{"id":5678153,"date":"2021-03-10T14:59:23","date_gmt":"2021-03-10T13:59:23","guid":{"rendered":"https:\/\/www.dr-delagranda.com\/endonasal-breach\/"},"modified":"2024-02-22T08:05:15","modified_gmt":"2024-02-22T07:05:15","slug":"endonasal-breach","status":"publish","type":"page","link":"https:\/\/www.dr-delagranda.com\/en\/endonasal-breach\/","title":{"rendered":"Endonasal breach"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; css=&#8221;.vc_custom_1619936862192{padding-top: 35vh !important;padding-bottom: 25vh !important;background-image: url(https:\/\/www.dr-delagranda.com\/wp-content\/uploads\/2021\/05\/breches-endonasales.jpg?id=5675679) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}&#8221;][vc_column offset=&#8221;vc_col-lg-offset-1 vc_col-lg-10 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243; css=&#8221;.vc_custom_1603286580076{padding-right: 12% !important;padding-left: 12% !important;}&#8221;]<div class=\"norebro-heading-sc heading text-shadow text-center\"\n\tid=\"norebro-custom-69f3cef60510d\" \n\t \n\t>\n\t\n\t\n\t\n\t<h1 class=\"title\">\n\t\tEndonasal breach\t<\/h1>\n\n\t\n\t\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content&#8221; css=&#8221;.vc_custom_1619517744409{padding-top: 8vh !important;}&#8221;][vc_column offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f3cef60539e\" \n\t \n\t>\n\n\t<p>The bony area separating the brain and meninges from the nasal cavity, sinuses and eyes is known as the anterior stage of the skull base. The anterior stage of the skull consists of the frontal, ethmoid and sphenoid bones. The brain is surrounded by 3 meninges (pia mater, arachnoid, dura mater) and bathed in cerebrospinal fluid. Occasionally, a bone breach can cause cerebrospinal fluid to pass from the brain to the sinuses and nose, or even from the middle ear to the nose via the eustachian tube. The passage of meningeal fluid (meningocele) or even brain fluid (encephalocele) through the breach is much rar<\/p>\n<p>Find out more about endonasal breach closure from Dr. Delagranda, ENT and cervico-facial surgeon in la Roche sur Yon.<\/p>\n\t\n<\/div>[\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1619600626772{padding-top: 6vh !important;padding-bottom: 8vh !important;}&#8221;][vc_column width=&#8221;2\/3&#8243; offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-offset-1 vc_col-xs-10&#8243; css=&#8221;.vc_custom_1619534081562{border-top-width: 1px !important;border-right-width: 1px !important;border-bottom-width: 1px !important;border-left-width: 1px !important;padding-top: 10px !important;padding-right: 10px !important;padding-bottom: 10px !important;padding-left: 10px !important;background-color: #f9f9f9 !important;border-left-color: #0a0a0a !important;border-left-style: dotted !important;border-right-color: #0a0a0a !important;border-right-style: dotted !important;border-top-color: #0a0a0a !important;border-top-style: dotted !important;border-bottom-color: #0a0a0a !important;border-bottom-style: dotted !important;border-radius: 1px !important;}&#8221;]<div class=\"norebro-text-sc \" \n\tid=\"norebro-custom-69f3cef6055bd\" \n\t \n\t>\n\n\t<div id=\"post-link-5678153\" class=\"sh-link post-link sh-hide\"><a href=\"#\" onclick=\"showhide_toggle('post', 5678153, 'SUMMARY', 'SUMMARY'); return false;\" aria-expanded=\"false\"><span id=\"post-toggle-5678153\">SUMMARY<\/span><\/a><\/div><div id=\"post-content-5678153\" class=\"sh-content post-content sh-hide\" style=\"display: none;\"><\/p>\n<ul>\n<li><a href=\"#breche-endonasale\">Base of the skull, anterior stage and endonasal osteomeningeal gap<\/a><\/li>\n<li><a href=\"#objectifs\">When should endonasal breach closure be performed?