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Biomedical subjects

G Sulsenti

Publications and source records attributed to G Sulsenti.

12 recordsLinked to original sources
PubMed1999

Septal perforations closure utilizing the backwards extraction-reposition technique of the quadrangular cartilage.

Nasal septal perforations are anatomical defects of the nasal septum, causing dynamic alterations in nasal physiology which may lead to variable symptoms and otolaryngological referral. Repair of nasal septal perforations continues to remain a difficult surgical problem, and nowadays there is no definitive solution for their successful surgical closure. Thirty patients with small- or medium-sized anterior nasal septal perforations were treated with a simple technique of backwards extraction-reposition of the quadrangular cartilage. Prior nasal septal surgery and repeated cautery were the most common cause of perforation. After a minimum follow-up of two years the success rate for relief of symptoms and closure of the perforation was 87 per cent. This technique showed very good results in small-sized and selected cases with medium-sized perforations, but the mucosal dissection employed is not suitable for medium to large perforations.

Adolescent↗
PubMed1996

Tailored nasal surgery for normalization of nasal resistance.

The nose acts as a physiologic airway resistor, accounting for around 50% of total airway resistance. Adequate nasal resistance is essential not only for correct functioning of the nose but to ensure normal pulmonary physiology. Pathological nasal resistance is determined by alterations in the shape and volume of the nasal cavities that singly or in association disrupt nasal aerodynamics, a condition that will present mainly in the form of obstructive disorders. The authors advise against considering nasal cavity surgery simply as surgery of the nasal septum. Nasal surgery should be addressed to normalizing the geometry of the nasal cavities in order to restore physiologic nasal resistance. Surgical procedures may be classified as follows: (1) surgery of the medial wall; (2) surgery of the lateral wall; and (3) surgery of the valve area. Septal surgery is systematically performed by the authors using the maxilla-premaxilla approach (MPA). Functional correction of the septum combines mobilization and/or removal of any deranged portion of the bony and/or cartilaginous septum, followed by reconstruction of the septum support, preferably using autogenous septal grafts. When reconstructing the medial wall, great care must be taken with the most important portion of the septum, i.e., the dorso-caudal margin and the cartilaginous elements. We have called this procedure Functional Osteocartilaginous Reconstruction of the Nasal Septum (FORNS). Obstructive swelling of the turbinates is one of the most common causes of nasal obstruction as it alters the shape and reduces the volume of the nasal cavities causing an exponential increase in nasal resistance. With regard to surgery of the lateral wall, the authors firmly believe that mutilating procedures like total inferior turbinectomy can in no way be considered functional surgery of the turbinates. On the contrary, aim of lateral wall functional surgery is not simply to widen the airway, but rather to restore normal aerodynamic contours to the lateral wall in order to prevent turbulence, a phenomenon which will cause increased nasal resistance. To do this, the authors make systematic use of Conservative Submucosal Turbinoplasty (CST). The procedure is designed especially to treat the submucosa since this is the main focus of anatomo-pathological alterations. Nasal valve surgery is one of the most high-risk surgical procedures since scarring, stiffening, or loss of structural support may cause severe and even irreversible damage. Any surgery of the valve area should therefore carry minimum risk of respiratory complications and aesthetic defects. In the light of these principles, the authors propose a valve area correction technique carried out exclusively through the hemitransfixion incision. This approach affords wide access to the whole valve area, allowing the rhino-surgeon to perform a range of corrections on the anatomic sub-units constituting the nasal valve complex. This same approach can be used to place various grafts. The authors propose a "tailored surgery to normalize the nasal resistances," i.e., a systematic surgery to reshape the volume of the various segments of the nasal chambers by repositioning as close to normalcy as possible the disrupted skeletal framework and recontouring streamlined nasal walls.

Airway Resistance↗
PubMed1996

[Modern corrective nasoseptal surgery].

Inner nose surgery should be addressed to normalize the geometry of the nasal cavities in order to restore physiologic nasal resistance. As the nasal septum plays a key role in the form and the function of the nose, a successful rhinosurgeon must be able to deal with all septal problems ranging from localized spurs to severely traumatized or surgically damaged nasal septa. Nasal airway obstruction due to septal derangements cannot be successfully solved simply by submucous resections of septal window(s) but does often require a range of corrective maneuvers on the anatomic sub-units constituting the septum. Septal surgery is systematically performed by the Authors using the maxilla-premaxilla approach (MPA) which allows access to and manipulation of the entire nasal septum including the caudal and anterior septal margins, columella, upper lateral cartilages, inferior nasal spine as well as floor of the nasal cavities and maxillary crest areas. Correction of the septum combines mobilization and/or removal of any deranged portion of the bony and/or cartilaginous septum, followed by reconstruction of the septum support, preferably using autogenous septal grafts. Reconstruction procedures are designed to reconstitute a stable medial wall and at the same time minimize scar tissue formation. Reconstruction is indispensable to avoid septal flapping occurring when the medial wall consists of muco-periosteal tissue only without firm intermediary support. When reconstructing the medial wall, great care must be taken with the most important portion of the septum, i.e. the dorso-caudal margin and the cartilaginous elements. However, many common nasal problems require procedures to correct the inside of the nose and the external pyramid at the same time. To effectively and efficiently address the challenge posed by the combination of internal and external nasal problems, a thorough understanding of respiratory rhinology as well a familiarity with the many procedures involved in both extensive septal surgery and external nasal pyramid surgery are imperative for the modern-day rhinosurgeon.

