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Canalplasty for auditory exostoses is reserved for symptomatic patients. This study reviewed the outcomes of our technique regarding cicatricial stenosis.
A chart review was conducted on patients undergoing canalplasty for auditory exostoses between 2002 and 2017. The surgical technique is described.
The study comprised 43 adults (50 operated ears). Exostoses were bilateral in 40 cases (94 per cent) and occlusive in 33 (66 per cent). After drilling, the external auditory meatus was covered with a graft in 34 cases (68 per cent) and a silicone sheet was used in 32 (64 per cent). Cicatricial stenosis appeared in eight cases (16 per cent). Skin grafts were not used in six of these eight cases (p < 0.04), and silicone sheets were used only in one of these eight (p < 0.01).
Canalplasty is challenging because of its potential complications. Our data showed that the use of skin grafts and silicone sheets to cover the bared external auditory meatus was associated with a lower rate of cicatricial stenosis.
An ancient yoga technique called sutra neti, which is extensively used in India to keep the sinuses healthy, led to complete velopharyngeal stenosis in a 67-year-old male patient who presented with bilateral nasal obstruction, mouth breathing, anosmia and a change in voice.
The patient was diagnosed by nasal endoscopy using a zero-degree Hopkins rod endoscope, and adhesions were released using coblation.
The patient had post-operative alleviation of symptoms and a patent velopharyngeal inlet on examination.
Vigorous sutra neti can lead to velopharyngeal stenosis. Release of the stenosis is then required to cure the nasal blockade.
The use of three-dimensional printing has been rapidly expanding over the last several decades. Virtual surgical three-dimensional simulation and planning has been shown to increase efficiency and accuracy in various clinical scenarios.
To report the feasibility of three-dimensional printing in paediatric laryngotracheal stenosis and discuss potential applications of three-dimensional printed models in airway surgery.
Retrospective case series in a tertiary care aerodigestive centre.
Three-dimensional printing was undertaken in two cases of paediatric laryngotracheal stenosis. One patient with grade 4 subglottic stenosis with posterior glottic involvement underwent an extended partial cricotracheal reconstruction. Another patient with grade 4 tracheal stenosis underwent tracheal resection and end-to-end anastomosis. Models of both tracheas were printed using PolyJet technology from a Stratasys Connex2 printer.
It is feasible to demonstrate stenosis in three-dimensional printed models, allowing for patient-specific pre-operative surgical simulation. The models serve as an educational tool for patients’ understanding of the surgery, and for teaching residents and fellows.
Takayasu’s arteritis is a rare idiopathic arteritis causing stenosis or aneurysms of the aorta, pulmonary arteries, and their branches. It usually occurs in women, but has been described in children.
The objective of this study was to determine the clinical presentation, demographic profile, vascular involvement, origins, management, and outcome of children diagnosed with Takayasu’s arteritis at a Southern African tertiary care centre between 1993 and 2015.
This is a retrospective analysis of all children with Takayasu’s arteritis captured on a computerised electronic database during the study period.
A total of 55 children were identified. The female:male ratio was 3.2:1, and the mean age was 9.7±3.04 years. Most originated outside the provincial borders of the study centre. The majority presented with hypertension and heart failure. In all, 37 (67%) patients had a cardiomyopathy with a mean fractional shortening of 15±5%. A positive purified protein derivative test was documented in 73%. Abdominal aorta and renal artery stenosis were the predominant angiographic lesions. A total of 23 patients underwent 30 percutaneous interventions of the aorta, pulmonary, and renal arteries: eight stents, 22 balloon angioplasties, and seven had nephrectomies. All patients received empiric tuberculosis treatment, immunosuppressive therapy, and anti-hypertensive agents as required. Overall, there was a significant reduction in systolic blood pressure and improvement in fractional shortening (p<0.05) with all treatments.
Takayasu’s arteritis is more common in girls and frequently manifests with hypertension and heart failure. The abdominal aorta and renal arteries are mostly affected. Immunosuppressive, anti-hypertensive, and vascular intervention therapies improve blood pressure control and cardiac function.
The pyriform aperture comprises the central area of facial bone structure. It is formed by the free corners of the nasal bone and the frontal processes of the maxillae, which articulate with each other at the nasomaxillary suture lines. Congenital nasal pyriform aperture stenosis might be linked to various craniofacial problems. This review presents all aspects of pyriform aperture stenosis and enlargement.
