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Biomedical subjects

Nick S Jones

Publications and source records attributed to Nick S Jones.

15 recordsLinked to original sources
PubMed2006

The complications of giant titanium implants in nasal reconstruction.

We present two cases where a large titanium implant has been used in nasal reconstruction without regard to the basic principles and current philosophy in reconstructive techniques. A full thickness nasal defect requires reconstruction with an inner lining, scaffolding and external skin. Autogenous grafts are preferable particularly when they are used for support or their insertion creates tension on the overlying soft tissue. We report serious complications that result from a disregard to these basic principles in two patients following the insertion of giant titanium nasal implants along with their management.

Adult↗
PubMed2006

Successful treatment of invasive cavernous sinus aspergillosis with oral itraconazole monotherapy.

An 83-year-old woman receiving long-term prednisolone treatment presented with a right optic neuropathy and right third, fourth, fifth, and sixth cranial nerve palsies secondary to sino-orbital aspergillosis with cavernous sinus involvement. Because the patient refused conventional treatment, she was given a two-year course of oral itraconazole 200 mg/day, leading to a complete imaging resolution of the lesion. Three years after completing treatment, there is no clinical or imaging evidence of disease recurrence. Visual and ocular motor function did not recover, but ptosis and proptosis improved. We believe this to be the first documented case of successful treatment of such a lesion with oral itraconazole monotherapy.

Administration, Oral↗
PubMed2006

Male subjects who could not perceive the pheromone 5a-androst-16-en-3-one, produced similar orbitofrontal changes on PET compared with perceptible phenylethyl alcohol (rose).

BACKGROUND: The aim of this study was to evaluate in how far cerebral blood flow changes in male subjects when exposed to a pheromone that they cannot consciously smell. METHODS: We used a boar taint steroid (5a-Androst-16-en-3-one), which is similar to human axillary sweat but could not be detected by the human volunteers who participated in this study. RESULTS: The pheromone produced activation of the orbitofrontal and frontal cortex in comparison to a baseline condition. The same regions were activated when the subjects smelled a rose-like odour. CONCLUSION: This study shows that a pheromone, which is not consciously detected, can evoke a response in the brain that is similar to a detectable odour.

Adult↗
PubMed2005

Sinogenic facial pain: diagnosis and management.

Most patients who present to an otorhinolaryngology clinic with facial pain and headaches believe they have sinusitis. There is an increasing awareness that neurologic causes are responsible for a large proportion of patients with headache and facial pain. If facial pain and pressure is the primary symptom, it is unlikely to be caused by sinus disease in the absence of any nasal symptoms or signs. Patients with facial pain who have no objective evidence of sinus disease are unlikely to be helped by surgery. Most patients with pain caused by sinusitis respond to medical therapy.

Anti-Bacterial Agents↗
PubMed2004

Midfacial segment pain: implications for rhinitis and sinusitis.

During the past decade, studies on facial pain have shown that there is a distinct group of patients who have a form of facial neuralgia that has all the characteristics of tension-type headache, except that it affects the midface; it is called midfacial segment pain. The pain is described as a feeling of pressure, although some patients might feel that their nose is blocked when they have no nasal airway obstruction. Midfacial segment pain is symmetric, and it might involve areas of the nasion (the root of the nose), under the bridge of the nose, on either side of the nose, the peri- or retro-orbital regions, or across the cheeks. There might be hyperesthesia of the skin and soft tissues over the affected area. Nasal endoscopy and CT scans are typically normal. Most patients with this condition respond to low-dose amitriptyline, but noticeable improvement might require up to 6 weeks.

Facial Neuralgia↗
PubMed2003

Intraoperative fluorouracil in endonasal laser dacryocystorhinostomy.

BACKGROUND: Although endonasal laser dacryocystorhinostomy (ELDCR) offers many advantages compared with conventional techniques, postoperative scarring leading to occlusion of the rhinostomy is more common with ELDCR. OBJECTIVE: To investigate whether fluorouracil applied to the rhinostomy site intraoperatively has an effect on the outcome. PARTICIPANTS: We randomly allocated 155 consecutive patients (201 procedures) to a control group and a fluorouracil group. Patients and investigators were masked to the choice of treatment. METHODS: All patients underwent ELDCR. A pledget soaked in isotonic sodium chloride solution or 0.5-mg/mL fluorouracil, randomly allocated by the pharmacy, was applied to the rhinostomy site for 5 minutes at the time of surgery. Patients were followed up for 12 months and their symptoms were assessed at each visit. RESULTS: Among patients followed up for 12 months or longer, ELDCR procedures performed with topical application of fluorouracil to the rhinostomy site were successful in 65 (76%), compared with 52 (63%) for the control group. This was not statistically significant when patients who failed to attend follow-up at or after 12 months were not counted as successfully treated (P =.21, chi(2) test). Even if those who failed to attend for follow-up were counted as successes, the effect of fluorouracil did not reach significance at the.05 level (P =.08, chi(2) test). CONCLUSION: The topical application of fluorouracil failed to increase the patency rates in ELDCR.

Administration, Topical↗
PubMed2003

Diagnosis and management of esthesioneuroblastoma.

Esthesioneuroblastoma is an uncommon malignant neoplasm of the nasal vault that in the past was considered benign or low-grade malignant. Surgical approaches in the main were transnasal, with a high recurrence rate and ultimate patient death. With the modern imaging of CT and MRI, should the patient be willing and fit enough, esthesioneuroblastoma currently should be approached using a craniofacial resection. Large tumors should be considered for preoperative chemotherapy and postoperative radiotherapy. Local tumor recurrence is not uncommon and is generally related to the attention to local anatomic dissection. Neck metastases, when they present, should be excised using a modified neck dissection. Distant metastases may present at any time during the course of the disease, generally within 36 months, and may respond to local radiotherapy or systemic chemotherapy. Five-year survival currently appears to be optimized by surgery followed by postoperative radiotherapy and is approximately 65%.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

Facial pain and sinonasal surgery.

