phenylephrine-hydrochloride and Oral-Fistula

Oronasal fistula (ONF) is a common complication encountered after palatoplasty. Repair is indicated when symptoms impact speech and swallowing. In spite of the variety of surgical approaches described to repair these defects, recurrence rates remain high. Traditionally, successful closure is said to be achieved in using a double-layered approach due to the three-dimensional aspect of the defect. The extent of the fistula into the nasal cavity has incited an increased curiosity in using local endonasal flaps. In recent years, endonasal reconstructive procedures have seen increased interest and application, from cranial base defect repairs to orbital reconstruction and beyond. The nasoseptal (NSF) and inferior turbinate flaps (ITF) possess a robust arterial supply and an exceptional reach with excellent results demonstrated in large defect repair. However, the use of these flaps in ONF repair is scarcely discussed in the literature, and their effectiveness is relatively undetermined. In this manuscript, we present a series of three patients who underwent a triple layer ONF closure, with the oral portion incorporating a turn-in mucosal flap plus a local palate rotation flap or greater palatine artery pedicled-rotation flap, and a NSF or an ITF for the nasal portion of the defect.

Topics: Fistula; Humans; Nose; Nose Diseases; Oral Fistula; Plastic Surgery Procedures; Surgical Flaps

The purpose of this study was to evaluate a single center's experience with adult patients who had cleft lip, cleft palate, or both. The authors aimed to identify common long-term needs in this patient population and evaluated the relationship of team-based care in meeting those needs. To do so, the authors retrospectively reviewed chart records from a single private practice and tertiary referral cleft center for all patients who were ≥15 years of age and who had a history of clefts of the lip or palate, or both, from January 1, 2013, to June 30, 2014. The authors compared the concerns of the patients who received cleft-team-based care by a single, multidisciplinary cleft team; multiple multidisciplinary cleft teams; or no formal cleft team. The authors analyzed data for 142 patients. The most common patient concerns were lip aesthetics (64%), nose aesthetics (61%), septal deviations (47%), nasal obstruction (44%), malocclusion (32%), oronasal fistulas (29%), and speech (21%). Oronasal fistulas were more commonly reported in the group of patients who had care by multiple teams (42.9%; P < .001). Malocclusion was more commonly reported in the group of patients who had care by multiple teams (50%; P = .001). The authors found that adult patients who have undergone rehabilitation for cleft lip and palate appear to have a common set of long-term needs. Multidisciplinary cleft-team-based care appears to be the most effective way to address these needs.

Topics: Adolescent; Adult; Aged; Cleft Lip; Cleft Palate; Female; Humans; Male; Malocclusion; Middle Aged; Nose; Oral Fistula; Retrospective Studies; Speech; Time Factors; Treatment Outcome; Young Adult

Extranodal natural killer (NK-)/T cell lymphoma, nasal type (ENKL),

Topics: Asian People; Cellulitis; Chemoradiotherapy; Dacryocystitis; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Lymphoma, Extranodal NK-T-Cell; Middle Aged; Nose; Oral Fistula; Positron-Emission Tomography; Rare Diseases; Treatment Outcome

The management of oral fistula to the nose depends on its etiology, its size and its location. Here, we describe a simple technique, inspired by the ones initially developed by Bardach for cleft palates repair. The surgical alternatives are discussed.. The double palatal flap is a simple technique, allowing closure in a single session of a central or centro-lateral palate fistula. The key of this technique is the dissection between nasal and palate mucous layers, providing a sufficient amount of laxity to close the defect without tension.. The double palatal flap can cover centro-lateral palate mucosal fistulae. It provides both aesthetic and functional results in a single stage. Reliability, simplicity and quickness are its main advantages. Outcomes are usually simple; Velar insufficiency may occur, that can be corrected by speech therapy.

