Deep-plane/composite rhytidectomy.
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Face↗
Biomedical subjects
M S Godin
Publications and source records attributed to M S Godin.
The anterior extension face-lift.
OBJECTIVE: To describe a face-lift technique with emphasis on extension of the temporal incision into the lateral orbital area. This modification serves several beneficial ends but must be used only in carefully selected patients. Gathering of excess skin in the lateral orbital area is prevented, eliminating the typical disparity between relatively tight lower and middle facial skin and flaccid upper facial skin, which is commonly seen after rhytidectomy. The anterior extension also helps to support the lower eyelid, which is helpful when lid laxity exists or when concomitant blepharoplasty is performed. SETTING: A private cosmetic surgery center. PARTICIPANTS: Thirty-five patients undergoing rhytidectomy (15 primary and 20 revision procedures). OUTCOME MEASURE: Patient satisfaction at 3 months after surgery. RESULTS: Thirty-four (97%) of 35 patients were pleased with their results. CONCLUSIONS: The anterior extension face-lift can provide excellent results in carefully selected patients. We have found this procedure to be especially helpful in patients undergoing revision surgery and in older patients with facial skin laxity.
Female↗
The use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty. A 6-year experience.
OBJECTIVE: To determine the safety and efficacy of expanded polytetrafluoroethylene (Gore-Tex soft-tissue patch, W. L. Gore & Assoc Inc, Flagstaff, Ariz) as an implant in rhinoplasty. DESIGN: A retrospective study of 137 patients who underwent rhinoplasty including augmentation with Gore-Tex over a 6-year period. A review of the medical literature concerning the use of Gore-Tex as an implant in the head and neck was also conducted. SETTING: Two major academic medical centers and two private office surgical centers. PARTICIPANTS: One hundred thirty-seven consecutive patients who received Gore-Tex implants in the course of rhinoplasty. INTERVENTION: Sixty-nine patients presented for primary rhinoplasty; the remaining 68 presented for revision surgery. All received Gore-Tex nasal implants to augment the nasal dorsum and/or base. The grafts ranged from 1 to 6 mm in thickness. Follow-up ranged from 6 to 80 months, with an average of 25 months. OUTCOME MEASURES: Clinically noted complications and patient satisfaction. RESULTS: Three (2.2%) of 137 grafts became infected and were removed. One graft was removed 5 months post-operatively because of excessive augmentation. None of the patients who underwent implant removal required subsequent augmentation. All 137 patients are pleased with their results. CONCLUSION: Gore-Tex is a safe and effective implant material to use in primary and revision rhinoplasty when augmentation is needed and autogenous material is not available or desirable.
Adolescent↗
The tension nose: open structure rhinoplasty approach.
The term tension nose is known to many rhinoplastic surgeons, yet confusion exists as to its precise meaning. We define the tension deformity as excessive growth of the quadrilateral cartilage, resulting in a high nasal dorsum and anterior and sometimes inferior displacement of the nasal tip cartilages. A review of the surgical literature shows that little attention has been given to the evaluation and management of this problem. We reviewed 50 consecutive primary rhinoplasty candidates and found that 46 percent had some manifestation of tension deformity that required correction at the time of surgery. The techniques of open structure rhinoplasty are ideally suited to manage the tension nose. The essence of correction is a deprojection-reprojection process. First, excessive elements of the septal cartilage and anterior nasal spine, which comprise what we have termed the nasal pedestal, are reduced, resulting in tip deprojection. Open structure methods are then employed to achieve reprojection of the domes by using cartilage grafts and suturing techniques to build strength, support, and elegance into the nasal tip.
Humans↗
The prognostic value of endotracheal tube-air leak following tracheal surgery in children.
