Nasoseptal Perforations: Endoscopic Repair Techniques

Author： Alobid Isam;Castelnuovo Paolo

Publisher： Thieme‎

Publication year： 2017

E-ISBN: 9783132054011

P-ISBN(Paperback): 9783132053915

Subject： R6 Surgery;R608 Surgical instruments and appliances;R76 Ear, Nose & Throat

Keyword：外科诊疗器械与用具,外科学,耳鼻咽喉科学

Language： ENG

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Description

This atlas offers a complete review of all endoscopic approaches available for the repair of nasoseptal perforations, following damage that may occur through trauma, infection, drug abuse, or as a result of endoscopic skull base surgery. Approaches are explained step by step using brilliant photographs from fresh cadaver dissections.

Key Features:

Internationally renowned specialists from Europe and the United States as editors and contributors
Full-color photos of fresh cadaver dissections illustrate all steps for each approach
Specific anatomic landmarks as revealed during each step are detailed, providing confidence in spatial orientation
Includes risks and potential complications as well as methods to reduce them
Videos of cadaver dissections and live surgery

Nasoseptal Perforations: Endoscopic Repair Techniques will be an important resource for residents, fellows, and surgeons in otolaryngology, plastic and reconstructive surgery, and cranio-maxillofacial surgery.

Chapter

Nasoseptal Perforations: Endoscopic Repair Techniques

Media Center Information

Acknowledgments

Contributors

1. Nasal Anatomy

1.1 Front Door to Nasal Cavity

1.1.1 Piriform Aperture

1.1.2 Nasal Pyramid

1.2 Medial Wall of Nasal Cavity: Nasal Septum

1.2.1 Septal Cartilage

1.2.2 Perpendicular Plate of Ethmoid

1.2.3 Vomer

1.2.4 Septal Crests of Palatine and Maxillary Bones

1.3 Lateral Nasal Wall

1.3.1 Lateral Wall of Nasal Cavity

1.3.2 Maxillary Sinus

1.4 Ceiling of Nasal Cavity: Nasal Vault, Ethmoid Cells, and Frontal Sinus

1.4.1 Ethmoid Cells

1.4.2 Frontal Sinus

1.5 Nasal Floor

1.5.1 Palatine Process of Maxilla

1.5.2 Horizontal Process of Palatine Bone

1.6 Back Door of Nasal Cavity

1.6.1 Choana

1.6.2 Sphenoid Sinus

2. Nasal Physiology

2.1 Normal Nasal Physiology

2.1.1 Mucous Blanket and Mucociliary Clearance

2.1.2 Innate Mucosal Immunity

2.1.3 Nasal Sensation/Innervation

2.1.4 Nasal Airflow

2.2 Abnormal Nasal Physiology

2.2.1 Disorders of Mucociliary Transport

2.2.2 Infection and Inflammation

2.2.3 Exposure to Ciliotoxic Agents

2.3 Tests of Nasal Physiology

2.3.1 Rhinomanometry

2.3.2 Acoustic Rhinometry

2.3.3 Mucociliary Transport

2.3.4 Ciliary Activity

2.4 Conclusion

3. Nasal Septum and Nasal Wall Vascularization

3.1 Introduction

3.2 Branches of Maxillary Artery (Arteria Maxillaris)

3.2.1 Sphenopalatine Artery (Arteria Sphenopalatina)

3.2.2 Posterior Superior Alveolar Artery (Arteria Alveolaris Superior Posterior)

3.2.3 Infraorbital Artery (Arteria Infraorbitalis)

3.2.4 Descending Palatine Artery and the Greater Palatine Artery (Arteria Palatine Descendens and Arteria Palatine Major)