Topics: Fistula; Humans; Nose; Oral Fistula; Reproducibility of Results; Surgical Flaps

Bilateral complete clefts represent the result of an incomplete fusion with all the morphologic components present. It is well known that patients with bilateral cleft lip and palate have typical characteristics such as insufficient medial face development with an orthodontic class III tendency, flat nose and short columella with abnormal nasolabial angle, bilateral oronasal fistulas, alterations in the number and position of the lateral incisors, and agenesis or supernumerary teeth. Successfully solving these cases, results in a difficult challenge and studies showing extended follow-up are not frequent. Bilateral complete clefts, including medial facial dysplasia, are a rare condition, not only difficult to be included in any classification but also of complex solution. These patients require multiple surgical procedures throughout life, and long-term results are often still far from ideal. Due to surgical intervention and diminished intrinsic growth potential, surgical results may change from initially good into a progressively disappointing outcome. However, if the ideal timing and type of surgery are known, in combination with the intrinsic growth potential, these results could be ameliorated. A patient with complete bilateral cleft, presenting hypoplasia of philtrum and premaxilla, flat nose with rudimentary columella and septum, is reported. A description of her interdisciplinary treatment and long-term outcome with an adequate and stable result was observed. Being the intrinsic growth restriction mainly localized in the central mid-face, a protocol oriented to stimulate facial development during growth period could be essential to reduce the number of surgical procedures and prevent sequels. Early referral to a specialized center is mandatory to achieve a correct treatment and result.

Topics: Aftercare; Cleft Lip; Cleft Palate; Face; Female; Humans; Infant; Lip; Long Term Adverse Effects; Maxillofacial Development; Nose; Nose Diseases; Oral Fistula; Plastic Surgery Procedures; Time-to-Treatment

The objective of this study was to compare the surgical outcome between 2 patient groups with complete unilateral cleft lip and palate who underwent different types of palatoplasty.. This is a cohort study between 2 groups of patients with complete unilateral cleft lip and palate who were operated using different surgical techniques from 2008 to 2011. About 28 patients were operated using a primary lip nose repair with vomer flap for hard palate single-layer closure and delayed soft palate repair (modified Oslo protocol) and 32 patients were operated using our protocol in Lima. Data collection was accomplished by evaluation of symptomatic oronasal fistulas, presence of velopharyngeal insufficiency and evaluation of dental arch relationships (scored using the 5-year-olds' index).. Our comparative study observed statistically significant differences between the 2 groups regarding the presence of oronasal fistulas and velopharyngeal insufficiency in favor of our palatoplasty technique. A statistically significant difference was not found in functional vestibular oronasal fistula development between the studied techniques for unilateral cleft palate repair. This comparative study did not observe significant differences in dental arch relationships between the studied techniques.. In this study, better surgical outcome than modified Oslo protocol regarding oronasal fistulas and velopharyngeal insufficiency on patients with complete unilateral cleft lip and palate was observed. The results arising from this study do not provide evidence that one technique is enough to obtain better functional closure of the alveolar cleft and dental arch relationship at 5 years.

Topics: Child; Cleft Lip; Cleft Palate; Cohort Studies; Dental Arch; Female; Follow-Up Studies; Humans; Male; Nose; Oral Fistula; Palate, Hard; Palate, Soft; Peru; Surgical Flaps; Treatment Outcome; Velopharyngeal Insufficiency

Techniques vary for addressing the nasal floor during cleft lip repair in patients with a cleft lip and palate. Sometimes, no closure is performed, leaving a symptomatic alveolar fistula until the time of alveolar bone grafting. Often, medial and lateral skin flaps are used, but these are often thin and unreliable. Anatomical nasal lining flaps are used to improve closure with robust, well-vascularized flaps that anatomically close the nasal floor.. A retrospective chart review was performed to identify patients with a unilateral or bilateral cleft lip and palate who underwent primary cleft lip repair with nasal lining flaps or with medial and lateral flaps. The primary outcome was presence of a symptomatic and/or visible oronasal fistula.. Sixty-four patients were included. Thirty-seven underwent closure with nasal lining flaps, whereas 27 underwent closure using Millard medial and lateral flaps. The rate of symptomatic/visible fistulas after cleft palate repair was 19 percent (seven of 37) for patients with nasal lining flaps and 44 percent (12 of 27) for patients with medial and lateral flaps (p = 0.0509, Fisher's exact test). The alveolar fistula rate was 3 percent (one of 37) for patients with nasal lining flaps and 30 percent (eight of 27) for patients with medial and lateral flaps (p = 0.0032, Fisher's exact test).. Nasal lining flaps at the time of cleft lip repair effectively close the anterior nasal floor in patients with a unilateral or bilateral cleft lip and palate. Decreasing the presence of alveolar fistulas after cleft palate repair improves the quality of life for patients with cleft deformities.. Therapeutic, III.

