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Biomedical subjects

David A Sherris

Publications and source records attributed to David A Sherris.

26 records · Page 2Linked to original sources
PubMed2002

Long-term follow-up of repair of external nasal deformities in patients with Wegener's granulomatosis.

OBJECTIVE: Wegener's granulomatosis is a disorder of the upper airway, lungs, and kidneys characterized histologically by necrotizing granulomas and vasculitis. One common result of Wegener's granulomatosis is destruction of the framework of the nose, resulting in a saddle-nose deformity. The study was initiated to determine the efficacy and safety of reconstructing external nasal deformities in these patients. STUDY DESIGN: A retrospective review. METHODS: We searched for all patients with Wegener's granulomatosis who underwent an external nasal reconstruction between the years of 1976 and 2000. RESULTS: Thirteen patients met the search criteria. The average duration of follow-up is 59 months (range, 10-177 mo). The initial surgery resulted in a satisfactory outcome in 10 of 13 patients (77%). Two of the patients who failed the primary surgery underwent successful revision rhinoplasty, and one chose not to undergo revision surgery. This resulted in a 92% (12 of 13) overall patient success rate. Ten of the 13 patients had an improvement in their nasal airway postoperatively, and the remaining three had no mention of postoperative airway in the record. The postoperative airway was not made worse in any of the patients operated on in the series. All of the patients had reconstruction when their Wegener's granulomatosis was in remission. Twelve of the 13 patients with an external deformity had a saddle-nose defect. The remaining deformity was a defect of the alar rim. Sixteen surgeries were preformed in total (15 dorsal repairs [12 primary, 3 revisions] and 1 alar rim repair). The most common graft materials used in the reconstruction of the dorsal deformities were costal cartilage (40% [6 of 15]) and calvarial bone (27% [4 of 15]). The remaining dorsal defects were repaired with irradiated rib (1 of 15), irradiated dura (1 of 15), conchal cartilage (1 of 15), iliac crest (1 of 15), and bony septum (1 of 15). The alar rim defect was repaired using a composite auricular graft. The overall success rates by graft type were as follows: costal cartilage, 83% (5 of 6); calvarial bone, 75% (3 of 4); composite auricular, 100% (1 of 1); iliac bone, 100% (1 of 1); conchal cartilage, 100% (1 of 1); septal bone, 100% (1 of 1); irradiated rib, 0% (0 of 1); and irradiated dura 0% (0 of 1). CONCLUSIONS: Reconstruction of external nasal deformities in patients with Wegener's granulomatosis is safe. Surgery does not appear to either induce a flare-up or accelerate the course of Wegener's granulomatosis. There may be a higher risk of failure in primary nasal dorsal repair in patients with Wegener's granulomatosis than in other patients undergoing dorsal augmentation. Irradiated materials in the series also appear to be more prone to resorption.

Adult↗
PubMedDate not supplied

Reconstruction of the nasal columella.

OBJECTIVE: To report techniques successful for nasal columella reconstruction. METHODS: Retrospective medical chart review of patients undergoing columella reconstruction by 2 of us (D.A.S. and P.A.H.) from January 1, 1982, to December 31, 2000. Photographs before tumor resection or trauma, after resection or trauma, and after reconstruction were examined by facial plastic surgeons masked to the cases and were rated on a 10-cm visual analogue scale. RESULT: Sixteen patients were identified, most of whom had columellar defects repaired with forehead flaps, nasolabial flaps, or nasofacial sulcus flaps. The mean improvement on the 10-cm visual analogue scale was 2.0 from before tumor resection or trauma to after reconstruction, and 5.0 from tumor resection or trauma to after reconstruction. CONCLUSION: Skin grafts, composite grafts, and several flaps, including nasolabial, nasofacial sulcus, and forehead flaps, are useful in repairing defects of the nasal columella.

Adolescent↗
PubMedDate not supplied

A grading system for nasal dorsal deformities.

