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Temporary nasosinusal drainage and lavage in chronic maxillary sinusitis: Statistical study on 847 maxillary sinuses
CURRENT
777
LITERATURE
Bilateral Cleft Lip: An Unorthodox Management. Martin IDS. Clin Plast Surg 20:659, 1993
Marsh JL,
The surgical challenge of bilateral cleft lip is greater than that of two unilateral cleft lips because of the associated nasal and maxillary anomalies. Bilateral synchronous surgery is preferred when addressing the problem of the lip. to place symmetric tissue expansile forces on the hypoplastic prolabium. and to prevent asymmetric deviation of the premaxilla. This should be performed after lip adhesion. Attention should be directed toward cephalad or caudal blood supply. The orbicularis oris muscle should be repaired in a manner that produces functional continuity without muscle bulges. Nasal reconstruction in this population should address the short columella, broad nasal tip which is tethered to the prolabium. absent basilar flare ofthe columella, and flat widespread alae. The premaxilla must be repositioned to a more superior, posterior location. which approximates the maxilla. The lip adhesion with bilateral nasal base reconstruction should be performed 8 weeks postpartum. The definitive lip repair with columellar reconstruction should be performed at least 6 months after the first surgery. At the toddler stage. the columella is lengthened, the nasal tip raised, and alar base widened. During the preschool stage. an open rhinoplasty is performed to support the nasal tip. Final nasal/lip reconstruction occurs in adolescence after the patient achieves his or her adult falzc. and dentoskeletal reconstruction has been performed. Normal lip and nose appearance and function are goals to be obtained with a minimal number of interventions, with consumption of as few resources as possible, and with minimal psychosocial disruption to the patient and family.R.H. HI\IIG Reprint mquests to Dr Marsh: Cleft Palate and Craniofacial Deformities Institute, St LouisChildren’s Hospital, I Children’s PI, St Louis. MO 631 IO.
Primary (Early) Alveolar Bone Grafting. Dado DV. Clin Plast Surg 30:683. 1993 Primary or early bone grafting consists of placing a bone graft at the cleft site before the eruption of the deciduous teeth. or before the age of 1 year has been reached. The goal is to attempt to preserve and improve arch form, stabilize a floating premaxilla in the bilateral cleft, and achieve tooth eruption in the area of the cleft. The success of a primary bone graft depends not only on the technical aspects of the surgical procedure, but also on its use in conjunction with a specific protocol that includes presurgical orthopedics, a lip repair performed in one stage at 6 to 8 weeks of age. and tinally, the bone graft placement done several months thereafter as a separate operative procedure. During the first week of birth, the cleft child should be seen by the cleft palate team. and a passive palatal appliance placed. Closure of the lip at 6 to 8 weeks helps the palatal appliance to mold the alveolar segments. The bone graft is performed when the alveolar segments are in alignment and are either touching. or 1 to 2 mm apart, usually at 4 to 5 months of age. The source of bone is split rib, which is cut into bone chips. The graft material is placed over the alveolar ridge and buccal plate. not palatally. Postoperative care includes elbow restraints, syringe feedings, uninterrupted use of the palatal appliance for 10 days, and no manipulation of the lip to inspect the surgical site for a week. Long-term results indicate that this method provides good arch form. minimal crossbite.
no inhibition of facial growth, and a lesser need for secondary
satisfactory tooth eruption, grafting.-R.H. HAUG
Reprint requests to Dr Dado: Division of Plastic Surgery. Loyola University Medical Center, 1160 S First Ave. Maywood. IL 60153.
Temporary Nasosinusal Drainage and Lavage in Chronic Maxillary Sinusitis: Statistical Study on 847 Maxillary Sinuses. Bertrand B, Eloy P. Ann Otol Rhino1 Laryngol 102: 858, 1993 Chronic maxillary sinusitis, verified by sinusocopy and computed tomography, permitted the diagnosis of coexisting chronic ethmoidal sinusitis in 498 patients. The patients were treated by temporary drainage and daily instillation of thiamphenicol glycinate hydrochloride and N-acetyl-L-cysteine. The association with ethmoidal sinusitis does not significantly modify the treatment duration: fewer than 4% of maxillary sinuses recover normal parameters after the 13rd day of lavage. making treatment for a longer time useless. Of the maxillary sinuses, 36.25% were not submitted to surget-y.-G.H. SPERBER Reprint requests to Dr Bertrand: Ear. Nose. and Throat Department. Chniques Ltni\ersitaires UCL de Mont-Godinne. B-5530 Yvoir. Belgium.
