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Medicine is in an era of technical development and innovation. Creating a tympanic membrane by using a 3D printer can exceed the disadvantages that classic graft materials have. The field of otolaryngology can be experiencing a paradigm shift towards the use of 3D-printer.
Whiplash syndrome is a quite common pathology and can be defined as a neck injury produced by a sudden acceleration-deceleration, the consequence of which is a sudden forward and backward movement of the head and neck. The main production mechanism is a sudden acceleration-deceleration process that has as a consequence the sudden extension/flexion of the neck. Starting from the many structures involved, the whiplash syndrome is an interdisciplinary challenge (ENT specialist, neurologist, orthopedist, ophthalmologist, psychologist) and can be described by multiple signs and symptoms.
Whiplash syndrome is a complex pathology both through the mechanism of production and symptoms, and through the forensic implications that it has. The interdisciplinary medical collaboration, the implementation of stricter rules on wearing the seat belt and the development by car manufacturers of chairs and head restraints that protect the head and neck of passengers, would be the preventive step in the occurrence and especially the chronicization of these lesions.
Andreea Grosu-Bularda, Claudiu Manea, Luana Lazarescu and Ioan Lascar
Nasal reconstruction is challenging, considering surgical techniques complexity and difficulties in remodelling a tridimensional structure. Reconstructive requirements are: correct deformity evaluation, selecting the most suitable treatment option, respecting the principle of aesthetic subunit, appropriate reconstruction of each affected nasal layer, long-term stabile functional and aesthetic results. Reconstructive procedures range from simple to very complex. Conventional techniques can fail in restoring a satisfactory appearance in severely disfigured patients, for whom a new possibility arises: Vascularized Composite Allografts (VCA) transplantation.
In this paper, we focus on nasal skeletal framework restoration. Structural defects may require a large amount of reconstructive material obtained usually from cartilage or bone autografts. Autologous cartilage is the gold standard in nasal architectural recovery, but in some cases, autologous graft sources are not available, imposing the necessity to use alternative solutions represented by the allografts or alloplastic materials. We analysed the specific features of skeletal allografts used in nasal reconstruction.
With current clinical experience, the use of cartilage and bone allografts (especially irradiated cartilage homografts) shows a promising reconstructive option for nasal structural defects. For extensive facial defects, including midface deformities, impossible to restore with traditional surgical techniques, a new reconstructive era was open through the development of the VCA field.
Diana Vlad, Veronica Trombitas, Mircea Capusan and Silviu Albu
Chronic rhinosinusitis is a very common medical condition that affects nasal and paranasal sinuses mucosa in both adults and children. Its pathology, however, still remains unclear and researchers focus more and more on the role of nitric oxide (NO), a free radical produced in normal conditions by the paranasal sinuses epithelium in healthy patients, in the development of this disease. NO’s role in the upper airway disease is not completely known, but it appears to act like a first-line host defence agent, maintaining the sinuses sterile due to its antiviral and bacteriostatic properties and by increasing mucociliary clearance. NO levels in the exhaled air of patients with CRS are lower than in healthy patients. One explanation for this might be the sinus obstruction that occurs in CRS because subjects with complete sinus opacification have the lowest levels. Furthermore, NO levels decrease after CRS treatments, suggesting that its measurement might help in monitoring the patient’s response to therapy. In this review, we discuss the NO synthesis in the respiratory tract, its involvement in airway pathology, its role in the pathogenesis of CRS and the current clinical uses for NO in CRS and several other airway diseases.
Hereditary angioedema (HAE) is a rare autosomal dominant disease consisting of recurrent angioedema attacks, varying in severity, possibly life-threatening and with frequent involvement of the head and neck areas. The patophysiology of HAE differs from histamine-mediated allergic angioedema. Three types of reduced quality or quantity in various complement or coagulation factors, leading to massive release of bradykinin, increase vascular permeability and produce capilary leakage. Clinical manifestations of HAE include swelling located predominantly in the head and neck area, hands, feet and urogenital area and abdominal pain caused by edema of the gastrointestinal tract mucosa. Diagnosis requires laboratory tests for complement components and genetic tests. A timely and correct diagnosis in the emergency room is of utmost importance, the medical treatment of HAE being substantially different from that of allergic angioedema. Although new therapies are available and in development, airway intervention and surgery are still life-saving procedures and the ENT surgeon is an important part of the multidisciplinary team managing an HAE attack.
BACKGROUND. In present days, there are described many reconstruction techniques for nasal post-traumatic and post-excision total defects, from simple suture to microsurgical free transfer in nasal reconstruction. It is important to follow the defect dimensions, its topography and also its etiology. The nasal aesthetic subunits principle is very important in aesthetic and functional reconstruction of a nasal defect.
MATERIAL AND METHODS. The clinical study from this paper was realised on the patients admitted in the Department of Plastic and Reconstructive Surgery of the Emergency Clinical Hospital from Bucharest, between 2012 and 2013. Different determinant factors were studied for the success of nasal reconstruction. It was compared the difference between the reconstruction of the whole nasal subunit, based on aesthetic subunits principle, and the reconstruction of the defect.
RESULTS. Although in our clinic the reconstruction of the defect is used in the majority of the cases and rarely the reconstruction based on aesthetic subunits principle, very good results were obtained, with a reduced number of complication and very few relapses.
CONCLUSION. The success of the reconstruction depends on multiple factors regarding the type of the defect. The grafts can give very good results in all aesthetic subunits, while the nasogenian flap has good results for the reconstruction of the nasal wing and lobule defects. The frontal flap is the first option for reconstruction of the dorsum nasi with satisfactory results. This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/159/1.5/137390
Ranko Mladina, Neven Skitarelić, Cemal Cingi and Nuray Bayar Muluk
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