Osteoplastic Frontal Sinusotomy

1976 ◽  
Vol 85 (4) ◽  
pp. 523-532 ◽  
Author(s):  
James M. Hardy ◽  
William W. Montgomery
Keyword(s):  
Postoperative Complications ◽  
Revision Surgery ◽  
Frontal Sinus ◽  
Chronic Sinusitis ◽  
Operative Approach ◽  
Indications For Surgery ◽  
Sinus Infection

The operative approach and findings of 250 osteoplastic frontal sinusotomy operations performed from 1956 through 1972 at the Massachusetts Eye and Ear Infirmary are reviewed. Indications for surgery were symptomatic and/or complicated disease of the frontal sinus, including primary chronic sinusitis and osteoma or trauma with or without associated infection. Immediate postoperative complications were minor. Follow-up of at least three years was obtained in 83% of the patients, and 93% of these have no significant symptoms to date. A distressing problem of persistent postoperative frontal pain is discussed in detail. Revision surgery has been performed in 6% of patients due to recurrent frontal sinus infection. The reasons for failure are analyzed, and recommendations are made to minimize the possibility of recurrence.

The impact of increasing interbody fusion levels at the fractional curve on lordosis, curve correction, and complications in adult patients with scoliosis

2020 ◽  
pp. 1-10
Author(s):  
Dominic Amara ◽  
Praveen V. Mummaneni ◽  
Shane Burch ◽  
Vedat Deviren ◽  
Christopher P. Ames ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Revision Surgery ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Pelvic Incidence ◽  
Secondary Analysis ◽  
Lumbar Interbody Fusion ◽  
Curve Correction ◽  
Surgery Rates

OBJECTIVERadiculopathy from the fractional curve, usually from L3 to S1, can create severe disability. However, treatment methods of the curve vary. The authors evaluated the effect of adding more levels of interbody fusion during treatment of the fractional curve.METHODSA single-institution retrospective review of adult patients treated for scoliosis between 2006 and 2016 was performed. Inclusion criteria were as follows: fractional curves from L3 to S1 > 10°, ipsilateral radicular symptoms concordant on the fractional curve concavity side, patients who underwent at least 1 interbody fusion at the level of the fractional curve, and a minimum 1-year follow-up. Primary outcomes included changes in fractional curve correction, lumbar lordosis change, pelvic incidence − lumbar lordosis mismatch change, scoliosis major curve correction, and rates of revision surgery and postoperative complications. Secondary analysis compared the same outcomes among patients undergoing posterior, anterior, and lateral approaches for their interbody fusion.RESULTSA total of 78 patients were included. There were no significant differences in age, sex, BMI, prior surgery, fractional curve degree, pelvic tilt, pelvic incidence, pelvic incidence − lumbar lordosis mismatch, sagittal vertical axis, coronal balance, scoliotic curve magnitude, proportion of patients undergoing an osteotomy, or average number of levels fused among the groups. The mean follow-up was 35.8 months (range 12–150 months). Patients undergoing more levels of interbody fusion had more fractional curve correction (7.4° vs 12.3° vs 12.1° for 1, 2, and 3 levels; p = 0.009); greater increase in lumbar lordosis (−1.8° vs 6.2° vs 13.7°, p = 0.003); and more scoliosis major curve correction (13.0° vs 13.7° vs 24.4°, p = 0.01). There were no statistically significant differences among the groups with regard to postoperative complications (overall rate 47.4%, p = 0.85) or need for revision surgery (overall rate 30.7%, p = 0.25). In the secondary analysis, patients undergoing anterior lumbar interbody fusion (ALIF) had a greater increase in lumbar lordosis (9.1° vs −0.87° for ALIF vs transforaminal lumbar interbody fusion [TLIF], p = 0.028), but also higher revision surgery rates unrelated to adjacent-segment pathology (25% vs 4.3%, p = 0.046). Higher ALIF revision surgery rates were driven by rod fracture in the majority (55%) of cases.CONCLUSIONSMore levels of interbody fusion resulted in increased lordosis, scoliosis curve correction, and fractional curve correction. However, additional levels of interbody fusion up to 3 levels did not result in more postoperative complications or morbidity. ALIF resulted in a greater lumbar lordosis increase than TLIF, but ALIF had higher revision surgery rates.