Juvenile Aggressive Cemento-Ossifying Fibroma: Case Report and Review of the Literature. Bertrand B, Eloy Ph. Cornelis JPh. et al. Laryngoscope 103: 1385. 1993 A case report of an 1 l-year-old boy diagnosed with cemento-ossifying tibroma involving the ethmoid sinuses, nasal fossae, and sphenoid sinus, with extension into the anterior cranial fossa. is presented. Computed tomographic and magnetic resonance imaging studies demonstrated a large, wellcircumscribed heterogenous lesion with a well-defined bony capsule, showing both displacement and erosion of bone. The surgical approach and immediate reconstruction with calvarial bone graft is described. On macroscopic examination the tumor exhibited a gritty consistence on dissection. Microscopic examination disclosed a homogeneously distributed spheroidal cementum-like calcification in a hbrovascular stroma. The differential diagnosis of lesions having both fibrous and osseous components is presented. Fibrous dysplasia, which is microscopically similar to ossifying fibroma. must be differentiated by its clinical and radiographic appearance. Unlike ossifying fibroma, fibrous dysplasia may appear polyostotic. is more homogenous, and has indistinct boundaries. The microscopic features of ossifying hbroma and cementoossifying fibroma include spheroidal calcifications homogeneouslv distributed in a fibrovascular stroma. Juvenile aggressive cemento-ossifying fibroma is distinguished as occurring prior to age 20, having more osteoclastic and osteoblastic activity, showing more cementicles, and having a more vascular and cellular stroma. A review of the literature of ossifying fibroma and cemento-ossifying fibroma of the paranasal sinuses disclosed the average age to be 18.6 years, with a female:male ratio of I : I. The ethmoid sinus was the most common location. and recurrences occurred in about a third of the cases reviewed. The authors recommended adequate excision (not discussed) and thorough follow-up.-J.M. WEES Reprint requests to Dr Bertrand: Ear. Nose, and Throat Department. Cliniques Universitaires UCL de Mont-Godinne, B-5230 Yvoir. Belgium.
777
LITERATURE
Bilateral Cleft Lip: An Unorthodox Management. Martin IDS. Clin Plast Surg 20:659, 1993
Marsh JL,
The surgical challenge of bilateral cleft lip is greater than that of two unilateral cleft lips because of the associated nasal and maxillary anomalies. Bilateral synchronous surgery is preferred when addressing the problem of the lip. to place symmetric tissue expansile forces on the hypoplastic prolabium. and to prevent asymmetric deviation of the premaxilla. This should be performed after lip adhesion. Attention should be directed toward cephalad or caudal blood supply. The orbicularis oris muscle should be repaired in a manner that produces functional continuity without muscle bulges. Nasal reconstruction in this population should address the short columella, broad nasal tip which is tethered to the prolabium. absent basilar flare ofthe columella, and flat widespread alae. The premaxilla must be repositioned to a more superior, posterior location. which approximates the maxilla. The lip adhesion with bilateral nasal base reconstruction should be performed 8 weeks postpartum. The definitive lip repair with columellar reconstruction should be performed at least 6 months after the first surgery. At the toddler stage. the columella is lengthened, the nasal tip raised, and alar base widened. During the preschool stage. an open rhinoplasty is performed to support the nasal tip. Final nasal/lip reconstruction occurs in adolescence after the patient achieves his or her adult falzc. and dentoskeletal reconstruction has been performed. Normal lip and nose appearance and function are goals to be obtained with a minimal number of interventions, with consumption of as few resources as possible, and with minimal psychosocial disruption to the patient and family.R.H. HI\IIG Reprint mquests to Dr Marsh: Cleft Palate and Craniofacial Deformities Institute, St LouisChildren’s Hospital, I Children’s PI, St Louis. MO 631 IO.
