BACKGROUND: A significant percentage of children with cleft palate suffer from otitis media with effusion and its consequences, such as deafness, chronic adhesive otitis and cholesteatoma. This study aimed to determine whether these effects can be minimised by selecting pharyngofixation as the surgical technique for cleft palate correction. METHODS: A retrospective study was performed of 155 patients (308 ears) who underwent surgery from age 5 months to 8 years and were followed up for 36-84 months. RESULTS: In all, 125 ears (41 per cent) had epitympanic retraction, 45 ears (14 per cent) had sinus tympani retraction and 5 patients (3 per cent) had cholesteatoma. Use of the pharyngofixation technique did not significantly correlate with (1) the severity of otological findings or (2) the incidence of retraction pockets in the epitympanum and sinus tympani (p = 0.53). CONCLUSION: Pharyngofixation did not significantly alter the severity of long-term otological findings.
- Klíčová slova
- Cholesteatoma, Cleft Palate, Eustachian Tube, Middle Ear Ventilation, Otitis Media with Effusion,
- MeSH
- chronická nemoc MeSH
- dítě MeSH
- farynx chirurgie MeSH
- kojenec MeSH
- lidé MeSH
- následné studie MeSH
- otitis media s výpotkem etiologie MeSH
- pooperační komplikace etiologie MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- rozštěp patra chirurgie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: This study compared the adverse effects of open surgery (OS) including lateral pharyngotomy and supraglottic laryngectomy vs. transoral robotic surgery (TORS) in the treatment of stage T1 and T2 carcinomas of the tongue base and supraglottis. METHODS: A retrospective study involving a 49 (13 female and 36 male) patients with untreated T1 or T2 carcinomas. Twenty two were operated on using TORS and 27 underwent conventional OS. The indicators for comparison were: total blood loss during surgery, post-operative pain measured with the Visual Analog Scale (VAS); global, emotional and physical post-operational states assessed with the standardized M.D. Anderson Dysphagia Inventory (MDADI) and psychosocial distress (PD) questionnaire. Apart from blood loss, subjective symptoms were evaluated 1 and 6 weeks and 6 months after surgery. The differences in indicators between groups were analyzed using Fisher's Least Significant Difference (LSD) test at the 5% significance level. RESULTS: Mean general OS and TORS associated blood loss were 405 and 29 ml, respectively. The mean MDADI score in TORS vs. OS patients one week, six weeks and six months postoperatively was 60.01 vs. 44.93, 91.01 vs. 62.19 and 94.18 vs. 93.56. The mean VAS score in the TORS vs. OS group at the same time intervals were 5.09 vs. 5.56, 2.09 vs. 3.11 and 1.27 vs. 1.33. All differences between TORS and OS were statistically significant with the exception of 6 month values for particular scores. The mean PD score in TORS vs. OS patients in one week, six weeks and 6 months was 26.82 vs. 25.11, 39.95 vs. 29.22 and 44.73 vs. 44.52. Only the six week distinctions were significant. The both methods were comparable in terms of the risk of locoregional tumour recurrence. CONCLUSIONS: The study confirmed the assumption of the TORS as a minimally invasive procedure significantly reducing the intraoperative blood loss, pain, swallowing and psychosocial distress as late as 6 weeks postoperatively in patients with early staged carcinomas of the tongue base and supraglottis.
- Klíčová slova
- MDADI, VAS, blood loss, carcinoma of tongue base and supraglottis, open surgery, psychosocial distress, transoral robotic surgery,
- MeSH
- dospělí MeSH
- epiglotis chirurgie MeSH
- farynx chirurgie MeSH
- krvácení při operaci statistika a číselné údaje MeSH
- laryngektomie škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory hrtanu chirurgie MeSH
- nádory jazyka chirurgie MeSH
- pooperační bolest etiologie MeSH
- psychický stres etiologie MeSH
- retrospektivní studie MeSH
- roboticky asistované výkony škodlivé účinky MeSH
- senioři MeSH
- spinocelulární karcinom chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
Supraglottic airway devices are routinely used for airway maintenance in elective surgical procedures where aspiration is not a significant risk and also as rescue devices in difficult airway management. Some devices now have features mitigating risk of aspiration, such as drain tubes or compartments to manage regurgitated content. Despite this, the use of these device may be associated with various complications including aspiration. This review highlights the types and incidence of these complications. They include regurgitation and aspiration of gastric contents, compression of vascular structures, trauma, and nerve injury. The incidence of such complications is quite low, but as some carry with them a significant degree of morbidity the need to follow manufacturers' advice is underlined. The incidence of gastric content aspiration associated with the devices is estimated to be as low as 0.02% with perioperative regurgitation being significantly higher but underreported. Other serious, but extremely rare, complications include pharyngeal rupture, pneumomediastinum, mediastinitis, or arytenoid dislocation. Mild short-lasting adverse effects of the devices have significantly higher incidence than serious complications and involve postoperative sore throat, dysphagia, pain on swallowing, or hoarseness. Devices may have deleterious effect on cervical mucosa or vasculature depending on their cuff volume and pressure.
