revisions, adequate alar structure exists to achieve the desired aesthetic and functional results with conservative surgical methods. In some primary and most revision cases, however, the existing tip structure is inadequate to create a structurally sound and aesthetically pleasing nasal tip without adding structure. In these cases, alar cartilage grafting techniques are indicated to recapitulate nasal tip contour and structure.


Assuntos
Cartilagem/transplante , Nariz/anormalidades , Nariz/cirurgia , Rinoplastia/métodos , Gráficos por Computador , Humanos , Costelas/transplante , Transplante Autólogo
9.
Facial Plast Surg Clin North Am ; 17(3): 395-417, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19698919

RESUMO

Nasal reconstruction has reached a point in its evolution such that its goals no longer include simply filling the defect. The contemporary facial reconstructive surgeon aims for an aesthetic and functional result in the vast majority of cases. Cutaneous nasal defects most often result from oncologic surgery, such as either Mohs excision or square technique, or, less commonly, traumatic or iatrogenic injury. This article discusses the current practices in the repair of nasal defects. Although this article focuses on reconstruction of oncologic defects, the principles discussed can be effectively applied to traumatic defects, as well.


Assuntos
Neoplasias Nasais/cirurgia , Rinoplastia/métodos , Neoplasias Cutâneas/cirurgia , Transplante de Pele/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Estética , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Masculino , Neoplasias Nasais/patologia , Procedimentos de Cirurgia Plástica/métodos , Medição de Risco , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Cicatrização/fisiologia
10.
Medscape J Med ; 10(7): 155, 2008 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-18769690

RESUMO

OBJECTIVE: To describe our experience with coblation technology for facial resurfacing METHODS: Retrospective chart review of all patients treated with coblation at our institution RESULTS: Twenty-four patients (22 female) underwent a total of 29 coblation procedures for aging face (n = 21) or acne scarring (n = 3). The perioral region was the most frequently treated aesthetic subunit (n = 14), followed by the lower eyelid (n = 7). Five patients underwent full-face coblation. Three patients underwent a second coblation procedure for aging face while a single patient with severe acne scarring underwent 3 procedures. Repeat coblation was delayed at least 5 months (mean, 9 months). Seventeen coblation procedures (59%) were performed concurrently with procedures including, but not limited to, injection treatment, rhinoplasty, blepharoplasty, or combined face/necklift; no adverse events occurred. Seven procedures, including a full-face coblation, were performed in the office under local anesthesia and oral sedation without any adverse events. Mean follow-up was 6 months (range, 1 week to 24 months). No complications were observed. All patients were satisfied with the results after their final coblation treatment. CONCLUSIONS: Facial coblation is a safe and effective treatment modality for facial resurfacing.


Assuntos
Acne Vulgar/cirurgia , Biotecnologia/métodos , Cicatriz/cirurgia , Face/cirurgia , Dermatoses Faciais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Ritidoplastia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Head Neck ; 30(10): 1339-43, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18720521

RESUMO

BACKGROUND: Atelectasis is commonly encountered in patients undergoing rectus abdominus tissue transfer. Primary closure of the anterior rectus sheath may contribute to this process. Augmentation of the closure with mesh may decrease the incidence of Atelectasis. METHODS: In this retrospective review 32 patients with preoperative and postoperative augmentation were compared to 23 who had primary closure of the anterior rectus sheath. RESULTS: Augmentation consisted of acellular dermis (25) or mesh (7). Postoperative atelectasis was radiographically detected in: 91% (n=29) of augmented patients versus 83% (n=19) of primary closure patients. Major atelectasis in 41% (n=13) of augmented patients versus 61% (n=14) of primary closure patients p<.05. The incidence of atelectasis was independent of skin flap size and operative times. CONCLUSIONS: The use of acellular dermis or mesh to augment the abdominal wall appears to reduce the high incidence of postoperative atelectasis following rectus-free flap harvest.


Assuntos
Parede Abdominal/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Atelectasia Pulmonar/etiologia , Reto do Abdome/transplante , Retalhos Cirúrgicos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colágeno , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Atelectasia Pulmonar/diagnóstico por imagem , Radiografia , Estudos Retrospectivos , Fatores de Risco , Telas Cirúrgicas , Resultado do Tratamento
12.
Facial Plast Surg Clin North Am ; 16(3): 337-344, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18620985

RESUMO

Male skin care has undergone significant development over the past decade, with many companies now marketing skin care products directly to the male consumer. Despite the claims of many of these companies, few over-the-counter products have data to support their efficacy at a clinical level. A basic, effective regimen for preventive male skin care should include twice-daily facial cleansing and twice-daily moisturizer application, which should include sunscreen during the day. This article focuses on topical therapies directed at the maintenance and repair of photoaged male skin. The future holds promise for new developments in skin care. However, in the absence of significant scientific breakthroughs, the most cost-effective intervention will continue to be prevention.


