PubMed Health⌕ Search

Biomedical subjects

Samuel S Becker

Publications and source records attributed to Samuel S Becker.

11 recordsLinked to original sources
PubMed2006

Reducing complications in rhinoplasty.

The dedicated rhinoplasty surgeon continues to acquire throughout his or her career an increasingly detailed understanding of the anatomy and the problems that occur related to rhinoplasty and a growing armamentarium of techniques to achieve improvement or correction. This article out-lines the authors' approach and discusses selected technical problems and approaches to reducing their occurrence. Focusing on the two essential goals-making the patient happy and making this the patient's only nasal surgery-primary rhinoplasty can be a uniquely rewarding experience for the patient and the surgeon.

Constriction, Pathologic↗
PubMed2006

Limits of endoscopic visualization and instrumentation in the frontal sinus.

BACKGROUND: Endoscopic limitations in the frontal sinus are poorly defined. We set out to define these limits. METHODS: Fifteen cadaveric heads underwent endoscopic frontal sinusotomies (Draf IIA, IIB, III). Areas of frontal sinus openings were calculated. Coordinates of the most distant points for instrumentation, visualization, and instrumentation with visualization in the frontal sinus were identified with the use of image guidance. RESULTS: Twenty-eight frontal sinuses were evaluated. The mean sinus opening areas were 47.5 mm2, 105.1 mm2, and 246.4 mm2 for Draf IIA, IIB, and III. Visualization exceeds instrumentation and visualized reach (P<0.05) regardless of different frontal sinusotomies. Anterior and lateral instrumentation and visualized reach increase as the frontal sinus opening increases (P IIB>IIA (P<0.04). There is no statistical difference for superior visualization, instrumentation, and visualized reach among various sinusotomies (P>0.05). CONCLUSIONS: Endoscopic visualization exceeds instrumentation and instrumentation exceeds visualized reach. Enlarging frontal sinus opening area increases instrumentation and visualization.

Cadaver↗
PubMed2006

Multimodality approach to sinus and nasal disorders: results of treatment as determined by a patient survey.

Patients with sinus and nasal disorders whose symptoms persist despite primary care may benefit from a referral to a dedicated nose and sinus center where all treatment modalities are available. The essential principle of a multimodality approach is that medical therapy, allergy treatment, and surgery are all important and useful tools. While various medical and surgical treatments of sinus and nasal disorders have been well described in the literature, overall assessments of comprehensive treatment are uncommon. For more than 7 years, the office practice of the senior author (D.G.B.) has been dedicated to the treatment of sinus and nasal disorders. In an effort to assess the results of the multimodality approach to therapy delivered there, we mailed questionnaires to 1,800 patients who had been treated at this practice over a 3-year period. Responses from 222 of these patients revealed that patients required less medication following treatment with a multimodality approach and that they expressed a high degree of satisfaction with the comprehensive care they received. In addition, most patients with asthma experienced relief of their asthma symptoms following treatment for sinonasal disease. We conclude that a stepwise, multimodality, specialty-center approach to treatment is beneficial for patients with persistent sinonasal disorders.

Anti-Asthmatic Agents↗
PubMed2005

A dedicated specialty center for nose and sinus care: an organized approach.

A specialty center focusing on a single, widespread medical problem and housing all treatment modalities is a revolutionary approach to medical treatment. Sinusitis, the most common chronic illness in the United States, is ideally suited to this approach. By housing the most advanced options for patients in a highly specialized treatment facility, attention is focused on the patient's problem, and treatment may be improved. In this article, an overview of the specialty center approach to sinus and nasal disorders is provided. State-of-the-art medical treatment, allergy evaluation and treatment, and surgical technology, including powered instrumentation and computerized image-guided surgery, are all employed in the treatment of functional nasal problems and cosmetic nasal requests. A subspecialty training program will allow for replication of this model for sinus and nasal care nationally. The Becker Nose and Sinus Center, LLC, is the first specialty center in New Jersey focused on diagnosing and treating patients who suffer from nasal and sinus disorders. The Nose and Sinus Center houses some of the most advanced options for patients in nose and sinus care in a highly specialized treatment facility and is a model for this organized approach to sinus and nasal care.

