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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4512_Библиотеки_им_академика_М_И_Перельмана
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Contents
https://t.me/med1917
7.5 Symptom-Based Treatment .......... 51
7.5.1 Epistaxis ............................. 51
7.5.2 Crusting and Nasal Congestion .......... 51
7.5.3 Conclusion ........................... 51
8. Nasal Perforation and Septal Prosthesis ............................................. 55
Meritxell Valls, Alfonso Santamaría, Isam Alobid
8.1 Anatomy
............................ 55
8.2 Indications .......................... 55
8.6 Discussion .......................... 58
8.7 Points of Difficulty and Technical
Solutions
............................ 61
8.3 Materials ............................ 55
8.8 Case Example ....................... 61
8.3.1 Prefabricated versus Custom Made ...... 55
8.9 Tips and Tricks....................... 61
8.4 Surgical Steps ....................... 55
8.5 Postoperative Care .................. 58
9. Free Grafts .............................................................................. 65
Hesham A. K. A. Mansour
9.1 Indications
9.2 Surgical Steps ....................... 65
.......................... 65
9.4 Complications ....................... 67
9.5 Tips and Tricks....................... 68
9.3 Case Example ....................... 67
10. Repair of Nasal Septal Perforation by Using Middle Turbinate Flap ............... 71
Deniz Hanci, Huseyin Altun
10.1 Introduction
........................ 71
10.4.1 Case 1 ............................... 73
10.4.2 Case 2 ............................... 74
10.2 Indications .......................... 71
10.5 Tip and Tricks ....................... 74
10.3 Surgical Steps ....................... 72
10.4 Case Examples ....................... 73
11. Inferior Turbinate Flap ................................................................. 79
Cristobal Langdon, Isam Alobid
11.1 Indications
11.2 Contraindications .................... 79
11.3 Anatomy ............................ 79
11.4 Surgical Steps ....................... 80
11.4.1 Sinonasal Cavity Preparation ........... 80
11.4.2 Posteriorly Based Inferior Turbinate Flap:
Surgical Technique .................... 80
11.4.3 Anteriorly Based Inferior Turbinate Flap . . 81
.......................... 79
11.4.4 Postoperative Care .................... 81
11.5 Case Example ....................... 82
11.6 Discussion .......................... 82
11.7 Conclusion .......................... 84
11.8 Complications ....................... 84
11.9 Tips and Tricks ....................... 84
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12. Lateral Nasal Wall Flap ................................................................ 89
Cristobal Langdon, Mauricio López-Chacón, Arturo Cordero Castillo, Alfonso Santamaría,
Paula Mackers, Isam Alobid
12.1 Indications
.......................... 89
12.2 Contraindications .................... 89
12.3 Anatomy ............................ 89
12.4 Surgical Steps ....................... 90
12.4.1 Sinonasal Cavity Preparation ........... 90
12.4.2 Detailed Surgical Technique ............ 90
12.5 Case Example ....................... 91
12.6 Discussion .......................... 92
12.7 Conclusion .......................... 92
12.8 Complications ....................... 92
12.9 Tips and Tricks ....................... 93
13. Anterior Ethmoidal Artery Septal Flap ............................................... 97
Paolo Castelnuovo, Fabio Ferreli, Pietro Palma
13.1 Surgical Anatomy
13.2 Relevant Analytical Factors ........... 98
.................... 97
13.5 Case Examples ....................... 102
13.5.1 Case 1 ............................... 102
13.5.2 Case 2 ............................... 103
13.3 Surgical Steps ....................... 99
13.6 Tips and Tricks ....................... 103
13.4 Complications and Technical Solutions 102
14. Unilateral Mucosal Advancement Flap ............................................... 107
Jung Soo Kim, Sung Jae Heo
14.1 Indications
14.2 Surgical Steps ....................... 107
14.2.1 General Aspects ...................... 107
14.2.2 Suturing Techniques ................... 108
14.2.3 Interposition Graft .................... 108
.......................... 107
14.2.4 Insertion of Silastic Sheet and
Postoperative Care .................... 109
14.3 Case Example ....................... 109
14.4 Tips and Tricks ....................... 109
15. Bilateral Cross-Over Flap Technique ................................................. 113
Shirley Shizue Nagata Pignatari, Aldo Cassol Stamm, Leonardo Balsalobre
15.1 Indications
15.2 Preoperative Considerations ......... 113
15.3 Instrumentation ..................... 113
15.4 Surgical Steps ....................... 113
16. Bilateral Septal Mucosal Flaps in Septal Perforations .............................. 119
José J. Letort
16.1 Introduction
