Novel Use of the Buccal Fat Pad for Sinocutaneous Fistulae Closure and a Review of Reconstructive Options

2021 ◽  
pp. 000348942110142
Author(s):  
Christopher Pool ◽  
Neerav Goyal ◽  
Jessyka G. Lighthall
Keyword(s):  
Animal Studies ◽  
Management Strategies ◽  
Disease Process ◽  
Fistula Formation ◽  
English Studies ◽  
Fat Pad ◽  
Management Options ◽  
Management Paradigms ◽  
Buccal Flap ◽  
Scar Contraction

Background: Sinocutaneous fistulae (SCF) are abnormal communications between the paranasal sinuses and the overlying skin. They may be difficult to manage due to facial geometry, scar contraction, and poor tissue vascularity. We describe a novel use of the buccal flap and review the literature to examine management options for this disease process. Methods: A PubMed/MEDLINE literature search was performed for studies published between January 1, 1950 and April 29, 2020 that describe management strategies for SCF. The clinical record, imaging, and operative reports were reviewed of the case in which the buccal fat flap was used in reconstruction. Results: A total of 359 articles were retrieved. After removing duplicate articles, non-English studies, animal studies, duplicate articles and studies that mentioned SCF without specific mention of management strategies, 51 articles were reviewed. Management paradigms throughout the articles include (1) removal of infection, (2) ensuring patency of sinus outflow tracts, (3) tensionless multilayered closure using well vascularized tissue, and (4) prevention or minimization of future risk factors for fistula formation. Conclusion: This article informs surgeons on reconstructive options for sinocutaneous fistulae including a novel description of the buccal fat flap.

scholarly journals Necrotizing Enterocolitis in Very Low Birth Weight Infants: A Systemic Review

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Bhoomika K. Patel ◽  
Jigna S. Shah
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Animal Studies ◽  
Very Low Birth Weight ◽  
Management Strategies ◽  
Gastrointestinal Disorder ◽  
Systemic Review ◽  
Low Birth Weight Infants ◽  
Management Options

Necrotizing enterocolitis (NEC) is the most common serious gastrointestinal disorder affecting very preterm or very low birth weight infants. The risk is inversely proportional to gestational age and weight at birth. Fetal growth restriction and compromise may be additional specific risk factors. Despite extensive research and animal studies etiopathogenesis, preventive strategies and management options remain controversial. The present paper reviews the literature for recent advances and newer insights for changing epidemiological trends, pathogenesis, role of inflammatory cytokines, and various preventive and management strategies.

scholarly journals Filling the Void: Use of the Interpositional Buccal Fat Pad to Decrease Palatal Contraction and Fistula Formation

FACE ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 33-40
Author(s):  
Todd E. Thurston ◽  
James Vargo ◽  
Katelyn Bennett ◽  
Christian Vercler ◽  
Steven Kasten ◽  
...  
Keyword(s):  
Dead Space ◽  
Average Length ◽  
Retrospective Chart Review ◽  
Fistula Formation ◽  
Fat Pad ◽  
Buccal Fat Pad ◽  
Muscle Transposition ◽  
Early Results ◽  
Dead Space Volume ◽  
Versatile Technique

Objective: The objective of this study was to evaluate the ability of the buccal fat pad flap (BFPF) to fill the void remaining after muscle transposition and study its effect on durability, fistula rate, palatal shortening/contraction, and relapse of muscle positioning in wide and challenging cleft repairs. Design: A retrospective chart review was performed. Charts were abstracted for standard demographics, reason for BFPF utilization, palatal length, palatal fistula, co-morbidities, and speech outcomes. Patients, Participants: Patients under age 3 who underwent primary palatoplasty between October 2007 and September 2015 which utilized a medially placed BFPF were identified. Results: Fifty-three patients were identified. Mean age at palatoplasty was 1.4 (0.78-2.55) years. Mean follow-up was 2.52 (0.02-7.26) years. Twenty-four (45.3%) patients had concerning intraoperative findings warranting flap utilization. Twenty-nine (54.7%) patients underwent BFPF for large dead-space volume. Four patients (7.55%) experienced a fistula. Thirty-nine patients had comments on their palatal length. Of these, 28 (71.8%) were of average length, and 8 (20.5%) were long. Thirty-three patients have undergone formal speech evaluation. Of these, 20 (60.6%) were of normal resonance, and 12 (36.4%) demonstrated nominal hypernasality. No patients have yet to require a secondary speech operation. Conclusion: Use of the BFPF has become more common in our practice particularly in challenging cleft palate repairs. It is a versatile technique addressing large interpositional dead space and thin outer and inner lamellae in the anterior soft palate after posterior muscle transposition. Early results, in difficult repairs, demonstrate excellent durability and that palatal length appears to be maintained, potentially lessening the need for secondary speech surgery.