Topics: Cleft Lip; Female; Humans; Infant; Male; Nose; Nose Diseases; Oral Fistula; Quality of Life; Respiratory Tract Fistula; Retrospective Studies; Surgical Flaps; Treatment Outcome; Wound Closure Techniques

Palatal fistulas anterior to the incisive foramen, generally seen as a complication of cleft lip and cleft palate repair, can be extremely difficult to repair. The requirements of the defect necessitate nasal lining, oral lining, and bone for maxillary arch continuity. Local pedicled flap has limited use in such patients with extensive scarring from previous surgeries. The authors have recently described a technique involving osteocutaneous free-tissue transfer of second toe for anterior oronasal fistulas.. The authors describe their experience of patients with anterior oronasal fistula who underwent osteocutaneous free-tissue transfer of second toe. Between 1991 and 2014, 3 patients with oronasal fistulas were operated utilizing bilaminar osteocutaneous free tissue transfer. Described are the surgical decision making, postoperative course, and surgical outcomes.. The mean age of the patients at the time of the procedure was 45.3 years with a mean follow-up of 12.6 years. All the patients had significant improvement of their regurgitation and speech difficulty. One of the patients with very large fistula had recurrence of the fistula which was repaired by local advancement of the original free flap.. Use of osteocutanous second-toe free flap can provide complete coverage of the fistula with nasal and oral skin lining and provides an alternative option for complicated anterior oronasal fistula.

Topics: Free Tissue Flaps; Humans; Middle Aged; Nose; Oral Fistula; Toes

Until now, there is no optimal technique for repairing oronasal fistula in patients with prior head and neck radiotherapy and trismus. Use of the silicone button is a safe, office-based, and validated method in this situation. The indications of this procedure are also clarified in this study. This is a retrospective study of four patients who underwent a newly designed endoscopic repair of oronasal fistula with silicone button under local anesthesia from July 2012 to August 2012. Data on the size of the defect, length of operation, symptom relief, and post-operative complications were collected. Four patients underwent endoscopic repair of oronasal fistula with silicone button under local anesthesia. The diagnoses were benign palate lesion s/p operation, oral cancer s/p operation and radiotherapy. The defect diameter varied from 1 to 1.5 cm. The operation durations were between 20 and 30 min. In all cases, nasal regurgitation symptoms were relieved. The hypernasality of one case improved, while another had decreased nasal crusting and foul odors. No major complications were noted. There was a minor complication in one case, which exhibited frequent crusting around the silicone button. Silicon button can act as a temporary obturator to improve quality of life of patients. The indications for this procedure include patient undergone head and neck radiotherapy with (1) chronic fistula (>6 months); (2) small defect (1-2 cm); and (3) trismus.. 4.

Topics: Aged; Endoscopy; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Mouth; Nose; Oral Fistula; Quality of Life; Radiotherapy; Retrospective Studies; Silicones; Taiwan; Treatment Outcome; Wound Closure Techniques

Cleft nose is an important sequela after primary cheiloplasty in cleft lip patients. Not touching the cleft lip nose in primary cleft lip repair was dogmatic in the past, although it meant severe functional, aesthetic, and psychologic problems for the child. Authors present their experience in one step lip, septum and nasal tip repair for this patients population.. From March 2012 to January 2013, during charity missions organized in Africa, 56 patients affected by cleft lip deformity and sequelas of previous cleft lip surgery were operated.. Two complications were recorded. A good nostril symmetry was reached in all the cases.. Authors present their experience in one step lip, septum and nasal tip repair for unilateral cleft lip patients. The big lack of this study is the absence of a long follow-up due to the surgery performed during charity missions. Thanks to the recent papers published in literature we can state that primary septal repositioning is a safe adjunctive technique to primary lip closure, although this operation reduces the psychosocial consequences of an otherwise uncorrected cleft nose deformity, it does not necessarily eliminate the need for a future operation.

