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Gilbert J Nolst Trenité

Publications and source records attributed to Gilbert J Nolst Trenité.

10 recordsLinked to original sources
PubMed2006

Reconstructive surgery of the leprosy nose: a new approach.

There has still been no reduction in the detection rate worldwide for leprosy, despite supervised multi-drug therapy. In time, leprosy can result in a severe saddle-nose deformity leading to functional problems, disfiguration and stigmatization. In severe cases, only the nasal skin tissue and the lower lateral cartilages are preserved. In such cases, the ideal would be to restore the cartilaginous skeleton but, by contrast with other causes of saddle-nose deformities, this is complicated by the quantity and the poor quality of the remaining nasal mucosa. Leprosy-related saddle-nose deformities are therefore challenging and difficult to reconstruct with the techniques that have been proposed in the past. In this study, 24 patients underwent rhinoplastic surgery involving the use of autogenous costal and/or auricular cartilage or composite grafts. The nasal septum, the upper laterals and the anterior nasal spine were reconstructed with a dorsal onlay attached to a columellar strut with an extension on the proximal side. Before surgery, the saddle-nose deformities were classified according to severity with a new system based on clinical symptoms and signs. Postoperative evaluation was performed at least two years after surgery (N=17). Functional and aesthetic improvement, resorption rate, warping, infection and extrusion were analysed. Functional and aesthetic improvements were achieved in 15/17 patients. None of the patients developed an infection and extrusion or warping of the implants was not observed. The resorption rate depended on the localization and the type of cartilage implant. In general, auricular conchal cartilage implant grafts resulted in less resorption than costal cartilage. Least resorption (4/17 patients) was observed in the dorsal onlay grafts of both conchal (1/6) and costal cartilage grafts (3/11). Resorption of columellar strut implants and shield grafts was observed in 7/17 patients. No resorption was seen of composite grafts (0/4) and alar battens (0/7). Autogenous cartilage implants can be used to reconstruct saddle-nose deformities in leprosy with a minimum risk of complications. The preoperative grade of severity was used as a basis for the development of guidelines for optimal long-term functional and aesthetic outcome.

Adolescent↗
PubMed2006

Reconstructive septal surgery.

To attain without compromise the surgical goal, a straight and concurrently solid septum, especially in cases of marked deviations or severe post-traumatic deformities (sometimes combined with external deformities), an excellent proven and well-known technique is extracorporal or external septoplasty. Surgery consists of excision of the quadrilateral cartilage and its division into straight fragments. To avoid postoperative sequelae such as saddling, the pieces of cartilage must be reconnected meticulously to form a straight and at the same time solid plate. This difficult and time-consuming procedure can be assisted by the use of a connecting material. Since 1996 we have been using a polydioxanone foil (PDS, Ethicon Norderstedt Germany) as the supporting material for this purpose. The PDS as well as the suture material is completely resorbed within 5 months, excluding long-term complications of other artificial implants.

Absorbable Implants↗
PubMed2005

Objective computerized determination of the minimum cross-sectional area of the nasal passage on computed tomography.

OBJECTIVES/HYPOTHESIS: Current methods that measure cross-sectional areas of the nasal passage on computed tomography (CT) do not determine the minimum cross-sectional area that may be an important factor in nasal airway resistance. Objective measurement of the dimensions of the nasal passage may help in the diagnosis, as well as the choice and evaluation of surgical treatment for upper airway insufficiencies. STUDY DESIGN: Retrospective and clinical study. METHODS: Software was developed that automatically calculates the minimum cross-sectional area of the nasal passage on CT. RESULTS: Evaluation shows that the minimization algorithm in the software reliably calculates the position and orientation of the oblique plane on which the minimum cross-section lies. CONCLUSION: The developed method may be used for objective and observer-independent evaluation of surgical treatment options.

Algorithms↗
PubMed2004

Otoplasty: a modified anterior scoring technique.

In the long history of otoplasty, the basic techniques used to correct prominent ears with a missing antihelix are based on incisions, scoring, and suturing of the cartilaginous framework of the auricle. In this article, modifications (subperichondrial dissection and adjusting sutures) of the anterior scoring technique of Chongchet are described.

Dissection↗
PubMed2003

Considerations in ethnic rhinoplasty.

Although it is difficult to define specific ethnic groups as they are multiracial mixtures determined by historical, geographical, and cultural factors, we can define basically five non-Caucasian groups that commonly request rhinoplasty. The specific anatomy, surgical options, implant material, grafts, and possible complications are discussed. The importance of blending the "new" nose with the ethnic features to achieve harmony in the facial aesthetic components is emphasized.

Biocompatible Materials↗
PubMed2002

Secondary rhinoplasty in the bilateral cleft.

