Mucosal Flap Research Articles

Unilateral arytenoid chondroplasty combined with minimally invasive mucosal flap plasty for bilateral vocal cord paralysis--clinical analysis of 66 cases

Objective: To analyze the efficacy of unilateral arytenoid chondroplasty combined with minimally invasive mucosal flap plasty in the management bilateral vocal cord paralysis. Methods: A total of 66 patients with bilateral vocal cord paralysis hospitalized in the First Hospital of Sun Yat-sen University from January 2018 to December 2023 were retrospectively analyzed, among whom there were 8 males and 58 females, with ages ranging from 35 to 86 years old(mean age (57.8±11.6) years). All patients underwent suspension laryngoscopic CO2 laser unilateral arytenoid chondroplasty and mucosal flap under general anesthesia. Postoperative follow-up period extended from 6 months to 6 years, with a median duration of 28 months. The study compared the degree of dyspnea and voice quality (subjective and objective evaluation) of the patients pre- and post-operatively, and analyzed the clinical differences between patients with and without preoperative or intraoperative tracheotomy, the extubation rate of tracheotomized patients, the recurrence rate, and the complication rate. Continuous variables conforming to normal distribution were tested by t-test and categorical variables by χ² test,the Wilcoxon rank-sum test was used to analyze the improvement in dyspnea before and after surgery. Results: Compared with the preoperative period, 59 patients showed improvement in postoperative dyspnea (U=161.5, P<0.01); there was no significant difference in voice disorder index 10, subjective auditory-perceptual assessment, and maximal vocalization time (P>0.05), all of which remained within the relative normal range. Tracheotomy was performed in 32 out of 66 patients, with predominantly degree Ⅲ- dyspnea (46.9%, 15/32), including 26 patients with preoperative tracheotomy and 6 patients with intraoperative tracheotomy. Among the 34 patients who did not undergo tracheotomy, the majority presented with degree Ⅱ-dyspnea (82.4%, 28/34). All patients achieved successful extubation following surgery, with a mean median time to extubation of 1 month. Conclusions: The combination of unilateral arytenoid chondroplasty and minimally invasive mucosal flap plasty represents a refined and effective therapeutic approach for bilateral vocal cord paralysis. This minimally invasive technique has the potential to reduce the rate of tracheotomy.

Short-Term Clinical and Technical Outcomes of a Modified Zenker's Peroral Endoscopic Myotomy (Z-POEM) With Mucosal Flap Incision.

Zenker's diverticulum (ZD) per-oral endoscopic myotomy (Z-POEM) is an effective treatment for symptomatic (ZD). A modification to Z-POEM is the mucosal flap incision (MFI). We describe the technical and clinical success of patients who underwent Z-POEM with MFI. We included patients who underwent Z-POEM with MFI for ZD at 8 international centers. The primary outcome was the rate of clinical success, assessed by post-procedure Kothari-Haber symptom score (KHSS) without retreatment. Secondary outcomes included technical success, serious adverse events, and clinical recurrence with need for retreatment. 36 patients (69% male, age 69 + 9 years) underwent Z-POEM with MFI for symptomatic ZD. Mean ZD size was 32 mm (+ 14). Clinical success was achieved in 35 (97%) cases. Median pre-procedure KHSS was 6 and median post-procedure KHSS was 1 (P <0.0001). Technical success was achieved in all cases. Mean procedure time was 57 minutes (+ 32), median follow up time was 196 days (IQR 39-499). There was one adverse event (3%) which was treated endoscopically. Z-POEM with MFI has a high rate of technical and clinical success. Prospective evaluation is needed to further validate this technique in patients with large ZD.

Raising a mucosal flap vs. tympanomeatal flap to repair subtotal perforations.

Raising a mucosal flap vs. tympanomeatal flap to repair subtotal perforations.

Endoscopic and Open Treatment Techniques for Posterior Glottic Stenosis in Children: A Systematic Review and Meta-Analysis.

