Survival benefit of postoperative RTx in stage IV rectal cancer after complete removal of tumors was not apparent. RTx could be recommended for selected patients at high risk of local recurrence or for palliation of symptoms.
In Asian rhinoplasty, dorsal augmentation often requires the use of alloplastic materials because sufficient amounts of autograft are difficult to harvest. Given considerations of aesthetics, costs, and the characteristics of the oriental nose, silicone or Gore-Tex is commonly used when augmenting the nasal dorsum to a great extent. Such materials can often result in postoperative complications and foreign-body sensations. Moreover, extrusion or visualization of the implant may occur because of thinning of the skin over time. Permacol collagen implants are specifically indicated for soft tissue reinforcement and repair of the head and face in plastic and reconstructive surgery. The handling versatility of the flexible collagen sheet allows it to be layered over itself until the requisite thickness and desired shape are obtained. A total of 50 patients who underwent nasal augmentation rhinoplasty between December 2007 and May 2011 were observed for at least 24 months. Depending on the nasal dorsum, we layered the collagen sheet up to a maximum of 4 times and we have not seen any case of severe resorption or overcorrection in the nasal configuration. Collagen implant material is safe for use in select rhinoplasty patients because of its low complication rate, as shown in our series. It could therefore be considered as a useful alternative when reconstruction is problematic because of the low quality or lack of available autologous grafts.
The otolaryngologist should consider empty sella syndrome for diagnostic guidance when evaluating patients with nontraumatic spontaneous cerebrospinal fluid (CSF) rhinorrhea. The radiographic finding of empty sella is frequently reported in patients with benign intracranial hypertension (BIH). Patients who have a spontaneous CSF leak in the absence of florid symptoms of BIH may have a disrupted pattern of CSF flow, and because they are actively leaking CSF before surgical repair, they may be at risk for developing elevated intracranial pressure and BIH after the CSF leaks have been successfully closed. We describe a patient with CSF rhinorrhea who developed headache, papilledema, and visual disturbance after surgical repair of the CSF leak. The leak was repaired by the placement of a septal cartilage plug with a free mucosal suture graft. This technique provides fundamental biomechanical stability, reduces the complexity of the multilayer packing method, and promotes an effective seal.
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