<\/a><\/li>\n<li><a href=\"#objectifs\">Objectives of breach closure<\/a><\/li>\n<li><a href=\"#intervention\">Surgical intervention<\/a><\/li>\n<li><a href=\"#intervention\">Post-operative recovery period<\/a><\/li>\n<li><a href=\"#complications\">Complications associated with endonasal breach closure<\/a><\/li>\n<li><a href=\"#questions\">Frequently asked questions<\/a><\/li>\n<li><a href=\"#rdv\">Appointment<\/a><\/li>\n<\/ul>\n<p><\/div>\n\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content&#8221; css=&#8221;.vc_custom_1621507389599{padding-top: 8vh !important;padding-bottom: 8vh !important;background-color: #0f2233 !important;}&#8221; el_id=&#8221;breche-endonasale&#8221;][vc_column offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243;]<div class=\"norebro-heading-sc heading text-center\"\n\tid=\"norebro-custom-69f3cef60580b\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tSkull base, anterior stage and endonasal osteomeningeal gap\t<\/h2>\n\n\t\t\t<div class=\"divider\"><\/div>\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f3cef6058c6\" \n\t \n\t>\n\n\t<p>The internal bony base of the skull is divided into three stepped pits (anterior, middle and posterior). The anterior cranial fossa or anterior third part is the highest, with the other 2 following in a stair-step pattern. ENT practitioners &#8220;commune&#8221; practice only involves the anterior floor via the endonasal side. The bony anterior stage separates the brain with the meninges from the face including the sinuses, nasal cavities and eyes. Anterior-stage bone is extremely thin over the eyes (1-2 millimeters thick), and even has holes in the cribiform plate of the ethmoid to allow olfactory nerve fibers to pass into the nose. In the middle and in front, the bone is the ethmoid, in the middle and on the sides behind, the bone is the sphenoid, and on the sides in front, the bone is the frontal.<\/p>\n<p>Endonasal osteomeningeal breaches have 2 possible origins:<\/p>\n<ul>\n<li>Traumatic: most frequent<\/li>\n<li>Spontaneous: the rarest<\/li>\n<\/ul>\n\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-heading-sc heading text-left\"\n\tid=\"norebro-custom-69f3cef605961\" \n\t \n\t>\n\t\n\t\n\t\n\t<h3 class=\"title\">\n\t\tTraumatic osteomeningeal breaches\t<\/h3>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f3cef6059f5\" \n\t \n\t>\n\n\t<p>In the event of severe traumatic fractures involving the face, such as car accidents, sports accidents (skiing, horseback riding, etc.) or falls, a bone breach may occur. In addition to the usual haematomas, haemosinus (blood in the sinuses) and deformities, there may be a flow of cerebrospinal fluid through the nose, which is not always perceived by the patient. When the patient feels this discharge, it may correspond to a sweet taste in the mouth. The breach, which is a bony opening, represents an unusual entry point to the meninges for commensal (usual) germs from the nose, exposing the patient to the risk of meningitis. Diagnosis is often obvious from a CT scan of the face.<br \/>\nManagement is the responsibility of the maxillo-facial surgeon, the ENT specialist and, if necessary, the neurosurgeon. An operation is not always necessary for cerebrospinal fluid drainage, which can stop spontaneously.<\/p>\n\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-heading-sc heading text-left\"\n\tid=\"norebro-custom-69f3cef605a83\" \n\t \n\t>\n\t\n\t\n\t\n\t<h3 class=\"title\">\n\t\tSpontaneous osteomeningeal breaches\t<\/h3>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f3cef605b1c\" \n\t \n\t>\n\n\t<p>Identification of these breaches is frequently more difficult despite CT scans with millimetric bone sections, as they are often very small. T2 MRI with fat saturation is useful, in particular to look for signs of cerebrospinal fluid hyperpressure (e.g. empty sella turcica, dilatation). Drainage is unilateral (from a single nostril), fluctuating and sometimes intermittent, with pauses lasting several months. The use of fluorescent tracers or contrast media injected intra-thecally (trans meningeally) is no longer possible in France, to identify and locate them. However, it is possible to collect the fluid flowing through the nose on one side only, and look for Beta 2 transferrin or beta trace in it, to be certain that it is indeed cerebrospinal fluid (rather expensive assay). The classic patient profile is: 40-50 years old, overweight, high blood pressure, hormonal disorders, but this is not systematic. Management varies from case to case (abstention, diamox\u00a9, intervention).