A literature search was conducted. Pyriform aperture definition, nasal development, congenital nasal pyriform aperture stenosis and pyriform aperture enlargement were reviewed.
One of the most common abnormalities is holoprosencephaly, which is a midline developmental deficiency that may also be present in combination with facial clefting. The aetiology of nasal pyriform aperture stenosis remains unclear. When diagnosed, the choice of treatment is between non-surgical and operative methods, depending on the seriousness of the problem. Provided the sufferer can maintain a secure air passage with the help of specialised medical procedures and respiratory tract adjuvants, operative therapy may be delayed.
The operative outcomes are extremely good, and the prognosis relies mainly on coexisting neural and endocrine problems. This paper evaluates the nasal pyriform aperture in detail.
Nasal stenosis is a rare but significant complication of chemoradiation treatment for nasopharyngeal carcinoma. It can cause distressing obstructive symptoms for the patient and potentially interfere with monitoring for recurrence. Quality-of-life indicators are known to be very poor in this group of patients; however, there is very little evidence in the literature as to management of this complication.
This paper presents an endoscopic day-case surgical procedure to address total posterior nasal stenosis, as conducted in three patients, which involves division of adhesions and removal of the posterior septum and posterior inferior turbinates, without the need for packing or stenting.
In this series, there was resolution of obstructive symptoms and no recurrence of stenosis during follow up (up to 20 months).
This endoscopic procedure performed to manage total nasal stenosis differs from those previously described in the literature, as post-operative stenting or packing is not required, and removal of the posterior aspect of the septum is performed routinely.
A theoretical study of an unsteady two-layered blood flow through a stenosed artery is presented in this article. The geometry of a rigid stenosed artery is assumed to be
-shaped. The flow regime is assumed to be laminar, unsteady and uni-directional. The characteristics of blood are modelled by the generalized Oldroyd-B non-Newtonian fluid model in the core region and a Newtonian fluid model in the periphery region. The governing partial differential equations are derived for each region by using mass and momentum conservation equations. In order to facilitate numerical solutions, the derived differential equations are nondimensionalized. A well-tested explicit finite-difference method (FDM) which is forward in time and central in space is employed for the solution of a nonlinear initial boundary value problem corresponding to each region. Validation of the FDM computations is achieved with a variational finite element method algorithm. The influences of the emerging geometric and rheological parameters on axial velocity, resistance impedance and wall shear stress are displayed graphically. The instantaneous patterns of streamlines are also presented to illustrate the global behaviour of the blood flow. The simulations are relevant to haemodynamics of small blood vessels and capillary transport, wherein rheological effects are dominant.
Anomalous aortic origins of the coronary arteries comprise approximately one-third of all coronary artery anomalies and are characterised by coronary arteries with anomalies of aortic origin involving abnormal courses, stenoses, and compression that can lead to myocardial ischaemia and sudden death. Operative techniques to treat these anomalies have not been standardised yet. Moreover, the management of potential complications has not been addressed. Common and rare forms of anomalous aortic origins of the coronary arteries are reviewed and understood standard techniques for an uncomplicated unroofing procedure are illustrated. Also noted are techniques that can be applied to unexpected anatomical findings and unwanted complications that could prove to be life-threatening. Several technical recommendations are offered.
Outpatient management of patients with structurally or functionally abnormal cardiac valves combines an ability to record an appropriate history, a directed physical examination, a knowledge of both the interpretation as well as the context of any associated testing, and an understanding of the care guidelines in the medical literature. This article attempts to integrate these various features to guide the clinician towards more appropriate and timely management of patients with cardiac valve disease.
Acquired airway stenosis can be challenging to manage endoscopically because of difficult field visualisation, instrument limitations and the risk of laser fire. At our institution, radiofrequency coblation has been successfully used for the resection of subglottic and tracheal stenosis in adults. This paper presents our experience with this technique.
A retrospective case note analysis of all cases of airway stenosis in adults from 2007 to 2012 was performed.