16.2 Indications .......................... 119
x
.......................... 113
........................ 119
15.4.1 Step 1. Creation of Flaps ................ 113
15.4.2 Step 2. Positioning of Flaps ............. 113
15.5 Case Example ....................... 114
15.6 Tips and Tricks ....................... 114
16.3 Surgical Technique .................. 120
16.3.1 Instrumentation ...................... 120
16.3.2 Technique ........................... 120
Contents
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16.4 Complications ....................... 122
16.6 Tips and Tricks ....................... 123
16.5 Case Example ....................... 122
17. Unilateral Nasal Floor and Inferior Meatus Flap .................................... 127
Meritxell Valls Mateus, Cristobal Langdon, Isam Alobid
17.1 Anatomy
............................ 127
17.2 Indications .......................... 127
17.3 Surgical Steps ....................... 127
17.4 Postoperative Care .................. 130
17.6 Discussion .......................... 130
17.7 Advantages and Limitations .......... 131
17.8 Case Example ....................... 131
17.9 Tips and Tricks ....................... 131
17.5 Complications and Technical Solutions 130
18. Facial Artery Musculomucosal Flap .................................................. 135
Tareck Ayad, Philippe Lavigne, Ilyes Berania
18.1 Introduction.
18.2 Indications .......................... 135
18.3 Anatomy ............................ 135
18.3.1 Facial Artery Pedicle ................... 135
18.3.2 Facial Artery Musculomucosal Flap ...... 135
........................ 135
18.4.5 Distal Flap Preparation ................. 137
18.4.6 Flap Inset ............................ 138
18.4.7 Closure of Donor Site .................. 138
18.4.8 Postoperative Care .................... 139
18.5 Contraindications .................... 139
18.6 Discussion .......................... 139
18.4 Surgical Technique .................. 135
18.4.1 Anesthesia ........................... 136
18.4.2 Drawing the Flap ..................... 136
18.4.3 Facial Artery Identification ............. 137
18.4.4 Flap Harvest .......................... 137
18.7 Case Example ....................... 140
18.8 Complications ....................... 140
18.9 Tips and Tricks ....................... 140
19. “Slide and Patch” Technique ......................................................... 145
Michele Cassano
19.1 Indications
19.2 Surgical Steps ....................... 145
19.3 Advantages and Disadvantages ....... 148
.......................... 145
19.5 Tips and Tricks ....................... 148
19.6 Complications and Technical Solutions 149
19.7 Conclusion .......................... 149
19.4 Case Example ....................... 148
20. Backward Extraction-Reposition Technique of Quadrangular Cartilage .......... 153
Ignazio Tasca, Giacomo Ceroni Compadretti
20.1 Indication
20.2 Surgical Anatomy and Operative
Implications
20.3 Patients Selection ................... 153
........................... 153
......................... 153
20.4 Surgical Steps ....................... 154
20.5 Complications and Technical Solutions 155
20.6 Case Examples ....................... 155
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20.6.1 Case 1 ............................... 155
20.6.2 Case 2 ............................... 156
20.7 Tips and Tricks ....................... 157
21. Pericranial Flap and Endoscopic Septal Repair ...................................... 161
Alfonso Santamaría, Cristobal Langdon, Mauricio López-Chacón, Arturo Cordero Castillo, Isam Alobid
21.1 Introduction
21.2 Surgical Anatomy .................... 161
21.2.1 Scalp Anatomy ....................... 161
21.2.2 Blood Supply ......................... 161
21.2.3 Sensory Innervation to Scalp ........... 162
21.3 Indications .......................... 162
........................ 161
21.4 Surgical Steps ....................... 162
21.5 Complications and Technical Solutions 163
21.6 Case Example ....................... 165
21.7 Tips and Tricks ....................... 166
22. Quality of Life .......................................................................... 169
Fabio Ferreli, Paolo Castelnuovo
22.1 Objective Assessment
................ 169 22.2 Subjective Assessment ............... 169
23. Endoscopic Repair for Septal Perforation: Algorithm .............................. 175
Fabio Ferreli, Paolo Castelnuovo
23.1 Introduction
........................ 175 23.2 Relevant Analytical Factors ........... 175
Index .................................................................................... 179
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Videos
https://t.me/med1917
12.1 Observation of perfect integration of the anterior portion of the PLNW flap to the nasal septum.
12.2 Endonasal endoscopic surgery. Releasing the poster ior attachment of the PLNW flap and closing the
posterior portion of the septal defect.