Academic Medical Centers↗
PubMed2004

Diagnostic and surgical endoscopy in functional septorhinoplasty.

Endoscopy has altered our ability to diagnose pathology accurately during the preoperative assessment, and it has also offered surgeons the ability to perform surgeries in a minimally invasive manner. In this article, we review the senior author's experience with diagnostic and surgical endoscopy in functional septorhinoplasty. A thorough examination of the nasal cavity in the patient seeking cosmetic rhinoplasty along with correction of nasal obstruction is enhanced by the performance of office nasal endoscopy. Endoscopically guided septoplasty is useful as a minimally invasive approach for isolated septal deformities, and it is an indispensable approach in difficult revision nasal surgeries in which obstructing septal deviation persists. Endoscopy is a critical diagnostic and surgical tool in patients seeking cosmetic nasal surgery who also have functional nasal complaints.

Endoscopy↗
PubMed2004

Nasal reconstruction: the state of the art.

PURPOSE OF REVIEW: Cutaneous malignancies of the nose are common problems and create the need for nasal reconstruction within many otolaryngology practices. In spite of the fact that such reconstruction is an ancient art, there continue to be innovations and advances that allow for more predictable and functional long-term results. RECENT FINDINGS: Analyzing the nasal defect through an organized algorithm can be useful in many circumstances, especially when one needs to consider vectors of tension, minimizing alar base asymmetry, resultant scars, and preservation of the intranasal airway. Application of the principle of aesthetic subunits has greatly improved the cosmetic results for many large nasal defects, and there have been some proposals to modify the original definitions and concept. Structural reconstruction is paramount with complex defects that involve the nasal framework or with those that are located in functionally critical areas. Autogenous cartilage grafting remains the gold standard, but the use of alloplastic and homograft materials for grafting continues to be reported as an alternative. Internal lining repair is essential with larger defects and the versatility of intranasal flaps is understood, but at times not available. Other flaps have been described and may be useful on such occasions. SUMMARY: There are many considerations during nasal reconstruction, and the surgeon must be facile with a variety of options within his/her armamentarium.

Algorithms↗
PubMed2003

Auricular cartilage in revision rhinoplasty.

Revision rhinoplasty is a challenge in reconstruction to the rhinoplasty surgeon, both in the techniques of repair and the choice of implant material for augmentation grafting. Often, patients seeking revision or reconstructive rhinoplasty have previously undergone septoplasty with sacrifice of major amounts of septal cartilage. These situations confront the surgeon with the need for a decision about the material that will be used for structural grafting. The senior author follows the time-tested approach of generations of surgeons who have used exclusively autogenous material for nasal reconstruction because of its superior long-term survival characteristics, its ready availability in the head and neck region, its resistance to infection and resorption, and its bendability and flexibility when implanted in the nose. With this in mind, the subject of this article is the use of auricular cartilage in revision rhinoplasty. Careful strategic planning must be undertaken to get the maximal and ideal benefit from the auricular cartilage. The revision rhinoplasty surgeon must understand the anatomy of the external ear and must be able to manage the precious cartilage supply to get the maximum use of it in reconstructive rhinoplasty.

Ear Cartilage↗
PubMed2003

Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches.