Outcomes and survivorship after conversion of failed hip hemiarthroplasty to total hip arthroplasty

2019 ◽  
pp. 112070001989142 ◽  
Author(s):  
Nana O Sarpong ◽  
Matthew J Grosso ◽  
Akshay Lakra ◽  
Carl L Herndon ◽  
Emma Jennings ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Femoral Component ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Complication Rates ◽  
Conversion Surgery ◽  
Total Hip ◽  
Estimated Blood Loss

Background: Arthroplasty is the treatment of choice for elderly patients with displaced femoral neck fractures. When compared to total hip arthroplasty (THA), higher revision rates have been reported for hemiarthroplasty (HA). Conversion of failed HA to THA can be complex, especially in the elderly population at risk for revision surgery complications. We report a single institution’s experience with conversion of failed HA to THA at mid-term follow-up. Methods: We identified patients converted from failed HA to THA from 2006 to 2016. Clinical data including indication for index and conversion surgery, maintenance or revision of femoral component during conversion, operative time, estimated blood loss, postoperative complications, and need for revision surgery were collected. Descriptive statistics were analysed in SPSS. Results: The cohort included 21 men and 39 women (mean age of 74.5 years). The mean follow-up after conversion HA to THA was 2.8 years. During conversion surgery, the femoral component was revised in 75.0% and retained in 25.0% of cases. After conversion HA to THA, the rate of major complications and re-revision at 2 years was 11.7% and 10.0%, respectively. Femoral revision versus retention did not affect complication rates (11.1% vs. 6.7%; p = 0.31) or re-revision rates (8.9% vs. 13.3%; p = 1.0). Conclusions: In this high-risk population, mid-term follow-up demonstrated tolerable complication and re-revision rates, the majority of which were for instability. We observed high rates of femoral component revision during conversion THA, although this did not increase the likelihood of postoperative complications or need for future surgery.

scholarly journals Functional outcome of Lumber Spinal Stenosis in Laminectomy, Laminotomy and Unilateral approach

2020 ◽  
Vol 9 (2) ◽  
pp. 105-110
Author(s):  
Md Moshiur Rahman ◽  
SIM Khairun Nabi Khan ◽  
Robert Ahmed Khan ◽  
Md Rokibul Islam ◽  
Umme Kulsum Sharmin Zaman ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Loss ◽  
Spinal Stenosis ◽  
Revision Surgery ◽  
Surgical Outcome ◽  
Leg Pain ◽  
Patients Âgés ◽  
Unilateral Approach ◽  
Satisfactory Outcome

Objective: The objective of the study was to compare the surgical outcome between Bilateral Laminotomy, Laminectomy and Unilateral approach in Lumber Spinal Stenosis. Methods: One hundred forty four (144) patients were going to underwent three prospective surgery such as Bilateral Laminotomy (48 patients), Laminectomy (48 patient) and Unilateral approach (48 patients). This study conducted between 2009 to 2014 at private medical hospitals in Dhaka. All the patients ages are e” 40. All the patients were observed prospectively. Clinical outcomes for back and leg pain were analyses using Oswestry Disability Index (ODI) questionnaires and Swiss score. Results: Satisfactory decompression was accomplished in all patients. The complications were less in patients who had experienced Unilateral Laminotomy rather than Bilateral Laminotomy and Laminectomy. Mean age of patients were 52.16+/ - 6.87 years with the range of 40-68 years. Among them 101 patients are male (70.11%) and 43 patients are female (29.99%). The rates of improvements are 79.17% in Laminectomy, 85.1% in Bilateral Laminotomy and 91.9% in Unilateral Laminotomy. From here unilateral Laminotomy have quite better results than others. Minimum follow up period was 2 years. Conclusion: Unilateral Laminotomy has a satisfactory outcome in Lumber Spinal Stenosis surgery in comparison to rest of two approaches. Postoperative complications were minimum in respect to blood loss, hospital stay and revision surgery. Bang. J Neurosurgery 2020; 9(2): 105-110

scholarly journals Long terms results of Draf type III (modified endoscopic Lothrop) frontal sinus drainage procedure in 122 patients: a single centre experience

