Current opinion in otolaryngology & head and neck surgery
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Curr Opin Otolaryngol Head Neck Surg · Feb 2015
ReviewPedicled flaps in endoscopic skull base reconstruction: review of current techniques.
To discuss the current applications and indications for the use of pedicled flaps in the reconstruction of endoscopic skull base defects. ⋯ Adoption of vascularized pedicled flaps over the last decade, particularly the recently popularized NSF, has greatly reduced complications associated with endoscopic skull base surgery. The need for vascularized flap reconstruction is governed primarily by defect size and location, and by the presence of a high-flow CSF leak. Additional vascularized flaps can be used in conjunction with the NSF, or as an alternative when the NSF is unfavorable or unavailable.
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Curr Opin Otolaryngol Head Neck Surg · Feb 2015
ReviewThe utility of lumbar drains in modern endoscopic skull base surgery.
Lumbar drains were once routinely used for cerebrospinal fluid (CSF) diversion in endoscopic skull base reconstruction. The vascularized pedicled nasoseptal flap has now become the reconstructive workhorse in the setting of high-flow leaks. High-flow CSF leaks occur when there is violation of a cistern or ventricle. As lumbar drains have the potential for significant complications and the rate of postoperative CSF leak has decreased with the use of vascularized flaps, lumbar drain use has been challenged. ⋯ Lumbar drains are not necessary in the settings of low-flow CSF leaks or even in all high-flow leaks. We consider the use of a lumbar drain in settings wherein a high-flow leak is encountered or anticipated and the patient has other risk factors that may make the risk of postoperative CSF leak higher or closure of the leak more difficult.
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Curr Opin Otolaryngol Head Neck Surg · Feb 2015
ReviewThe role of nasal treatments in snoring and obstructive sleep apnoea.
This review highlights recent advances and views on the role of the nose in snoring and obstructive sleep apnoea. ⋯ Snoring and obstructive sleep apnoea are upper airway disorders in which the role of the nose has been well researched. Studies support that nasal surgery improves quality of life in snoring, but it may not lead to resolution of snoring. Likewise, nasal treatments for obstructive sleep apnoea increase the quality of life and treatment compliance in some patients. Further stratification of patients who may benefit from nasal intervention may clarify the role of nasal surgery.