In an effort to determine if the endotracheal tube-leak pressure has prognostic value in relation to a successful outcome after one-stage laryngotracheal reconstruction or cricoid split surgery, a retrospective analysis was performed on 17 children who had undergone such surgery. The daily leak pressures, length of intubation, and ultimate outcome of attempts at extubation were noted. One hundred percent of patients with a leak pressure of less than 20 cm H2O on the day before extubation were successfully extubated. In contrast, the failure rate was 100% in children extubated with a leak of greater than 30 mm H2O. The difference between these two groups was statistically significant (chi 2, 13.03). Sixty percent of patients with leak pressures in the range of 21 to 30 cm H2O were successfully extubated. The endotracheal tube-leak pressure is a parameter that has prognostic value, and should be considered in determining when to extubate children who have undergone tracheal reconstructive surgery.
Airway Obstruction↗
Occult surgical glove perforations in otolaryngology-head and neck surgery.
With the advent of the acquired immunodeficiency syndrome crisis, it has become imperative that all surgeons minimize their risk of direct contact with the patient's body fluids. In the course of performing surgery, perforations are frequently created in surgical gloves, which often go unnoticed. This study determined the frequency with which occult glove perforations occurred in 134 consecutive head and neck surgical procedures. One thousand fifty gloves (650 gloves used in surgery, 400 unused control gloves) were analyzed for the presence of perforations large enough to permit the passage of fluid. An unrecognized glove perforation was detected in 25% of surgical cases. The duration of surgery correlated strongly and positively with the incidence of perforation. Perforation rates varied widely for specific types of procedures, and are reported for each of the five subdivisions within otolaryngology-head and neck surgery. The implications of these results are described, and recommendations for the use of protective measures, especially in reference to the use of double-gloving, are made.
Equipment Failure↗
Fourth branchial pouch sinus: principles of diagnosis and management.
The fourth branchial pouch sinus is a congenital anomaly which most frequently manifests itself by recurrent episodes of neck abscess or acute suppurative thyroiditis. This lesion usually becomes symptomatic before the age of 10 years and is more common than has previously been suspected. It has been found on the left side in 93% of the 28 cases reported in the English literature. Barium swallow during periods of quiescence and nasopharyngoscopy have frequently been successful in identifying the presence of these embryological remnants. Definitive therapy consists of total excision of the sinus tract, which can be facilitated by direct endoscopic placement of a Fogarty catheter into the sinus lumen before surgical exploration. The embryological basis for the occurrence of these sinuses is discussed.
Branchioma↗
The transoropalatal approach to the atlantoaxial-clival region: considerations for the head and neck surgeon.
The transoropalatal approach to the atlantoaxial-clival area provides excellent exposure for neurosurgical decompression and fusion procedures. The technique has been effectively applied in the treatment of bony and soft tissue abnormalities of the anterior spinal region. Although this approach is safe and reliable, it is not part of the otolaryngologist's usual surgical armamentarium. In the present study, we describe the case histories of five patients who underwent resection of the odontoid process for cervicomedullary compression. Neurological compromise was manifested by progressive upper and/or lower extremity paresis in all patients. In each patient, a transoropalatal approach was used. The surgical technique is discussed, and the prevention of possible sequelae, including velopharyngeal incompetence and palatal or pharyngeal wound dehiscence, is addressed.
Adult↗
Cost effectiveness of regional anesthesia in carotid endarterectomy.
The purpose of this prospective study was to assess safety, efficacy, and hospital costs (excluding medications) and laboratory tests related to general (GA) and regional anesthesia (RA) for carotid endarterectomy (CEA). One hundred patients underwent CEA; 50 received GA and 50 received RA. Thirty-eight men (eight diabetic) and 12 women (two diabetic), with an average age of 62.4 (47 to 79) years comprised the GA group; 35 men (six diabetic) and 15 women (one diabetic), with an average age of 64.1 (51 to 74) years comprised the RA group. Twenty-one patients (17 men, 4 women) in the GA and 24 patients (19 men, 5 women) in the RA group had hypertension. Every patient had some stigmata of cardiac disease. Patients receiving GA for CEA spent an average of 1.2 days in the surgical Intensive Care Unit (ICU) and 6.1 days in a regular hospital bed, for an average cost of $4547. The patients who underwent CEA under RA had an average of 0.1 ICU days and 4.1 regular hospital days, for a cost of $2067. RA saved $2480 per patient and $124,000 in our study group, with no increase in mortality or morbidity rates (P less than 0.001). RA is superior to GA in cost-effectiveness for patients undergoing CEA.