2011 ◽  
Vol 49 (2) ◽  
pp. 195-201
Author(s):  
C. Georgalas ◽  
F. Hansen ◽  
W.J.M. Videler ◽  
W.J. Fokkens
Keyword(s):  
Revision Surgery ◽  
Frontal Sinus ◽  
Symptom Burden ◽  
Drainage Procedure ◽  
Type Iii ◽  
Sinus Drainage ◽  
Sinus Obliteration ◽  
Revision Operations ◽  
Draf Iii

Objectives: To assess the effectiveness and factors associated with restenosis after Draf type III (Endoscopic Modified Lothrop) frontal sinus drainage procedure. Design: Retrospective analysis of prospectively collected data. Patients: A hundred and twenty two consecutive patients undergoing Draf III procedure for recalcitrant chronic frontal rhinosinusitis (CRS) (71%), frontal sinus mucocoele (15%), benign frontal sinus tumours (9%) and cystic fibrosis with severe CRS (5%) were followed up for an average of 33 months. Outcome measures: Symptom burden (Visual Analogue Scale and Rhinosinusitis Outcome Measure), patency of neo-ostium and revision surgery. Results: At the end of follow up, ninety percent of patients had a patent neo-ostium, while 88% were either clinically better or completely asymptomatic. Thirty-nine patients required endoscopic revision surgery and 9 eventually underwent frontal sinus obliteration. Sixty percent of revision operations were performed during the first two years. RSOM showed a significant improvement in both general and nasal symptoms while on a VAS, headache improved significantly. The only factor weakly associated with re-stenosis was the presence of allergy. There were no major complications during any of the procedures. Conclusion: Draf III Procedure is safe and effective for patients who have failed conventional frontal sinus procedures and a valid alternative to frontal sinus obliteration. Although the revision rate may appear to be quite significant, it can often be performed as an outpatient procedure and needs to be balanced against the reduced morbidity and the ease of follow-up.

scholarly journals Comparison between the draf IIc and standard draf IIb procedure for frontal sinus drainage: single center experience and comparison of outcomes

2020 ◽  
Vol 12 (5) ◽  
pp. 167-170
Author(s):  
Aigerim Kvarantan ◽  
Gorazd Poje ◽  
Livije Kalogjera
Keyword(s):  
Frontal Sinus ◽  
Chronic Sinusitis ◽  
Postoperative Recovery ◽  
Treatment Results ◽  
Related Data ◽  
Single Center Experience ◽  
Uneventful Postoperative Recovery ◽  
Sinus Drainage ◽  
Frontal Sinuses

Aims: Inadequate surgical frontal sinus drainage in chronic sinusitis cases refractory to conservative treatment results in a poor clinical response and is associated with recurrent frontal recess stenosis. Endonasal frontal sinus drainage procedures are classified according to Draf into three groups: DrafIIb enables unilateral orbit to septum drainage and the IIc is the extension of the IIb across the midline. The purpose of our report is to review chronic sinusitis cases treated at our Department using the standard (IIb) or modified (IIc) procedure and compare results. Methods: Patient- and surgery-related data were retrieved on patients operated between 2013 and 2016 for chronic frontal sinusitis using the standard/modified DrafIIb procedure.The modified IIb (i.e. IIc) procedure was performed so that both frontal sinus ostia were visualized by performing an intersinusseptectomy: the aim was to provide drainage to both frontal sinuses simultaneously. Results: In the observed period, 26 patients were treated: 12 using the modified DrafIIb (IIc) and 14 using the standard DrafIIb procedure. There were no significant differences between groups regarding age, sex, number of previous procedures or follow-up period. All patients had an uneventful postoperative recovery and there were no cases of re-stenosis observed in the DrafIIc group; there were seven cases of restenosis in the DrafIIb group.

