Felipe S. G. Fortes

The Posterior Pedicle Inferior Turbinate Flap: A New Vascularized Flap for Skull Base Reconstruction

Background: Expanded endonasal approaches (EEA) for the resection of lesions of the anterior and ventral skull base can create large defects with a significant risk of postoperative cerebrospinal fluid (CSF) leaks or exposure of the internal carotid artery. In these cases, a reconstruction using a vascularized flap facilitates rapid and complete healing of the defect. The Hadad‐Bassagasteguy flap (HBF), a posterior pedicle nasoseptal flap, is our preferred reconstructive option; however, a prior posterior septectomy or prior wide sphenoidotomies preclude its use. We have developed two additional pedicled flaps to reconstruct these selected patients: the transpterygoid temporoparietal fascia flap, which is suitable for large defects, and the posterior pedicle inferior turbinate flap (PPITF), the subject of this paper.

Transpterygoid transposition of a temporoparietal fascia flap: a new method for skull base reconstruction after endoscopic expanded endonasal approaches.

Background: Endoscopic expanded endonasal approaches (EEAs) for the resection of lesions of the anterior and ventral skull base can create large defects that present a significant risk of postoperative cerebrospinal fluid (CSF) leak. These defects, especially in patients who received preoperative radiotherapy, are best reconstructed with vascularized tissue. The Hadad‐Bassagasteguy flap, a pedicled nasoseptal flap, is our preferred method for reconstruction. This option is not available, however, in patients who underwent a previous posterior septectomy or in those with tumors that invade the pterygopalatine fossa (PPF) or sphenoid sinus rostrum. In this scenario, we have used a temporoparietal fascial flap (TPFF) for the reconstruction of large surgical defects.

Endoscopic anatomy of the pterygopalatine fossa and the transpterygoid approach: development of a surgical instruction model.

Introduction: The pterygopalatine fossa (PPF) is a narrow space located between the posterior wall of the antrum and the pterygoid plates. Surgical access to the PPF is difficult because of its protected position and its complex neurovascular anatomy. Endonasal approaches using rod lens endoscopes, however, provide better visualization of this area and are associated with less morbidity than external approaches. Our aim was to develop a simple anatomical model using cadaveric specimens injected with intravascular colored silicone to demonstrate the endoscopic anatomy of the PPF. This model could be used for surgical instruction of the transpterygoid approach.

Aortoesophageal fistula caused by aneurysm of the thoracic aorta: Successful surgical treatment, case report, and literature review

Aortoesophageal fistula induced by atherosclerotic thoracic aortic aneurysm is rare, but is usually a fatal disorder, with few survivors reported. We report the case of a 72-year-old man with aortoesophageal fistula successfully treated in a two-stage operation. In the first stage, we performed resection and replacement of the aortic aneurysm with a prosthetic graft in situ, esophagectomy, cervical esophagostomy, and jejunostomy. After the patient recovered well postoperatively, a transmediastinal retrosternal interposition of the stomach was performed, with esophagogastroanastomosis in the cervical area, to re-establish the gastrointestinal tract. We include a discussion of the causes, diagnostic approach, management of the aorta and esophagus, and review of the literature.

Melhora da qualidade de vida em crianças após adenoamigdalectomia

O aumento de volume das tonsilas palatina e faringea e um dos problemas mais frequentes do consultorio do otorrinolaringologista e e a principal causa de apneia obstrutiva do sono em criancas. OBJETIVO: Avaliar o impacto da adenoamigdalectomia na qualidade de vida em criancas com hiperplasia adenoamigdaliana. FORMA DE ESTUDO: Clinico prospectivo. MATERIAL E METODO: Trinta e seis pais ou responsaveis de criancas submetidas a adenoamigdalectomia foram entrevistados antes e apos a cirurgia atraves do questionario sobre qualidade de vida especifica desenvolvido por Serres et al., 2000, que inclui os dominios: sofrimento fisico, disturbios do sono, problemas de fala e degluticao, desconforto emocional, limitacao das atividades e preocupacao do responsavel. RESULTADOS: A qualidade de vida de todas as criancas melhorou apos a cirurgia. Foi observada correlacao direta entre o grau de obstrucao e disturbios do sono, preocupacao paterna, e na media dos dominios. Correlacionando-se os dominios entre si, observamos relacao estatistica entre sofrimento emocional e disturbios do sono, preocupacao paterna e disturbios do sono, limitacao das atividades fisicas e desconforto emocional. CONCLUSAO: O aumento das tonsilas e a apneia obstrutiva do sono pioram a qualidade de vida das criancas, principalmente pelo sofrimento fisico e disturbios do sono. A adenoamigdalectomia realmente traz uma melhora importante na qualidade de vida destes pacientes.