Topics: Adolescent; Adult; Child; Child, Preschool; Cleft Lip; Esthetics; Female; Fistula; Humans; Infant; Male; Medical Missions; Nasal Septum; Nose; Nose Diseases; Oral Fistula; Plastic Surgery Procedures; Postoperative Hemorrhage; Rhinoplasty; Surgical Wound Dehiscence; Young Adult

A cleft lip and palate consists of fissures of the upper lip and/or palate, and is the most commonly seen orofacial anomaly that involves the middle third of the face. Early treatment of patients with a cleft lip and palate is important because of esthetic, functional, and psychological concerns. Nasoalveolar molding provides excellent results when started immediately after birth. This clinical report describes the presurgical management of an infant with a complete unilateral cleft of the soft palate, hard palate, alveolar ridge, and lip.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Dental Prosthesis Design; Humans; Infant, Newborn; Nose; Nose Diseases; Oral Fistula; Palatal Obturators; Palate, Hard; Palate, Soft; Preoperative Care; Respiratory Tract Fistula; Stents

The aim of this publication is to offer teams specializing in the primary and secondary treatment of labio-alveolar-palatal clefts a prosthetic evaluation for more rational management of the dental sequellae of clefts for patients who, when they reach adulthood, often wish to improve their facial esthetics, in which the dental element plays a significant part. The reorganization and restoration of the upper anterior teeth, and their esthetic integration with respect to the face and lips, would then be less of a problem for plastic surgeons or orthodontists. In this respect, the installation in this sector of implants, following ambitious bone surgery involving the sacrifice, in bilateral forms, of the teeth of the medial process is a protocol that could usefully be taken into account.

Topics: Anodontia; Bone Transplantation; Cleft Lip; Cleft Palate; Cooperative Behavior; Dental Implants; Dental Prosthesis, Implant-Supported; Esthetics, Dental; Humans; Incisor; Lip; Nose; Nose Diseases; Oral Fistula; Orthodontics, Interceptive; Palate, Soft; Patient Care Planning; Patient Care Team; Plastic Surgery Procedures; Respiratory Tract Fistula; Tooth Abnormalities; Tooth Extraction; Wound Healing

Most of palatal fistula occur from poor repairation of cleft palate, leaving an abnormal channel between mouth and nose. Palatal fistula can cause a series of complications, such as voice and hearing disorder, poor oral and nasal hygiene, psychological diseases and so on. However, hard palate fistula secondary to Leukemia infection is rarely seen, it hasn't been reported yet. We report one case with hard palate fistula and nasal septum perforation after Leukemia infection.

Topics: Fistula; Humans; Infections; Leukemia; Nasal Septal Perforation; Nose; Nose Diseases; Oral Fistula; Palate, Hard; Postoperative Complications

Oronasal fistulas are a frequent complication after cleft palate surgery. Numerous repair methods have been described, but wound-healing problems occur often. The authors investigated, for the first time, the suitability of multilayered amniotic membrane allograft for fistula repair in a laboratory experiment (part A), a swine model (part B), and an initial patient series (part C).. In part A, one-, two-, and four-layer porcine and human amniotic membranes (n = 20 each) were fixed in a digital towing device and the force needed for rupture was determined. In part B, iatrogenic oronasal fistulas in 18 piglets were repaired with amniotic membrane allograft, autofetal amniotic membrane, or small intestinal submucosa (n = 6 each). Healing was evaluated by probing and visual inflammation control (no/moderate/strong) on postoperative days 3, 7, 10, and 76. Histological analysis was performed to visualize tissue architecture. In part C, four patients (two women and two men, ages 21 to 51 years) were treated with multilayered amniotic membrane allograft.. In part A, forces needed for amniotic membrane rupture increased with additional layers (p < 0.001). Human amniotic membrane was stronger than porcine membrane (p < 0.001). In part B, fistula closure succeeded in all animals treated with amniotic membrane with less inflammation than in the small intestinal submucosa group. One fistula remained persistent in the small intestinal submucosa group. In part C, all fistulas healed completely without inflammation.. Amniotic membrane is an easily available biomaterial and can be used successfully for oronasal fistula repair. The multilayer technique and protective plates should be utilized to prevent membrane ruptures.. Therapeutic, V.

Topics: Animals; Biological Dressings; Cleft Palate; Female; Fistula; Humans; Male; Nose; Nose Diseases; Oral Fistula; Oral Surgical Procedures; Plastic Surgery Procedures; Postoperative Complications; Swine; Transplantation, Homologous; Treatment Outcome; Wound Healing

Crohn's disease (CD) is a chronic granulomatous inflammatory bowel disease which may also involve the extraintestinal organs such as joints, liver, skin and perianal tissue. Involvement of the nasal cavity is quite rare in CD. This case report presents a 28-year-old girl with CD and saddle nose deformity, alar collapse and palatal perforation as extraintestinal manifestations of the disease in addition to persistent truncus arteriosus-type 4.

