Mohammadreza Omrani Otorhinolaryngologist, International Board of Facial Plastic and Reconstructive...

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Transcript of Mohammadreza Omrani Otorhinolaryngologist, International Board of Facial Plastic and Reconstructive...

  • Slide 1
  • Mohammadreza Omrani Otorhinolaryngologist, International Board of Facial Plastic and Reconstructive Surgery
  • Slide 2
  • Rare Manifestations of aero digestive tract From subtle cosmetic, to life threatening disorders
  • Slide 3
  • Based on anatomic 1- anterior Neuropore 2- central Midface 3-nasobuccal membrane
  • Slide 4
  • Anterior neuropore; medial to optic reccesses on 3 rd week Behind nasal bones, in front of septal cartilage; prenasal space Prenasal space apex: cribriform area, foramen cecum, closed by fonticulus frontalis ( between nasal bone and frontal bones
  • Slide 5
  • Dermoid, glioma, meningocele, encephalocele
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  • Meninge only; meningocele Brain and meninge; meningoencephalocele Asia; 1/6000 No gender, family tendency, 40% other anomalies
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  • Occipital Sincipital; Naso frontal, Naso ehtmoidal, Naso orbital, 25% of all EC. Basal; less common, between SOF and C P. Intra nasal mass, later in life manifest
  • Slide 8
  • Both sincipital and basal; Pulsatile, bluish, compressible lesions with transillmination. Expand with crying, straining, compression on jugular veins. HRCT, MRI, ddx of agenesis of CC, hydrocephalus MRI; ddx of meningocele from meningoencephalocele, saggital and contrast; help relation to Intra cranial cavity
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  • Management; Surgery, first few months of life; Lowered risk of meningitis, better cosmetics, more complete repair of dural defect. Small; endoscopic approach Large; combined approach Defect; peri cranial flap or calvarial bone Complications; CSF, menigitis, hydrocephalus. Reccurance; 4-10%
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  • Glial tissue without patent CSF path, 5-20% fibrous affiliation, Rare, non familial, but males Extranasal (60%) Intra nasal (30%) Combined (10%)
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  • Smooth, firm, non compressible, in glabella, sometimes in nose side and naso maxillary lines.
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  • Polypoid, pale mass, protruding from nostril, no transillumination, no change with crying Mostly, lateral nasal valve near to middle turbinate, but septum. Rarely; oral cavity, naso pharynx, orbit Pathology; no ependymal tissue in gliomas Dx; CT, MRI, Endoscopy
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  • Surgery Extra; lateral rhinotomy, midline, bicoronal, external rhinoplasty ( may the best) Osteotomy for fibrous stalk Intra; endoscopic, 4-10% reccurance.
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  • Fronto nasal inclusion cyst, anterior neuropore. Midline nasal mass; 1/3000-40 000 Most common; dermoids, 10% of all dermoids Sporadic, male Accompanying hydrocephalus, mental retard, pinna, aural atresia, hyperthelorism in 5- 41%
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  • Mid line pit or mass, a dimple on rhinion Firm, lobulated, non compressible mass with a sinus, with discharge or infection, no enlargement with crying, no transillumination. A hair is in minority, but pathognomic Recurrent meningitis shows a tract to CNS, 4- 45% Intra cranial extension
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  • Thin slice 1-3mm CT with contrast, Bifid cista galli, but if normal, no IC extension MRI; ddx nonenhancing dermoid from hemangioma or teratoma, high intensity T1 crista galli; dermoid extension
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  • Extra cranial approach; access to midline, skull base, accptable scar, reconstruction of dorsum Best; external Rhinoplasty Transglabellar sub cranial approach, midline vertical approach, lateral rhinotomy. IC; bicoronal extended approach
  • Slide 18
  • Normal nasal development; w 4-12 W5; lateral and medial nasal prominences Arhinia, polyrhinia, Proboscis lateralis, roberts Syndrom ( midline nasal cleft)
  • Slide 19
  • Very rare, 30 cases Sporadic, or with other malformations With genetic disorders, trisomy 10, 13, 21 No external nose, no airway, maxillary hypoplasia, small high arched palate, hypertelorism Hypernasality? Hyposmia
  • Slide 20
  • Early; cleft feeder, or gastrostomy tube Prosthsis, vertical distraction osteogenesis Split thickness skin graft with long term stenting Restenosis; common, dilation Tissue expander, grafts, DCR, flaps
  • Slide 21
  • Double nose, suplementary nostril, Only 4 cases, anterior ( duplicate septum and passage) and posterior ( choanal atresia) 1 st ; choana 2 nd ;lateral wall anastomosis Excision of suplementary nostril with primary closure
  • Slide 22
  • A tube to medial canthus and the same side heminasal aplsia 2 nd to fusion of maxillary process CNS and orbital disorders, CT, treament delayed till facial growth completes Restenosis, dilation
  • Slide 23
  • Ocular hypertelorism Broad nasal root Lack of nasal tip Tessier classification; 9-14; cranial, 0-8; facial
  • Slide 24
  • Median nasal cleft; bifid nose, internasal displasia Accompanying median cleft lip, airway is acceptable
  • Slide 25
  • Male, 1/1000 complete cleft lip; nasal floor, Left, right, bilateral; 6, 3,1 Most severe; bilateral complete cleft lip; flattened tip, short columella, maxillary hypoplasia, prognathism
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  • Unilateral cleft lip; less severe, lateralized ala in the side, flat retracted nostril, caudal septum displaced to cleft side, cleft side maxillary hypoplasia, bifid, asymmetric nasal tip Treatment; primary and secondary rhinoplasty First attempt; 1 st lip surgery, 2 nd ; strut or shield graft for projection; stage 1 in 4-6 y, stage 2 ; 8-12y, following orthodontic correction Definitive op; 16-18 y
  • Slide 27
  • Over growth of nasal process of maxillary bone, manifest in 1 st few months, Central mega incisor, hyper telorism, flat nasal bridge, pituitary disorders, with dental, facial anomalies Symptoms like choanal atresia, fail to pass NG CT; width of pyriform, cavity and choana all reduced, but height of cavity and choana normal
  • Slide 28
  • Width in newborn > 11mm, in CNPAS< 8 Central incisor; investigate CNS, chromosomal, pituitary.
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  • Treatmnet; nonsurgical ( drops and tubes) surgical; sub labial, drilling, 4w stent
  • Slide 30
  • Dacrocystocele; obstruction, epiphora 30% duct obstruction in neonate, but this anomaly is rare Susceptible to aspiration, resolves in 9 months Endoscopy; cystic mass in inferior meatus CT; confirmation, NLD and sac enlarged, inf meatus cyst Op; feeding, infection, obstruction
  • Slide 31
  • W3-4; placodes appear. W5-6; naso buccal membrane rupture; fialure; choanal atresia Another theory; abnormal migration of neural crest cells ( Treacher Collins)
  • Slide 32
  • 1/5000-8000, 2/3 unilateral, right sided 50% of all, and 75% of bilateral; anomalies; CHRGE, polydactily, Crouzon Syndrom, nasal, palatal, auricular deformities Problem; narrow cavity, lateral bony obstruction by pterygoid plates, medial obstruction by thickened vomer, membranous obstruction Mixed atresia; 71%, no pure membrane atresia.
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  • Bilateral; cyanotic event, Fail to pass 6F catheter, in 32mm distance CT; ddx stenosis and atresia; Stenosis; narrowed but patent choana, space