To evaluate the outcomes of open and endoscopic posterior cricoid split grafting and mucosal flaps for the treatment of pediatric posterior glottic stenosis (PGS). COCHRANE Library, CINAHL, PubMed, and Scopus databases. Studies were grouped by treatment method. Outcomes included decannulation rate, improvement in airway obstruction, remaining vocal symptoms, and subsequent airway procedures. A meta-analysis of continuous measures and proportions (%) with 95% confidence interval (CI) was conducted. Nineteen studies with 223 patients were included, with 72 patients having isolated PGS. Twelve studies (n = 23) reported endoscopic repair (group 1), while seven studies (n = 49) reported open techniques (group 2). Most patients in group 1 and group 2 had grade IV PGS (55.9% [26.1%-83.5%] and 56.9% [30.5%-80.8%], respectively). Post-operatively, 70.8% [43.5%-91.7%] of group 1 patients had tracheostomies with 83.4% [62.1%-95.5%] subsequently being decannulated, whereas 97.3% [89.1%-99.8%] of group 2 patients had tracheostomies post-operatively with 90.2% [79.2%-96.5%] subsequently being decannulated. Group 1 and group 2 had 87.1% [70.5%-96.3%] and 84.4% [64.9%-95.5%] improvement in airway obstruction, respectively. There are multiple open and endoscopic surgical options for pediatric PGS. Posterior cricoid split with cartilage graft and mucosal advancement flaps can be performed for high PGS grades. Endoscopic and open techniques are efficacious with high decannulation rates and improvement in airway obstruction, with endoscopic surgeries offering a less invasive approach. Laryngoscope, 2024.

Modified diverticular peroral endoscopic myotomy with peridiverticular adhesiolysis and mucosal flap reconstruction

Modified diverticular peroral endoscopic myotomy with peridiverticular adhesiolysis and mucosal flap reconstruction

Nasal flap preservation in endoscopic dacryocystorhinostomy for nasolacrimal duct obstruction.

To compare surgical outcomes between the conventional endoscopic dacryocystorhinostomy (DCR) and a modified endoscopic DCR for the treatment of nasolacrimal duct obstruction (NLDO), and evaluate factors associated with the surgical success rate. Medical records of patients who underwent primary DCR surgery between January 2016 and July 2020 at the Otorhinolaryngology Department of Eye and Ear International Hospital, Lebanon were reviewed. The study group consisted of 50 consecutive modified endoscopic DCR and the control group consisted of 138 consecutive conventional endoscopic DCR. The success rates at 1y were 98.0% (49 out of 50) for modified DCR, significantly higher compared to 84.8% (117/138) for the conventional DCR; there was no significant difference in the success rate throughout the years in terms of both surgical techniques. The modified surgery vs traditional [adjusted odds ratio (aOR)=14.96] and having an adjunctive septoplasty surgery vs not (aOR=3.99) were significantly associated with higher odds of success. Mucosal flap preservation and apposition shows significant improvement in the surgical success rate. Moreover, there is no statistically significant difference found in terms of complication rate and mean operative time between the conventional and the modified techniques.

To evaluate the outcome of external dacryocystorhinostomy without flaps in the cases of adult chronic dacryocystitis

: To evaluatethe efficacy of external dacryocystorhinostomy without mucosal flaps in adult population.: In this prospective, non-comparative interventional study 50 adult cases with epiphora due to chronic dacryocystitis was selected. All patients were managed with external dacryocystorhinostomy without anastomosis of the nasal and lacrimal mucosal flaps and success rate was evaluated by relief of epiphora and lacrimal syringing on day 1, day 7, and then after 1 month, 3 months &amp; 6 months subsequently.: Total number of cases operated were 52 eyes with female preponderance (38 cases 78%), with left laterality (76%) with success rate of 92%. With mean operating time 27.71min. : External dacryocystorhinostomy without mucosal flaps is a better method of managing the cases of chronic dacryocystitis with higher success rate with minimal skill and time consumption.