OBJECTIVES: To examine the causes of facial pain that persists after endoscopic and other sinonasal surgery. STUDY DESIGN & SETTING: A study of a cohort of 973 patients presenting in the outpatient clinic with symptoms of facial pain and/or rhinosinusitis. The study subgroup consisted of 75 patients with facial pain persisting after sinus surgery (endoscopic procedure n = 48, other intranasal procedures n = 27). The patients in the subgroup were studied with particular reference to their original presenting symptoms, endoscopic signs, and findings at CT as well as their symptoms when they presented to this unit and, importantly, these were analysed in the context of their response to treatment and follow-up after a mean of 2 years 7 months. RESULTS: Of the 75 patients who had persistent pain after surgery, 40 had no evidence of disease at endoscopy or CT at their initial presentation, whilst 35 had preoperative evidence of sinonasal disease. However, after surgery and re-evaluation, as well as neurological medical treatment, it was found that sinonasal disease was not the cause of these patients pain. The causes of their facial pain that persisted after sinonasal surgery were tension-type headache, atypical facial pain, migraine, paroxysmal hemicrania, cluster headache but the most common cause was 'midfacial segment pain', which has all the characteristics of tension-type headache but primarily affects the midface. CONCLUSIONS & SIGNIFICANCE: Some patients with facial pain are undergoing endoscopic sinus surgery in the mistaken belief that rhinosinusitis is the cause of their facial pain. All surgeons dealing with facial pain should be familiar with non-sinonasal diagnoses. A new category of facial pain, 'midfacial segment pain', is described and proposed.

Adolescent↗
PubMedDate not supplied

The use of Heanley bone-cutting forceps to reduce the thickened and broad bony dorsum in rhinoplasty.

Heanley bone-cutting forceps can be used in a modified rhinoplasty technique for patients with nasal bones that are broad and thickened by callus as a result of several previous nasal fractures. In these patients, the conventional technique of dehumping followed by medial and lateral osteotomies may leave a roof of thickened nasal bones due to callus formation that prevents the pyramid from being narrowed. In this situation, Heanley forceps may be used instead of medial osteotomies to resect paramedian segments of the remaining thickness of the nasal bones so that the nasal bones can be medialized. If no dehumping is required and the bones are just splayed and thickened by callus, Heanley forceps can be used before infracturing and lateral osteotomies. Several points are important for the success of this technique, including introducing the beaks of the forceps submucosally in the correct plane on each side of the nasal bones, advancing the tips of the forceps as far as the nasion, and mobilizing the bony segments before performing lateral osteotomies.

Bony Callus↗
PubMedDate not supplied

Immediate autogenous cartilage grafts in rhinoplasty after alloplastic implant rejection.

BACKGROUND: It is accepted in rhinoplasty that complications are more common with alloplastic implants than with autografts. There is little guidance in the literature on how to deal with the cosmetic and/or functional problems that follow alloplastic implant rejection. The conventional advice has been to remove the allograft and not place any graft at the same time. The present article presents our experience treating allograft rejection and immediately repairing any structural defect with autografts. OBJECTIVE: To demonstrate that immediate nasal reconstruction using autogenous cartilage is a good technique when an alloplastic material has to be removed because of rejection, inflammation, or infection. DESIGN: A retrospective analysis of outcome for a case series. METHODS: A retrospective review of the management of 8 patients who presented to 2 tertiary referral centers with alloplastic implant rejection following rhinoplasty. In 7 cases, the alloplastic implant had to be removed because it had migrated and caused a foreign body reaction; in 1 case, the implant had caused a bacterial infection. RESULTS: In all 8 cases, the nasal deformity that followed the removal of the allograft was so marked that the nose was immediately reconstructed with autogenous cartilage. The patients all made a good recovery after immediate reconstruction, although skin changes associated with the alloplastic implant remained after a mean follow-up of 3 years 3 months. CONCLUSION: The use of autogenous cartilage is a good option for nasal augmentation immediately after the removal of an alloplastic implant.

Adult↗
PubMedDate not supplied

The anatomy of the sphenopalatine artery for the endoscopic sinus surgeon.

BACKGROUND: This study was performed to determine the variations in the branching pattern of the sphenopalatine artery medial to the crista ethmoidalis. Seventy-seven cadaver head sides that had been sectioned sagittally in the midline with their septum removed were used after injecting pink latex to highlight the arterial vessels. METHODS: The mucosa from the middle meatus from the level of the basal lamella was removed until the artery and its branches were seen and then was examined under the microscope to identify the position of the arterial branches. RESULTS: The sphenopalatine artery and its branches were identified in 75 specimens. Of these 75 specimens, 73 (97%) had 2 or more branches medial to the crista ethmoidalis, 49 (67%) had 3 or more branches, 26 (35%) had 4 or more branches, and 1 specimen had 10 branches. In two specimens the artery presented as a single trunk. CONCLUSION: The sphenopalatine artery normally starts to branch lateral to the crista ethmoidalis and these branches vary widely. It is important that the surgeon who undertakes ligation or cautery of the artery is aware of these variations, otherwise they may overlook some of the branches. With an endoscopic approach, removal of the crista ethmoidalis helps visualize these branches.

Cadaver↗