<\/p>\n<p>Endonasal osteomeningeal breaches are a risk factor for meningitis, and patients should be vaccinated against the germs most frequently implicated: Pneumococcus and Haemophilus influenzae.<\/p>\n\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row&#8221; css=&#8221;.vc_custom_1621507667167{background: #ffffff url(https:\/\/www.dr-delagranda.com\/wp-content\/uploads\/2021\/05\/breche-ethmoidale-traumatique.jpg?id=5675681) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}&#8221; el_id=&#8221;objectifs&#8221;][vc_column][vc_empty_space height=&#8221;120px&#8221;][vc_row_inner][vc_column_inner width=&#8221;7\/12&#8243; css=&#8221;.vc_custom_1607095018746{padding-right: 10% !important;padding-left: 10% !important;background-color: rgba(255,255,255,0.95) !important;*background-color: rgb(255,255,255) !important;}&#8221;][vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-heading-sc heading text-left\"\n\tid=\"norebro-custom-69f3cef605bc9\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tIndications and objectives of endonasal breach closure\t<\/h2>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f3cef605c76\" \n\t \n\t>\n\n\t<p>Endonasal breach closure concerns adults with an identified, persistent endonasal breach, but also adults with a persistent endonasal breach complicated by meningitis.<\/p>\n<p>Endonasal breach closure should be performed in cases of :<\/p>\n<ul>\n<li>Nose that runs continuously or intermittently, with a very clear, transparent liquid as thin as water, on one side only, spontaneously or during effort (the contracted abdomen increases the pressure of the cerebrospinal fluid) through one nostril and into the throat (anterior and posterior rhinorrhea).<\/li>\n<li>Signs of meningitis with authenticated endonasal breach. Closure will take place after the meningitis has healed, if necessary. Indeed, if we&#8217;re lucky, meningitis can lead to local scarring fibrosis, which obstructs the breach. Meningitis is diagnosed by lumbar puncture. Clinical signs suggestive of meningitis include severe headache, stiff neck, discomfort with light (photophobia) and noise (phonophobia), nausea and vomiting, and extreme fatigue (asthenia).<\/li>\n<\/ul>\n<p>Objectives of endonasal breach closure are:<\/p>\n<ul>\n<li>Stop the flow of cerebrospinal fluid.<\/li>\n<li>Reduce the risk of meningitis and empyema (brain abscess).<\/li>\n<\/ul>\n\t\n<\/div>[vc_empty_space height=&#8221;80px&#8221;][\/vc_column_inner][vc_column_inner width=&#8221;5\/12&#8243;][\/vc_column_inner][\/vc_row_inner][vc_empty_space height=&#8221;120px&#8221;][\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content&#8221; css=&#8221;.vc_custom_1621507409954{padding-top: 8vh !important;padding-bottom: 8vh !important;}&#8221; el_id=&#8221;intervention&#8221;][vc_column offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243;]<div class=\"norebro-heading-sc heading text-center\"\n\tid=\"norebro-custom-69f3cef605d01\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tThe different stages of the intervention\t<\/h2>\n\n\t\t\t<div class=\"divider\"><\/div>\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-heading-sc heading text-left\"\n\tid=\"norebro-custom-69f3cef605d89\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tThe surgical procedure\t<\/h2>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f3cef605e08\" \n\t \n\t>\n\n\t<p>Under general anaesthetic in the operating theatre, the sinus is opened and emptied, the breach is identified if possible and exposed as best as possible, biological glue and a natural patch of fat taken from the abdomen or tendon taken from the thigh (fascia lata) are placed at the site of the breach. The graft is held in place by absorbable strands and a flexible silicone arch. This flexible support arch is removed after 15-21 days under local anaesthesia.