Topics: Adult; Anodontia; Crohn Disease; Female; Humans; Nasal Obstruction; Nose; Nose Diseases; Oral Fistula; Truncus Arteriosus, Persistent

A seven month-old girl with bilateral choanal atresia presented to our institution with oro-nasal fistula secondary to a previous atresia repair. Examination revealed obstruction of both choanae and the presence of a fistula located in the hard palate. Endoscopic repair of the atresia and a two-layer closure of the fistula were carried out in one sitting. Follow-up of the patient for 6 months showed patent choanae and a healed palatal fistula.

Topics: Choanal Atresia; Endoscopy; Female; Humans; Infant; Nose; Oral Fistula

We investigated the effect of the bacterial flora of the nose and throat on the outcome of the initial repairs of the cleft palate in the presence of prophylactic antibiotics.. A retrospective review of 90 procedures in 66 patients who had cleft palate repair between April 2005 and June 2007 was conducted at Booth Hall Children's Hospital, Manchester, U.K. Both isolated cleft palate and cleft lip and palate patients were included. Exclusion criteria included syndromic cases, other medical disorders, and revisions of previous cleft palate repairs. Nose and throat swabs were taken on admission. Benzyl penicillin and flucloxacillin were given perioperatively. The occurrence of oronasal fistulas was correlated with the bacteria grown on culture.. The oronasal fistula rate was 15.9%. The highest fistula rate in procedures with positive swabs was seen with Moraxella catarrhalis.. M. catarrhalis has not been previously recognized as a pathogen in cleft palate repairs. This study demonstrates a higher fistula rate in procedures positive for M. catarrhalis. Other factors that may have contributed to the fistula formation include the severity of the initial cleft and technical factors. Further study is required before a definitive link can be established.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Cleft Lip; Cleft Palate; Floxacillin; Follow-Up Studies; Humans; Moraxella catarrhalis; Moraxellaceae Infections; Nose; Nose Diseases; Oral Fistula; Penicillin G; Pharynx; Postoperative Complications; Respiratory Tract Fistula; Retrospective Studies; Staphylococcus aureus; Streptococcus; Treatment Outcome

Repairs of the cleft nose, lip, and palatal deformity remain challenging endeavors for reconstructive surgeons. Postsurgical nasomaxillary hypoplasia is a common finding in patients with extensive clefts. This complex deformity has a pronounced impact on the social behavior and self image of the subject. Esthetic and functional rehabilitation of this postsurgical defect is scarcely reported in the literature. Support in the form of prostheses or stents to prevent tissue collapse is usually required in these patients following surgery. This clinical case presentation discusses the fabrication of an internal nasal stent for a cleft nose, lip, and palate patient following surgical reconstruction. Two prostheses using two prosthetic materials (Polymethyl methacrylate, flexible resin) were prepared to compare their efficacy. The final prostheses improved the patient's appearance, making the postsurgical defect less conspicuous.

Topics: Adolescent; Biocompatible Materials; Cleft Lip; Cleft Palate; Dental Prosthesis Design; Denture Design; Denture, Partial; Female; Humans; Maxilla; Nose; Nose Diseases; Oral Fistula; Palatal Obturators; Plastic Surgery Procedures; Polymethyl Methacrylate; Postoperative Complications; Prostheses and Implants; Prosthesis Design; Respiratory Tract Fistula; Stents; Treatment Outcome

This paper reports the case of a 50-year-old man who underwent superselective embolization after severe posterior rhinorrhagia caused by hypertension. Twelve hours after the procedure, left-sided hemiparesis and right-sided facial nerve paresis developed, followed by ulceration and necrosis of the soft palate, diaphragm, and right nasal ala. Reconstruction was implemented with porous polyethylene for the nasal pyramid, a forehead flap and a mucosal flap from the oral vestibulum for polyethylene coverage, and a rotational palatal flap for closure of the oroantral fistula. Exposure of the material occurred after 4 weeks, and removal was followed by satisfactory maintenance of the shape and function of the nose. Postembolization necrosis is a rare complication of the area, and there are very few similar reports in the literature.