Ten adult patients underwent coblation resection for airway stenosis. All lesions were classified as McCaffrey stage I (i.e. less than 1 cm long). Causes of stenosis included: idiopathic stenosis (40 per cent), previous tracheostomy (30 per cent) and endotracheal intubation (20 per cent). Six patients (60 per cent) required a single procedure and 4 (40 per cent) required multiple interventions. All patients reported significant improvement in their symptoms following treatment. All patients were alive at the time of writing and none have required open resection.
Radiofrequency coblation is an attractive alternative technique for the treatment of idiopathic or acquired airway stenosis in adults.
Cicatricial pemphigoid can affect all mucosa of the upper aerodigestive tract; however, hypopharyngeal involvement is less frequent.
This paper presents a 69-year-old male diagnosed as having cicatricial pemphigoid who was experiencing difficulty swallowing. Videofluorography with barium swallow demonstrated narrow flow through the medial hypopharynx, but not through the lateral hypopharynx. Direct laryngoscopy revealed that the postcricoid hypopharyngeal lumen had become narrow due to circumferential scar formation. Interestingly, detached thin membranous webs were observed beyond the circumferential scar.
This report describes important videofluorographic and direct laryngoscopic findings showing rare hypopharyngeal involvement in a case of cicatricial pemphigoid.
Acquired nasopharyngeal stenosis typically occurs as a result of surgery or irradiation of the nasopharynx. Sarcoidosis has numerous manifestations in the head and neck region, although an association with nasopharyngeal stenosis has not previously been reported.
A 40-year-old man with sarcoidosis developed severe acquired nasopharyngeal stenosis. This was successfully managed with balloon dilatation, followed by pharyngoplasty with local pharyngeal flap reconstruction.
This report is intended to prompt consideration of nasopharyngeal stenosis as a potential cause of nasal obstruction in patients with sarcoidosis, and to draw attention to the need to consider sarcoidosis in the differential diagnosis of patients with acquired nasopharyngeal stenosis. We also demonstrate the viability of pharyngoplasty in the management of nasopharyngeal stenosis in the setting of sarcoidosis.
To illustrate a case of an iatrogenic mucosal tear in the trachea which caused a one-way valve effect, obstructing the airway and manifesting as post-extubation stridor.
We report a case of iatrogenic tracheal mucosal tear secondary to violent movement during intubation. The patient presented with post-extubation stridor that worsened over three days. Initial evidence suggested tracheal stenosis. Computed tomography scans revealed a mucosal tear at the level of the seventh cervical to second thoracic vertebrae. The tear was caused by forceful inflow of air as breathing became more and more difficult, resulting in a false tract. A tracheostomy changed the direction of airflow, bypassing the tear. The inflated tracheostomy tube cuff acted as a stent to keep the flap in place as healing occurred.
Iatrogenic laryngotracheal injuries are common, especially when endotracheal intubation is performed under unfavourable emergency conditions. A tracheal mucosal tear is a rare entity which is almost always undiagnosed. However, a tracheal mucosal flap may be suspected when changes in patient position alter the nature and severity of the resultant stridor and/or respiratory distress. In such cases, an inflated tracheostomy tube cuff should be kept in place for an adequate period, to act as a stent and help keep the flap in place while healing occurs.
This paper presents a numerical investigation of plaque growth in a diseased artery using the two-way fluid–structural interaction (FSI) technique. An axis-asymmetric 45% stenosis model is used as the base model to start the plaque growth approximation. The blood is modelled as a non-Newtonian fluid described by the Casson model. The artery tissue is assumed to be a nonlinear material. The two-way FSI simulation is carried out in a way that mimics the unsteady blood flow through a diseased artery by using a pulsatile flow condition. After each flow velocity cycle, the numerical results are extracted and used to modify the stenosis geometry based upon critical wall shear stress (WSS) values and an accepted relationship between the concentration of low density lipoprotein and WSS. The simulation procedure is repeated until the growth-updated stenosis morphology reaches 79% severity. The behaviour of the flow velocity is analysed at each growth stage, together with the WSS, to determine the change of plaque morphology due to growth. The effects of WSS and pressure on the artery wall at the final stage (79% severity) of the plaque growth model are also compared with results from the authors’ previous work, to demonstrate the importance of the morphology change in plaque growth modelling.
