Use of Bone-Cartilaginous Unit in Revision Rhinoplasty

2018 ◽  
Vol 39 (8) ◽  
pp. 841-847
Author(s):  
Amir A Sazgar ◽  
Yeganeh Teimouri ◽  
Amir K Sazgar
Keyword(s):  
Nasal Obstruction ◽  
Composite Graft ◽  
Septal Cartilage ◽  
Outcome Evaluation ◽  
Common Finding ◽  
Level Of Evidence ◽  
Revision Rhinoplasty ◽  
Tertiary Center ◽  
Patient Questionnaires ◽  
A New Technique

Abstract Background Insufficient septal cartilage is a common finding when performing revision rhinoplasty. Such cases require costal or conchal cartilage to be harvested, which is time consuming and brings the risk of morbidity. A new technique involves the use of a septal bone-cartilage composite graft or a bone-cartilaginous (BC) unit as a rhinoplasty graft. Objectives The aim of this research was to evaluate the subjective and objective effects of using a BC unit graft in revision rhinoplasty. Methods In this clinical trial, we examined 40 patients with insufficient septal cartilage for grafting who were referred to a tertiary center and a private setting from January 2016 to March 2017 for revision septorhinoplasty. The patients had nasal deformity and nasal obstruction. Assessment of surgical outcome was based on anthropometric measurements and by measuring the width of the middle nasal third from photographs, and on 2 patient questionnaires: the Nasal Obstruction and Septoplasty Effectiveness (NOSE) and the Rhinoplasty Outcome Evaluation (ROE) questionnaires. Results Nasolabial angles and the middle nasal third improved significantly after surgery (P < 0.005). Based on the NOSE questionnaire, 85% of patients had no or mild nasal obstruction, and the ROE questionnaire indicated that 62.5% were completely or very satisfied with the appearance of their nose. Conclusions The BC unit is an effective graft in revision rhinoplasty, and can be used in place of the rib graft. In skilled hands, harvesting of this graft results in no morbidity and is not time consuming. Level of Evidence: 4

Caudal Septal Division and Interposition Batten Graft: A Novel Technique to Correct Caudal Septal Deviation in Septoplasty

2019 ◽  
Vol 128 (12) ◽  
pp. 1158-1164 ◽  
Author(s):  
Shin Ae Kim ◽  
Yong Ju Jang
Keyword(s):  
Postoperative Complications ◽  
Nasal Obstruction ◽  
Surgical Outcomes ◽  
Septal Cartilage ◽  
Septal Deviation ◽  
Surgical Approaches ◽  
Symptom Improvement ◽  
Level Of Evidence ◽  
Novel Technique ◽  
Evaluation Scores

Background: Correction of caudal septal deviation is a challenging task that may require multiple surgical approaches. Objective: To introduce a novel technique – caudal septal division and interposition batten graft – and evaluate its surgical outcomes in patients undergoing correction of caudal septal deviation. Method: The surgical procedure includes a division of the deviated caudal L-strut preserved after resection of the deviated quadrangular septal cartilage at the central portion. A batten graft made of septal cartilage or bone is interposed between the cut ends of the caudal L-strut, the upper part of which mobilized toward the more concave side of the nasal cavity, and then sutured. The medical records of 29 patients with caudal septal deviation who underwent septoplasty using caudal L-strut division and interposition batten graft technique between January 2016 and March 2018 were retrospectively reviewed. Patient satisfaction and symptom improvement were evaluated by using the Nasal Obstruction Symptoms Evaluation scores. Endoscopic assessment of deviation correction was performed and postoperative complications were analyzed. Results: Of the 29 patients, 19 (65.5%) answered the telephonic interview. Mean Nasal Obstruction Symptoms Evaluation scores were 62.1 preoperatively and 9.2 postoperatively, exhibiting significant improvement ( P < .001). Satisfaction was rated as much improved in 9 (32.0%) patients, improved in 16 (57.0%), unchanged in 2 (7%), and worse in 1 (4%). Records of endoscopic examinations showed that 26 (82.9%) patients had a straight septum, 4 (11.4%) had improved but persisting caudal deviation, and 2 (5.7%) had no available data. Four patients had postoperative complications: 2 had septal abscesses, 1 had wound dehiscence, and 1 had synechia. All of these complications were managed without persistent problems. Conclusions: Caudal septal division and interposition batten graft can serve as an alternative surgical approach with acceptable surgical outcomes for managing severely deviated caudal septum. Level of evidence: 4