- MeSH
- elektivní chirurgické výkony MeSH
- extubace škodlivé účinky přístrojové vybavení MeSH
- faryngitida patologie MeSH
- farynx patologie chirurgie MeSH
- lidé MeSH
- perioperační období MeSH
- pooperační komplikace patofyziologie MeSH
- poruchy polykání patologie terapie MeSH
- zajištění dýchacích cest * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
CONCLUSION: The authors found the procedure, when used with the proper indications, to be an uncomplicated and expeditious method that presents little risk to surrounding structures, has no residual cosmetic or functional consequences for the patient, presents a low risk of complications, and has a good oncological outcome. The main indications for this procedure are related to the extent of the tumour and the surgeon's experience with the method. OBJECTIVES: This study assessed the radical extent of each surgery, which was determined histopathologically, local and general complications to determine the safety of the procedure, and oncological and post-operative efficacy. METHOD: In the 1970s, Tichy described, in Czech literature, an approach to treating oropharyngeal tumours through a lateral pharyngotomy with the approach extended by resection of the mandibular angle. From 2000 to 2006 the authors use this method to treat 63 patients having oropharyngeal cancer in various stages (T1 19%, T2 46%, T3 14%, T4 21%). RESULTS: Microscopically, the operation was non-radical in three cases (4.8%). Of the local complications encountered, pharyngocutaneous fistulas were the most frequent, three cases (4.8%), and postoperative bleeding was seen in two cases (3.2%). General complications were seen in four cases (6.4%).
- MeSH
- adjuvantní radioterapie MeSH
- dospělí MeSH
- farynx chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mandibula chirurgie MeSH
- nádory orofaryngu radioterapie chirurgie MeSH
- pooperační komplikace MeSH
- senioři MeSH
- spinocelulární karcinom radioterapie chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIM OF THE STUDY: A gastric tube is commonly used in thoracic esophageal reconstruction. When a gastric tube is not available, pedicled jejunum transfer and colonic interposition are alternative methods. Oral end of the reconstructed esophagus occasionally has poor blood flow and may result in partial necrosis of the oral segment. We performed additional microvascular blood flow augmentation, the "supercharge" technique, to improve a blood flow circulation in the oral segment of the reconstructed esophagus. METHODS: A series of 86 esophageal reconstructions with microvascular blood flow augmentation using the "supercharge" technique were performed. Reconstructive methods included a gastric tube in five patients, a gastric tube combined with a free jejunual graft in one, an elongated gastric tube in eight, a pedicled colonic interposition in 22, and a pedicled jejunum in 50. Recipient vessels were used in neck or chest region. RESULTS: The color and blood flow of the transferred intestine appeared greatly improved after microvascular blood flow augmentation. Thrombosis was noticed in three patients during the surgery, and all thrombosies were salvaged by re-anastomosis. There were only three patients with partial graft necrosis of oral segment, two patients with anastomotic leakage, one anastomotic stricture. CONCLUSIONS: Augmentation of microvascular blood flow by this "supercharge" technique can be expected to reduce the risk of leakage and partial necrosis of the transferred intestine. This technique contributes to the successful reconstruction of esophageal defect.
