Rotation-Transposition Correction of Nasal Deformity in Tessier Number 1 and 2 Clefts

2009 ◽  
Vol 46 (6) ◽  
pp. 674-680 ◽  
Author(s):  
Mamoon Rashid ◽  
Muhammad Zia ul Islam ◽  
Muhammad Sarmad Tamimy ◽  
Ehtesham ul Haq ◽  
Samina Aman ◽  
...  
Keyword(s):  
Lateral Nasal Wall ◽  
Nasal Deformity ◽  
Postoperative Results ◽  
Transposition Flap ◽  
Patients Âgés ◽  
Female Patients ◽  
Minimal Scarring ◽  
Flap Viability ◽  
Alar Rim

Objective: To formulate a standardized procedure for repair of the nasal component of Tessier number 1 and 2 clefts. Patients and Methods: The procedure was performed from 1998 to 2007 in 13 patients with congenital nasal clefts of different degrees of expression corresponding to Tessier 1 and 2. The patients’ ages ranged from 3 months to 28 years. There were 10 male and three female patients. In the absence of any standard published technique for these rare defects, we devised our own method, which we find uniformly applicable to all such cases. We use a composite muco-chondro-cutaneous lateral alar flap to recreate the alar rim. The resulting defect on the lateral nasal wall is then covered with a transposition flap from the dorsum. An alar rim z-plasty was added in cases where notching was evident. Results: In all cases, no problem of flap viability was encountered and all healed well with minimal scarring. The postoperative results were satisfactory and have remained stable over an average 6-month follow-up period. Conclusions: We recommend this technique to be used for the correction of nasal deformity associated with Tessier clefts number 1 and 2. We feel that this technique is relatively simple and easily reproducible.

Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

2015 ◽  
Vol 95 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Maria Angela Cerruto ◽  
Carolina D'Elia ◽  
Francesca Maria Cavicchioli ◽  
Stefano Cavalleri ◽  
Matteo Balzarro ◽  
...  
Keyword(s):  
Uterine Prolapse ◽  
Pelvic Organ ◽  
Consecutive Series ◽  
Complication Rates ◽  
Early Complications ◽  
Robot Assisted ◽  
Female Patients ◽  
The Mean ◽  
Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

scholarly journals The nasal cantilever technique in children undergoing primary cleft lip surgery: novel concepts and review

2020 ◽  
Vol 5 (1-2) ◽  
pp. 53-62
Author(s):  
Badr M. I. Abdulrauf
Keyword(s):  
Learning Curve ◽  
Cleft Lip ◽  
Nasal Bone ◽  
Case Series ◽  
Nasal Deformity ◽  
Challenging Issue ◽  
Primary Surgery ◽  
Novel Concept ◽  
Cleft Nasal Deformity

AbstractBackgroundNasal deformity associated with cleft lip deformity is a challenging issue, encompassing controversies, theories, and a diversity of techniques. Historically, esthetic outcomes have ranged from being below expectations to barely acceptable.MethodBased on the concept that the nasal cartilaginous framework in clefts is similar to that of a collapsing pyramid, a novel suspension technique has been described. The entire cartilaginous structure is lifted from the infratip segment with a loop suture and is secured in a cantilever fashion onto the periosteum overlying the nasal bone. This part of the operation is performed in a semiclosed manner. The technique is applied during primary surgery in bilateral and unilateral nasal cleft lip deformities, with changes in the orientation of the cantilever loop suture. Studies conducted by Masters S. Tajima, H. McComb, H. Thomson, D. Fisher, and J. Mulliken, which are most relevant to this article, have been reviewed and discussed throughout.ResultsThe technique was first applied over 10 years ago. A case series of nine children whose parents consented to the developing technique is presented with follow-up ranging from months to years, along with technical descriptions and illustrative drawings. None of these cases had preoperative orthopedic correction, molding, or postoperative nostril splints. The esthetic outcome was optimal enough; none of the cases requested a secondary correction.ConclusionThe nasal cantilever technique is a novel concept in cleft nasal deformity, which can be used in conjunction with an appropriate lip technique, per the surgeon’s discretion. Other than a learning curve, we believe that it provides a solid correction by securing the cartilaginous structures after they have been mobilized to a stable base, the nasion.