scholarly journals Functional and aesthetic outcomes of spreader graft and auto-spreader flap after nasal hump removal

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Maged Baher Naguib ◽  
Mohamed Rifaat Ahmed ◽  
Yasser Taha Madian ◽  
Tarek Mohamady Elnahriry ◽  
Wael Elshahat Eldeeb
Keyword(s):  
Nasal Obstruction ◽  
Operative Time ◽  
Nasal Valve ◽  
Spreader Graft ◽  
Spreader Flap ◽  
The Mean ◽  
The Difference ◽  
A New Technique ◽  
Nasal Valve Collapse ◽  
Duration Of Operation

Abstract Background Following the reduction of the nasal hump to a desired level, spreader grafts are usually positioned to prevent the complication of nasal valve collapse. Auto-spreader flap is a new technique that gained more popularity recently and can be used as an alternative to spreader graft. This RCCT compared between both techniques aesthetically and functionally as well as the operative time. Results Forty patients, 17 males (42.5%) and 23 females (57.5%), were included. The mean duration of operation in auto-spreader flap was 11.8 ± 3.4 min, while it was 19.2 ± 3.2 min in spreader graft. The difference between the two procedures was statistically significant (P < 0.05). Functional assessment of nasal obstruction was done for all patients in both groups preoperative that was (75.6 ± 19.9) which showed marked improvement when re-evaluated 3 moths postoperatively (18.9 ± 14.7), and after 6 months NOSE scale was (29.1 ± 20.2). The overall aesthetic satisfaction was 62.5% (25 of 40) irrespective of the surgery done. Sixteen out of 20 patients in spreader group and 9 out of 20 in auto-spreader flap group. Conclusion Auto-spreader flap and spreader graft are very effective surgical procedure for treatment of nasal obstruction due to internal nasal valve dysfunction, but the auto-spreader flap had shorter operative time. However, spreader graft has a superior aesthetic outcome.

scholarly journals Functional Dart-Throwing Motion: A Clinical Comparison of Four-Corner Fusion to Radioscapholunate Fusion Using Inertial Motion Capture

2020 ◽  
Vol 09 (04) ◽  
pp. 321-327
Author(s):  
Sina Babazadeh ◽  
Ferraby Ling ◽  
Nhan B. Nguyen ◽  
Trieu H. Pham ◽  
Pubudu N. Pathirana ◽  
...  
Keyword(s):  
Cohort Study ◽  
Level Of Evidence ◽  
Fusion Surgery ◽  
Tertiary Center ◽  
Significant Difference ◽  
Partial Fusion ◽  
Dart Throwing ◽  
Radioscapholunate Fusion ◽  
Healthy Control ◽  
Throwing Motion