3.2.5 Artery of Foramen Rotundum

3.2.6 Artery of Pterygoid Canal or Vidian Artery (Arteria Canalis Pterygoidei)

3.2.7 Pharyngeal Branch or Pterygovaginal Artery (Ramus Pharyngeus)

3.3 Branches of Facial Artery (Arteria Facialis)

3.3.1 Superior Labial Artery (Arteria Labialis Superior)

3.3.2 Lateral Nasal Artery (Arteria Lateralis Nasi)

3.4 Branches of Ophthalmic Artery (Arteria Ophthalmica)

4. Nasal Perforation Etiology

4.1 Introduction

4.2 Pathogenesis

4.3 Etiology

4.3.1 Traumatic Causes

4.3.2 Intranasal Drug Abuse

4.3.3 Occupational Exposure

4.3.4 Neoplasm

4.3.5 Systemic Diseases

4.4 Conclusion

5. Systemic Diseases Associated with Septal Perforation

5.1 Infectious Diseases

5.1.1 Tuberculosis

5.1.2 Leprosy

5.1.3 Syphilis

5.1.4 Human Immunodeficiency Virus

5.1.5 Fungal Infections

5.2 Multisystemic Disorders (Vasculitis and Autoimmune Diseases)

5.2.1 Granulomatosis with Polyangiitis

5.2.2 Eosinophilic Granulomatosis with Polyangiitis

5.2.3 Sarcoidosis

5.2.4 Systemic Lupus Erythematosus

5.3 Conclusion

6. Preoperative Clinical Evaluation of Patient

7. Conservative Treatment

7.1 Introduction

7.2 Pathogenesis

7.3 Symptoms

7.4 Conservative Treatment

7.4.1 Saline Irrigation

7.4.2 Ointments

7.4.3 Nasal Packs

7.4.4 Hemostatic and/or Reabsorbable Agents

7.5 Symptom-Based Treatment

7.5.1 Epistaxis

7.5.2 Crusting and Nasal Congestion

7.5.3 Conclusion

8. Nasal Perforation and Septal Prosthesis

8.1 Anatomy

8.2 Indications

8.3 Materials

8.3.1 Prefabricated versus Custom Made

8.4 Surgical Steps

8.5 Postoperative Care

8.6 Discussion

8.7 Points of Difficulty and Technical Solutions

8.8 Case Example

8.9 Tips and Tricks

9. Free Grafts

9.1 Indications

9.2 Surgical Steps

9.3 Case Example

9.4 Complications

9.5 Tips and Tricks

10. Repair of Nasal Septal Perforation by Using Middle Turbinate Flap

10.1 Introduction

10.2 Indications

10.3 Surgical Steps

10.4 Case Examples

10.4.1 Case 1

10.4.2 Case 2

10.5 Tip and Tricks

11. Inferior Turbinate Flap

11.1 Indications

11.2 Contraindications

11.3 Anatomy

11.4 Surgical Steps

11.4.1 Sinonasal Cavity Preparation

11.4.2 Posteriorly Based Inferior Turbinate Flap: Surgical Technique

11.4.3 Anteriorly Based Inferior Turbinate Flap

11.4.4 Postoperative Care

11.5 Case Example

11.6 Discussion

11.7 Conclusion

11.8 Complications

11.9 Tips and Tricks

12. Lateral Nasal Wall Flap

12.1 Indications

12.2 Contraindications

12.3 Anatomy

12.4 Surgical Steps

12.4.1 Sinonasal Cavity Preparation

12.4.2 Detailed Surgical Technique

12.5 Case Example

12.6 Discussion

12.7 Conclusion

12.8 Complications

12.9 Tips and Tricks

13. Anterior Ethmoidal Artery Septal Flap

13.1 Surgical Anatomy

13.2 Relevant Analytical Factors

13.3 Surgical Steps

13.4 Complications and Technical Solutions

13.5 Case Examples

13.5.1 Case 1

13.5.2 Case 2

13.6 Tips and Tricks

14. Unilateral Mucosal Advancement Flap

14.1 Indications

14.2 Surgical Steps

14.2.1 General Aspects

14.2.2 Suturing Techniques

14.2.3 Interposition Graft

14.2.4 Insertion of Silastic Sheet and Postoperative Care

14.3 Case Example

14.4 Tips and Tricks

15. Bilateral Cross-Over Flap Technique

15.1 Indications

15.2 Preoperative Considerations

15.3 Instrumentation

15.4 Surgical Steps

15.4.1 Step 1. Creation of Flaps

15.4.2 Step 2. Positioning of Flaps

15.5 Case Example

15.6 Tips and Tricks

16. Bilateral Septal Mucosal Flaps in Septal Perforations

16.1 Introduction

16.2 Indications

16.3 Surgical Technique

16.3.1 Instrumentation

16.3.2 Technique

16.4 Complications

16.5 Case Example

16.6 Tips and Tricks

17. Unilateral Nasal Floor and Inferior Meatus Flap

17.1 Anatomy

17.2 Indications

17.3 Surgical Steps

17.4 Postoperative Care

17.5 Complications and Technical Solutions

17.6 Discussion

17.7 Advantages and Limitations

17.8 Case Example

17.9 Tips and Tricks

18. Facial Artery Musculomucosal Flap

18.1 Introduction

18.2 Indications

18.3 Anatomy

18.3.1 Facial Artery Pedicle

18.3.2 Facial Artery Musculomucosal Flap

18.4 Surgical Technique

18.4.1 Anesthesia

18.4.2 Drawing the Flap

18.4.3 Facial Artery Identification

18.4.4 Flap Harvest

18.4.5 Distal Flap Preparation

18.4.6 Flap Inset

18.4.7 Closure of Donor Site

18.4.8 Postoperative Care

18.5 Contraindications

18.6 Discussion

18.7 Case Example

18.8 Complications

18.9 Tips and Tricks

19. “Slide and Patch” Technique

19.1 Indications

19.2 Surgical Steps

19.3 Advantages and Disadvantages

19.4 Case Example

19.5 Tips and Tricks

19.6 Complications and Technical Solutions

19.7 Conclusion

20. Backward Extraction-Reposition Technique of Quadrangular Cartilage

20.1 Indication

20.2 Surgical Anatomy and Operative Implications

20.3 Patients Selection

20.4 Surgical Steps

20.5 Complications and Technical Solutions

20.6 Case Examples

20.6.1 Case 1

20.6.2 Case 2

20.7 Tips and Tricks

21. Pericranial Flap and Endoscopic Septal Repair

21.1 Introduction

21.2 Surgical Anatomy

21.2.1 Scalp Anatomy

21.2.2 Blood Supply

21.2.3 Sensory Innervation to Scalp

21.3 Indications

21.4 Surgical Steps

21.5 Complications and Technical Solutions

21.6 Case Example

21.7 Tips and Tricks

22. Quality of Life

22.1 Objective Assessment

22.2 Subjective Assessment

23. Endoscopic Repair for Septal Perforation: Algorithm

23.1 Introduction

23.2 Relevant Analytical Factors

Index

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