scholarly journals Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110075
Author(s):  
Rachel M. Frank ◽  
Hytham S. Salem ◽  
Catherine Richardson ◽  
Michael O’Brien ◽  
Jon M. Newgren ◽  
...  
Keyword(s):  
Bone Loss ◽  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Shoulder Stabilization ◽  
Simple Shoulder Test ◽  
Female Patients

Background: Nearly all studies describing shoulder stabilization focus on male patients. Little is known regarding the clinical outcomes of female patients undergoing shoulder stabilization, and even less is understood about females with glenoid bone loss. Purpose: To assess the clinical outcomes of female patients with recurrent anterior shoulder instability treated with the Latarjet procedure. Study Design: Case series; Level of evidence, 4. Methods: All cases of female patients who had recurrent anterior shoulder instability with ≥15% anterior glenoid bone loss and underwent the Latarjet procedure were analyzed. Patients were evaluated after a minimum 2-year postoperative period with scores of the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale. Results: Of the 22 patients who met our criteria, 5 (22.7%) were lost to follow-up, leaving 17 (77.2%) available for follow-up with a mean ± SD age of 31.7 ± 12.9 years. Among these patients, 16 (94.1%) underwent 1.6 ± 0.73 ipsilateral shoulder operations (range, 1-3) before undergoing the Latarjet procedure. Preoperative indications for surgery included recurrent instability with bone loss in all cases. After a mean follow-up of 40.2 ± 22.9 months, patients experienced significant score improvements in the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale ( P < .05 for all). There were 2 reoperations (11.8%). There were no cases of neurovascular injuries or other complications. Conclusion: Female patients with recurrent shoulder instability with glenoid bone loss can be successfully treated with the Latarjet procedure, with outcomes similar to those of male patients in the previously published literature. This information can be used to counsel female patients with recurrent instability with significant anterior glenoid bone loss.

scholarly journals Penile Reconstruction for a Case of Genital Lymphoedema Secondary to Proteus Syndrome

ISRN Urology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
F. Ashouri ◽  
J. Manners ◽  
R. Rees
Keyword(s):  
Urinary Catheter ◽  
Sexual Debut ◽  
Proteus Syndrome ◽  
Main Concern ◽  
Penile Skin ◽  
Penile Shaft ◽  
Cosmetic Appearance ◽  
Minimal Scarring ◽  
Thickness Skin

To our knowledge penile lymphoedema secondary to Proteus syndrome has not previously been reported. Hence we report a case of a 16-year-old male who was referred with features of right hemi-hypertrophy and severe lymphoedema affecting his scrotum and penis. He had previously undergone scrotal reduction surgery at the age of 13, but had since developed worsening penile oedema. His main concern was that of cosmetic appearance prior to sexual debut, and he also complained of erectile dysfunction. An MRI confirmed gross oedema of the penile skin, but normal underlying cavernosal structure, and no other anatomical abnormality. Under general anaesthesia, the entire diseased penile skin was excised. Two full thickness skin grafts were harvested from the axillae, and grafted onto the dorsal and ventral penile shaft respectively. A compressive dressing and urinary catheter was applied for 7 days. Follow-up at 4 months confirmed complete graft take with minimal scarring, and the patient was very satisfied with the cosmetic outcome. He had also noticed a recovery in erectile activity, and feels psychologically and physically more prepared for sexual relations.