Abstract Background Dart-throwing motion (DTM) is an important functional arc of the wrist from radial extension to ulna flexion. An aim of partial fusion surgery of the wrist is to maintain maximal functional motion while addressing the pathology. The radioscapholunate (RSL) fusion, accompanied with partial resection of the distal scaphoid, is thought to allow better DTM than other partial wrist fusions such as the four-corner fusion (4CF). Question Does an RSL fusion allow better functional DTM than 4CF, and how does this range compare with healthy wrists and the patient's contralateral wrist? Patients and Methods Patients who have undergone an RSL fusion or 4CF at our tertiary center were identified and invited to present to have their DTM arc measured. To accurately measure DTM, a previously validated inertial measurement device was used. Patient's functional DTM arc was measured in both unrestrained (elbow and shoulder free to move) and restrained (elbow and shoulder immobilized) fashions. This was compared with their contralateral wrist and a group of healthy control volunteers. Results Overall five RSL fusions, 10 4CF and 24 control patients were enrolled in the study. There was no significant difference between functional DTM when 4CF and RSL fusion were compared. Both had significantly reduced functional DTM arc than control patients. There was no significant difference between the operated wrist compared with the patient's contralateral unoperated wrist. Conclusion RSL fusion is not significantly better at maintaining functional DTM when compared with 4CF. Both surgeries result in decreased functional DTM arc when compared with control patients. This is a cohort study and reflects a level of evidence IV. Level of Evidence This is a Leve IV, cohort study.

scholarly journals Olfactory and Gustatory Dysfunctions as a Clinical Manifestation of Coronavirus Disease 2019 in a Malaysian Tertiary Center

2020 ◽  
pp. 000348942096316 ◽  
Author(s):  
Kuganathan Ramasamy ◽  
Jeyasakthy Saniasiaya ◽  
Norhaslinda Abdul Gani
Keyword(s):  
Nasal Obstruction ◽  
Telephone Interview ◽  
Complete Recovery ◽  
Sudden Onset ◽  
Olfactory Dysfunction ◽  
Rt Pcr ◽  
Younger Age ◽  
Tertiary Center ◽  
The Mean ◽  
Polymerase Chain

Objective: To investigate the prevalence of olfactory and gustatory dysfunction among patients with COVID-19 infection and the recovery rate. Methods: Adult patients (≥18 years) tested positive for COVID-19 via reverse transcription-polymerase chain reaction (RT-PCR) and admitted in Hospital Tuanku Ja’afar Seremban, Malaysia, were recruited in this study. Patients completed a questionnaire via telephone interview comprising the following details: age, sex, ethnicity, comorbidities, general and otorhinolaryngological symptoms, onset and duration of olfactory and gustatory dysfunction. Patients with persistent olfactory and gustatory dysfunction at the time of the initial interview were followed-up every 3 to 5 days till resolution. Results: A total of 145 patients were included in our study. The mean age of patients was 43.0 ± 17.7 (range: 18-86). Fever (44.1%) and cough (39.3%) were the most prevalent general symptoms. Thirty-one patients (21.4%) reported olfactory dysfunction and 34 (23.4%) reported dysgeusia. There was a significant association between both olfactory and gustatory dysfunction ( P < .001). Altered sense of smell or taste occurred before other symptoms in 7 (15.9%); concomitant in 16 (36.4%) and after in 15 (34.1%). Six patients (13.6%) reported isolated sudden-onset anosmia. The median duration of olfactory and gustatory dysfunctions was 7 days. Complete recovery was achieved for 70.5% of the patients within 7 days of symptom onset. Only 6 (19.4%) of the 31 patients with olfactory dysfunction experienced nasal obstruction or rhinorrhea. Olfactory dysfunction was not significantly associated with nasal obstruction or rhinorrhea. Olfactory dysfunction was significantly associated with younger age ( P = .002), female ( P = .011), and hyperlipidemia ( P = .012). Gustatory dysfunction was significantly associated with fever ( P = .019) and cough ( P = .039). Conclusion: Olfactory and gustatory dysfunction is a pertinent manifestation of COVID-19. Most of the affected patients achieve rapid and complete recovery. Sudden onset of olfactory and gustatory dysfunction should be recognized as a major symptom of COVID-19 as we implore to contain this pandemic.