scholarly journals Subsidence in Collarless Corail Hip Replacement

2015 ◽  
Vol 9 (1) ◽  
pp. 194-197 ◽  
Author(s):  
Veenesh Selvaratnam ◽  
Vishwanath Shetty ◽  
Vishal Sahni
Keyword(s):  
Rheumatoid Arthritis ◽  
Revision Surgery ◽  
Hip Replacement ◽  
X Rays ◽  
Indications For Surgery ◽  
Retrospective Case ◽  
Female Ratio ◽  
X Ray ◽  
Male To Female

The purpose of this study was to assess whether subsidence occurs in collarless Corail hip replacement (CCHR) and to ascertain the extent and timing of subsidence if present. Retrospective case notes analysis was performed. Sixty eight patients who had CCHR were identified from our database. Male to female ratio was 32:36. Their mean age was 74.2 years (range 37-95 years). Indications for surgery were osteoarthritis in 64 (94%) patients, rheumatoid arthritis in two (3%) patients and avascular necrosis in two (3%) patients. Subsidence was measured at 6 weeks, 6 months and 1 year post-op compared to initial post-op x-rays. At 6 weeks x-ray 21 patients did not have any subsidence, 18 patients had 1 millimeter (mm) subsidence, 10 patients had 2mms subsidence, 4 patients had 3mms subsidence, 5 patients had 4mms subsidence, 1 patient had 5mms subsidence, 4 patients had 6 mms subsidence and 1 patient each had subsidence of 7mms, 9mms, 11mms, 13mms and 26 mms respectively. When compared with 6 months x-rays only 2 patients had a further subsidence of 2mms while another patient had 3mms subsidence. No further subsidence occurred at 1 year follow up x-rays. One patient had revision surgery due to symptomatic subsidence (29mms) at 6 months follow up. Subsidence does occur in the first 6 weeks in collarless Corail hip replacement, and to a lesser extent until 6 months postoperatively, but does not progress further.

Sagittal alignment changes and postoperative complications following surgery for adult spinal deformity in patients with Parkinson’s disease: a multi-institutional retrospective cohort study

2020 ◽  
Author(s):  
Atsuyuki Kawabata ◽  
Toshitaka Yoshii ◽  
Kenichiro Sakai ◽  
Takashi Hirai ◽  
Masato Yuasa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postoperative Complications ◽  
Spinal Deformity ◽  
Revision Surgery ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adult Spinal Deformity ◽  
Loss Of Correction ◽  
Radiographic Parameters

Abstract Background: Parkinson’s disease (PD) has been reported to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, those studies are limited, and few have made direct comparisons with patients who do not have PD. Methods: A retrospective cohort study. We retrospectively reviewed all surgically treated ASD patients with at least a 2-year follow-up. Among them, 27 had PD (PD(+) group). Clinical data were collected on early and late postoperative complications as well as any revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. We compared the surgical outcomes and radiographic parameters of PD patients with those of non-PD patients. Results: For early complications, the PD(+) group demonstrated a higher rate of delirium than the PD(−) group. Deep vein thrombosis and pulmonary embolism rates tended to be higher in the PD(+) group. With regard to late complications, the rate of pseudarthrosis was significantly higher in the PD(+) group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD(+) group ( p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD(+) group. Conclusion: Extra attention should be paid to perioperative complications, especially delirium and thrombosis, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of pseudarthrosis were greater in these patients.

scholarly journals Postoperative Complications Following Ankle Fractures in the Geriatric Population: A Case Series

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0009
Author(s):  
Matthew Anderson ◽  
Aaradhana J. Jha ◽  
Sameer M. Naranje ◽  
Gean C. Viner ◽  
Haley McKissack ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Internal Fixation ◽  
Revision Surgery ◽  
Open Reduction ◽  
Illicit Drugs ◽  
Standard Procedure ◽  
Case Series ◽  
Ankle Fractures ◽  
Increased Risk