- MeSH
- chirurgické laloky MeSH
- dospělí MeSH
- ezofágoplastika metody MeSH
- ezofágus krevní zásobení MeSH
- farynx chirurgie MeSH
- jejunum transplantace MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrochirurgie MeSH
- mikrocirkulace MeSH
- senioři MeSH
- výkony cévní chirurgie metody MeSH
- žaludek transplantace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
During the course of head and neck surgery for cancer the reconstructive surgeon is involved in replacement of pharyngeal mucosal defects. Siedenberg (7) first reported free transplantation in 1959 using a segment of jejunum, Roberts (5) using jejunum, Nakayama (3) using colon and Jurkiewicz (4) using ileum and jejunum. Green (2) in 1966 using microsurgical techniques demonstrated 100% survival of free transfers of jejunum and also patches of jejunum in dogs. We have used free interposing iso-peristaltic jejunal loop transfer in 30 patients to bridge the cervical esophagus defects for advanced cancer of hypopharynx, larynx and cervical esophagus after ablative cancer surgery. The major complication rate was 13% (4/30 cases) including total flap failure and loss of interposed jejunal segment. The minor complication rate was 36% (11/30 cases) including postoperative hypothyroidism in 2 patients. Intra-abdominal hemorrhage or peri-operative mortality was not observed in any of our cases. Total post-operative average hospital stay was 15 days, and median swallowing time was 10 days. Complication rates and success of early functional and social restoration have been analyzed.
- MeSH
- ezofágoplastika metody MeSH
- farynx chirurgie MeSH
- jejunum transplantace MeSH
- lidé MeSH
- nádory hrtanu chirurgie MeSH
- nádory hypofaryngu chirurgie MeSH
- nádory jícnu chirurgie MeSH
- pooperační komplikace MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Sleep apnea syndrome must be exactly confirmed by the standard set or collection of examinations from rhonchopathy. The diagnosis is distinguished and identify by ENT examination, nocturnal recording by polyMESAM or by complete polysomnography. Then is performed neurological and maxillomandibular examination, X-rays pictures (cephalometric data), and CT of pharynx. Part of patient is indicated to undergo surgery. In region of velopharyngeal space we performed classical uvulopalatopharyngoplasty (UPPP), described first time by Fujita 1981 in Detroit [4]. It means, that we take out both tonsils and then remove part of soft palate to enlarging the velopharyngeal space. The findings of retrobasilingual obstruction and obesity are negative predictors for success of UPPP. Narrowing of posterior airway space is indication for the alternative therapy called maxillomandibular advancement. We prefer the surgery by classical method without laser. Adenotomy is performed in children population since residuum of adenoids, and sometimes tonsillectomy should be added for good postoperative results. Part of patient should undergo septoplasty due to local findings of obstruction or another anatomical abnormalities on the level of nasal cavity or nasopharynx. This surgery is very important for this reason of treatment by CPAP.
OBJECTIVE: The objective of this study was to evaluate the craniofacial morphology of children with unilateral cleft lip and palate (UCLP) resulting from differing management protocols practiced in Prague from 1945 to 1976. DESIGN: The craniofacial morphologies of four groups of patients were compared. Two groups were assessed retrospectively (individuals born from 1945 to 1963), and two groups were followed on a longitudinal basis (individuals born from 1966 to 1976). SETTING: The study was conducted at the Cleft Lip and Palate Center at the Department of Plastic Surgery, Prague, which has a catchment area population of 6 million. PATIENTS: The subjects were a consecutive series of adult males (n = 84) who had complete UCLP without associated malformations. INTERVENTIONS: Patients born from 1945 to 1955 did not receive centralized orthodontic therapy. From 1945 to 1965, the alveolar process in the area of the cleft was not surgically repaired. Primary bone grafting was used for the group born from 1965 to 1972, and primary periosteoplasty was used in the subsequent period. Throughout the period covered by the study, the palate was operated on by pushback and pharyngeal flap surgery. From 1945 to 1965, the lip was repaired initially according to Veau, and later according to Tennison and Randall, and during this time, fixed appliances were used for orthodontic treatment. RESULTS: The results for the period from 1945 to 1955 are characterized by mandibular overclosure with anterior crossbite. Centralized orthodontic treatment in the later period improved sagittal jaw relations due to the posterior displacement of the mandible and an edge-to-edge bite was attained, but maxillary retrusion was unchanged. Primary bone grafting increased retrusion of the maxilla, which was compensated by further posterior displacement of the mandible. An edge-to-edge bite was also obtained. Primary periosteoplasty reduced maxillary retrusion, and the marked proclination of the upper dentoalveolar component with fixed appliances resulted in a positive overjet. It was no longer necessary to push the mandible back to the extent required in bone grafting. CONCLUSION: Effective orthodontic treatment made the greatest contribution to improved facial development. It allowed compensation of maxillary retrusion by changes in the position of the mandible or by proclination of the upper dentoalveolar component with fixed appliances. The applied surgical methods using primary bone grafting caused deterioration of the anterior growth of the maxilla.