There is no uniform grading system for nasal dorsal deformities currently in general use among surgeons who perform rhinoplasty. Given the popularity of this procedure among both the general public and surgeons, it is time that there was a uniform system describing dorsal deformities. Such a system has value in the education of students of rhinology and cosmetic nasal surgery. We have developed one such system, and applied it to 100 cases. In all cases it accurately describes the major pathological conditions of the dorsum, if present, as noted on physical examination. We have found application of this system to be facile.

Female↗
PubMedDate not supplied

Refinement in reanimation of the lower face.

Both the temporalis muscle transfer and the static sling procedure are techniques that improve deglutition, speech, and aesthetics in patients who are afflicted with paralysis of the lower part of the face. A refinement that is applicable to either of these procedures is described. By bringing the perioral attachment of either the muscle or the static sling exactly to the midline of the upper and lower lips, the surgeon can make the patient's mouth more symmetrical. This simple refinement will improve the results obtained with either procedure and has not been associated with any increased perioperative risks or complications.

Aged↗
PubMedDate not supplied

Forehead flap periorbital reconstruction.

OBJECTIVE: To evaluate functional and aesthetic results of periorbital defect repair using forehead flaps. DESIGN: Retrospective review of patients who received periorbital defect repair by 3 of us with a paramedian forehead flap alone or in conjunction with other local or regional flaps, bone grafts, or cartilage grafts. Flap survival, functional results, and postoperative complications were determined by physical examination at regular follow-up. Three experienced surgeons other than us quantified aesthetic outcomes using a 10-cm visual analog scale. RESULTS: Eighteen patients underwent periorbital defect repair between August 1, 1989, and December 31, 2000. Defects ranged from 8 to 300 cm(2) (mean, 46.8 cm(2)) in area. The most commonly involved primary structures were the medial canthus, lacrimal drainage system, and medial upper eyelid. The mean improvement on a 10-cm visual analog scale was 1.6 from before resection to after reconstruction and 3.8 from tumor resection to after reconstruction. In all relevant cases, globe coverage and lacrimal drainage system patency were excellent. No patients experienced fistula formation or eyelid retraction. CONCLUSION: The reliability, versatility, and relative technical simplicity of the forehead flap provide excellent cosmetic and functional results in reconstruction of intermediate-sized periorbital defects, especially those associated with nasal defects.

Adolescent↗
PubMedDate not supplied

An alternative method of middle vault reconstruction.

Surgery of the nasal valves is a challenging aspect of rhinoplasty surgery. The middle nasal vault assumes an important role in certain aspects of nasal valve collapse. Techniques that address pathologies of the middle vault include the placement of spreader grafts and the butterfly graft. We present an alternative technique of middle vault reconstruction that allows simultaneous repair of nasal valve collapse and creation of a smooth dorsal profile. The surgical technique is described in detail and representative cases are discussed.

Cartilage↗
PubMedDate not supplied

Effects of the nasal muscles on the nasal airway.

BACKGROUND: The nasal muscles and their function are not clearly defined. The nasal muscles generally are thought to act synergistically to produce mimetic motion and affect the nasal airway. We proposed direct examination of the effects of the nasal muscles on the nasal airway. METHODS: Rhinomanometry was performed on volunteers. After paralysis of the nasal muscles with lidocaine, rhinomanometry was performed again to measure nasal airway function with the patient at rest and attempting to flare his/her nostrils. Each patient's rhinomanometric results (at rest and attempting to flare the nostrils) taken before injection of lidocaine served as the control for comparison of his/her results postinjection. The structural tension of the ala at rest and with active flaring of the nostril was measured also, and the results pre- and postparalysis with lidocaine were compared. RESULTS: The data from both the stiffness (structural tension) and the airflow portions, taken together, support the following conclusions. First, the paralysis was significant, although not complete. Clinical and stiffness data supported complete paralysis. Airflow data, which we think most sensitive, support a statistically significant affect of the injection, although incomplete paralysis. CONCLUSION: All of the evidence supports an important role for the nasal muscles when actively used to increase nasal airflow. Second, the majority of the evidence supports an important resting nasal muscle tension that opens the nasal airway.

Air Movements↗