Secondary rhinoplasty in bilateral clefts is very complex due to its specific pathological anatomical characteristics. In this article, the general and specific characteristics of the nose of the bilateral clefts are described and careful preoperative assessment is emphasized. We discuss the timing of the operation considering growth inhibition and psychological aspects and a systematic rational surgical approach, dividing the operative procedure into: septal surgery, tip surgery, osseocartilaginous vault surgery, maxillary augmentation, and alar base reallocation. We report results of a retrospective study to evaluate the postoperative care with a custom-made vestibulum device to prevent stenosis of the vestibulum caused by scar tissue retraction in the postoperative period.

Adolescent↗
PubMedDate not supplied

Influence of polydioxanone foil on growing septal cartilage after surgery in an animal model: new aspects of cartilage healing and regeneration (preliminary results).

OBJECTIVE: To determine whether late complications after septoplasty in growing septal cartilage in children can be prevented by the use of a resorbable polydioxanone (PDS) foil in combination with the cartilage. DESIGN: Animal study with 45 young rabbits, operated on at the nasal septum. Four typical septoplasty procedures were carried out, including elevation of the mucoperichondrium, cartilage excision, and reimplantation of crushed and noncrushed cartilage; for each of the procedures, resorbable PDS foil was used in half of the animals. Observation time ranged from 2 weeks to 5 months, to observe the healing process until complete outgrowth of the septum and complete resorption of the foil were achieved. SETTING: Ear, Nose, and Throat Department at University of Pécs, Pécs, Hungary. MAIN OUTCOME MEASURE: Histomorphologic findings on specimens of septum stained with hematoxylin-eosin and periodic acid-Schiff stains. RESULTS: Depending on the surgical procedure, there were various degrees of differences between the groups with and without PDS. After elevation of the mucoperichondrium, there were almost no differences between the 2 groups. After cartilage resection, reimplantation, and crushing, however, there was a remarkable difference between groups. In the group without PDS, septal deviations and poorly regenerated cartilage were observed, but in the group with PDS no significant deviation after complete regeneration of septal cartilage was observed. CONCLUSIONS: The resorbable PDS foil prevented a secondary deviation in the surgically treated growing septal cartilage in young rabbits. Use of this foil could reduce late complications such as septal deviations and possibly prevent growth inhibition in the growing nasal septum after septoplasty.

Animals↗
PubMedDate not supplied

Interest in facial plastic and reconstructive surgery among otorhinolaryngologists: a survey in The Netherlands.

OBJECTIVE: To assess the interest of Dutch otorhinolaryngologists in facial plastic and reconstructive surgery (FPRS). METHODS: We conducted a 22-question survey among otorhinolaryngology physicians and residents concerning their experience with and interest in FPRS. The response rate was 71% (335/475; 275 physicians and 60 residents). RESULTS: Most respondents associated FPRS with rhinoplasty, otoplasty, and the reconstruction of skin cancer defects. Of the physicians, 81% said that 1% to 33% of their practice involves FPRS; 62% were satisfied with this percentage, whereas 36% would like it to be higher. Approximately 70% of physicians regarded their training in FPRS as insufficient, although most (70%) had taken supplementary courses. Moreover, 73% of the otorhinolaryngology physicians and 72% of all respondents said that FPRS should be taught during and after residency, with a preference for hands-on courses. Finally, 84% of all respondents thought that FPRS should be part of the field of otorhinolaryngology, whereas 48% thought that it should become a subspecialty. CONCLUSION: There is interest in integrating FPRS training into the Dutch otorhinolaryngology residency program, as it is in the United States.

Attitude↗
PubMedDate not supplied

Postoperative management of nasal vestibular stenosis: the custom-made vestibular device.

OBJECTIVE: To evaluate the effect of a custom-made postoperative vestibular device on the occurrence and severity of restenosis. DESIGN: This was a retrospective study conducted at the Department of Otorhinolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery of the Academic Medical Center. In this tertiary care center between January 1994 and December 2000, 52 patients treated for nasal vestibular stenosis received a vestibular device directly postoperatively, with the intention to decrease the risk of restenosis. The vestibular device was composed of thermoplastic acrylic material and had a lumen to facilitate breathing. The shape of the device was custom-made within 1 week after surgery and was subsequently worn by the patient for 12 weeks (6 weeks continuously and 6 weeks only during the night). After this period, the occurrence and severity of restenosis of the nasal vestibule were evaluated and the necessity for a potential adjuvant operation was assessed. RESULTS: Preoperatively, of the 52 patients, 38 (73%) had severe stenosis, 13 (25%) had moderate stenosis, and 1 (2%) had mild stenosis. Postoperatively, 15 (29%) of the patients had mild restenosis, 1 had a case of moderate stenosis, and 1 had a case of severe stenosis. Only the latter patient required a subsequent revision. Functional improvement was noticed in 51 (98%) of the patients, whereas 49 (94%) of the patients showed aesthetic improvement after the initial procedure. CONCLUSIONS: In case of surgical treatment of vestibular stenosis, the use of a custom-made vestibular device may help prevent restenosis. In addition to functional improvement, the device may also improve the aesthetic result. The device does not seem to have any negative adverse effects, was easy to make, and was comfortable for the patient to wear.

Adolescent↗