The outcomes of digital tip amputation replacement as a composite graft in a paediatric population

2015 ◽  
Vol 41 (2) ◽  
pp. 164-170 ◽  
Author(s):  
D. P. Butler ◽  
L. Murugesan ◽  
J. Ruston ◽  
A. C. Woollard ◽  
B. Jemec
Keyword(s):  
Graft Survival ◽  
Composite Graft ◽  
Paediatric Population ◽  
Graft Replacement ◽  
Level Of Evidence ◽  
Cold Intolerance ◽  
Functional Difficulties ◽  
Parental Questionnaire ◽  
Nail Deformity

Limited studies exist on the outcome of replacing an amputated fingertip as a composite graft. We report the outcomes and predictors for composite graft survival along with the long-term morbidity. A retrospective review of all patients <16 years who underwent composite graft replacement of an amputated fingertip was performed. Long-term morbidity was evaluated through a standardized parental questionnaire. A total of 120 patients were identified, of whom 97 were eligible for inclusion. Parental questionnaires were completed for 42 (43%) patients. There was a 10% complete and 34% partial graft survival rate. Patients aged ⩽4 were significantly more likely to have complete graft take than those >4. Of the patients, 17% developed post-operative complications; 48% of patients reported a hook-nail deformity and 17% reported cold intolerance. Only 5% of patients reported any functional difficulties long term. The rate of complete composite graft survival in a paediatric population is low, although the long-term function of these patients is good. Level of evidence: 3

scholarly journals A study of radiological presentation in bronchogenic carcinoma along with prevelance of pulmonary TB in a tertiary center

2020 ◽  
Vol 8 (5) ◽  
pp. 1675
Author(s):  
Hemant Kumar Sharma ◽  
Babulal Bansiwal ◽  
Anil Saxena ◽  
Shinu A. ◽  
Abdul Qayyum Ansari
Keyword(s):  
Lung Cancer ◽  
Bronchogenic Carcinoma ◽  
Smoking Habit ◽  
Smoking History ◽  
Common Finding ◽  
Local Immunity ◽  
Radiographic Findings ◽  
Pulmonary Tb ◽  
Male Predominance ◽  
Tertiary Center

Background: Lung cancer is most common cause of cancer related death in men and women world wise responsible for over 1 million death annually. Lung cancer is leading cause of cancer death in united states and worldwide. Lung cancer is the most common neoplasm contributing more frequent among males causing cancer related mortality in both sexes. Objective of this study was to radiological presentation in bronchogenic carcinoma along with   prevalence of pulmonary TB in a tertiary center.Methods: Total of 100 patients with histologically proven lung cancer, from July 2018 to June 2019 at a tertiary center Kota Rajasthan. Data of participants regarding demographics, history of smoking habit, clinical presentation, histopathological type, radiographic findings on chest radiograph, ultrasonography, computed tomography (CT) scan, Statistical analysis was performed using descriptive statistics of the collected data.Results: Most common age group of bronchogenic carcinomas was seen between 60-69 years of age (37%) with male predominance (82%).  smoking history present in about (80%) patients.  Most common radiological presentation was a mass lesion present in 91% patients (n=91) followed by unilateral hilar prominence present in 44% of patients (n=44). Other common finding includes mediastinal widening (38%), collapse (26%). pleural effusion (22%), metastasis (22%), cavitation (13%), consolidation (12%), bony erosion (11%), pneumothorax (5%), and pancost tumor (4%).  prevalence of pulmonary TB in bronchogenic carcinoma is 9% and this is due to high burden of pulmonary TB in India.Conclusions: In this study adenocarcinoma was found to be most common type of lung cancer. Smoking is most common risk factor. Pulmonary TB coexistence with bronchogenic carcinoma was more common. The local immunity is deteriorated in cancer cases.

