Choice of Material for Nasofrontal Duct Obliteration in Frontal Sinus Fracture

FACE ◽  
2021 ◽  
pp. 273250162110504
Author(s):  
John W. Rutland ◽  
Christopher P. Bellaire ◽  
Abigail Katz ◽  
Helen Liu ◽  
Annie Arrighi-Allisan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Graft ◽  
Frontal Sinus ◽  
Donor Site ◽  
Bone Grafts ◽  
Postoperative Outcomes ◽  
Management Algorithm ◽  
Sinus Infection ◽  
Increased Risk ◽  
Frontal Sinus Fracture

Introduction: Within the surgical management algorithm for frontal sinus fracture (FSF), the choice of material for nasofrontal duct (NFD) obliteration is controversial, and a multitude of materials have been described in the literature. The present study aims to perform a systematic review to determine postoperative outcomes associated with various NFD obliteration materials. Methods: Two independent reviewers identified studies to be included based on inclusion and exclusion criteria. Odds ratios and Fisher’s Exact Tests were then used to compare outcomes between cohorts based on the material used for NFD obliteration. Complications under review included donor site complications, reoperations, frontal sinus infections, cerebrospinal fluid leaks, cosmetic defects, persistent pain and/or headaches, and mucocele formation. Results: Twenty-nine studies met inclusion criteria. The use of a vascularized flap was associated with a reduced risk of reoperation and postoperative frontal sinus infection compared with non-flap materials (OR = 0.23 (CI: 0.05, 1.04), P = .05. The use of avascular bone graft was associated with an increased risk of reoperation (OR = 8.89 (CI: 2.24, 29.94), P < .001. Use of bone graft was associated with increased postoperative frontal sinus infection compared with non-bone materials (OR = 3.92 (CI: 1.28, 11.96)), P = .017 and postoperative mucocele formation, P = .0035. The use of bone graft was associated with increased risk of total postoperative complications (OR = 2.68 (CI: 1.41, 5.11), P < .01. Use of autologous materials was associated with decreased number of total complications when compared with non-autologous materials (OR = 0.13 (CI: 0.02, 0.99), P = .02. Conclusions: Avascular grafts, such as bone grafts, for NFD obliteration may be associated with an increased risk of reoperation. In particular, bone grafts are associated with higher rates of reoperation, postoperative infection and mucocele formation. Vascularized flaps appear to offer excellent postoperative outcomes with minimal operative morbidity. This systematic review may be useful in further refining the roles of certain materials in NFD obliteration for FSF surgery.

scholarly journals Frailty assessment in older urological patients prior to surgery: a systematic review and narrative synthesis

2020 ◽  
Vol 12 ◽  
pp. 175628722091661 ◽  
Author(s):  
Andrea Haren ◽  
Rajni Lal ◽  
David Walker ◽  
Rajesh Nair ◽  
Judith Partridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Care ◽  
Preoperative Assessment ◽  
Perioperative Period ◽  
Adverse Outcomes ◽  
Assessment Tools ◽  
Postoperative Outcomes ◽  
Narrative Synthesis ◽  
Standard Clinical Practice ◽  
Increased Risk

Background: Radical cystectomy (RC) and urinary diversion are the recommended treatment for patients with muscle invasive bladder cancer. This is complex surgery, associated with significant patient morbidity and mortality. Frailty has been shown to be an independent risk factor for adverse outcomes in several surgical populations. Preoperative assessment of frailty is advocated in current guidelines but is not yet standard clinical practice. Aims: This systematic review and narrative synthesis aims to examine whether patients undergoing RC are assessed for frailty, what tools are used, and whether an association is found between frailty and adverse outcomes in this population. Results: Nine studies, published within the last 4 years, describe the use of tools reporting to measure frailty in the RC population. All demonstrate increased risk of adverse postoperative outcomes with higher frailty levels. Only one study used a validated frailty tool. The majority of studies measure frailty using variations on a tool derived from a large database (ACS-NSQIP) effectively counting co-morbidities, rather than assessing the multidomain nature of the frailty syndrome. Conclusion: The recognition of frailty as an important consideration in the perioperative period is welcome. This systematic review and narrative synthesis demonstrates the need for collaboration in research and delivery of clinical care for older surgical patients. Such collaboration may provide clarity regarding terms such as frailty and multimorbidity, preventing the development of assessment tools inaccurately measuring these discreet syndromes interchangeably. More accurate assessment of patients in terms of frailty, multimorbidity and functional status may allow better modification and shared decision making leading to improved postoperative outcomes in older patients undergoing RC.