Humans↗
PubMed1989

A new technique for functional surgery of the nasal valve area.

Nasal valvular obstruction is a neglected and disregarded clinical entity in current practice. Rhinomanometry and nasal endoscopy allow a better evaluation of the degree and the site of the stenosis. The distinction between nasal valve and nasal valve area is fundamental in surgical practice. Valvular disturbances are often induced or aggravated by rhinoplastic procedures due to scar tissue formation in the region of the nasal valve area and/or to excessive resection of supporting cartilaginous structures. Routine septal surgery is often followed by sequelae in the valve area structures. The treatment of valvular disturbances is basically surgical. A systematic surgical approach should comprise the structures of the nasal valve area as well as the structures functionally related to it. After a brief review of the techniques described in the literature, the authors present an original corrective technique for the valve area deformities, performed through the hemitransfixion incision. This technique results from previous experience founded on Cottle's surgical philosophy. This technique assures the correction of the valve area deformities as well as the performance of surgical manoeuvres extended to the osteocartilaginous pyramid and the nasal cavities. It is therefore possible to properly correct the areas of resistance and to re-establish adequate functional relationships between the various parts.

Cartilage↗
PubMed1989

[The nasal valve area: structure, function, clinical aspects and treatment. Sulsenti's technic for correction of valve deformities].

The nasal valve and nasal valve area are two entities which should not be confused. The nasal valve area is the narrowest portion of the nasal passage. It is bounded: medially by the septum; superiorly and laterally by the caudal margin of the upper lateral cartilage and its fibro-adipose attachment to the pyriform aperture ('empty triangle'); inferiorly by the floor of the pyriform aperture. The nasal valve, on the other hand, is the specific slit-like segment between the caudal margin of the upper lateral cartilage and the septum. From a physiological and surgical point of view, this distinction is fundamental. The nasal valve area is the site of the highest nasal resistance. Therefore, small deformities of the valve area may severely impair the dynamics of nasal air flow. Rhinomanometry and nasal endoscopy permit the best definition of valve pathophysiology. After having discussed the various surgical techniques reported in the literature, the authors present an original technique for the surgical correction of valvular deformities. It is completely performed through Cottle's hemitransfixion incision. The technique has several advantages: a) performance of only one incision, sufficient to visualize the entire nasal valve and cartilaginous vault, thus minimizing the risk of scar tissue formation; b) through the space thus created it is possible not only to correct the entire septum, but also to inspect and easily reach the structures constituting the nasal valve area; c) it is possible to use various types of grafts to support or reconstruct the valve area; d) it is possible to reach the key area as well as to do lateral osteotomies: all variations in shape and position of the nasal pyramid may be performed in order to normalize direction and pressures of nasal air flow: e) through the retrograde undermining of the lower lateral cartilages the resistance of the cul-de-sacs may be optimally adjusted; f) it is possible to change the shape, size and position of the nostrils as well as to properly correct the columella and naso-labial angle. The technique, therefore, permits maximum correction of valvular deformities with the concomitant functional modification of any abnormalities of the nasal pyramid.

Adult↗
PubMedDate not supplied

[Post-surgical results of 48 septal perforations].

We have studied the post-surgical results of 48 perforations of the nasal septum, regarding their etiology, location and size, which must be taken into account when deciding which closure technique to use.

Adult↗
PubMedDate not supplied

[Carbon dioxide laser uvulopalatopharyngoplasty (UPPP). Part I. Surgical technique].

Snoring should not be regarded merely as a socially disruptive nuisance, but also as a potential risk factor of increased morbidity and mortality. Since numerous therapeutic approaches have been developed to treat snoring, the physician is faced with the dilemma of deciding which of the many possible treatments is the best for each snorer. Snoring is a sign of partial occlusion at the oropharyngeal level. Increased nasal airway resistance (NAR) may induce pharyngeal inspiratory collapse. Surgical treatment should be directed towards hindering pharyngeal collapse by surgical resection of redundant oropharyngeal tissue and/or surgical normalization of nasal resistance. Eighty-three consecutive patients suffering from snoring as major complaint together with nasal stuffiness were included in the study. Patients with OSA were excluded from the study. Increased nasal airway resistance (NAR) was a common finding in our population. Nasal surgery, involving both the external pyramid and nasal cavity, aimed at normalizing NAR was performed in 63 patients. In 15 cases, UPPP was performed contemporaneously or as a second surgical step. In 5 patients with no nasal abnormalities, pharyngeal surgery was the only surgical procedure. Personal variation of the classic UPPP is illustrated step by step in Part I. The procedure is carried out using the carbon dioxide laser, which offers several advantages both to surgeon and patient. The modified technique, which is associated with minimal morbidity, appears easy to standardize and successful in treating snoring. Results of the surgical procedures (nasal surgery and/or carbon dioxide laser UPPP) performed to treat snoring are reported in Part II.

Adolescent↗