scholarly journals SACRECTOMY ASSOCIATED WITH VERTEBRECTOMY: A NEW TECHNIQUE USING DOWEL GRAFTS FROM CADAVERS

2018 ◽  
Vol 26 (4) ◽  
pp. 260-264
Author(s):  
Thiego Pedro Freitas Araújo ◽  
Douglas Kenji Narazaki ◽  
William Gemio Jacobsen Teixeira ◽  
Fábio Busnardo ◽  
Alexandre Fogaça Cristante ◽  
...  
Keyword(s):  
Case Series ◽  
Cadaver Study ◽  
New Technique ◽  
Biomechanical Stability ◽  
Surgical Time ◽  
Level Of Evidence ◽  
Second Stage ◽  
Posterior Spine ◽  
A New Technique ◽  
New Surgical Technique

ABSTRACT Objective: The purpose of this study was to demonstrate, in a case series, a new sacrectomy technique using an iliac crest dowel graft from a cadaver. Study design: Report of a case series with description of a new surgical technique. Methods: The technique uses four bars to support the posterior spine and a dowel graft in the iliac wings, with compression of the spine and pelvis above it, to support the anterior spine. Three cases were operated on, and in all of them, a vertebrectomy was used. Results: In the first two cases, the technique was performed as a two-stage surgery. The first stage was performed via the anterior and peritoneal access routes, and the second stage via the posterior access route. In the third case, retroperitoneal access via the anterior route meant that the technique could be performed in one stage, resulting in an overall reduction in surgical time (1250 vs. 1750 vs. 990 minutes, respectively). Conclusion: The new technique enables fixation with biomechanical stability, which is essential to support the stress in the lumbosacral transition and promote earlier rehabilitation. Level of evidence IV, case series.

Improvement of Alar Concavity With Scroll Ligament Preservation: Sandwich Technique

2020 ◽  
Vol 40 (10) ◽  
pp. 1064-1075 ◽  
Author(s):  
Güncel Öztürk
Keyword(s):  
Outcome Evaluation ◽  
Nasal Valve ◽  
Level Of Evidence ◽  
Easy Method ◽  
Transposition Flap ◽  
Sandwich Technique ◽  
Novel Technique ◽  
Primary Rhinoplasty ◽  
External Nasal Valve

Abstract Background Excessive concavity of the lower lateral crura can cause significant aesthetic problems for the nasal tip and can be associated with significant functional problems, such as insufficiencies in the external nasal valve. Objectives The aim of this study was to develop a novel technique for the improvement of several alar concavities that preserve the scroll area. Methods In this retrospective study, 51 primary rhinoplasty patients with unoperated alar concavity deformities were assessed. Alar concavities were repaired with alar strut grafts and a superior transposition flap or superior-based sliding flap, which were designed with the “sandwich” technique. Additionally, the scroll ligament was completely preserved in the 2 variants of the technique. All patients who were included in the study were assessed with the Rhinoplasty Outcome Evaluation (ROE) questionnaire before surgery and at their 1-year follow-up appointment. Results The median age of patients was 29.2 years (range, 19-49 years). The ROE scores ranged between 90 and 100 points after 1 year. The median score was 91.2 points, and this was significantly increased at the 1-year follow-up appointment (P = 0.002). Patient satisfaction was found to be excellent in 92% of the included patients. Patients were also evaluated in terms of functionality. The patients’ patency scores increased to 9.4 from 6.1 (out of 10) after a 12-month follow-up (P = 0.003). Conclusions This “sandwich” technique involves a combination of superior transposition flaps, superior-based sliding flaps, and alar strut grafts. Thus, patients who receive this treatment may also benefit from new flap techniques and vertical and longitudinal scroll ligament preservation. This new technique presents a novel and easy method for the reconstruction of severe alar concavities. Level of Evidence: 4

Importance of Space-Occupying Anatomical Variations in Peroneal Tendoscopy

2020 ◽  
pp. 107110072096632
Author(s):  
Ivan Bojanić ◽  
Igor Knežević ◽  
Damjan Dimnjaković
Keyword(s):  
High Efficiency ◽  
Preoperative Evaluation ◽  
Case Series ◽  
Anatomical Variations ◽  
Common Finding ◽  
Peroneal Tendon ◽  
Ankle Pain ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Peroneus Brevis