Clinical Outcomes of Endonasal Dacryocystorhinostomy Using Fibrin Glue for Lacrimal Sac and Nasal Mucosal Flaps

Purpose: To assess the clinical outcomes of fibrin glue in endonasal dacryocystorhinostomy (DCR) for patients with primary nasolacrimal duct obstruction and to compare the surgical success rates between groups with the lacrimal sac flap using fibrin glue and without flap formation.Methods: In this prospective study, a total of 45 patients (63 eyes) underwent endonasal DCR. Fibrin glue was applied to the mucosal flap at the osteotomy site in the nasal cavity. The subjects were divided into two groups: group 1 (with lacrimal sac flap using fibrin glue), consisting of 20 patients (28 eyes), and group 2 (without flap), including 25 patients (35 eyes). To evaluate the two groups, subjective symptoms were asked to the patients, and endoscopic examinations were performed.Results: There were no statistically significant differences observed in terms of age, sex, timing of tube removal, or follow-up period between the groups. Group 1 showed significantly better results compared to the control group in terms of the degree of granuloma observed at 6 months postoperatively and the level of patient discomfort reported at 3 months postoperatively.Conclusions: Endonasal DCR with the lacrimal sac flap using fibrin glue achieves higher functional success, reduces patient discomfort at 3 months postoperatively, reduces granuloma formation at 6 months postoperatively, and improves membranous closure compared to flapless surgery.

Prevention, detection and management of adverse events of third-space endoscopy.

Third space endoscopy (TSE) or sub-mucosal endoscopy using a mucosal flap valve (SEMF) enables the endoscopist to operate in the deeper layers of the gastrointestinal tract or gain access to the mediastinal/peritoneal cavity for natural orifice transoral endoscopic surgery (NOTES). TSE procedures are essentially endoscopic surgical procedures with a variable learning curve. Adverse events (AEs) during TSE are specific and follow a certain pattern across the spectrum of TSE procedures. These can be broadly categorized according to either type of AE, time of presentation relative to the procedure or according to degree of severity. Three major categories of AEs encountered during TSE include insufflation related AEs, mucosal injuries (MIs) and bleeding. Other relevant AEs include infectious complications, aspiration pneumonia, post-procedural chest/abdominal pain, atelectasis, cardiac arrhythmias, pleural effusion and pulmonary embolism. Reported incidence of AEs during TSE procedures varies according to the type and complexity of procedure. Acquaintance regarding potential risk factors, technical tips and precautions, alarm signs for early recognition, assessment of degree of severity, morphological characterization of AEs and finally, expeditious selection of appropriate management strategy are crucial and imperative for successful clinical outcomes. The current review discusses the current evidence and practical guidelines for prevention, early detection and management of TSE-related AEs.

A Case of Nasoseptal Flap Reconstruction for Refractory Medial Canthal Fistula.

Sino-orbital cutaneous fistulas (SOCFs) are a rare and challenging complication from conditions including granulomatosis with polyangiitis. SOCFs are difficult to manage due to poor vascular supply, compromised tissue, and systemic immunocompromise, which lead to a high rate of recurrence. Given the overall rarity of SOCFs, optimal surgical repair remains controversial, with options ranging from conservative management, onlay grafts, and vascularized flaps. This case report describes a novel one-step approach to SOCF closure using a composite chondral mucosal nasoseptal flap in a patient with a large left medial canthal SOCF that had recurred despite 2 prior attempts at closure including a vascularized paramedian forehead flap. Nasoseptal flaps may provide vascularized mucosal tissue to allow for greater success in closure over traditional, external flaps, and skin grafts.

Long-term Outcome of Conjunctival Transposition Flaps for Contracted Sockets.