Endonasal endoscopic exposure of the internal carotid artery: An anatomical study

The aim of this work was to define the anatomical landmarks, limitations, and difficulties of obtaining internal carotid artery (ICA) exposure via endonasal endoscopic approaches (EEA).

Profile of voice professionals seen in a tertiary health center

UNLABELLED Work-related laryngopathy may have negative consequences for voice professionals. AIM To analyze the profile of voice professionals seen in a tertiary level hospital. STUDY DESIGN a longitudinal historical cohort. METHODS A retrospective analysis of patient files. Diagnosis was reached using videostroboscopy. RESULTS 163 patients (119 females and 44 males) were seen. The mean age was 36.5 years. Professionals included spoken voice users (salesman, teachers, telemarketers, receptionists, health professionals) and singers. The most frequent diagnoses were: minor structural changes (33%), nodules (22%), Reinkes edema (10%), and polyps (6%). A correlation was observed between smoking, age and gender; there was an association between smoking and Reinkes edema, leucoplasia and tabagism, females and Reinkes edema, nodules and minor structural changes, and also between patients aged over 40 years and Reinkes edema, and patients under 40 with nodules, laryngitis, and minor structural changes. Symptoms lasted more than 6 months in 74% of patients. CONCLUSION The profile of voice professionals seen in a tertiary hospital included spoken voice patients and singers. In our study minor structural changes predominated, followed by nodules, Reinke edema and polyps.

Mandibular Subluxation for Distal Cervical Exposure of the Internal Carotid Artery

Introduction: Surgical access to the distal segment of the cervical internal carotid artery (ICA) is a challenge because of the limited exposure imposed by bony structures and concern regarding cranial nerve and major vasculature injury. Our objective is to quantify the additional exposure of the distal cervical ICA obtained with mandibular subluxation (MS) compared with maneuvers that do not mobilize the mandible.

Tissue Maturation Correlating to Clinical Manifestations in Juvenile Angiofibroma

Objectives: Juvenile nasopharyngeal angiofibroma is a rare benign tumor that affects young male patients and shows a characteristic development from its origin. It is not a true neoplasm, but shows features of vascular processes, developing into a more fibrous condition. The aim of this study was to correlate the clinical manifestations and the histologic findings of the tumor. Methods: Thirty-six patients without previous treatment were studied. We correlated the incidence and duration of the clinical manifestations (nasal obstruction, epistaxis, nasal and/or pharyngeal tumor, and facial deformity) and morphometric histologic analyses of the central region of the tumor (number, caliber, and presence of muscle cells in the vessel wall, and tissue maturity and cellularity). Results: The duration of nasal obstruction, the presence of nasal and/or pharyngeal tumor, and facial deformity were significantly correlated with the number of vessels, the tissue maturation, and the cellularity of the tumor. Epistaxis showed a strong correlation with the presence of muscle fibers in the vessels. Conclusions: There are correlations between the duration of the clinical manifestations and histologic maturation in the central portion of the tumor.

Endoscopic anatomy of the approaches to the sellar area and planum sphenoidale

UNLABELLED The productive work between otolaryngologists and neurosurgeons has resulted in the emergence of endoscopic endonasal skull base surgery. The goal of the present study is to describe the endoscopic anatomy of the endonasal approach to the sellar region and planum sphenoidale, highlighting the key points of the surgical approach and the neurovascular landmarks. METHOD Descriptive study of the endoscopic endonasal dissection of 9 fresh cadavers with exposure of the anatomic structures. RESULTS The endoscopic endonasal ethmoidectomy and sphenoidotomy allows an expanded access to the sellar area and planum sphenoidale. The surface anatomy of the sphenoid sinus is easily identifiable and provides safe landmarks, guiding the intracranial dissection. CONCLUSION The endoscopic endonasal approach to the skull base by the ENT and neurosurgeon is feasible, but it requires adequate anatomical knowledge and endoscopic skills for its realization, which can be obtained by practicing in cadavers.