<\/p>\n\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-heading-sc heading text-left\"\n\tid=\"norebro-custom-69f3cef605e77\" \n\t \n\t>\n\t\n\t\n\t\n\t<h3 class=\"title\">\n\t\tPost-surgery recovery period\t<\/h3>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f3cef605f09\" \n\t \n\t>\n\n\t<p>The patient usually returns home after 3 days in hospital.<br \/>\nYou will need to lie down for the first 24 hours to limit pressure, and a specific medication to lower cerebrospinal fluid pressure may be prescribed for a few days.<br \/>\nAfter hospitalization, you should remain at home for 21 days, resting and checking for nose or throat bleeding and hematoma at the donor site.<br \/>\nThe surgeon will give you one month&#8217;s leave from work if necessary.<br \/>\nPressure sports are not recommended for the first 2 months, and resumption should be gradual.<br \/>\nPain is moderate, mainly in the donor site. It is controlled by class I or II analgesics.<br \/>\nPost-operative care at home: humidification of the nose with very mild saline, without pressure. Nosewash should be gentle, but should only be started after 4 days.<br \/>\nScar: On the donor site (abdomen in the umbilicus, barely visible, or on the side of the thigh over 7 cm), but none on the face.<\/p>\n\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content&#8221; css=&#8221;.vc_custom_1621507420059{padding-top: 8vh !important;padding-bottom: 8vh !important;background-color: #0f2233 !important;}&#8221; el_id=&#8221;complications&#8221;][vc_column offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243;]<div class=\"norebro-heading-sc heading text-left\"\n\tid=\"norebro-custom-69f3cef605f88\" \n\t \n\t>\n\t\n\t\n\t\n\t<h3 class=\"title\">\n\t\tComplications associated with endonasal breach closure\t<\/h3>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f3cef60602a\" \n\t \n\t>\n\n\t<p>In addition to the risks inherent in any surgery involving general anaesthesia, endonasal breach closure presents rare complications:<\/p>\n<ul>\n<li>Nasal haemorrhage (epistaxis) after the procedure, very minor.<\/li>\n<li>Infection.<\/li>\n<li>Nasal scabs.<\/li>\n<li>Bridles responsible for limiting nasal flow.<\/li>\n<\/ul>\n<p>Exceptional complications are what make this operation so difficult, but they can be managed with experience and technical instruments such as neuronavigation:<\/p>\n<ul>\n<li>Compressive intra-orbital hematoma.<\/li>\n<li>Double vision (diplopia).<\/li>\n<li>Blindness.<\/li>\n<li>Meningitis.<\/li>\n<\/ul>\n<p>Persistent discharge of cerebrospinal fluid does not constitute a complication, but rather a failure of the graft. Meningitis is not a complication, but a consequence of the existing osteomeningeal breach.<\/p>\n<p>Please refer to the ENT College&#8217;s explanatory sheet on endonasal osteomeningeal breach closure for further explanations:<\/p>\n<p><a href=\"https:\/\/www.dr-delagranda.com\/wp-content\/uploads\/2021\/05\/fiche-orl-fermeture-breche-osteo-meningee.pdf\" target=\"_blank\" rel=\"noopener\">\u2794 <span style=\"font-weight: 400;\">Fermeture des br\u00e8ches osteom\u00e9ning\u00e9es<\/span><\/a><\/p>\n\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content&#8221; css=&#8221;.vc_custom_1621507427448{padding-top: 8vh !important;padding-bottom: 10vh !important;}&#8221; el_id=&#8221;questions&#8221;][vc_column offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243;]<div class=\"norebro-heading-sc heading text-center\"\n\tid=\"norebro-custom-69f3cef6060af\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tFrequently asked questions\t<\/h2>\n\n\t\t\t<div class=\"divider\"><\/div>\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f3cef606144\" \n\t \n\t>\n\n\t<p>Here is a selection of questions frequently asked by Dr Delagranda&#8217;s patients during consultations for endonasal breach closure in La Roche-sur-Yon.<\/p>\n\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-accordion-s\u0441 accordion-box  outline\" \n\tid=\"norebro-custom-69f3cef6061bf\"\n\tdata-norebro-accordion=\"0\"\n\t \n\t>\n\n\t<div id=\"1605017264328-06613f59-3c90\" class=\"item justify\">\n\t\n\t<div class=\"title\">\n\t\t\t\t<h4>Is surgery compulsory?