To assess the efficacy, and reintervention rate, of a conjunctival transposition technique in the treatment of contracted fornices in anophthalmic sockets. Retrospective case-note review of patients with contracted anophthalmic sockets who received a novel conjunctival mucosal transposition flap for augmentation of socket lining. Contracted anophthalmic sockets were categorized as grade 1 (minimal contraction), grade 2 (inferior and/or superior fornix), grade 3 (advanced scarring of the entire upper and lower fornices), and grade 4 (severe palpebral phimosis, recurrent cases, and irradiated sockets). Of 32 patients (56% male), 53% had mild-to-moderate contracted anophthalmic sockets (grades 1 or 2). The transposition flap was combined with secondary ball implantation (3 cases), ball exchange (1 case), primary orbital floor (1 case), or revisional floor (3 cases) implantation. By an average follow up of 9.2 years, 16% (5 cases with grade 3 or 4) required additional relining, with another patient declining further surgery; this yielding an overall anatomic success of 81% (100% in grades 1 and 2; 60% in grades 3 and 4). At the last follow up, 91% of patients had adequate socket lining and 94% reported a comfortable socket with stable prostheses. Having results similar to free grafting but without remote donor-site morbidity, this novel transposition flap satisfactorily addresses mild-to-moderate fornix contracture, and most patients achieve stable and comfortable prosthetic wear. Some patients with severe contracted anophthalmic sockets required further autologous grafting: this generally arose because the transposition flap included tissue from above the socket's horizontal raphé (with later contracture of the upper fornix).

Secondary cleft palate correction with 3D-printed thermoplastic polyurethane film – a case report

Cleft palate is an oronasal communication that can affect the area comprehending the lips and the soft palate. Its clinical signs vary depending on the degree of the defect and the age of the animal, ranging from nasal secretion, coughing, sneezing, halitosis, respiratory difficulty, aspiration pneumonia, and loss of body condition. Its diagnosis is based on inspection of the oral cavity and imaging tests. Palatal defects must be surgically corrected as quickly as possible, using mucosal flaps, grafts, or implants. A desire to evolve alternative treatments for cleft palates drives the search for ways to manufacture customized pieces. 3D printing and biomaterials have enhanced in detail and applicability; combined with design tools and imaging exams, they allow for the making of precise implants and anatomical models for the planning and execution of surgical procedures. This report describes the case of a female, mixed-breed feline treated at a veterinary clinic; it was diagnosed with secondary cleft palate, had a history of falling, and underwent previous palatoplasties with recurrence. A surgical reintervention was performed to implant a 3D-printed TPU film to close its secondary cleft palate.

Efficacy of injection of autologous adipose tissue in the treatment of patients with complex and recurrent fistula-in-ano of cryptoglandular origin

BackgroundAdipose tissue injections, a rich source of mesenchymal stem cells, have been successfully used to promote anal fistula healing. This study aimed to investigate the efficacy of adipose tissue injection in treating patients with complex and recurrent fistulas of cryptoglandular origin.MethodsWe conducted a prospective, single-center, open-label, non-randomized, interventional clinical trial from January 2020 to December 2022. We enrolled nine patients, who were evaluated after at least 12 months of follow-up. All patients had seton removal, fistula tract excision or curettage, and a mucosal flap if possible or, alternatively, an internal opening suture. We used a commercially available system to collect and process adipose tissue prior to injection. This system allowed the collection, microfragmentation, and filtration of tissue.ResultsSelected cases included six men and three women with a median age of 42 (range 31–55) years. All patients had an extended disease course period, ranging from 3 to 13 (mean 6.6) years, and a history of multiple previous surgeries, including two to eight interventions (a mean of 4.4 per case). All fistulas were high transsphincteric, four cases horseshoe and two cases with secondary suprasphincteric or peri-elevator tract fistulas. Six cases (66%) achieved complete fistula healing at a mean follow-up of 18 (range 12–36) months. Three cases (33.3%) experienced reduced secretion and decreased anal discomfort.ConclusionsIn patients with complex and recurrent fistulas, such as the ones described, many from palliative treatments with setons, the adjuvant injection of adipose tissue might help achieve complete healing or improvement in a significant percentage of cases.ClinicalTrialsThe study protocol was prospectively registered on ClinicalTrials.gov (NCT 04750499).