Secretory Carcinoma in Children and Young Adults: A Case Series

2021 ◽  
pp. 109352662110469
Author(s):  
Caroline T Simon ◽  
Jonathan B McHugh ◽  
Raja Rabah ◽  
Amer Heider
Keyword(s):  
Case Series ◽  
Salivary Gland Neoplasm ◽  
Low Grade ◽  
Secretory Carcinoma ◽  
Patients Âgés ◽  
Male Predominance ◽  
Small Series ◽  
Children And Young Adults ◽  
Grade Malignancy

Secretory carcinoma (SC), previously known as mammary analogue secretory carcinoma, is a rare salivary gland neoplasm that typically presents as a slow-growing painless lesion in the head and neck. SC occurs mainly in adults but has been described in children with the youngest reported patient diagnosed at five years of age. In children the gender distribution has been reported as female to male ratio of 1:1.2. SC is generally considered a low-grade malignancy with characteristic morphological features and immunological profile. SC also harbors ETV6-NTRK3 fusion (t(12;15)(p13:q25)). Surgical resection with or without lymph node dissection is the standard treatment, with generally favorable clinical outcomes. Here we present a single institution case series of six patients (ages 9-21) with SC and a review of the previously described pediatric cases. Our small series showed male predominance in pediatric patients with predominantly low-grade and stage tumors. All cases underwent complete surgical resections and when follow up is available there was no evidence of recurrences or metastases. To the best of our knowledge, this is the only SC case series comprised exclusively of pediatric and youth patients.

scholarly journals Percutaneous Tennis Elbow Release Under Local Anaesthesia

2012 ◽  
Vol 6 (1) ◽  
pp. 129-132 ◽  
Author(s):  
MA Nazar ◽  
S Lipscombe ◽  
S Morapudi ◽  
G Tuvo ◽  
R Kebrle ◽  
...  
Keyword(s):  
Local Anaesthesia ◽  
Tennis Elbow ◽  
Long Term Results ◽  
Dash Score ◽  
Day Case ◽  
Horse Riding ◽  
Minimal Scarring ◽  
Percutaneous Release ◽  
The Mean

Introduction: When the non-operative treatment of tennis elbow fails to improve the symptoms a surgical procedure can be performed. Many different techniques are available. The percutaneous release of the common extensor origin was first presented by Loose at a meeting in 1962. Despite the simplicity of the operation and its effectiveness in relieving pain with minimal scarring this procedure is still not widely accepted. This study presents the long-term results of percutaneous tennis elbow release in patients when conservative measures including local steroid injections have failed to relieve the symptoms. Patients and Methods: Percutaneous release of the extensor origin was performed in 24 consecutive patients (seven male and seventeen female), providing 30 elbows for this study. The age of the patients ranged from 26 to 71 years with mean age of 55 years. The technique involved a day case procedure in the operating theatre using local anaesthesia without the need for a tourniquet. The lateral elbow was infiltrated with 5mls 1% lignocaine and 5mls 0.5% bupivicaine with 1:200,000 adrenaline. All operations were performed by the senior author. The patients were assessed post operatively by using DASH (disabilities of arm, shoulder and hand) score and Oxford elbow scores. The mean follow up period was 36 months (1-71months). Results: Twenty one patients returned the DASH and Oxford elbow questionnaires. Four patients were lost in the follow up. The post operative outcome was good to excellent in most patients. Eighty seven percent of patients had complete pain relief. The mean post-op DASH score was 8.47 (range 0 to 42.9) and the mean Oxford elbow score was 42.8 (range 16 to 48). There were no complications reported. All the patients returned to their normal jobs, hobbies such as gardening, horse riding and playing musical instruments. Conclusion: In our experience Percutaneous release of the epicondylar muscles for humeral epicondylitis has a high rate of success, is relatively simple to perform, is done as a day case procedure and has been without complications. Percutaneous release is a viable treatment option after failed conservative management of tennis elbow.

Gamma Knife surgery for pediatric arteriovenous malformations: a 25-year retrospective study

2012 ◽  
Vol 10 (5) ◽  
pp. 445-450 ◽  
Author(s):  
Eduard B. Dinca ◽  
Patricia de Lacy ◽  
John Yianni ◽  
Jeremy Rowe ◽  
Matthias W. R. Radatz ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Lesion Volume ◽  
Bleeding Rate ◽  
Patients Âgés ◽  
Obliteration Rate ◽  
Telephone Interviews ◽  
Presenting Symptoms ◽  
Martin Grade ◽  
The Mean