Managment of Frontal Sinus Fracture: Obliteration Sinus with Cancellous Bone graft

2011 ◽  
Vol 65 (4) ◽  
pp. 250 ◽  
Author(s):  
Sahib Muminagic ◽  
Tarikc Masic ◽  
Emina Babajic ◽  
Mithat Asotic
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Frontal Sinus ◽  
Cancellous Bone Graft ◽  
Frontal Sinus Fracture

scholarly journals Systemic Administration of PTH Supports Vascularization in Segmental Bone Defects Filled with Ceramic-Based Bone Graft Substitute

Cells ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 2058
Author(s):  
Holger Freischmidt ◽  
Jonas Armbruster ◽  
Emma Bonner ◽  
Thorsten Guehring ◽  
Dennis Nurjadi ◽  
...  
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Bone Grafts ◽  
Bone Graft Substitute ◽  
Therapeutic Strategies ◽  
Care Providers ◽  
Sprague Dawley ◽  
Duration Of Treatment ◽  
Autologous Bone ◽  
Autologous Bone Grafts

Non-unions continue to present a challenge to trauma surgeons, as current treatment options are limited, duration of treatment is long, and the outcome often unsatisfactory. Additionally, standard treatment with autologous bone grafts is associated with comorbidity at the donor site. Therefore, alternatives to autologous bone grafts and further therapeutic strategies to improve on the outcome and reduce cost for care providers are desirable. In this study in Sprague–Dawley rats we employed a recently established sequential defect model, which provides a platform to test new potential therapeutic strategies on non-unions while gaining mechanistic insight into their actions. The effects of a combinatorial treatment of a bone graft substitute (HACaS+G) implantation and systemic PTH administration was assessed by µ-CT, histological analysis, and bio-mechanical testing and compared to monotreatment and controls. Although neither PTH alone nor the combination of a bone graft substitute and PTH led to the formation of a stable union, our data demonstrate a clear osteoinductive and osteoconductive effect of the bone graft substitute. Additionally, PTH administration was shown to induce vascularization, both as a single adjuvant treatment and in combination with the bone graft substitute. Thus, systemic PTH administration is a potential synergistic co-treatment to bone graft substitutes.

scholarly journals Potential Use of Eggshell as Bone Graft Compared with Bovine for Bone Defect: A Systematic Review Study

2021 ◽  
Vol 9 (F) ◽  
pp. 470-473
Author(s):  
Hanif Andhika Wardhana ◽  
Mujaddid Idulhaq ◽  
Rhyan Darma Saputra ◽  
Rieva Ermawan ◽  
Musa Fasa Roshada
Keyword(s):  
Systematic Review ◽  
Bone Graft ◽  
Bone Regeneration ◽  
Bone Defect ◽  
Clinical Performance ◽  
Bone Grafts ◽  
Bone Tissue Regeneration ◽  
In Vivo Studies ◽  
Bovine Bone

Background : The use of Bone Graft in the management of Bone Defect is a challenge in the world of orthopedics. Recently, eggshell containing hydroxyapatite has become a new hope in the use of an economical and efficient bone graft in the treatment of bone defects. The aim of this systematic review was to explore the available literature on the clinical performance of eggshells as bone grafts in guided bone regeneration. Method : Two databases (PubMed and Cochrane) were searched from January 2010 to September 2020. Clinical trials using eggshells as bone grafts were included in the review. Animal and in vivo studies were excluded from the review. Results : A total of 202 studies were taken, then screened and 15 studies finally included. Clinical and radiological evaluations show complete recovery after the procedure. Comparison with synthetic hydroxyapatite shows similar healing characteristics. Conclusion : Eggshell compared to bovine showed no difference in bone healing. Within the limitations of the included studies, eggshells can be used safely and efficiently in integrated bone regeneration procedures. Keywords: Bone tissue regeneration; eggshell; bovine; bone defect; bone graft  

scholarly journals Postoperative Morbidity and Complications in Elderly Patients after Harvesting of Iliac Crest Bone Grafts

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 759
Author(s):  
Marie Sophie Katz ◽  
Mark Ooms ◽  
Marius Heitzer ◽  
Florian Peters ◽  
Philipp Winnand ◽  
...  
Keyword(s):  
Wound Healing ◽  
Elderly Patients ◽  
Bone Graft ◽  
Postoperative Morbidity ◽  
Iliac Crest ◽  
Donor Site ◽  
Bone Grafts ◽  
Scar Formation ◽  
Delayed Wound Healing ◽  
Gait Disturbances