Comparative Study between Endoscopic Surgical Excision of Anterior Glottic Web with or without Keel Placement

Abstract Background A focal narrowing of the airway caused by fibrotic tissue at the level of the true vocal folds is known as anterior glottic web. Congenital anterior glottic webs are less common than acquired anterior glottic webs. Endotracheal intubation, laryngeal trauma or surgery close to the anterior commissure, radiotherapy, and, in rare cases, inflammatory processes can cause them at any age. Objective To decide the need for endoscopic keel placement for management of anterior glottic web, prevention of vocal cord adhesions and to reduce the recurrence. Patients and Methods This study was systematic review and meta-analysis study included research articles with the following criteria; retrospective, prospective, case series, case report studies, published in English language, in the last 25 years, only studies on humans, studies on congenital and acquired anterior glottic web, studies with endoscopic keel placement, and studies without keel placement. Results The main findings of the current study was that; among keel used studies, the recurrence proportion was 13.5% with 95% Confidence interval (5.5%-24.2%), the proportion of granulation from pooled studies was found in 3.44% with 95% Confidence interval (1.16%-7.5%)and regarding voice improvement in this meta-analysis high significant improvement (94.2%) with 95% Confidence interval (85.8%-99%) was reported; Recurrence among the 3 studies did not use keel was 30.6% with 95% Confidence interval (7%-61. 8%). However, the voice improvement was reported among 97.4% with 95% Confidence interval (91.5 %-99.9%) Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2019. Conclusion The optimal treatment of acquired anterior glottic web remains controversial; Placement of a keel has low recurrent rate and good voice improvement but had several disadvantages such as the need for two separate operations under general anaesthesia, prolonged recovery, and the risk of infection and granuloma formation. However other techniques as the mucosal flap technique had better voice improvement without granulation formation with high success rates.

Clinical classification, staging and treatment strategy of radionecrosis of the nasopharynx and skull base

Objective:To establish a staging system for guiding clinical treatment and prognostic risk assessment by retrospectively analyzing the cases with radionecrosis of the nasopharynx and skull base （RNSB） after radiotherapy for nasopharyngeal carcinoma. Methods:A total of 86 cases of RNSB from January 2019 to December 2022 visited Department of Otorhinolaryngology Head and Neck, the People's Hospital of Guangxi Zhuang Autonomous Region. Seventeen patients gave up the treatment, and 69 patients who underwent treatment were included for analysis. By analyzing the results of electronic nasopharyngolaryngoscopy combined with magnetic resonance （MR）, CT, and other imaging examinations, a staging system for RNSB was proposed. The relationship between the staging system and the surgical effectiveness and clinical prognosis was further analyzed. Results:According to the severity and extent of destruction of soft tissue, bone, and the adjacent neurovascular structures, the RNSB was categorized into closed type （n=5） and open type （n=64）, of which the open type was subdivided into five types: type Ⅰ（n=4）, type Ⅱ（n=6）, type Ⅲ（n=39, of which 21 cases were type Ⅲa and 18 cases were type Ⅲb）, type Ⅳ（n=12）, and type Ⅴ（n=8）. The clinical stage of RNSB were classified based on nasopharyngolaryngoscopy and imaging examinations, receiving the second course of radiotherapy or not, the involvement of the infection site, the extent of bone destruction, the degree of internal carotid artery involvement, and the degree of brain tissue necrosis: stageⅠ（1-2 scores）, 11 cases at stageⅡ（3-4 scores）, 24 cases at stage Ⅲ（5-6 scores）, and 30 cases at stage Ⅳ（ ≥ 7 scores or more）. Twenty-two patients chose conservative treatment （2 patients at stage Ⅰ, 3 patients at stage Ⅱ, 7 patients at stage Ⅲ, and 10 patients at stage Ⅳ）. Forty-seven patients chose nasal endoscopic surgical treatment （2 patients at stage Ⅰ, 8 patients at stage Ⅱ, 17 patients at stage Ⅲ, and 20 patients at stage Ⅳ）, of which 16 cases had received free mucosal flap and/or stented septum mucosal flap repair. Patients at stages Ⅰ, Ⅱ, and Ⅲ achieved satisfactory efficacy after surgical treatment. In addition, higher clinical stage was found to correlate with the worse prognosis and higher incidence of perioperative complications, which included failure of healing because of surgical site infection, cerebrospinal fluid nasal leakage, progressive osteonecrosis, nasopharyngeal hemorrhage, and death. Conclusion:The staging system proposed in our study can be used for early detection of RNSB during regular follow-up, and is also valuable for clinical treatment guidance and prognosis assessment.