Object The authors present their 25-year experience in treating pediatric arteriovenous malformations (AVMs) to allow comparisons with other historic studies and data in adults. Methods Data were collected from a prospectively maintained departmental database selected for age and supplemented by case note review and telephone interviews as appropriate. Results Three hundred sixty-three patients, ages 1–16 years (mean ± SD, 12 ± 3.2 years), underwent 410 treatments; 4 had planned 2-stage treatments and 43 were retreated subsequent to an initial partial response. Fifty-eight percent received general anesthesia for the procedure. Sixteen percent had previously undergone embolization. The most common presenting symptoms were as follows: hemorrhage (80.2%), epilepsy (8.3%; overall seizure prevalence 19.9%), and migrainous headaches (6.3%). Only 0.28% of the AVMs were incidental findings. The mean lesion volume was 3.75 ± 5.3 cm3 (range 0.01–32.8 cm3), with a median Spetzler-Martin grade of III (range I–V). The mean peripheral (therapeutic) dose was 22.7 ± 2.3 Gy (range 15–25 Gy), corresponding to a mean maximum dose of 43.6 ± 6 Gy (range 25–51.4 Gy). The obliteration rate was 71.3% in patients who received one treatment and 62.5% for retreated patients, with a mean obliteration time of 32.4 and 79.6 months, respectively. The overall obliteration rate was 82.7%. No follow-up data are as yet available for the 4 patients who underwent the staged treatments. Only 4 patients received peripheral doses below 20 Gy, and the AVM was obliterated in 3 of these patients. The other patients received 20, 22.5, or 25 Gy and had obliteration rates of 82.6%, 77.7%, and 86.3%, respectively. The bleeding rate postradiosurgery was 2.2%, and the cumulative complication rate was 3.6%, with radionecrosis being the most common complication (1.1%). Conclusions Surprisingly, there was no correlation (p = 0.43) between outcome and radiosurgical dose when that dose was between 20 and 25 Gy, thus suggesting that the lower of these 2 doses may be effective. Radiosurgery for pediatric AVM is safe and effective.

Thoracoscopic Sympathectomy for Hyperhidrosis

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 652-657 ◽  
Author(s):  
Scott D. Wait ◽  
Brendan D. Killory ◽  
Gregory P. Lekovic ◽  
Francisco A. Ponce ◽  
Kathy J. Kenny ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Well Being ◽  
Sympathetic Chain ◽  
Horner’S Syndrome ◽  
Compensatory Sweating ◽  
Horner's Syndrome ◽  
Thoracoscopic Sympathectomy ◽  
Safe Treatment ◽  
Female Patients

Abstract BACKGROUND Hyperhidrosis (HH) profoundly affects a patient's well-being. OBJECTIVE We report indications and outcomes of 322 patients treated for HH via thoracoscopic sympathectomy or sympathotomy at the Barrow Neurological Institute. METHODS A prospectively maintained database of all patients who underwent sympathectomy or sympathotomy between 1996 and 2008 was examined. Additional follow-up was obtained in clinic, by phone, or by written questionnaire. RESULTS A total of 322 patients (218 female patients) had thoracoscopic treatment (mean age 27.6 years; range, 10–60 years). Mean follow-up was 8 months. Presentations included HH of the palms (43 patients, 13.4%), axillae (13 patients, 4.0%), craniofacial region (4 patients, 1.2%), or some combination (262 patients, 81.4%). Sympathectomy and sympathotomy were equally effective in relieving HH. Palmar HH resolved in 99.7% of patients. Axillary or craniofacial HH resolved or improved in 89.1% and 100% of cases, respectively. Hospital stay averaged 0.5 days. Ablating the sympathetic chain at T5 increased the incidence of severe compensatory sweating (P = .0078). Sympathectomy was associated with a significantly higher incidence of Horner's syndrome compared with sympathotomy (5% vs 0.9%, P = .0319). Patients reported satisfaction and willingness to undergo the procedure again in 98.1% of cases. CONCLUSION Thoracoscopic sympathectomy is effective and safe treatment for severe palmar, axillary, and craniofacial HH. Ablating the T5 ganglion tends to increase the severity of compensatory sweating. Sympathectomy led to a higher incidence of ipsilateral Horner's syndrome compared with sympathotomy.

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