13.1 Repair of middle size anterior septal perforation using anterior ethmoidal artery septal flap.
13.2 Revision of endoscopic septoplasty and double septal perforation closure using anterior ethmoidal artery
septal flap.
15.1 Septal perforation repair using bilateral crossover flap.
17.1 Septal perforation repair using unilateral inferior meatal mucosal flap (cadaver demonstration).
17.2 Septal perforation repair using unilateral inferior meatal mucosal flap (surgical demonstration).
20.1 Septal perforation repair using backwards extraction-reposition technique of the quadrangular cartilage.
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Foreword
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When confronted to write a foreword for this book, I
wondered whether it was actually needed.
Expanded endonasal approaches (EEA) has raised
the needfor partial or total reconstruction of thenasal
septum to reduce morbidity after surgical removal of
skull base tumors during which partial or complete
septal resection needed to be carried out to achievean
adequate approach or to reconstruct the skull base
defect. Subsequently, septal perforation and aesthetic
changes may occur in some cases. Other causes of
septal perforations include trauma, surgery, inflammatory or infections, neoplasms, or abuse of inhaled
substances.
Thus, on one hand, this topic does not need any
introduction. All rhinologists have faced more than
one septal defect along their working life, small and
larger ones. The first ones were bravely approached
surgically, the latter treated with whateverointments
and saline douching to reduce crusting and bleeding.
But, so far,no successful surgicalapproach hasguaranteed the closure of perforations that included the total
septum or, in other words, when the septum is totally
absent. Thus, this book represents a comprehensive
overview about the current techniques to achieve
close septal perforations and offers an innovative
approach to “reconstruct” the full septum that, from
my modest point of view, is a surgical revolution. This
book comprehensivelyand completelycovers the surgical steps of all the different endoscopic approaches
to repair septal perforations. It is a “must” in the
libraries of any rhinologist.
On the other hand, I am happy to “ introduce” Paolo
Castelnuovo, one of the “popes” in Rhinology and
Extended Endoscopic Skull Base Surgery. His written
contributions are a “must” for those starting in this
field—to see how skillfully he dissects in full knowl-
edge of anatomy. It is like watching a wonderful
movie.
Isam Alobid established the Skull Base Unit at our
Institution some 10 years ago and has pushed himself
into the forefront of Rhinology, publishing extraordinary articles and organizing FESS and Skull Base
courses since long, thus his name “rings a bell” in our
subspecialty since long.
I am sure that both “pioneers” have f ulfilled the
expectations raised by the title of the book. It is going
to become a major success.
Manuel Bernal-Sprekelsen
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Preface
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Over the past two decades, there has been a dramatic
evolution in the manner in which septal perforation
repair with endoscopic techniques are approached
and managed. Although there are some chapters on
external approaches to repair septal defects included
in otherbooks about rhinoplasty,there is no book that
comprehensively and completely covers the surgical
steps of all the different endoscopic approaches to
repair septal perforation.
This textbook represents a current state of the art
in septal perforation repair. It includes a detailed
exposition of the techniques required for complete
and successful reconstruction of nasal septum written
by many of the world experts who have played an
important role in the innovation and expansion of this
field.
Webelievethat this book, withphoto series of fresh
cadaver dissection, explanatory drawings and correlated radiological images, and short and long followup, could be shown to meet the educational and
reference needs of the target audiences.
Finally, I would like to express my sincere thanks to
all contributors for their excellent contributions and
for their willingness to share their fund of experience
and knowledge to promote the art and science of
septal perforation repair, which reflects positively on
the quality of life of the patients whom we serve and
to whom we will forever be indebted.
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