Clinical analysis of resection and dura skull base reconstruction of cranionasal communication tumor in 31 cases

Objective:To explore the methods of resection, dura and skull base repair and reconstruction of cranionasal communication tumor. Methods:Data of 31 patients with cranionasal communication tumor who underwent dura and skull base reconstruction after tumor resection from 2018 to 2022 were collected. Follow-up lasted for 3 to 41 months. Results:A total of 31 patients were enrolled, including 20 males and 11 females. The ages ranged from 19 to 74 years, with a median age of 57 years old. There were 17 benign lesions（one case of hemangioma, one case of Rathke cyst, one case of squamous papilloma, one case of craniopharyngioma, two cases of meningocele, two cases of varus papilloma, two cases of meningioma of grade Ⅰ, three cases of schwannoma, four cases of pituitary tumor） and 14 malignant lesions（one case of osteosarcoma, one case of poorly differentiated carcinoma, two cases of varus papilloma malignancy, two cases of olfactory neuroblastoma, two cases of adenocarcinoma, two cases of adenoid cystic carcinoma, four cases of squamous cell carcinoma） . Sixteen cases underwent nasal endoscopy combined with craniofacial incision and 15 cases underwent nasal endoscopy surgery alone. Complete resection of the mass and dura and skull base reconstruction were performed in all 31 patients, and free graft repair was performed in 8 cases（fascia lata in 5 cases and nasal mucosa in 3 cases）. Twenty-three cases were repaired with pedicled flaps（septal mucosal flap alone in 11 cases, septal mucosal flap combined with free graft in 6 cases, and cap aponeurosis combined with free graft in 6 cases）. Eight out of 31 patients underwent skull base bone repair. Postoperative cerebral hemorrhage occurred in 1 case, cerebrospinal fluid leakage in 1 case, intracranial infection in 2 cases. All patients were successfully treated without severe sequelae. Cerebrospinal fluid leakage and intracranial infection occurred in one patient after radiotherapy, who recovered after conservative treatment. All 17 patients with benign lesions survived. Thirteen out of 14 patients with malignant lesions received radiotherapy after surgery, nine survived without recurrence, five cases recurred, of which 2 survived with tumor, one underwent reoperation and 2 died. Conclusion:Cranionasal communication tumors are high-risk diseases of anterior and middle skull base, and various surgical repair methods could be selected after complete resection of the tumor. Successful reconstruction and multidisciplinary cooperation are crucial for treatment outcome.

Advances in Skull Base Reconstruction After Transnasal Endoscopy

Endoscopic transnasal approach have experienced rapid development and gradual maturation in just a few decades (Kassam AB, Prevedello DM, Carrau RL, et al, 2011; Eloy J A, Vivero R J, Hoang K, et al, 2009). It has expanded from the removal of conventional pituitary tumours to the application of an endoscopic extended transsphenoidal approach for the resection of tumours in the intrasellar, suprasellar and even ventricular systems (Cappabianca P, Cavallo L M, Esposito F, et al, 2008). Larger bone and dural defects at the skull base, causing more severe postoperative complications and resulting in a multiplication of the healthcare burden (Eloy J A, Shukla P A, Choudhry O J, et al, 2013). Skull base Reconstruction after tumour removal has become a great challenge. Currently, skull base reconstruction is mainly divided into soft and rigid reconstruction, and soft reconstruction is represented by the technique of pedicled nasal septum mucosal flap (PNSF) (Thorp B D, Sreenath S B, Ebert C S, et al, 2014)0. As for rigid reconstruction, it is still controversial (Shin J, Forbes J, Lehner K, et al, 2019; Eloy J A, Shukla P A, Choudhry O J, et al, 2012). From the current studies, rigid reconstruction has a role that cannot be ignored. In this article, we will describe the development of skull base surgery and several high-profile skull base reconstruction techniques.

