A systematic review of the surgical techniques for the treatment of internal nasal valve collapse: where do we stand?

AbstractNasal obstruction is one of the most common complaints in the otolaryngology clinic. It can be a complex problem and may be multifactorial. Nasal valve dysfunction can be a cause of nasal obstruction, particularly in patients who have undergone previous reduction rhinoplasty. The exact site of the nasal valve is contentious and is frequently subdivided into the internal and external nasal valves. Accurate assessment is crucial for correct diagnosis and management planning. Various surgical and non-surgical techniques for addressing the problem of nasal valve collapse have been described in the literature. The choice of technique will depend on the causative pathology, availability of graft material, surgical experience and patient preference.

Download Full-text

Pyriform Aperture Enlargement for Internal Nasal Valve Obstruction in Adults: Systematic Review and Surgical Classification

Otolaryngology ◽

10.1177/0194599821994739 ◽

2021 ◽

pp. 019459982199473

Author(s):

Humoud Hajem ◽

Charles Botter ◽

Mohammad Al Omani ◽

Vincent Sounthakith ◽

Eléonore de Bressieux ◽

...

Keyword(s):

Systematic Review ◽

Nasal Obstruction ◽

Surgical Techniques ◽

Major Complication ◽

Inferior Turbinate ◽

Lateral Nasal Wall ◽

Safe Procedure ◽

Nasal Valve ◽

Level Of Evidence ◽

Pyriform Aperture

Objective Pyriform aperture enlargement or “pyriplasty” is an uncommonly used procedure for internal nasal valve obstruction in adults besides functional rhinoplasty, inferior turbinate reduction, and septoplasty. A systematic review of the literature was performed to analyze current surgical techniques, their suggested indications, and their related outcome in terms of success and complications. Data Sources The search was performed on PubMed, EMBASE, SCOPUS, and Cochrane databases. Review Methods The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies on congenital, traumatic, tumoral, or infectious internal nasal valve obstruction were excluded. Results Eight articles were finally included. Three types of pyriplasty have been described according to the level of bone resection: low-level pyriplasty through the sublabial approach, mid-level pyriplasty through endonasal approach, and extended pyriplasty through either approach. Indications included (1) clinically or radiologically narrow pyriform aperture, (2) previously unsuccessful internal nasal valve surgery, (3) lateral nasal wall collapse, and (4) inferior turbinate’s head hypertrophy. Subjective improvement of nasal obstruction was reported in these 4 indications. No major complication was encountered. Conclusion Pyriplasty for nasal obstruction is a simple and safe procedure that could be effective in selected cases. However, level of evidence is currently low, and success rate may vary with indications and pyriplasty techniques. Moreover, there is no clear definition of normal pyriform aperture dimensions to date. Further prospective studies are thereby necessary and should include radiological analysis of pyriform aperture and validated nasal obstruction measurement tools.

Download Full-text

Surgical techniques for the treatment of nasal valve collapse

The Laryngoscope ◽

10.1002/lary.20495 ◽

2009 ◽

Vol 119 (7) ◽

pp. 1281-1290 ◽

Cited By ~ 60

Author(s):

Patrick M. Spielmann ◽

Paul S. White ◽

S. S. M. Hussain

Keyword(s):

Surgical Techniques ◽

Nasal Valve ◽

Nasal Valve Collapse

Download Full-text

A New Surgical Technique of Internal Nasal Valve Collapse

Türk Rinoloji Dergisi ◽

10.24091/trhin.2008-2-3 ◽

2008 ◽

Vol 1 (2) ◽

pp. 62-66

Author(s):

Erdal SEREN

Keyword(s):

Surgical Technique ◽

Nasal Valve ◽

Nasal Valve Collapse ◽

New Surgical Technique

Download Full-text

Bioabsorbable Implant for Treatment of Nasal Valve Collapse with or without Concomitant Procedures

Facial Plastic Surgery ◽

10.1055/s-0041-1726464 ◽

2021 ◽

Author(s):

Douglas M. Sidle ◽

Pablo Stolovitzky ◽

Ellen M. O'Malley ◽

Randall A. Ow ◽

Nathan E. Nachlas ◽

...

Keyword(s):