Modeling Habitat Suitability and Management Options for Maintaining Round Whitefish (Prosopium cylindraceum) in Adirondack Ponds

2021 ◽  
Author(s):  
Amy Kathleen Conley ◽  
Matthew D. Schlesinger ◽  
James G. Daley ◽  
Lisa K. Holst ◽  
Timothy G. Howard
Keyword(s):  
Species Distribution Model ◽  
Management Strategies ◽  
Distribution Model ◽  
Nonnative Species ◽  
Simulated Population ◽  
Management Options ◽  
The Past ◽  
Almost All ◽  
Reintroduction Success ◽  
Maximum Air Temperature

Habitat loss, acid precipitation, and nonnative species have drastically reduced the number of Adirondack waterbodies occupied by round whitefish (Prosopium cylindraceum). The goal of this study was to 1) increase the probability of reintroduction success by modeling the suitability of ponds for reintroduction and 2) better understand the effects of different rates of pond reclamation. We created a species distribution model that identified 70 waterbodies that were physically similar to occupied ponds. The most influential variables for describing round whitefish habitat included trophic, temperature, and alkalinity classes; waterbody maximum depth; maximum air temperature; and surrounding soil texture and impervious surface. Next, we simulated population dynamics under a variety of treatment scenarios and compared the probability of complete extirpation using a modified Markov model. Under almost all management strategies, and under pressure from nonnative competitors like that observed in the past 30 years, the number of occupied ponds will decline over the next 100 years. However, restoring one pond every 3 years would result in a 99% chance of round whitefish persistence after 100 years.

scholarly journals Tiered healthcare in South Africa exposes deficiencies in management and more patients with infectious etiology of primary adrenal insufficiency

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241845
Author(s):  
Thabiso Rafaki Petrus Mofokeng ◽  
Kwazi Celani Zwakele Ndlovu ◽  
Salem A. Beshyah ◽  
Ian L. Ross
Keyword(s):  
South Africa ◽  
Adrenal Insufficiency ◽  
Online Survey ◽  
Management Strategies ◽  
Adrenal Crisis ◽  
Public Healthcare ◽  
Antibody Testing ◽  
Management Options ◽  
Primary Adrenal Insufficiency ◽  
The Public

Objective We wished to determine the prevalence, etiology, presentation, and available management strategies for primary adrenal insufficiency (PAI) in South Africa (SA), hypothesizing a prevalence greater than the described 3.1 per million. There is great inequity in healthcare allocation, as two parallel healthcare systems exist, potentially modifying PAI patients’ clinical profiles, private being better resourced than public healthcare. Methods An online survey of physicians’ experience relating to PAI. Results The physicians were managing 811 patients, equal to a prevalence of 14.2 per million. Likely causes of PAI in public/ academic vs private settings included: AIDS-related [304 (44.8%) vs 5 (3.8%); p<0.001], tuberculosis [288 (42.5%) vs 8 (6.0%); p<0.001], autoimmune disease [50 (7.4%) vs 88 (66.2%); p<0.001], malignancy [27 (4.0%) vs 7 (5.3%); p = 0.500], genetic including adrenoleukodystrophy (ALD) [5 (0.7%) vs 16 (12.0%); p<0.001], respectively. Overall, more patients presented with nausea [101 (74.3%) and vomiting 89 (65.9%), than diarrhoea 76 (58.9%); p = 0.008 and 126 (15.5%) in adrenal crisis. Features suggestive of a crisis were hypoglycaemia [40 (78.4%) vs 42 (48.8%); p = 0.001], shock [36 (67.9%) vs 31(36.9%); p<0.001], and loss of consciousness [25 (52.1%) vs 27 (32.9%); p = 0.031]. Greater unavailability of antibody testing in the public vs. the private sector [32 (66.7%) vs 30 (32.1%); p = 0.001], [serum-ACTH 25 (52.1%) vs 16 (19.5%); p<0.001] and glucocorticoids were [26 (54.2%) vs 33 (40.2%); p = 0.015]. Many patients, 389(66.7%) were not using identification, indicating that they need steroids in an emergency. Conclusion A survey of South African physicians suggests a higher prevalence than previously reported. Patients presented with typical symptoms, and 15.5% presented in adrenal crisis. Significant disparities in the availability of physicians’ expertise, diagnostic resources, and management options were noted in the public versus private settings. Greater awareness among health practitioners to timeously diagnose PAI is required to prevent a life-threatening outcome.