- MeSH
- alveolární plastika MeSH
- chirurgické laloky MeSH
- dospělí MeSH
- farynx chirurgie MeSH
- hodnotící studie jako téma MeSH
- lidé MeSH
- longitudinální studie MeSH
- malokluze etiologie patologie MeSH
- mandibula patologie MeSH
- maxila patologie MeSH
- maxilofaciální vývoj * MeSH
- okostice chirurgie MeSH
- ortodoncie korekční MeSH
- ortodontické aparáty MeSH
- patro chirurgie MeSH
- ret chirurgie MeSH
- retrospektivní studie MeSH
- rozštěp patra patofyziologie chirurgie MeSH
- rozštěp rtu patofyziologie chirurgie MeSH
- transplantace kostí MeSH
- zubní okluze MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika MeSH
Retrospective studies into the effects of some aspects of treatment on facial development were based on x-ray films obtained in 58 men with unilateral cleft lip and palate operated on by palatal pushback. Because of mandibular retroposition, individuals subjected to systematic orthodontic treatment had better sagittal jaw relations and occlusion of incisors than insufficiently treated patients. The retroposition was attained with orthodontic proclination of upper incisors leading to a positive overjet and retraining the anterior development of the mandible. In patients with complete clefts operated on at about 6 years of age, sagittal jaw relations were more favorable than in those who had surgical repair at 4 years of age. The superior results in the group operated at a later age were due, in part, to the slighter retrusion of the maxilla. These differences were not apparent in incomplete clefts nor in patients with isolated cleft palate reported earlier. On the basis of these observations, a differentiated approach was proposed for determining the most convenient age for palatoplasty, according to individual types of clefts and their extent. The findings provided evidence of the essential role of orthodontic therapy for the configuration of the lower face in clefts.
- MeSH
- chirurgické laloky metody MeSH
- dítě MeSH
- dospělí MeSH
- farynx chirurgie MeSH
- kefalometrie MeSH
- lidé MeSH
- malokluze patologie patofyziologie terapie MeSH
- mandibula růst a vývoj patologie MeSH
- maxila růst a vývoj patologie MeSH
- maxilofaciální vývoj * MeSH
- ortodoncie korekční MeSH
- předškolní dítě MeSH
- radiografie MeSH
- retrospektivní studie MeSH
- řezáky patologie MeSH
- rozštěp patra diagnostické zobrazování patologie patofyziologie chirurgie MeSH
- rozštěp rtu diagnostické zobrazování patologie patofyziologie chirurgie MeSH
- techniky palatinální expanze MeSH
- věkové faktory MeSH
- zubní okluze MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
The authors submit their own experience with pharyngogastric anastomosis in patients where on account of circumferential cancer of the oesophagus and hypopharynx laryngopharyngooesophagectomy had to be performed. For the anastomosis a tubular flap of the greater curvature of the stomach was used which was pulled through the posterior mediastinum and sutured with the mucosa and musculature of the residual pharynx and the preserved upper half of the epiglottis. The operation is pretentious and requires satisfactory cardiopulmonary function of the patient. A disadvantage of the operation is substantial loss of gastric function, compensated by the patients by a therapeutic diet and medicinal substitution of the gastric chemism. An obvious advantage of the operation is the radical character of the oncological procedure and rapid rehabilitation of swallowing which was restored in the authors' patients on the 8th to 14th day.
- MeSH
- anastomóza chirurgická metody MeSH
- dospělí MeSH
- farynx chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory hltanu chirurgie MeSH
- nádory hypofaryngu chirurgie MeSH
- nádory jícnu chirurgie MeSH
- žaludek chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