Topics: Embolization, Therapeutic; Epistaxis; Facial Nerve Diseases; Facial Paralysis; Follow-Up Studies; Humans; Ischemia; Male; Maxillary Artery; Middle Aged; Mouth Mucosa; Necrosis; Nose; Nose Diseases; Oral Fistula; Palate, Soft; Paresis; Plastic Surgery Procedures; Polyethylene; Prosthesis Design; Prosthesis Implantation; Respiratory Tract Fistula; Skin Transplantation; Surgical Flaps

The aim of this study was to evaluate a modified surgical technique for premaxilla repositioning with concomitant autogenous bone grafting in bilateral trans-foramen cleft lip and palate patients.. The study included 50 bilateral trans-foramen cleft lip and palate patients. Bone graft was harvested from the mandibular symphysis in 24 patients. Whenever more grafting was necessary, the iliac crest bone was used as the donor site (26 patients). The premaxilla was displaced by rupturing the bone and the palatine mucosa, and repositioned in a more adequate position using a surgical guide. The premaxilla and the grafts were fixed with miniplates and screws or screws only. The surgical guide was kept in place for 2 months, whereas the miniplates and screws were removed after 6 months, together with the complete bilateral lip and nose repair. Follow-up examinations were performed at 3, 6, and 12 months by means of periapical and occlusal radiographs, and by clinical examination. Thereafter, the patients were referred for completion of the orthodontic treatment.. Overall, in 48 cases (96%) the treatment achieved total graft integration, with complete closure of the bucconasal and palatal fistulas, and premaxilla stability (either at first surgery or after reoperation). In the remaining 2 patients (4%), the treatment failed, due to necrosis of the premaxilla.. The procedure is complex and involves risk. However, the patient's social inclusion, especially at the addressed age group, is the best benefit achieved.

Topics: Bone Plates; Bone Screws; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Graft Survival; Humans; Male; Maxilla; Nasal Cavity; Necrosis; Nose; Nose Diseases; Oral Fistula; Osteotomy; Palate; Periosteum; Postoperative Complications; Respiratory Tract Fistula; Surgical Flaps

To determine the presence of Staphylococcus aureus in a nasal flora and oral environment, the correlation between frequency of transmission of S. aureus and oronasal fistula size, and the pattern of methicillin resistance on S. aureus strains in children with cleft lip and palate (CLP).. Thirty-two CLP children with and without oronasal fistulas, ranging in age from 5 to 13 years were examined for oronasal fistula presence and size. Stimulated saliva samples and nasal swab samples were taken and investigated for S. aureus presence. S. aureus presence and counts were correlated with fistula presence and size.. Saliva samples showed statistical differences between the groups with and without oronasal fistulas with an area ranging from 0.80 to 28.26 mm2. The S. aureus counts were significantly higher (r = .535, p = .002) in saliva samples from children with larger oronasal fistula. The S. aureus count was not significantly different (r = -.013, p = .942) in nasal samples compared with oronasal fistula size. Methicillin resistance with disk-diffusion method was recorded as sensitive (> or =13 mm) in all S. aureus strains.. The results of this study indicate a positive correlation between fistula size and S. aureus transmission to one oral environment through oronasal fistulae, and a positive correlation between frequency of S. aureus transmission and fistula size. All S. aureus strains were sensitive to methicillin. These results may have implications for preventive treatment of CLP children.

Topics: Adolescent; Child; Child, Preschool; Cleft Lip; Cleft Palate; Colony Count, Microbial; Disk Diffusion Antimicrobial Tests; Humans; Methicillin-Resistant Staphylococcus aureus; Nose; Nose Diseases; Oral Fistula; Respiratory Tract Fistula; Saliva; Staphylococcus aureus

Topics: Aged; Bandages; Female; Foreign-Body Migration; Humans; Nose; Nose Diseases; Oral Fistula; Palate, Hard; Polyps