Anesthesia, Conduction↗
Tortuosity of the right common carotid artery simulating aneurysm.
Among the problems that confront the vascular surgeon, a pulsatile, right-sided neck mass requires a careful and logical evaluation. It has long been known that tortuosity of the right common carotid artery, frequently associated with advanced hypertension, can physically mimic a right carotid aneurysm. The question, then, is whether carotid angiography, with a higher attendant risk of morbidity and mortality, is preferable to less invasive diagnostic modalities such as computerized tomography (CT) and ultrasonography for initial evaluation. In our study, 31 consecutive patients with a pulsatile right neck mass, indistinguishable on physical examination from a carotid aneurysm, were evaluated using CT scan of the neck and either radionuclide scan or angiography. In all of the patients, the masses were confirmed to be tortuous right common carotid arteries and not aneurysms. Because a kinked carotid artery simulating an aneurysm occurs so frequently, noninvasive diagnostic techniques, such as CT and ultrasonography, should precede angiography. We also discuss demographic characteristics commonly associated with tortuosity of the right common carotid artery.
Aged↗
Effect of commercially available pantyhose on venous return in the lower extremity.
Although compression stockings have long been recognized as a physiologically significant tool for the promotion of venous return from the lower extremity, the role of nonprescription, commercially available support hose has not been assessed in this regard. The present study involved 100 consecutive women with no known prior history of vascular disease, who responded to an advertisement for free evaluation of the venous status of their legs. The subjects, all of whom wore commercial support hose routinely, were screened for the presence of venous disease by means of Doppler ultrasonography, phleborheography, and a detailed history focusing on risk factors and unrecognized symptoms of venous disease. Photoplethysmography (PPG) was then used to evaluate the efficiency of venous return from the lower extremity with and without the support hose in place. Worsening of PPG results occurred in 43% of the women with commercial stockings in place, whereas 23% improved and 34% showed no change. Women 50 years of age and older had a somewhat higher tendency toward poorer PPG results while wearing the support hose. Furthermore, measurements in women who showed evidence of venous disease by an abnormality in one or more of the screening tests were significantly different from the overall group (p = 0.025): 61% exhibited worsening of PPG results when wearing stockings, only 14% showed improvement, and 25% were unchanged. These results suggest that the use of a commercial support hose may be particularly deleterious to older women and is contraindicated in those with evidence of venous disease in the lower extremity.
Adult↗
Nasal augmentation using Gore-Tex. A 10-year experience.
OBJECTIVE: To determine on an ongoing basis the safety and efficacy of expanded polytetrafluoroethylene (Gore-Tex soft tissue patch and preformed nasal implants) as an implant in rhinoplasty. DESIGN: A retrospective study of 309 consecutive patients who underwent rhinoplasty, including augmentation with Gore-Tex, during a 10-year period. SETTING: Two major academic medical centers and 2 private office surgical centers. INTERVENTION: One hundred sixty-two patients (52%) presented for primary rhinoplasty; the remaining 147 (48%) presented for revision surgery. All received Gore-Tex implants to augment the nasal dorsum and/or base. The grafts ranged from 1 to 10 mm in thickness. Follow-up ranged from 5 months to 10 years, 5 months, with an average of 40.4 months. MAIN OUTCOME MEASURES: Clinically noted complications and patient satisfaction. RESULTS: Ten (3.2%) of 309 grafts became infected and were removed. One graft was removed and 1 graft was modified and replaced postoperatively because of excessive augmentation. Infection requiring removal occurred in 8 patients (5.4%) undergoing revision rhinoplasty and in 2 patients (1.2%) undergoing primary rhinoplasty. Nasal septal perforation was present preoperatively in 3 of the patients who developed infection requiring removal, and we consider it a contraindication for nasal Gore-Tex implantation. CONCLUSIONS: Gore-Tex remains an effective implant material for nasal augmentation in rhinoplasty. The complication rate in primary cases is low. The risk of infection necessitating removal rises significantly in revision cases, where its use may still be desirable but must be weighed more carefully.
Female↗