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures are among the most common orthopedic injuries. While open reduction and internal fixation (ORIF) is the standard treatment for displaced ankle fractures in younger patients, there is controversy regarding the optimal management of these injuries among geriatric patients due to the high prevalence of comorbidities. Closed manipulation leads to poor long-term functional outcomes, with high rates of malunion and non-union in all populations as well as higher mortality in patients over 65 years of age. However, surgical management in the elderly carries rates of complications as high as 20-40%. The purpose of this study was to investigate risk factors for healing complications following ORIF of ankle fractures in patients greater than 75 years of age. Methods: All patients 75 years of age and older undergoing open reduction and internal fixation of ankle fractures at a single institution from 2008 to 2018 were identified. Patients with polytrauma and/or pilon fractures were excluded. Patient medical records were reviewed to obtain information regarding details about the injury, surgery, and follow-up as well as patient demographics and comorbidities. Radiographs from post-operative clinic visits were examined by a foot and ankle certified orthopedic fellow for each patient and the time for complete union was recorded as well as any delayed union or malunion. Fisher’s exact tests were used to compare post-operative complications (wound infection, wound dehiscence, sepsis, deep vein thrombosis, revision surgery, and malunion/nonunion) among those with and without specific comorbidities. Results: Patients with other comorbidities had a statistically significant increased risk of revision surgery (p<0.0001). Additionally, those who used illicit drugs had statistically significant increased risk of sepsis (0.0213). Revision surgeries included syndesmotic screw removal, a standard procedure which does not necessarily imply presence of complication. Conclusion: Elderly patients are susceptible to various postoperative complications. Substance abuse is associated with revision surgery, while the presence of other comorbidities collectively is associated with sepsis. To optimize postoperative management, surgeons should be aware of patient comorbidities and exceptionally attentive at follow-up examinations for these patients.

scholarly journals Feasibility of a septal mucosal flap for preventing re-stenosis following the Draf III procedure

2017 ◽  
Vol 132 (1) ◽  
pp. 79-82 ◽  
Author(s):  
O Erdur ◽  
K Ozturk ◽  
K Erkan
Keyword(s):  
Revision Surgery ◽  
Frontal Sinus ◽  
New Technique ◽  
Nasoseptal Flap ◽  
Mucosal Flap ◽  
Frontal Recess ◽  
Common Problems ◽  
A New Technique ◽  
Draf Iii

AbstractBackground:Re-stenosis and a consequent need for revision surgery are the most common problems in the follow-up period following endoscopic modification of the Lothrop procedure.Method:This paper reports a new technique for reconstructing and resurfacing of the posterior frontal recess bone for prevention of re-stenosis.Results:A 46-year-old man presented with a frontal sinus osteoma, and treatment featured an endoscopic modification of the Lothrop procedure. A vascularised, posteriorly based, septal mucosal flap was used in reconstruction. There have been no reported issues over 24 months of follow up.Conclusion:The use of a nasoseptal flap seems feasible to reduce scarring and recurrence of (common) frontal recess stenosis after a Draf III operation.

scholarly journals Sagittal alignment changes and postoperative complications after adult spinal deformity surgery in patients with Parkinson’s disease: A multi-institutional retrospective study

2020 ◽  
Author(s):  
Atsuyuki Kawabata ◽  
Toshitaka Yoshii ◽  
Kenichiro Sakai ◽  
Takashi Hirai ◽  
Masato Yuasa ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Postoperative Complications ◽  
Spinal Deformity ◽  
Revision Surgery ◽  
Adult Spinal Deformity ◽  
Sacral Slope ◽  
Loss Of Correction ◽  
Mechanical Complications

Abstract Background: Parkinson’s disease (PD) has been reported to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, those reports are limited, and few have made direct comparisons with patients who do not have PD.Methods: We retrospectively reviewed all surgically treated patients with ASD and at least 2 years of follow-up. Among them, 27 had PD (PD(+) group). Clinical data were collected on early and late postoperative complications and revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. From the same database, we also retrieved 206 controls without PD (PD(−) group) matched for age, sex, and body mass index.Results: For early complications, the PD(+) group showed a higher rate of delirium than the PD(−) group. Deep vein thrombosis and pulmonary embolism rates tended to be higher in the PD(+) group. For late complications, the rate of pseudarthrosis was significantly higher in the PD(+) group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD(+) group (p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD(+) group.Conclusion: Extra attention should be paid to perioperative complications, especially delirium and thrombosis, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of revision surgery due to mechanical complications were higher in these patients.

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