Most surgical endeavours are directed towards relieving stenosis of root canals or the spinal canal and/or stabilizing the spinal column. Correction of spinal curvatures is one of the major endeavours of spine surgeons. The spine can be regarded as two columns: anterior and posterior. The anterior column comprises the ligaments and bones back to the posterior longitudinal ligament (PLL) and the posterior column the elements posterior to the PLL. The spinal cord derives its blood supply from anterior and posterior longitudinal arteries arising from the vertebral arteries, and radicular arteries arising from the aorta. Trauma is the major cause of non-operative spinal cord injury (SCI) and, although vertebral fracture or dislocation is frequently present, SCI can occur when there is no radiographic abnormality. Epidural clonidine infusion has been shown to be effective and may avoid the possibility of staff attributing myelopathic symptoms to local anaesthetic effects.
To review cases of congenital external auditory canal anomaly with cholesteatoma, documenting clinical presentation, cholesteatoma site and extent, complications, and surgery.
Retrospective review of all cases of congenital canal anomaly with cholesteatoma treated between 1998 and 2009.
Of 41 cases with canal anomalies, 17 (43.9 per cent) had associated cholesteatoma. Medical records were unretrievable for four cases. Of the remaining 13 patients (five females and eight males, age range four to 73 years, mean 21 years), 10 presented chiefly with recurrent otorrhoea, two with postauricular discharge from mastoid abscess, and one with otalgia, postauricular tenderness and neck stiffness. Hearing loss was conductive in 10 patients (76.9 per cent) and sensorineural (severe to profound) in three. No facial nerve palsy was documented. Cholesteatoma was seen in all cases on high resolution computed tomography, and confirmed intra-operatively. Six patients underwent canalplasty with split skin grafting, and seven modified radical mastoidectomy. Six patients recovered well, two needed repeated canalplasty for soft tissue restenosis, and five needed cautery and split skin grafting for mastoid cavity granulation tissue.
Congenital canal anomaly is uncommon. Canal cholesteatoma should be suspected in all cases, and high resolution temporal bone computed tomography undertaken in all patients aged four years or more. In patients with otorrhoea, the risk of cholesteatoma is greater. Treatment is generally surgery; the type depends on the disease extent.
This paper is concerned with the numerical simulation of a thermodynamically compatible
viscoelastic shear-thinning fluid model, particularly well suited to describe the
rheological response of blood, under physiological conditions. Numerical simulations are
performed in two idealized three-dimensional geometries, a stenosis and a curved vessel,
to investigate the combined effects of flow inertia, viscosity and viscoelasticity in
these geometries. The aim of this work is to provide new insights into the modeling and
simulation of homogeneous rheological models for blood and a basis for further
developments in modeling and prediction.
To describe our technique of endaural meatoplasty for mastoid surgery, and to publish an online video demonstration.
After the endaural incision, a skin incision is accurately marked over the anterior conchal bowl, identified by pushing the anti-helix anteriorly. This should meet the line of the endaural incision superiorly and extend inferiorly to the lower anterior edge of the conchal cartilage. After performing the incision, a segment of conchal cartilage is removed. The soft tissue meatoplasty is facilitated by resecting a triangular segment of skin and underlying soft tissue medial to the conchal incision (on which it is based). The free edges are closed with absorbable sutures after the (attico)mastoidectomy.
We have used this method on 64 patients over the past two years. Satisfactory functional and cosmetic outcomes were achieved in all.
Our technique is simple, easy to learn, quick and effective in helping to achieve our goal of a dry mastoid cavity with an adequate meatoplasty.
We evaluated the efficacy of laryngotracheal reconstruction with costal cartilage grafting for the treatment of idiopathic laryngotracheal stenosis.
From January 2001 to December 2005, 129 patients with laryngotracheal stenosis were treated at our hospital. Of these patients, five (4 per cent) female patients whose ages ranged from 14 to 34 years were identified as having idiopathic laryngotracheal stenosis. These patients were treated with a modified laryngotracheal reconstruction with anterior costal cartilage grafting. A Montgomery T-tube remained in place for 12 to 22 months.
Three patients presented with grade three and two with grade two stenosis. Three patients were decannulated after one procedure, with normal respiratory function and good exercise tolerance; one patient was decannulated after two procedures. One patient failed decannulation. The mean time to decannulation was 13 months.
Laryngotracheal reconstruction with anterior costal cartilage grafting is a safe and effective method, and provides an alternative treatment for idiopathic laryngotracheal stenosis.