Vestibular Stenosis Research Articles

Smallpox: what every otolaryngologist should know

Objective In light of recent terrorist events and the potential threat of smallpox as a biological agent, we present information concerning smallpox to better inform the otolaryngologist concerning this disease and its prevention. Study design We performed a review of the smallpox and smallpox vaccination literature over the past 200 years using MEDLINE, PREMEDLINE, Centers for Disease Control and Prevention Internet site, World Health Organization Internet site, and references found in previous publications not found in MEDLINE or PREMEDLINE. Our search focused on the pathogenesis, clinical presentation, course, unique manifestations in the head and neck, diagnosis, and treatment of smallpox, as well as the method of smallpox vaccination, vaccination contraindications, and complications. Results Smallpox is a viral disease with a high mortality rate. Its clinical course, manifestations, and methods of prevention are carefully analyzed in light of otolaryngology practice. Conclusion Smallpox manifestations in the head and neck often presented as acute airway obstruction and also as long-term sequelae such as ectropion, nasal vestibular stenosis, conductive hearing loss, and blindness. Most chronic sequelae involve the head and neck. Smallpox vaccination is effective but not without potential serious risks.

Indications and use of composite grafts in 100 consecutive secondary and tertiary rhinoplasty patients: introduction of the axial orientation.

The fragile alar rims are complex structures whose specialized and supportive skin ensures the competence of the external valves and the patency of the inlets to the nasal airways. A chart review was performed of 100 consecutive secondary or tertiary rhinoplasty patients in whom the author had placed composite grafts before February 1999. Follow-up continued for at least 12 months. In 94 percent of the patients, composite grafts were harvested from the cymba conchae by removing the cartilage with its adherent anterior skin. In 6 percent of the patients, independently indicated alar wedges supplied the grafts. Six patients required secondary procedures to thin the alar rims, but such revisions have not been necessary since primary contouring of the cartilaginous graft component was instituted. Three auricular donor-site complications (one keloid, two thickened graft contours) were successfully revised through office procedures. Prior cosmetic rhinoplasty in a patient with normal alar cartilage anatomy exceeded all other etiologies as the cause of the deformity for which composite grafts were indicated (50 percent). The second most common etiology was deformity from prior rhinoplasty in a patient with alar cartilage malposition (33 percent of patients). Congenital deformities (7 percent of patients), trauma (6 percent), and prior tumor ablation (4 percent) comprised the remaining etiologies. Composite grafts were used most frequently to correct alar notching or asymmetry in rim height (43 percent of patients) or to provide an increase in apparent or real nasal length (28 percent). External valvular incompetence (14 percent of patients), nostril or vestibular stenosis (11 percent), or combined vestibular stenosis and lateral alar wall collapse (4 percent) were less common indications. Most composite grafts were oriented in the coronal plane (parallel to the alar rims). However, nostril or vestibular stenosis was corrected by sagittally placed composite grafts, and a third orientation (axial plane), to the author's knowledge not described previously, was used in patients with combined nostril stenoses and flattening of the alar walls. In this secondary rhinoplasty series, iatrogenic alar rim deformities or stenoses following cosmetic rhinoplasty dominated other causes requiring composite graft reconstruction (83 percent of patients). Of these 83 patients, 39.7 percent had preexisting alar cartilage malpositions, further supporting the importance of making accurate anatomical diagnosis part of every preoperative rhinoplasty plan.

Rhinoplasty in the cleft-lip patient: a retrospective study

Introduction. The aim of this study was to evaluate the postoperative results of secondary rhinoplasty in cleft-lip patients.1 Methods. In total 155 patients were evaluated. Series I: n = 52 (1988–94) Five bilateral and 47 unilateral clefts; male/female ratio: 25:27; age: 15–44 years; follow-up: 1–6 years. Series II: with adjusted technique and postoperative treatment (vestibulum device n = 83) n = 103 (1994–2000), 22 bilateral and 81 unilateral clefts; male/female ratio: 54:49; age: 9–52 years; follow-up: 1–5 years. Results. Series I: • subjective and objective functional-aesthetic improvement: 95% • slight to moderate recurrence of the caudal septal deviation: 30% • recurrence of severe vestibular stenosis: 10% Series II: • subjective and objective functional-aesthetic improvement: 98% • slight to moderate recurrence of the caudal septal deviation: 9% • recurrence of severe vestibular stenosis: 2% Considering the results of series I, the surgical technique was adjusted to prevent the recurrence of the caudal septal deviation and a specific postoperative treatment was developed to prevent scar retraction leading to recurrence of severe vestibular stenosis (custom-made vestibulum device). Conclusion. Adjustment of the surgical technique and the use of a custom-made vestibulum device resulted in a considerable improvement of postoperative results of secondary rhinoplasty in the cleft-lip patient.