Assuntos
Técnicas Cosméticas , Envelhecimento da Pele/fisiologia , Higiene da Pele , Humanos , Masculino , Envelhecimento da Pele/patologia , Neoplasias Cutâneas/prevenção & controle
13.
Laryngoscope ; 118(5): 768-75, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18197134

RESUMO

CONTEXT: Although commonly performed, data are lacking regarding efficacy and safety of lymph node dissection (LND) for recurrent/persistent papillary thyroid cancer (PTC). OBJECTIVE: Evaluate the efficacy and morbidity of LND in recurrent/persistent PTC. DESIGN: Retrospective review of central or lateral LND performed for persistent/recurrent PTC between January 2004 and March 2006. SETTING: Multidisciplinary thyroid cancer clinic with a single surgeon at an academic medical center. PARTICIPANTS: Seventy-five patients who underwent 79 LND for persistent/residual PTC. Safety analysis included all 79 resections. Exclusion criteria for the efficacy analysis were factors prohibiting evaluation of thyroglobulin (Tg) response. Forty-one resections were included in the efficacy analysis. INTERVENTION: Selective LND per standard of care. MAIN OUTCOME MEASURE: Primary outcome was the Tg response to LND. Secondary outcomes were surgical complications. RESULTS: Thirty-nine of the 41 evaluable resections also had Tg data allowing classification of Tg response. Of 39 classifiable resections, 16 (41%) resulted in undetectable postoperative stimulated Tg levels. An additional 12 resections resulted in significant (> or =50%) reductions in suppressed or stimulated Tg levels for an overall improvement rate of 72%. Of all 79 resections, 25 (32%) resulted in minor and 7 (9%) resulted in major complications. CONCLUSIONS: LND for persistent/recurrent PTC is a relatively safe procedure in experienced hands. It can lead to an undetectable Tg in 41% of cases and produce a major Tg reduction in an additional 31%. Its efficacy in short-term follow-up is comparable with that reported for I-131, and it should be considered in the management of persistent/recurrent PTC.


Assuntos
Carcinoma Papilar/cirurgia , Excisão de Linfonodo , Recidiva Local de Neoplasia , Neoplasias da Glândula Tireoide/cirurgia , Adolescente , Adulto , Idoso , Algoritmos , Carcinoma Papilar/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Equipe de Assistência ao Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/métodos , Tireoglobulina/sangue , Neoplasias da Glândula Tireoide/patologia , Resultado do Tratamento
14.
Otolaryngol Head Neck Surg ; 137(2): 228-32, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17666246

RESUMO

OBJECTIVE: We sought to evaluate the functional and aesthetic outcomes of immediate facial reconstruction with a Gore-Tex (expanded polytetrofluoroethylene) sling in irradiated patients undergoing large head and neck tumor extirpation with facial nerve resection. STUDY DESIGN AND SETTING: We conducted a retrospective study of 17 patients at two academic institutions who underwent extirpative surgery with immediate Gore-Tex sling reconstruction and completed radiotherapy. Functional and aesthetic results were evaluated at three intervals. RESULTS: All patients had excellent immediate results and good or excellent intermediate-term results. At long-term follow-up, results were good to excellent in 47% and unacceptable in 35% of patients. CONCLUSION: In irradiated patients undergoing total parotidectomy with immediate facial reconstruction using Gore-Tex slings, early results are excellent, but there is a high incidence of major wound complications and unacceptable results in long-term follow-up. SIGNIFICANCE: There is a high rate of late complications associated with immediate facial reconstruction with Gore-Tex slings in irradiated patients.


Assuntos
Paralisia Facial/cirurgia , Politetrafluoretileno , Próteses e Implantes , Idoso , Idoso de 80 Anos ou mais , Materiais Biocompatíveis , Paralisia Facial/etiologia , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
16.
Otolaryngol Head Neck Surg ; 136(6): 914-9, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17547979

RESUMO

OBJECTIVE: Free tissue transfer to the skull base provides a watertight seal to prevent CSF leakage and donor tissue tailored to the individual defect. STUDY DESIGN AND SETTING: Retrospective chart review of 38 patients who underwent free tissue transfer to the skull base between November 1995 and October 2005 at an academic, tertiary referral center. RESULTS: There were 23 male and 15 female patients (average age, 58.1 years) with skull base defects resulting from oncologic resection or head trauma most frequently. Donor sites included the radial forearm (25), rectus abdominis (12), latissimus dorsi (4), anterolateral thigh, scapula, serratus anterior, and ulna (1 each). Seven patients required a second free tissue transfer indicated for flap death (3), partial flap necrosis (2), pneumocephalus (1), or tumor recurrence (1). Two patients died in the immediate postoperative period. CONCLUSIONS: Free tissue transfer is a robust option in the repair of post-surgical and post-traumatic skull base defects.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Microcirurgia , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/lesões , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
17.
Laryngoscope ; 116(9): 1553-7, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16954977