Common problems and symptoms

2020 ◽  
pp. 151-174
Keyword(s):  
Nervous System ◽  
Muscle Weakness ◽  
Cognitive Abilities ◽  
Management Strategies ◽  
Disease Process ◽  
Signs And Symptoms ◽  
Complete Paralysis ◽  
Common Problems ◽  
The Brain ◽  
Neurological System

Any damage to the neurological system due to a disease process, infection, or injury frequently results in certain abnormal signs and symptoms. Depending on the degree of damage and the region of the brain or peripheral nervous system affected, neurological disorders can result in partial or complete paralysis, muscle weakness, pain and spasticity, seizures, and abnormal cognitive abilities. This chapter present some of the more commonly occurring problems with some management strategies.

scholarly journals Delayed buccal fat pad herniation: An unusual complication of buccal flap in cleft surgery

2009 ◽  
Vol 42 (01) ◽  
pp. 104-105
Author(s):  
Puneet Tuli ◽  
Atul Parashar ◽  
Vipul Nanda ◽  
Ramesh K. Sharma
Keyword(s):  
Cleft Palate ◽  
Nasal Mucosa ◽  
Donor Site ◽  
Unusual Complication ◽  
Fat Pad ◽  
Buccal Fat Pad ◽  
The Third ◽  
Buccal Flap ◽  
Fat Herniation ◽  
Cleft Surgery

ABSTRACTBuccal musculomucosal flap is commonly used in cleft palate surgery for providing additional lining when nasal mucosa is inadequate. We report an unusual complication of progressively increasing fat herniation from the sutured donor site which started appearing on the third postoperative day. This necessitated excision of the protruding fat pad on the seventh postoperative day. The possible mechanism and precautions for prevention of this complication are discussed.

scholarly journals A rare case of arteriovenous fistula formation in a patient with inferior vena cava thrombosis, successfully managed with endovascular recanalisation

2019 ◽  
Vol 5 (4) ◽  
pp. 20190007
Author(s):  
Vanya Joshi ◽  
Frances Sheehan ◽  
Alexander Chapman
Keyword(s):  
Inferior Vena Cava ◽  
Arteriovenous Fistula ◽  
Animal Studies ◽  
Inferior Vena ◽  
Vena Cava ◽  
Lower Extremities ◽  
Venous Hypertension ◽  
Fistula Formation ◽  
Ivc Thrombosis ◽  
Ivc Filters

Inferior vena cava (IVC) filters are recommended for patients with proximal deep vein thrombosis (DVT) who are not eligible for anticoagulation. Long-dwelling filters are well-known to be associated with the development of IVC thrombosis. Chronic caval occlusion can lead to a severe post-thrombotic syndrome (PTS), with manifestations of chronic venous insufficiency in the lower extremities. Animal studies have shown that post-thrombotic inflammation can trigger the development of an arteriovenous fistula (AVF), however, there is limited evidence for this phenomenon in patients with PTS. We describe the case of a spontaneous AVF in a patient with long-standing IVC thrombosis. It was postulated that the AVF could be compounding the venous hypertension and severe swelling of his lower extremities. The case additionally demonstrates the successful results of endovascular recanalisation for an occluded filter in the presence of an AVF.

scholarly journals Benefits and Limitations of Decision Support Systems (DSS) with a Special Emphasis on Weeds

Agronomy ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 548 ◽  
Author(s):  
Panagiotis Kanatas ◽  
Ilias S. Travlos ◽  
Ioannis Gazoulis ◽  
Alexandros Tataridas ◽  
Anastasia Tsekoura ◽  
...  
Keyword(s):  
Decision Support ◽  
Decision Support Systems ◽  
Weed Management ◽  
Crop Production ◽  
Support Systems ◽  
Management Strategies ◽  
Farming Systems ◽  
Climatic Conditions ◽  
Management Options ◽  
The Right

Decision support systems (DSS) have the potential to support farmers to make the right decisions in weed management. DSSs can select the appropriate herbicides for a given field and suggest the minimum dose rates for an herbicide application that can result in optimum weed control. Given that the adoption of DSSs may lead to decreased herbicide inputs in crop production, their potential for creating eco-friendly and profitable weed management strategies is obvious and desirable for the re-designing of farming systems on a more sustainable basis. Nevertheless, it is difficult to stimulate farmers to use DSSs as it has been noticed that farmers have different expectations of decision-making tools depending on their farming styles and usual practices. The function of DSSs requires accurate assessments of weeds within a field as input data; however, capturing the data can be problematic. The development of future DSSs should target to enhance weed management tactics which are less reliant on herbicides. DSSs should also provide information regarding weed seedbank dynamics in the soil in order to suggest management options not only within a single period but also in a rotational view. More aspects ought to be taken into account and further research is needed in order to optimize the practical use of DSSs for supporting farmers regarding weed management issues in various crops and under various soil and climatic conditions.

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