Background and objectives: In oral and maxillofacial operations, the iliac crest is a commonly used donor site from which to harvest bone for augmentation prior to dental implantation or for reconstruction of jaw defects caused by trauma or pathological lesions. In an aging society, the proportion of elderly patients undergoing iliac crest bone grafting for oral augmentation is growing. Although postoperative morbidity is usually moderate to low, the age and health of the patient should be considered as risk factors for complications and delayed mobilization after the operation. The aim of this retrospective study was to evaluate the postoperative morbidity and complications in elderly patients after the harvesting of iliac crest bone grafts for oral surgery. Material and Methods: Data were collected from a total of 486 patients (aged 7–85) who had a surgical procedure that included the harvesting of iliac crest bone grafts for intraoral transplantation. All patients were operated on between 2005 and 2021 in the Department for Oral and Maxillofacial Surgery of the University Hospital in Aachen, Germany. As parameters for postoperative morbidity and complications, gait disturbances, hypesthesia of cutaneous nerves, incision hernias, iliac crest fractures, delayed wound healing, and unfavorable scar formation at the donor site were all evaluated. Results: The study was performed with 485 patients due to the exclusion of one patient as the only one from whom grafts were taken from both sides. When younger and older patients were compared, neither gait disturbances (p = 0.420), nor hernias (p = 0.239), nor fractures (p = 0.239), nor hypesthesia (p = 0.297), nor wound healing delay (p = 0.294), nor scar problems (p = 0.586) were significantly different. However, the volume of the graft was significantly correlated with the duration of the hospital stay (ρ = 0.30; p < 0.01) but not with gait disturbances (ρ = 0.60; p = 0.597). Additionally, when controlling for age (p = 0.841), sex (p = 0.031), ASA class (p = 0.699), preexisting orthopedic handicaps (p = 0.9828), and the volume of the bone graft (p = 0.770), only male sex was associated with the likelihood of suffering gait disturbances (p = 0.031). Conclusions: In conclusion, harvesting bone grafts from the anterior iliac crest for intraoral augmentation is a safe procedure for both young and elderly patients. Although there is some postoperative morbidity, such as gait disturbances, hypesthesia, scar formation, or delayed wound healing at the donor site, rates for these minor complications are low and mostly of short duration. Major complications, such as fractures or incision hernias, are very rare. However, in our study, the volume of the bone graft was associated with a longer stay in hospital, and this should be considered in the planning of iliac crest bone graft procedures.

Treatment of frontal sinus fracture by obliteration with iliac crest bone graft

2011 ◽  
Vol 40 (10) ◽  
pp. 1109
Author(s):  
R.O. Veras-Filho ◽  
M.F.R. Gabrielli ◽  
E.R. Watanabe ◽  
V.A. Pereira-Filho ◽  
M.A.C. Gabrielli
Keyword(s):  
Bone Graft ◽  
Frontal Sinus ◽  
Iliac Crest ◽  
Iliac Crest Bone Graft ◽  
Frontal Sinus Fracture

scholarly journals Sinus Preservation Management for Frontal Sinus Fractures in the Endoscopic Sinus Surgery Era: A Systematic Review

2010 ◽  
Vol 3 (3) ◽  
pp. 141-149 ◽  
Author(s):  
Kenny B. Carter ◽  
David M. Poetker ◽  
John S. Rhee
Keyword(s):  
Systematic Review ◽  
Frontal Sinus ◽  
English Literature ◽  
Management Strategies ◽  
Posterior Wall ◽  
Sinus Surgery ◽  
Search Terms ◽  
Pubmed Database ◽  
Frontal Sinus Fracture ◽  
Modern Era

We systematically reviewed the existing literature supporting the efficacy and safety of sinus preservation management for frontal sinus fractures in the modern era of endoscopic frontal sinus surgery. A systematic review of the English literature for the targeted objective was conducted using the PubMed database between January 1995 and August 2008. The PubMed database was queried using two major search terms of frontal sinus fracture or frontal sinus injury along with manual review of citations within bibliographies. Citations acquired from the primary search were filtered and relevant abstracts were identified that merited full review. Articles were identified that included any cohort of patients with frontal sinus fractures involving the frontal sinus outflow tract or posterior wall with sinus preservation management. A total of 231 citations were generated, and 56 abstracts were identified as potentially relevant articles. Sixteen articles merited full review, with seven articles meeting inclusion criteria for sinus preservation. There were 515 total patients in the studies with 350 patients managed with frontal sinus preservation. Similar short-term complications and effectiveness were found between fractures managed with sinus preservation and those with traditional management. Sinus preservation appears to be a safe and effective management strategy for select frontal sinus fractures. More transparent reporting of management strategies for individual cases or cohorts is needed. A standardized algorithm and categorization framework for future studies are proposed. Longer-term follow-up and larger prospective studies are necessary to assess the safety and efficacy of sinus preservation protocols.

scholarly journals The Use of Bone Grafts, Bone Graft Substitutes, and Orthobiologics for Osseous Healing in Foot and Ankle Surgery

2019 ◽  
Vol 4 (3) ◽  
pp. 247301141984901 ◽  
Author(s):  
Jonathan R. Peterson ◽  
Fangyu Chen ◽  
Eugene Nwankwo ◽  
Travis J. Dekker ◽  
Samuel B. Adams
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Bone Grafts ◽  
Bone Graft Substitute ◽  
Autologous Bone Graft ◽  
Donor Site Morbidity ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
Bone Graft Substitutes

Achieving fusion in osseous procedures about the foot and ankle presents unique challenges to the surgeon. Many patients have comorbidities that reduce osseous healing rates, and the limited space and high weightbearing demand placed on fusion sites makes the choice of bone graft, bone graft substitute, or orthobiologic agent of utmost importance. In this review, we discuss the essential characteristics of grafts, including their osteoconductive, osteoinductive, osteogenic, and angiogenic properties. Autologous bone graft remains the gold standard and contains all these properties. However, the convenience and lack of donor site morbidity of synthetic bone grafts, allografts, and orthobiologics, including growth factors and allogenic stem cells, has led to these being used commonly as augments. Level of Evidence: Level V, expert opinion.

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