Adverse Events ◽

Nasal Obstruction ◽

Large Population ◽

Inferior Turbinate ◽

Nasal Valve ◽

Serious Adverse Events ◽

Vas Scores ◽

Nasal Implant ◽

Nasal Valve Collapse

AbstractThe aim of the study is to report outcomes after treatment of nasal valve collapse with a bioabsorbable nasal implant. It involves two prospective, multicenter, post-market studies evaluating long-term effectiveness of the LATERA implant for severe to extreme nasal obstruction. Participants underwent implant alone or with concomitant inferior turbinate reduction (ITR) and/or septoplasty. Outcome measures included the change from baseline Nasal Obstruction Symptom Evaluation (NOSE) scores, NOSE responder rates, visual analog scale (VAS) scores, and adverse events. A total cohort of 277 participants (109 implants only, 67 implants + ITR, 101 implants + septoplasty + ITR) enrolled at 19 U.S. centers was available for analysis with 177 participants (69 implants only, 39 implants + ITR, 69 implants + septoplasty + ITR) available at 2 years. The mean changes from baseline in NOSE scores and VAS scores were statistically significant (p < 0.001) at all follow-up periods. The baseline NOSE score of 77.8 ± 13.6 was improved to 24.2 ± 23.6 at 24 months. Greater than 90% of participants were NOSE responders across all follow-up periods, 6.1% withdrew for lack of treatment effect. The baseline VAS score of 66.7 ± 18.8 was improved to 21.1 ± 23.9 at 24 months. There were no serious adverse events related to the device or implant procedure. Implant retrieval rate was 4.0% (22/543 implants). Nonserious adverse events were mild to moderate in severity, typically occurred within 6 months of implant, and resolved or were stable. Significant reductions in NOSE and VAS scores and high responder rates from our large population of patients with nasal obstruction who had nasal valve implants confirm sustained effectiveness at 24 months after treatment. The studies are registered on www.clinicaltrials.gov (NCT02952313 and NCT02964312).

Download Full-text

Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211001715 ◽

2021 ◽

pp. 175319342110017

Author(s):

Saskia F. de Roo ◽

Philippe N. Sprangers ◽

Erik T. Walbeehm ◽

Brigitte van der Heijden

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Meta Analysis ◽

Surgical Techniques ◽

Open Release ◽

Flap Coverage ◽

Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

Download Full-text

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

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-020-00058-6 ◽

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.

Download Full-text

1285 Reporting of Robotic Pancreaticoduodenectomy As A Surgical Innovation: Systematic Review and Narrative Synthesis

British Journal of Surgery ◽

10.1093/bjs/znab259.812 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

D Scroggie ◽

K S Lee ◽

R Purves ◽

E Sewart ◽

S Van Laarhoven ◽

...

Keyword(s):

Systematic Review ◽

Synthesis Method ◽

Surgical Techniques ◽

Learning Curves ◽

Narrative Synthesis ◽

Minimal Access ◽

Surgical Innovation ◽

Research Reporting ◽

Full Text Review ◽

Robotic Pancreaticoduodenectomy

Abstract Aim Pancreaticoduodenectomy (PD) is most commonly performed using open surgical techniques. Minimal access approaches have reduced the morbidity of many types of surgery, however technical limitations have hindered the widespread adoption of laparoscopic methods for PD. There has been increasing use of surgical robots to facilitate a minimal access approach, motivated by improved visualisation, ergonomics and dexterity compared to standard laparoscopic methods. Methods for the safe introduction of novel techniques are lacking, and the way in which surgical innovations are reported may affect adoption into clinical practice. The aim of this study is to understand how robotic PD has been reported as a surgical innovation. Method A systematic review is being conducted by the trainee led RoboSurg Collaborative. A literature search was performed to identify primary research reporting outcomes of robotic PD. Articles are being screened in duplicate by title and abstract, then by full text review. The following data will be extracted: study methodology and rationale; centre, surgeons and patient details; governance and ethical considerations; learning curves; details of the intervention, including modifications; and how outcomes were reported, including use of core outcome sets. The data will be analysed using a narrative synthesis method. Results The search identified 1305 articles reporting on robotic pancreas surgery. An interim report of progress will be presented. Conclusions A rich narrative synthesis will enable innovators to understand how robotic PD has been reported. This will encourage transparent, methodical, and meaningful reporting of robotic PD, increasing the quality of clinical evidence.

Download Full-text

Least possible fixation techniques of 4-part valgus impacted fractures of the proximal humerus: a systematic review

Orthopedic Reviews ◽

10.4081/or.2016.6211 ◽

2016 ◽

Vol 8 (1) ◽

Cited By ~ 5

Author(s):

Andreas Panagopoulos ◽

Irini Tatani ◽

Dimitrios Ntourantonis ◽

Ioannis Seferlis ◽

Antonis Kouzelis ◽

...

Keyword(s):

Systematic Review ◽

Avascular Necrosis ◽

Proximal Humerus ◽

Constant Score ◽

Surgical Techniques ◽

Case Series ◽

Cochrane Library ◽

Operation Rate ◽

Fixation Techniques

The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score >80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3.1%) being more common in open techniques. The overall re-operation rate was very low (3.7%). Insufficient study designs cannot provide definite treatment recommendations and quantitative data synthesis of outcome. In general, LPFT for 4-part VI fractures leads to satisfactory outcomes with low incidence of complications. A considerable risk of biases can be attributed to fracture classification, proper radiological control, mean age of patients, mixed types of fixation methods, nonage adjusted clinical scoring and small follow up periods. These factors are discussed in detail. Level of evidence: systematic review of literature (level IV) as most of the studies were level IV.

Download Full-text