scholarly journals Evaluation of the effectiveness of the use of free diced cartilage in dorsal and tip nasal rhinoplasty

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Amr Gouda Shafik ◽  
Mohamed Naguib Mohamed ◽  
Hassan Mohamed Hassan
Keyword(s):  
Nasal Obstruction ◽  
Outcome Evaluation ◽  
Open Rhinoplasty ◽  
Nasal Tip ◽  
Advantages And Disadvantages ◽  
Evaluation Scores ◽  
Symptom Evaluation ◽  
Significant Difference ◽  
Diced Cartilage ◽  
Tip Rhinoplasty

Abstract Background Rhinoplasty is considered one of the most challenging operations in the plastic surgery. Esthetic or functional reshaping purposes of the nose can be stressing for both surgeon and patient. Different types of graft materials have been used to perform augmentation rhinoplasty. Free diced cartilage (FDC) was recently established in dorsal nasal rhinoplasty for better handling of irregularities as well as contour deficits of dorsal nasal outcomes. The main purpose of the present study is to assess the effectiveness of the use of FDC in dorsal nasal and nasal tip rhinoplasty and evaluation of its advantages and disadvantages using the validated Nasal Obstruction Symptom Evaluation (NOSE) scale and the Rhinoplasty Outcome Evaluation (ROE) questionnaire to assess nasal obstruction and patient satisfaction. Results This prospective study was conducted between March 2018 and December 2019, 20 patients were included and planned for rhinoplasty using FDC to camouflage dorsal and nasal tip deformities. All patients (11males and 9 females) underwent open rhinoplasty through inverted v columellar incision, taken FDC from nasal septum. A statistical significant difference between pre- and post-operative NOSE scores was found (P < 0.001). Post-operative rhinoplasty outcome evaluation scores ranged from 45 to 100 with mean ± SD (83.15 ± 13.22). Excellent satisfaction was the most noted in 17 patients (85%), while 2 patients (10%) reported good satisfaction and 1 patient (5%) with acceptable satisfaction. Conclusion It was found that the FDC technique is an effective method for camouflage and augmentation of nasal dorsum as well as nasal tip in reconstructive and esthetic rhinosurgery for either primary or secondary rhinoplasty.

Narrowing the Wide Tip via Endonasal Approach

2021 ◽  
Author(s):  
Omotara Sulyman ◽  
Steven Dayan
Keyword(s):  
Healing Time ◽  
Open Rhinoplasty ◽  
Endonasal Approach ◽  
Nasal Tip ◽  
Nasal Anatomy ◽  
Facial Plastic ◽  
The Aesthetic ◽  
Contractile Forces ◽  
Tip Rhinoplasty ◽  
Gain Access

AbstractRhinoplasty is arguably the most complex and intricate surgery performed by facial plastic surgeons. Nasal tip refinement of a broad nasal tip has remained the most challenging part of rhinoplasty as sophisticated techniques are critical to achieve aesthetically pleasing and structurally sound nasal tips that can withstand the contractile forces of healing. Successful tip refinement relies on an in-depth preoperative and intraoperative understanding of the patient's nasal anatomy, well developed arsenal of techniques, the experience of the surgeon, and the aesthetic desires of the patient. Although the approach to gain access to the nasal tip so as to successfully reshape the tip has been a topic of debate over many years, the aim of this article is to outline and demonstrate how the broad nasal tip can be successfully recontoured through an endonasal approach using nondestructive techniques that have been effectively used in open rhinoplasty. We believe that there continues to be a place for endonasal tip rhinoplasty especially in this era in which patients desire less invasive procedures with shorter healing time.

scholarly journals Criteria for Defining ‘Severe Septal Deviation’

2014 ◽  
Vol 5 (1) ◽  
pp. 6-8
Author(s):  
Rahil Muzaffar ◽  
Owais Mattoo ◽  
Raja Salman Khurshid ◽  
Shafqat Islam
Keyword(s):  
Nasal Obstruction ◽  
Septal Deviation ◽  
Nasal Discharge ◽  
List Type ◽  
Nasal Valve ◽  
Deviated Nasal Septum ◽  
Evaluation Scores ◽  
Symptom Evaluation ◽  
External Nasal Deformity ◽  
Valve Area