Primary (Early) Alveolar Bone Grafting. Dado DV. Clin Plast Surg 30:683. 1993 Primary or early bone grafting consists of placing a bone graft at the cleft site before the eruption of the deciduous teeth. or before the age of 1 year has been reached. The goal is to attempt to preserve and improve arch form, stabilize a floating premaxilla in the bilateral cleft, and achieve tooth eruption in the area of the cleft. The success of a primary bone graft depends not only on the technical aspects of the surgical procedure, but also on its use in conjunction with a specific protocol that includes presurgical orthopedics, a lip repair performed in one stage at 6 to 8 weeks of age. and tinally, the bone graft placement done several months thereafter as a separate operative procedure. During the first week of birth, the cleft child should be seen by the cleft palate team. and a passive palatal appliance placed. Closure of the lip at 6 to 8 weeks helps the palatal appliance to mold the alveolar segments. The bone graft is performed when the alveolar segments are in alignment and are either touching. or 1 to 2 mm apart, usually at 4 to 5 months of age. The source of bone is split rib, which is cut into bone chips. The graft material is placed over the alveolar ridge and buccal plate. not palatally. Postoperative care includes elbow restraints, syringe feedings, uninterrupted use of the palatal appliance for 10 days, and no manipulation of the lip to inspect the surgical site for a week. Long-term results indicate that this method provides good arch form. minimal crossbite.
no inhibition of facial growth, and a lesser need for secondary
satisfactory tooth eruption, grafting.-R.H. HAUG
Reprint requests to Dr Dado: Division of Plastic Surgery. Loyola University Medical Center, 1160 S First Ave. Maywood. IL 60153.
Temporary Nasosinusal Drainage and Lavage in Chronic Maxillary Sinusitis: Statistical Study on 847 Maxillary Sinuses. Bertrand B, Eloy P. Ann Otol Rhino1 Laryngol 102: 858, 1993 Chronic maxillary sinusitis, verified by sinusocopy and computed tomography, permitted the diagnosis of coexisting chronic ethmoidal sinusitis in 498 patients. The patients were treated by temporary drainage and daily instillation of thiamphenicol glycinate hydrochloride and N-acetyl-L-cysteine. The association with ethmoidal sinusitis does not significantly modify the treatment duration: fewer than 4% of maxillary sinuses recover normal parameters after the 13rd day of lavage. making treatment for a longer time useless. Of the maxillary sinuses, 36.25% were not submitted to surget-y.-G.H. SPERBER Reprint requests to Dr Bertrand: Ear. Nose. and Throat Department. Chniques Ltni\ersitaires UCL de Mont-Godinne. B-5530 Yvoir. Belgium.
Juvenile Aggressive Cemento-Ossifying Fibroma: Case Report and Review of the Literature. Bertrand B, Eloy Ph. Cornelis JPh. et al. Laryngoscope 103: 1385. 1993 A case report of an 1 l-year-old boy diagnosed with cemento-ossifying tibroma involving the ethmoid sinuses, nasal fossae, and sphenoid sinus, with extension into the anterior cranial fossa. is presented. Computed tomographic and magnetic resonance imaging studies demonstrated a large, wellcircumscribed heterogenous lesion with a well-defined bony capsule, showing both displacement and erosion of bone. The surgical approach and immediate reconstruction with calvarial bone graft is described. On macroscopic examination the tumor exhibited a gritty consistence on dissection. Microscopic examination disclosed a homogeneously distributed spheroidal cementum-like calcification in a hbrovascular stroma. The differential diagnosis of lesions having both fibrous and osseous components is presented. Fibrous dysplasia, which is microscopically similar to ossifying fibroma. must be differentiated by its clinical and radiographic appearance. Unlike ossifying fibroma, fibrous dysplasia may appear polyostotic. is more homogenous, and has indistinct boundaries. The microscopic features of ossifying hbroma and cementoossifying fibroma include spheroidal calcifications homogeneouslv distributed in a fibrovascular stroma. Juvenile aggressive cemento-ossifying fibroma is distinguished as occurring prior to age 20, having more osteoclastic and osteoblastic activity, showing more cementicles, and having a more vascular and cellular stroma. A review of the literature of ossifying fibroma and cemento-ossifying fibroma of the paranasal sinuses disclosed the average age to be 18.6 years, with a female:male ratio of I : I. The ethmoid sinus was the most common location. and recurrences occurred in about a third of the cases reviewed. The authors recommended adequate excision (not discussed) and thorough follow-up.-J.M. WEES Reprint requests to Dr Bertrand: Ear. Nose, and Throat Department. Cliniques Universitaires UCL de Mont-Godinne, B-5230 Yvoir. Belgium.