RESUMO

OBJECTIVES: Laryngotracheal stenosis is a complex problem resulting most often from intubation, trauma,or autoimmune disease. Management options include dilation or airway reconstruction including laryngotracheoplasty (LTP), cricotracheal resection (CTR), and tracheal resection (TR). We describe our experience with management of this difficult problem. STUDY DESIGN: Retrospective chart review of patients treated for laryngotracheal stenosis between January 1995 and July 2005 at an academic, tertiary referral center. METHODS: A total of 127 patients were treated during the study period. Patients were followed, and hospital records were reviewed. RESULTS: There were 38 male and 89 female patients with an average age of 55.5 years treated for laryngotracheal stenosis resulting from intubation (64), idiopathic (25) or autoimmune disease (18), radiation (9), trauma (5), prior surgery (4), and relapsing polychondritis (2). Thirty-three percent were treated for grade I stenosis, 44% grade II, 19% grade III, and 4% grade IV. Seventy percent of patients undergoing initial dilation required a subsequent procedure. LTP, CTR, or TR was performed in 43%, 48%, 71%, and 100% of patients with grade I through IV stenosis, respectively. Among 76 patients undergoing LTP, CTR, or TR, 24 (32%) required a subsequent intervention. Among 36 patients treated with primary LTP, CTR, or TR, only 10 (28%) required further therapy. Twenty-two of 35 (63%) tracheostomy-dependent patients were ultimately decannulated. Three patients died in the immediate postoperative period. CONCLUSIONS: Patients undergoing dilation for laryngotracheal stenosis require multiple procedures. However, major reconstructive procedures are well tolerated and currently represent a viable primary treatment for laryngotracheal stenosis.


Assuntos
Laringoestenose/terapia , Estenose Traqueal/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Broncoscopia , Feminino , Humanos , Laringoestenose/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Estenose Traqueal/etiologia , Traqueotomia , Resultado do Tratamento
18.
Head Neck ; 28(7): 649-52, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16691556

RESUMO

BACKGROUND: DuraPrep is a widely used, alcohol-based surgical prep solution. The risk of surgical fire associated with incomplete drying of this agent in the context of electrosurgical procedures has been described previously. To date, there have been no reports of fire during tracheostomy associated with a flammable prep agent before entering the airway. We describe an operating room fire occurring during awake tracheostomy associated with the use of DuraPrep. METHODS: A 62-year-old man with copious body hair underwent tracheostomy in the operating room. The neck was prepared with DuraPrep surgical solution, and after at least 3 minutes, the operative field was draped. Activation of electrocautery ignited a fire, and the patient was burned on his neck and shoulders. RESULTS: The fire was extinguished, and the patient recovered from both the tracheostomy and the burns. CONCLUSION: This case illustrates that DuraPrep should be avoided in the hirsute patient, because body hair interferes with drying of this solution and increases the risk of fire.


Assuntos
2-Propanol/efeitos adversos , Eletrocoagulação/efeitos adversos , Incêndios , Complicações Intraoperatórias/etiologia , Iodo/efeitos adversos , Traqueostomia , Etanol , Cabelo , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Fatores de Risco
20.
Laryngoscope ; 115(6): 968-72, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15933502

RESUMO

OBJECTIVE: Cerebrospinal fluid (CSF) leaks can occur after head trauma or skull base surgery. Persistent or spontaneous leaks should be repaired, since they put patients at risk for serious intracranial complications. Although numerous repair methods have been successful, the occasional patient develops a persistent leak. We describe our experience with free tissue transfer for repair of recalcitrant CSF leaks. STUDY DESIGN: Retrospective chart review of patients undergoing free tissue transfer for repair of a CSF leak between November 1995 and October 2004. Setting was an academic, tertiary care referral center. METHODS: Twelve patients with persistent CSF leak were studied. Eleven of 12 patients had undergone a previous repair attempt ranging from endoscopic repair with fat graft to craniotomy and primary repair of the dural defect. All patients underwent radial forearm free tissue transfer. RESULTS: There were six female and six male patients. Average age was 52.7 years (range, 22-80 y). The most common presenting complaints were intracranial abscess, recurrent meningitis, or pneumocephalus (n=9) and CSF otorrhea or rhinorrhea (n=8). Cause was head trauma (n=6), prior surgery (n=4), cholesteatoma (n=1), or meningoencephalocele (n=1). Eleven of 12 patients failed prior procedures (range, 0-6 procedures; mean, 1.9). Ten flaps were placed in the anterior skull base and two were in the middle or posterior skull base. Radial forearm free tissue transfer resulted in sustained resolution of CSF leakage in all 12 patients. CONCLUSIONS: Free tissue transfer is an efficacious option in the repair of recalcitrant CSF leaks.


Assuntos
Otorreia de Líquido Cefalorraquidiano/cirurgia , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Antebraço/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Abscesso Encefálico/complicações , Colesteatoma/cirurgia , Traumatismos Craniocerebrais/cirurgia , Encefalocele , Feminino , Humanos , Masculino , Meningite/complicações , Meningomielocele/cirurgia , Pessoa de Meia-Idade , Pneumocefalia/complicações , Recidiva , Reoperação , Estudos Retrospectivos , Base do Crânio/cirurgia , Resultado do Tratamento
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