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This paper presents a novel method for spreader graft placement without dorsum resection in patients who have a deviated septum with a narrow internal nasal valve angle.
A Killian incision was used for the endonasal septoplasty, and all spreader grafts were harvested from excised deviated septal cartilages. Procedures were conducted under general anaesthesia at the same centre by the same surgical team that performed the endonasal procedure. Successful placement of spreader grafts was achieved endonasally.
Although the endonasal placement of spreader grafts seems to be more difficult than placement conducted by an open approach technique, an endonasal procedure has many advantages. Our technique provides surgeons with the opportunity to shorten operation time, obtain autologous septal graft material and secure the columellar architecture. Surgeons familiar with the classical (endonasal) septoplasty procedure can easily apply this technique to widen a narrow internal nasal valve angle, without corrupting nasal integrity.
This study aimed to evaluate retrospectively the results of experience with end-to-end anastomosis of cranial nerves VII and XII, performed due to transection of the facial nerve during acoustic neuroma removal.
We assessed the facial reanimation results of 33 patients whose facial nerves had been transected during acoustic neuroma excision via a retrosigmoid approach, between 1985 and 2006, and who underwent end-to-end hypoglossofacial anastomosis. We compared the facial nerve functions of patients receiving short term (two to three years) and long term (more than three years) follow up, and we assessed any complications of the anastomosis.
A House–Brackmann grade III facial function was achieved in 46.2 and 86.4 per cent of the patients in the short and long term, respectively. House–Brackmann grade IV facial function was achieved in 53.8 and 13.6 per cent of the patients in the short and long term, respectively. There was a statistically significant difference between the facial recovery results, comparing the short and long term follow-up periods (p = 0.03). Disarticulation was the most common complication, seen in 19 (57.6 per cent) patients; numbness of the tongue was the next commonest (10 (30.3 per cent) patients). None of the patients developed dysphagia.
Despite such morbidities as disarticulation and tongue numbness, end-to-end hypoglossofacial anastomosis is still an effective procedure for the surgical rehabilitation of static and dynamic facial nerve functions. Significant improvement in facial nerve function can occur more than three years post-operatively.
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