<\/h4>\n\t\t<div class=\"control\">\n\t\t\t<span class=\"ion-plus\"><\/span>\n\t\t<\/div>\n\t<\/div>\n\n\t<div class=\"content\">\n\t\t<div class=\"wrap\">\n\t\t\t<p>Yes, once the indication has been confirmed, as meningitis and brain abscesses (empyema) are significant risks associated with breaches.<\/p>\n\t\t<\/div>\n\t<\/div>\n\n<\/div><div id=\"1605017264387-ae52c0b0-c778\" class=\"item justify\">\n\t\n\t<div class=\"title\">\n\t\t\t\t<h4>Is the effect guaranteed?<\/h4>\n\t\t<div class=\"control\">\n\t\t\t<span class=\"ion-plus\"><\/span>\n\t\t<\/div>\n\t<\/div>\n\n\t<div class=\"content\">\n\t\t<div class=\"wrap\">\n\t\t\t<p>No, it depends on the graft&#8217;s acceptance and viability. Grafting is effective in the vast majority of cases.<\/p>\n\t\t<\/div>\n\t<\/div>\n\n<\/div><div id=\"1605017264450-ed4b6523-622c\" class=\"item justify\">\n\t\n\t<div class=\"title\">\n\t\t\t\t<h4>Is the effect long-lasting?<\/h4>\n\t\t<div class=\"control\">\n\t\t\t<span class=\"ion-plus\"><\/span>\n\t\t<\/div>\n\t<\/div>\n\n\t<div class=\"content\">\n\t\t<div class=\"wrap\">\n\t\t\t<p>Yes.<\/p>\n\t\t<\/div>\n\t<\/div>\n\n<\/div><div id=\"1607181181696-2c504641-4d75\" class=\"item justify\">\n\t\n\t<div class=\"title\">\n\t\t\t\t<h4>Is it painful?<\/h4>\n\t\t<div class=\"control\">\n\t\t\t<span class=\"ion-plus\"><\/span>\n\t\t<\/div>\n\t<\/div>\n\n\t<div class=\"content\">\n\t\t<div class=\"wrap\">\n\t\t\t<p>Very little, but more at the donor site than in the nose.<\/p>\n\t\t<\/div>\n\t<\/div>\n\n<\/div><div id=\"1708340543992-bc165153-a8d2\" class=\"item justify\">\n\t\n\t<div class=\"title\">\n\t\t\t\t<h4>Fees and coverage of the procedure<\/h4>\n\t\t<div class=\"control\">\n\t\t\t<span class=\"ion-plus\"><\/span>\n\t\t<\/div>\n\t<\/div>\n\n\t<div class=\"content\">\n\t\t<div class=\"wrap\">\n\t\t\t<p>Endonasal breach closure is covered by health insurance. Contact your mutual insurance company to find out whether any extra fees will be covered.<\/p>\n\t\t<\/div>\n\t<\/div>\n\n<\/div>\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; css=&#8221;.vc_custom_1621507434638{background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}&#8221; el_id=&#8221;rdv&#8221;][vc_column parallax=&#8221;content-moving&#8221; parallax_image=&#8221;5676558&#8243; css=&#8221;.vc_custom_1622240898242{padding-top: 20vh !important;padding-bottom: 20vh !important;}&#8221;][vc_row_inner][vc_column_inner css=&#8221;.vc_custom_1619469911864{padding-right: 7% !important;padding-left: 7% !important;}&#8221; offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10&#8243;]<div class=\"norebro-heading-sc heading text-center\"\n\tid=\"norebro-custom-69f3cef60692c\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tDo you have a question? Need more information?\t<\/h2>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f3cef6069cd\" \n\t \n\t>\n\n\t<p>Dr. Antoine Delagranda is available to answer any questions you may have about endonasal breach closure.\u00a0 Dr Delagranda is a specialist in ENT surgery at the Clinique st-charles in La Roche sur Yon.<\/p>\n\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-button-sc btn-wrap text-center\" \n\tid=\"norebro-custom-69f3cef606a9f\"\n\t \n\t>\n\n\t<a href=\"#consultation\" \n\t\tclass=\"btn  btn-outline btn-large\">\n\n\t\t\n\t\t\n\t\t<span class=\"text\">\n\t\t\tBook an appointment\t\t<\/span>\n\n\t\t\n\t\t\n\t\t\t<\/a>\n\n<\/div>[\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; el_id=&#8221;consultation&#8221;][vc_column offset=&#8221;vc_col-lg-offset-0 vc_col-lg-12 vc_col-md-offset-0 vc_col-md-12 vc_col-sm-offset-0 vc_col-xs-12&#8243;][vc_row_inner css=&#8221;.vc_custom_1619533987520{padding-top: 8vh !important;padding-bottom: 6vh !important;}&#8221;][vc_column_inner offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10&#8243;]<div class=\"norebro-heading-sc heading text-center\"\n\tid=\"norebro-custom-69f3cef606cfe\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tENT consultation for endonasal breach closure in Vend\u00e9e\t<\/h2>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f3cef606daf\" \n\t \n\t>\n\n\t<p style=\"text-align: center;\">Dr Antoine Delagranda will be happy to answer any questions you may have about endonasal breach closure surgery. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon in the Vend\u00e9e.<\/p>\n\t\n<\/div>[\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; gap=&#8221;30&#8243; equal_height=&#8221;yes&#8221; el_class=&#8221;upper-layer&#8221; css=&#8221;.vc_custom_1636446388832{padding-right: 10% !important;padding-bottom: 8vh !important;padding-left: 10% !important;}&#8221; el_id=&#8221;rdv&#8221;][vc_column width=&#8221;1\/3&#8243;][vc_row_inner css=&#8221;.vc_custom_1502457070774{margin-right: 0px !important;margin-left: 0px !important;background-color: #f9f9f9 !important;}&#8221;][vc_column_inner css=&#8221;.vc_custom_1607088904656{background-color: #f7f7f7 !important;}&#8221;][vc_empty_space height=&#8221;50px&#8221;]<div class=\"norebro-icon-box-sc icon-box text-`{`object Object`}`\" \n\tid=\"norebro-custom-69f3cef606e7b\" \n\t \n\t>\n\n\t<div class=\"icon-wrap shape-fill brand-bg-color shape-rounded\">\n\t\t\t\t\t<span class=\"linea-basic-geolocalize-01\"><\/span>\n\t\t\t<\/div>\n\n\t<div class=\"content-wrap\">\n\n\t\t<div class=\"content-center with-full\">\n\t\t\t<div class=\"wrap\">\n\t\t\t\t<h3>Medical office<\/h3>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\t\t\t<\/div>\n\t\t\n\t\t<p class=\"description content-full\">\n\t\t\tClinique Saint Charles<br \/>\n11 boulevard Ren\u00e9 Levesque<br \/>\n85016 La Roche-sur-Yon<br \/>\nVend\u00e9e\t\t<\/p>\n\n\t\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;50px&#8221;][\/vc_column_inner][\/vc_row_inner][vc_empty_space height=&#8221;10px&#8221;][\/vc_column][vc_column width=&#8221;1\/3&#8243;][vc_row_inner css=&#8221;.vc_custom_1502457070774{margin-right: 0px !important;margin-left: 0px !important;background-color: #f9f9f9 !important;}&#8221;][vc_column_inner css=&#8221;.vc_custom_1607088917620{background-color: #f7f7f7 !important;}&#8221;][vc_empty_space height=&#8221;50px&#8221;]<div class=\"norebro-icon-box-sc icon-box text-`{`object Object`}`\" \n\tid=\"norebro-custom-69f3cef606f64\" \n\t \n\t>\n\n\t<div class=\"icon-wrap shape-fill brand-bg-color shape-rounded\">\n\t\t\t\t\t<span class=\"linea-basic-calendar\"><\/span>\n\t\t\t<\/div>\n\n\t<div class=\"content-wrap\">\n\n\t\t<div class=\"content-center with-full\">\n\t\t\t<div class=\"wrap\">\n\t\t\t\t<h3>Secretary for appointment<\/h3>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\t\t\t<\/div>\n\t\t\n\t\t<p class=\"description content-full\">\n\t\t\t+33(0)2 51 44 44 85<br \/>\nMonday to Friday<br \/>\n9am-12pm \/ 2pm-6pm\t\t<\/p>\n\n\t\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;50px&#8221;][vc_empty_space height=&#8221;25px&#8221; el_class=&#8221;vc_hidden-sm vc_hidden-xs&#8221;][\/vc_column_inner][\/vc_row_inner][vc_empty_space height=&#8221;20px&#8221;][\/vc_column][vc_column width=&#8221;1\/3&#8243;][vc_row_inner css=&#8221;.vc_custom_1502457070774{margin-right: 0px !important;margin-left: 0px !important;background-color: #f9f9f9 !important;}&#8221;][vc_column_inner css=&#8221;.vc_custom_1607088929872{background-color: #f7f7f7 !important;}&#8221;][vc_empty_space height=&#8221;50px&#8221;]<div class=\"norebro-icon-box-sc icon-box text-`{`object Object`}`\" \n\tid=\"norebro-custom-69f3cef607017\" \n\t \n\t>\n\n\t<div class=\"icon-wrap shape-fill brand-bg-color shape-rounded\">\n\t\t\t\t\t<span class=\"linea-basic-clock\"><\/span>\n\t\t\t<\/div>\n\n\t<div class=\"content-wrap\">\n\n\t\t<div class=\"content-center with-full\">\n\t\t\t<div class=\"wrap\">\n\t\t\t\t<h3>Opening hours<\/h3>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\t\t\t<\/div>\n\t\t\n\t\t<p class=\"description content-full\">\n\t\t\tClinic reception<br \/>\nMonday to Friday<br \/>\n8am-12.30pm \/ 1.30pm-6.30pm<br \/>\nClosed : Sat \/ Sun\t\t<\/p>\n\n\t\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;50px&#8221;][\/vc_column_inner][\/vc_row_inner][vc_empty_space 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