Long-term Results of Punctoplasty With Canalicular Triangular Flap in Punctal Stenosis.

The aim was to describe the punctoplasty technique with canalicular triangular flap, and present the long-term results of the technique in patients with inferior punctal stenosis. The files of the patients who were diagnosed with punctal stenosis grade 0, 1, and 2 and underwent a canalicular triangular flap were evaluated retrospectively. The study was approved by the local ethical committee of the University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul. The demographic data, symptoms, prior interventions, punctal stenosis grading, associated eye pathologies, fluorescein clearance test, Munk score, and follow-up time were recorded. The puncta were evaluated biomicroscopically, and photographs were taken at each visit. The patients with at least 6 months of follow-up were included in the study. The loss of epiphora symptom, positive dye disappearance, and puncti ≥grade 3 opening were accepted as a success. A hundred and nine inferior puncti of 64 patients with symptoms of epiphora and punctal stenosis diagnosis were included in the study. Thirteen eyes were excluded as they were diagnosed to have punctal atresia or canalicular stenosis of a variable degree beyond punctum. The rest 96 eyes of 55 patients-65 eyes of 36 females and 31 eyes of 19 males-were included in the study as having pure punctal stenosis. The mean age of the patients was 64.3 ± 9.01 years (40-88 years). Forty-one patients had bilateral and 14 patients had unilateral punctal stenosis. Sixty-six were grade 1, and 30 were grade 2. Epiphora was the most commonly reported symptom.The mean follow-up time was 21.17 ± 10.5 months (6-46 months). In 76 (79.1%) eyes of 96, Munk score was 0 and in 15 (15.6%) eyes, Munk score was 1. Anatomical success as having puncta larger than grade 2 was recorded in 97.9%, and functional success was recorded in 94.6% of anatomically successful eyes. No restenosis was recorded in any punctum. Although the techniques of 1-snip, 2-snip, 3-snip, and 4-snip punctoplasty are performed with variable success rates in punctal stenosis patients, there is always a risk of restenosis due to the incision of the flap and unpredictability of the way the tissues will epithelize. In the canalicular triangular flap technique, the canalicular mucosal flap is preserved, and the continuity of the lacrimal mucosa with conjunctiva is provided, which utilizes appropriate re-epithelization of the wound edges, resulting in a wide punctal opening for the upper lacrimal system in the long term.

Novel Technique for Median Cleft Lip Comprising the Simultaneous Formation of the Columella, Philtrum, and Cupid's Bow.

Numerous surgical techniques for median cleft lip repair have been described; however, most cause excessively sharp peaks or the collapse of Cupid's bow. We report a technique for median cleft lip repair using a mucosal skin flap and full-thickness skin graft and 15 years of follow-up. Our technique provides acceptable formation of the columella, philtrum, and the two peaks of Cupid's bow. In this paper, we cite our previously reported techniques and add new findings and discussion based on the long-term postoperative outcomes of this procedure. Advantages and disadvantages of this technique are discussed, and a possible solution to achieve a more satisfactory result is suggested. Advantages and disadvantages of this new technique are discussed, and a possible solution to achieve a more satisfactory result is suggested.

Flap Fixation in Endoscopic Dacryocystorhinostomy: A Comparative Study.

The usual procedure for nasolacrimal duct obstruction is dacryocystorhinostomy (DCR). Flap-based DCR techniques lead to better surgical outcome provided flaps do not dislocate in the post-operative period. This study was conducted to compare gelfoam with merocel tamponade for fixation of mucosal flaps in endoscopic DCR. Merocel tamponade was used for fixation of flaps in 26 patients. Gelfoam was used in 26 patients, and surgical results were compared. The surgical success rate was greater in merocel tamponade fixation with less complications. Merocel tamponade can be used successfully for mucosal flap fixation in endoscopic DCR for better surgical outcome.