This study presents a comparative analysis of current surgical approaches for the treatment of nasopharyngeal angiofibroma, including extension of tumors, postoperative morbidity, complications, and recurrence rate. Twenty-four patients who underwent surgery with the diagnosis of juvenile nasopharyngeal angiofibroma at our department between 1993 and 2003 were retrospectively reviewed according to their clinical presentation, surgical approaches, and prognosis. Radkowski staging scale was used for staging tumors. The transpalatal approach was used in 10 patients before 1999 with tumor stages between Ia and IIa. Transpalatal fistula was encountered in one. Nine patients underwent transnasal endoscopic surgery after 1999 with tumor stages between Ia and IIIa. Lateral rhinotomy in four patients and a degloving approach in one patient were used with tumor stages between IIa and IIIa; postoperative nasal crusting was the most annoying problem in these groups. Recurrent tumor was seen in only one patient who had undergone the transpalatal approach in the 12- to 56-month follow-up period. In this regard, the transnasal endoscopic approach can be used successfully in place of the transpalatal approach due to the former's lesser surgical morbidity and wide lateral exposure of the field in patients with nasopharyngeal angiofibroma. Also, many patients who underwent lateral rhinotomy for the removal of stage IIa, IIb, and IIIa tumors can successfully be treated using the transnasal endoscopic approach. In tumors that extend, infratemporal fossa lateral rhinotomy and degloving approaches provide the optimal exposure but have higher potential for morbidity than does transnasal endoscopic surgery.

Topics: Adolescent; Adult; Angiofibroma; Endoscopy; Follow-Up Studies; Humans; Male; Nasopharyngeal Neoplasms; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Nose; Nose Diseases; Oral Fistula; Palate; Postoperative Complications; Prognosis; Retrospective Studies

Patent nasopalatine ducts connecting the oral and nasal cavities are a rare developmental anomaly that has not been reported in the orthodontic literature. Only 36 cases of unilateral, central, or bilateral patent nasopalatine ducts are documented since the first publication in 1881. Some patients with this condition exhibit clinical symptoms, but not all elect to have definitive treatment with surgical repair or chemical ablation. This report describes the appearance of nasopalatine ducts in an adolescent male after rapid maxillary expansion [corrected]

Topics: Adolescent; Humans; Male; Nose; Oral Fistula; Palatal Expansion Technique; Palate, Hard; Respiratory Tract Fistula

We present an audit of primary cleft palate surgery in our unit including rates of two important post-operative complications. Multidisciplinary audit clinics ran from March 1998 to April 2002 to follow up all local patients with a cleft lip or palate who had undergone primary palatal surgery in our unit. One hundred and forty eight patients were studied. Patient ages at follow-up ranged from 3 years and 10 months to 17 years and 4 months. Two surgeons performed the primary surgery. One hundred and twenty eight Wardill-Kilner and 20 Von Langenbeck repairs were performed. We found a 4.7% rate of oro-nasal fistula development requiring surgical closure, and a 26.4% rate of velopharyngeal insufficiency (VPI) requiring subsequent pharyngoplasty. We noted that the type of cleft involved affected the rate of VPI, 16% of patients with unilateral cleft lip and palate versus 29.2% of patients with a solitary cleft palate requiring secondary surgery. Outcome of surgery was determined by a 'Cleft Audit Protocol for Speech' (CAPS) speech therapy assessment at follow-up clinics. Only 14.9% of all patients assessed demonstrated any degree of hypernasality. Our results compare favourably with other recent studies including the Clinical Standards Advisory Group (CSAG) report into treatment of children with cleft lip and palate.

Topics: Adolescent; Child; Child, Preschool; Cleft Palate; Female; Fistula; Humans; Infant; Male; Medical Audit; Mouth; Nose; Nose Diseases; Oral Fistula; Patient Care Team; Pharynx; Plastic Surgery Procedures; Postoperative Complications; Speech; Speech Therapy; Treatment Outcome; Velopharyngeal Insufficiency

Six cases that required soft-tissue replacement in the central midface are presented. The greatest number of flaps were used for large defects in patients with cleft palates who had undergone multiple previous operations. Several were for palatal defects attributable to cocaine abuse, and one was used for lining in a nasal reconstruction. There were no flap losses and, on the basis of these experiences, it is concluded that this is an excellent method for providing soft tissue in these difficult situations.

Topics: Adolescent; Aged; Child; Cleft Lip; Cocaine-Related Disorders; Forearm; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Oral Fistula; Palate; Plastic Surgery Procedures; Surgical Flaps

We report 3 new cases of a centrofacial destructive process associated with chronic nasal abuse of cocaine. This complex first described in 1988 is a rare entity involving sinonasal tract necrosis after cocaine abuse. Of special interest in this report is a male patient with columella and lip involvement instead of the more usual rhinopalatal destruction. This cocaine abuse complex should be included in the differential diagnosis of centrofacial midline destructive processes in young patients as the first diagnostic possibility. We suggest a management strategy for these patients.