Auricular composite grafting to repair nasal vestibular stenosis

Nasal vestibular stenosis is defined as a narrowing of the nasal inlet resulting in airway obstruction. Causes include nasal trauma, infection, and iatrogenic insults. The objectives of this article are to illustrate nasal vestibular stenosis and to analyze common causes and surgical treatments. The operative technique of the senior author (M.S.K.), will be presented. Donor site morbidity and patient outcomes will be discussed. Sixteen patients were seen during a 5-year period. Eleven women and 5 men were evaluated and found to have nasal vestibular stenosis. Three patients had stenosis as a result of nasal fracture or laceration. Stenosis developed in the remaining 13 as a result of nasal surgery. All patients underwent auricular composite grafting, and grafts took in 100%. Partial skin slough occurred in up to 50%; however, re-epithelialization was seen within 3 weeks. Complications were seen at the donor site. Immediate patient satisfaction was seen and continues during long-term follow-up. (Otolaryngol Head Neck Surg 2000;122:529-32.)

Auricular composite grafting to repair nasal vestibular stenosis.

Nasal vestibular stenosis is defined as a narrowing of the nasal inlet resulting in airway obstruction. Causes include nasal trauma, infection, and iatrogenic insults. The objectives of this article are to illustrate nasal vestibular stenosis and to analyze common causes and surgical treatments. The operative technique of the senior author (M.S.K.), will be presented. Donor site morbidity and patient outcomes will be discussed. Sixteen patients were seen during a 5-year period. Eleven women and 5 men were evaluated and found to have nasal vestibular stenosis. Three patients had stenosis as a result of nasal fracture or laceration. Stenosis developed in the remaining 13 as a result of nasal surgery. All patients underwent auricular composite grafting, and grafts took in 100%. Partial skin slough occurred in up to 50%; however, re-epithelialization was seen within 3 weeks. Complications were seen at the donor site. Immediate patient satisfaction was seen and continues during long-term follow-up.

Endoscopically guided midfacial degloving in infants for removal of congenital and acquired midfacial masses

Midface degloving allows excellent exposure for a variety of congenital and acquired pediatric facial masses. The petite facial skeleton of the infant and child, however, can limit the utility of this dissection, thereby necessitating external approaches and altered cosmesis. Endoscopic assistance can aid in safe and complete removal of these masses without the need for external surgical approaches. In this series, five infants underwent midfacial degloving for midface lesions. Those masses that could not be adequately visualized underwent midfacial degloving with endoscopic assistance. Successful surgical removal was accomplished without complications, with follow-up ranging from 1 to 5 years. No surgical nasal deformity, vestibular stenosis, or decrease in midfacial growth was noted. Midfacial degloving with endoscopic guidance in selected cases is a cosmetically appealing option for lesions not otherwise resectable by standard midface degloving.

Correction of nasal vestibuler stenosis

This short report deals with a case of nasal vestibular stenosis in a child following healing of acid bums and its early surgical correction. The fabrication of a special stent and its use in preventing recurrence of the contracture is also discussed.

Winter Meeting of the American Academy of Facial Plastic and Reconstructive Surgery

The following reports are from the 1993 Winter Meeting of the American Academy of Facial Plastic and Reconstructive Surgery held at the Boca Raton (Fla) Resort on January 15 and 16, 1993. Since 1975, nasal continuous positive airway pressure has been used as the primary mode of respiratory support in infants at Columbia-Presbyterian Hospital, New York, NY. Short, wide nasal prongs are used to increase the airflow, which reduces the incidence of upper and lower airway complications. The presentation by<b>Jeffery Ahn, MD</b>, discussed the complications of this method, which resulted in nasal deformities from pressure necrosis. These include alar and vestibular stenosis as well as columellar notching and transection. Treatment consists of scar revision and/or composite grafting followed by padded nasal stenting for 2 months. A historical overview of the cleft lip nose preceded the report of a series of revision cleft lip rhinoplasties by<b>Wayne Larrabee, Jr, MD</b>

The midfacial degloving approach to sinonasal disease.