Background: We hypothesized that peroneal tendons disorders are more commonly associated with anatomical variations, which could overcrowd the retrofibular groove. Methods: This single-center retrospective case study covered 84 consecutive cases that had undergone peroneal tendoscopy. Peroneal tendoscopy was performed on 82 patients, predominantly female (3:1) with a median age of 46 years. The preoperative evaluation and all the procedures were performed by a single surgeon using a standardized technique. Results: Two patients required revision surgery 8 and 52 months after the index procedure due to persistent posterolateral ankle pain. Peroneal tendoscopy was performed as a solitary procedure in 45.1% (37/82) of cases, while the remaining cases involved peroneal tendoscopy as a supplementary procedure. Low-lying peroneus brevis muscle belly (LLMB) was the most common finding in this series in 53.7% (44/82) of cases. In 41.5% (34/82) of cases, longitudinal tears of the peroneus brevis tendon were noted. Some patients presented with more than 1 concomitant peroneal tendon pathology. The LLMB was observed in 23.5% (8/34) of cases with a longitudinal tear of the peroneus brevis tendon. Conclusion: Peroneal tendon anatomical variations, especially LLMB, were associated with the presence of peroneus brevis tendon ruptures and intrasheath peroneal tendon subluxations as well as posttraumatic posterolateral ankle pain. Due to high rates of undiagnosed and misdiagnosed cases of LLMB preoperatively, we believe special care should be taken to recognize it during tendoscopy. Peroneal tendoscopy is a high-efficiency, low-complication method to treat some peroneal tendon conditions. Level of Evidence: Level IV, case series.

Y-Shaped En-Bloc Mortise-Tenon Rhinoplasty Technique

2019 ◽  
Vol 40 (1) ◽  
pp. NP8-NP20 ◽  
Author(s):  
Zheng Tan ◽  
Wentao Sun ◽  
Wenjing Yang ◽  
Xiaoling Zhu ◽  
Fan Dong ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Septal Cartilage ◽  
The Novel ◽  
En Bloc ◽  
Level Of Evidence ◽  
Cartilage Grafts ◽  
Asian Patients ◽  
Caudal Portion ◽  
Aesthetic Results ◽  
Nose Deformity

AbstractBackgroundNasal tip management is the most important and challenging aspect of rhinoplasty. Costal cartilage can be utilized in septal extension grafting to effectively correct nasal shape deformity.ObjectivesThe authors described their experience with costal cartilage grafting for septal extension utilizing a novel en-bloc mortise-tenon technique to correct primary or secondary nose deformity or to enhance nasal appearance in Asian patients.MethodsFrom July 2015 to December 2017, costal cartilage grafts were applied as septal extension biomaterials utilizing the novel en-bloc mortise-tenon technique in 278 consecutive Asian rhinoplasty patients with primary (n = 95), secondary (n = 173), and tertiary (n = 10) nose deformity or in patients needing nasal reshaping. The age of the patients ranged from 19 to 46 years. In all cases, the mucoperichondria of the nasal septum were dissected bilaterally from the septal cartilage. The prepared en-bloc costal cartilage graft was mounted onto the caudal portion of the septal cartilage and fixed to the septum with 5-0 polydioxanone sutures.ResultsThe follow-up duration ranged from 10 months to 2.5 years. Of the 278 patients treated, 5 were male and 273 were female. External lengthening of the nose from the nasal root to the tip ranged from 3 to 10 mm. All patients except 1 were satisfied with the shape of the nose.ConclusionsThe authors obtained good aesthetic results utilizing the novel en-bloc mortise-tenon method for connecting costal cartilage grafts as septal extension materials in patients with different types of nasal deformity and in patients needing nose reshaping.Level of Evidence: 4

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