Topics: Adult; Bone Transplantation; Chronic Disease; Cocaine-Related Disorders; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Nose Diseases; Oral Fistula; Oroantral Fistula; Palatal Obturators; Respiratory Tract Fistula; Rhinoplasty; Surgical Flaps; Turbinates

To compare growth, speech, and nasal symmetry outcomes of three methods of hard palate repair.. Consecutive available records of children born with unilateral bony complete cleft lip and palate over the period 1972 to 1992.. Identical management of lip, nose, alveolus, and soft palate. Hard palate repair by Cuthbert Veau (CV) from 1972 to 1981, von Langenbeck (vL) from 1982 to 1989, or medial Langenbeck (ML) from 1989 to 1991.. For growth: GOSLON yardstick or 5-year model index. For speech: articulation test. Nasal anemometry. For nasal symmetry: Coghlan computer-based assessment. All these measures were developed during the period of data collection but not for this project.. There was a strong trend toward more favorable anteroposterior maxillary growth with the change from CV to vL to ML techniques. This fell short of statistical significance because of the small sample size. There was a significant reduction in cleft-related articulation faults (p =.01) considered to be related to improved arch form. In the absence of improved rates of velopharyngeal insufficiency or nasal symmetry, increased surgical experience was discounted as a significant contribution to improved growth and articulation outcomes.. Reduced periosteal undermining and residual exposed palatal shelf from CV to vL to ML improved incisor relationships and articulation.

Topics: Child; Child, Preschool; Cleft Palate; Female; Humans; Infant; Male; Maxilla; Nose; Oral Fistula; Oral Surgical Procedures; Palate, Hard; Plastic Surgery Procedures; Speech Articulation Tests; Surgical Flaps; Treatment Outcome; Velopharyngeal Insufficiency; Voice Quality

To determine if oral bacteria colonize the cleft nasal floor in patients with unilateral oronasal fistula when compared with the unaffected nasal floor and whether the results obtained would be of benefit in assessing oronasal fistulae in the clinic.. Prospective study of 26 patients with cleft palate and unilateral oronasal fistula. Microbiological culture swabs were taken from the mouth and nasal floors of patients. The unaffected nasal floor was used as a control. Bacterial isolates were identified and compared in the laboratory by a senior microbiologist.. A significant growth of oral bacteria from the cleft nasal floor when compared with the unaffected nasal floor.. Four patients were excluded because no growth was found on any culture plate. In the remaining 22 cases, a light growth of oral flora was found in the cleft nasal floor in only 3 patients. No statistical correlation between culture of oral bacteria and the cleft nasal floor could be found (p =.12).. The relative lack of colonization of the cleft nasal floor by oral bacteria may reflect poor transmission of bacteria through the fistula, competition with commensal nasal flora, or an inability of oral bacteria to survive in a saliva-depleted area. The investigation is not helpful in the assessment of oronasal fistulae in the clinic.

Topics: Adolescent; Adult; Child; Child, Preschool; Fistula; Humans; Infant; Mouth; Nose; Nose Diseases; Oral Fistula; Prospective Studies

Nasal septal abscess is a rare complication of septal haematoma. Nasal obstruction and, less frequently, pain are the usual presenting features. We report a case of a nasal septal abscess in a 21-year-old female patient who developed a naso-oral fistula. To our knowledge this is the first report of such an unusual presentation of a septal abscess. The aetiology, pathogenesis and management of septal abscesses are discussed.

Topics: Abscess; Adult; Female; Fistula; Humans; Nasal Septum; Nose; Nose Diseases; Oral Fistula; Streptococcal Infections; Wounds, Nonpenetrating

Topics: Alveolar Process; Bone Transplantation; Cleft Palate; Facial Muscles; Fascia; Hearing Disorders; Humans; Lip; Maxilla; Maxillary Diseases; Mouth Mucosa; Nose; Nose Diseases; Oral Fistula; Speech Disorders; Surgical Flaps; Temporal Muscle; Tongue

Topics: Bone Transplantation; Humans; Mouth Abnormalities; Nose; Nose Diseases; Oral Fistula

Topics: Cleft Lip; Cleft Palate; Fistula; Humans; Mouth; Nose; Oral Fistula; Paranasal Sinuses