The midfacial degloving approach was first described by Casson et al. in 1974 but despite a number of papers in the American literature advocating its use, it has not gained popularity in Europe. The advantages and application of the technique are presented in 36 patients, ranging from 7-78 years of age. The approach is ideally suited for extensive benign lesions in the nasal cavity, ethmoid and sphenoid sinuses and enables access to the nasopharynx and infratemporal fossa whilst avoiding an external incision. These lesions have included angiofibroma (13 cases), inverted papilloma (five cases), a variety of cysts (three cases) and six miscellaneous cases of benign pathology. Malignant lesions which have not breached the anterior cranial fossa may also be removed, up to and including bilateral maxillectomy (nine cases) and this can be combined with orbital clearance. The approach may be repeated if necessary and is associated with few significant complications though vestibular stenosis, oro-antral fistula, nasolacrimal damage and upward rotation of the nasal tip may occur. Strategies to avoid these problems can be undertaken and long-term cosmetic results are excellent.

Z-Plasty Correction of Congenital Nasal Vestibular Stenosis

Stenosis of the nasal vestibule is a difficult problem to alleviate because surgical treatment of this area often results in cicatrix formation and restenosis. Surgery and other forms of trauma are the most common cause of nasal vestibular stenosis. Posttraumatic vestibular stenosis involves primarily the floor of the vestibule. An usual case of bilateral congenital vestibular stenosis involving primarily the soft tissues of the lateral aspects of the nasal vestibules is reported. The Z-plasty correction of this stenosis is outlined with pertinent photographs and schematic drawings.

A CASE OF GASTRODUODENAL ULCER PRESENTED WITH WHOLE-CIRCUMFERENCE STENOSIS OF THE PYLORIC VESTIBULE

We describe a case of gastroduodenal ulcer in which pyloric vestibular stenosis exacerbated in a short time and we had difficulties in differentiation from advanced gastric cancer.The case was a 71-year-old male who had had head injury and was being medicated for sustaining headache. On October 16, 1989, the patient was admitted to our hospital because of melena. Upper gastrointestinal series revealed a probable advanced gastric cancer. Borrmann type 4. Biopsy cytology, however, showed no malignant findings. Because of markedly exacerbated stenosis at the pyloric vestibule, pyloric-side gastrectomy and duodenectomy were carried out on November 22. In the excised specimen, giant girdle ulcer (Ul-II) in 3 lines at the lesser curvature, anterior and posterior wall of lower body of stomach, and a whole-circumference stenosis 7 cm in length reaching to the duodenal bulb at the anal-side were observed. Histopathological findings included mild inflammatory findings at mucous membrane, submucosal proliferation of collagen fiber, and marked hypertrophy of intrinsic muscle layer at the whole-circumference stenosis site. This pyloric vestibular stenosis might be due to repeated chronic inflammation. Possible factors causing exacerbation can be medication and circulatory disturbance.

Repair of nasal septal perforation utilizing the midface degloving technique.

A technique utilizing the midfacial degloving approach in the repair of nasal septal perforations in 24 patients is reported. The midface degloving approach was limited to patients with septal perforations greater than 3 cm and failed prior attempts at surgical closure. Bilateral posteriorly based unipedicled flaps were utilized in the septal closure. Complete closure was accomplished in 75% (18/24) of cases, with a follow-up of one to three years. Complications included reperforation in 25% (6/24) of cases and partial vestibular stenosis in 20% (5/24) of cases. A modification of our technique, relining the nasal floor with postauricular full-thickness skin grafts, has alleviated vestibular stenosis.

Stricture of the nasal vestibule: A complication of nasotracheal intubation in newborn infants

Nasal vestibular stenosis after prolonged nasotracheal intubation has been observed in two newborn infants. The causes of this deformity are felt to be pressure on the nasal vestibule andlor excessive motion of the tube The deformity has undesirable cosmetic potential and may require corrective surgery.

New technique for corrective surgery of nasal tip.

IN RHINOPLASTY correction of nasal tip has challenged surgical skill and esthetic sense of surgeons. It is, in effect, axiomatic that the tip makes nose. It can also be said that most of imperfections in a rhinoplasty are readily discernible in reconstructed tip. One may ask: What are surgical and esthetic errors and mistakes in failures to approximate perfect nasal tip ? The pinched-in surgical tip is not only esthetically inadequate but also, as a rule, functionally imperfect. The sacrifice of cartilage or vestibular skin or mucosa, with healing followed by contracture-induced synechiae between lateral crus and septum or columella and, in some cases, between lateral nasal wall, septum, and mesial crura, often gives a bizarre effect. The production of alar clefts, alar collapse, vestibular stenosis or artesia, dimples and dents in alae, web-like cicatrices in vestibule, and scar