OBJECTIVE: To determine whether the choice of surgical approach affects the rate of postoperative cerebrospinal fluid leakage in patients who have undergone surgical resection of acoustic neuroma. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Three hundred patients who underwent surgery for acoustic neuromas were selected by consecutive medical record number until 100 resections via each surgical approach (translabyrinthine, middle fossa, and retrosigmoid) had been gathered. MAIN OUTCOME MEASURES: Surgical approach used, cerebrospinal fluid leak incidence, tumor size, patient age. RESULTS: Postoperative cerebrospinal fluid leak of any severity was observed in 13% of translabyrinthine, 10% of middle fossa, and 10% of retrosigmoid patients. These difference in the rate of cerebrospinal fluid leakage were not statistically significant (p = 0.82). The majority of leaks were managed conservatively with fluid and activity restriction, often accompanied by a period of lumbar subarachnoid drainage. There was a need to return to the operating room for a definitive procedure in 4% of translabyrinthine, 2% of middle fossa, and 3% retrosigmoid patients; again not statistically different among the approaches (p = 0.43). Tumor size was not correlated with cerebrospinal fluid leak rate (p = 0.13). Patient age, for patients older than 50 years, was suggestive of increased odds of cerebrospinal fluid leak (p = 0.06). CONCLUSION: Neither surgical approach nor tumor size affects the rate of postoperative cerebrospinal fluid leakage or the necessity of managing a leak with a return to the operating room. Cerebrospinal fluid leakage rates have remained stable in recent decades despite numerous innovative attempts to improve dural closure, seal transected air cell tracts, and occlude anatomic pathways. The finding that leak rates were similar among three dissimilar surgical techniques suggests that factors other than techniques of wound closure, such as transient postoperative rises in cerebrospinal fluid pressure, may be responsible for these recalcitrant cases.

Adult↗
PubMed2003

Treatment of nasal obstruction from nasal valve collapse with alar batten grafts.

Nasal obstruction may require treatment with rhinoplasty techniques. One cause of nasal obstruction is known as nasal valve collapse. This refers to narrowness and weakness at the nasal valve, the narrowest part of the nasal airway. There are a number of surgical approaches available to treat nasal valve collapse. Selection of the appropriate surgical intervention depends on proper identification of the anatomic cause of the collapse. Alar batten grafts are especially useful for addressing nasal valve collapse caused by a weak nasal sidewall. In this report, we review the senior author's experience with the use of alar batten grafts for nasal valve collapse. Twenty-one patients had septoplasty with placement of alar batten grafts; all patients noted improvement in their nasal breathing. Seven patients underwent ear cartilage harvest with alar batten grafts, and five of them noted improvement, one noted partial improvement, one noted no improvement. Six patients underwent revision septorhinoplasty with alar batten grafting, and ten patients underwent revision septorhinoplasty with ear cartilage harvest and alar batten grafting. These patients all reported improvement in their nasal breathing postoperatively. Six patients underwent revision rhinoplasty (no septoplasty) with ear cartilage and battens. These patients hold special interest because no other intranasal procedures were performed that affected nasal breathing. All six of these patients reported significant improvement of their nasal breathing and all patients were satisfied with their postsurgical cosmetic appearance. The nasal valve area is considered to be the location of the least cross-sectional area in the nose. When narrowing of the nasal valve is a result of collapse of the nasal sidewall, alar batten grafts are a useful technique to address the patient's nasal obstruction.

Female↗
PubMedDate not supplied

Intermediate crural overlay in rhinoplasty: a deprojection technique that shortens the medial leg of the tripod without lengthening the nose.

OBJECTIVE: To review the indications for, surgical techniques of, and results of intermediate crural overlay of the alar cartilages in rhinoplasty. DESIGN: Prospective study of patients undergoing intermediate crural overlay of the lower lateral cartilages. The setting was a facial plastic surgery private practice. Patients included 10 primary rhinoplasty patients and 1 revision rhinoplasty patient who underwent intermediate crural overlay of the lower lateral cartilages. The main outcome measures were postoperative photographs and patient records, which were reviewed for tip projection and rotation, preservation of the double break, bossae, and knuckling. RESULTS: Intermediate crural overlay decreased projection in all 11 patients and increased the nasolabial angle in 7 patients. One patient had no change in the nasolabial angle, and 3 patients had counterrotation of 1 degrees , 3 degrees , and 4 degrees . A postoperative physical examination revealed that no patient had developed bossae, tip asymmetries, or knuckling. In addition, the double break was maintained in all the study patients. CONCLUSIONS: Intermedial crural overlay is a reliable technique for achieving tip deprojection. Overall, the nasolabial angle is maintained (although in 3 patients, clinically insignificant counterrotation did occur). In addition, the length of the intermediate crura is reduced, but the double break is preserved. In the group of patients with thin skin and tip overprojection secondary to overdevelopment of the lower lateral cartilages, intermediate crural overlay achieves tip deprojection while controlling the nasolabial angle and preserving the natural curvature of the dome.

Adolescent↗