ABSTRACT Objective Criteria for defining ‘severe septal deviation’ and to describe the clinical profile of the same. Study Retrospective study. Materials and methods Hundred patients who were diagnosed with severe DNS and treated with extracorporeal septoplasty (ECSP) from September 2010 to December 2012, were retrospectively evaluated for this study. A review of their clinical charts formed the basis of this study. Results In this study, majority of patients (96%) had nasal obstruction as their prime symptom followed by postnasal discharge in 60% cases, headache in 40% cases and anterior nasal discharge in 30% cases. External nasal deformity was reported by 22 patients. Snoring was seen in 24% of patients with same percentage complaining of altered sense of smell and throat discomfort. Epistaxis, sneezing and facial pain were seen in 14% patients. Epiphora was complained by only 8% of patients. In this study, nasal endoscopy/anterior rhinoscopy was used to type the septal deformity. The commonest septal deviation was C-shaped cephalocaudal (48%), followed by S-shaped cephalocaudal (18%), C-shaped AP (16%), S-shaped AP (12%) and sharp septal deviation/angulation in 6% cases. All but three patients (6%) had deviated nasal septum involving multiple Cottle's areas. These three patients had sharp septal angulation involving Cottle's area 2 only. In this study, most common region involving DNS was area 1 + 2 + 3 (48%) followed by area 2 + 4 + 5 (28%) and 1 + 2 + 3 + 4 (18%). Area 2 was invariably involved in 100% of cases. NOSE (nasal obstruction symptom evaluation) scores. Preoperatively, mean NOSE score was 67.60 ± 5.26 (65.34-72.86). NSS (nasal symptoms score): – Preoperatively, mean NSS was –5.08 ± 0.38 (–5.46-–4.70). Conclusion A septal deviation is regarded as ‘severe’ if patient satisfies all of the below-mentioned criteria: – Preoperatively, mean NOSE score should be 65.34 or more. Preoperatively, mean NSS should be –4.70 or more negative. The septal deviation must cause significant obstruction to Cottle's area 2 or nasal valve area. Patients of severe septal deviation report significantly higher rates of snoring (24% in our study) and PND (60% in our study) when compared with mild/moderate cases. All severe septal deviations display significant obstruction of Cottle's area 2/nasal valve area and it is thus concluded that a severe septal deviation must cause significant obstruction of area 2/nasal valve. How to cite this article Mattoo O, Muzaffar R, Khurshid RS, Islam S. Criteria for Defining ‘Severe Septal Deviation’. Int J Head Neck Surg 2014;5(1):6-8.

Hemitransdomal versus Dome-Binding Suture

2017 ◽  
Vol 34 (01) ◽  
pp. 102-106 ◽  
Author(s):  
Fernando Casanueva ◽  
Felipe Cardemil ◽  
Deniz Gerecci
Keyword(s):  
Surgical Training ◽  
Rotational Axis ◽  
Open Rhinoplasty ◽  
Training Center ◽  
Objective Data ◽  
Lateral Crus ◽  
Nasal Tip ◽  
Significant Difference ◽  
Oregon Health ◽  
Suture Placement

AbstractThe dome-binding suture (DBS) and hemitransdomal suture (HTS) are suture techniques used to narrow and define the nasal tip. The DBS can create a pinched, unnatural appearance, while the HTS puts the lateral crus in a more favorable orientation. This allows a natural contour between the nasal tip and alar lobule while maintaining alar margin support. Objective measurement of the rotational axis of the lateral crus between the DBS and the HTS has not been reported in the literature. To determine whether the DBS or HTS technique results in a more favorable rotational axis of the lateral crus as measured by the alar surface septal angle (ASSA). Open rhinoplasty with cephalic trim and placement of a DBS or HTS was performed in 6 cadaveric heads, for a total of 12 lower lateral cartilages at the VirtuOHSU Simulation and Surgical Training Center at Oregon Health and Science University (OHSU). ASSA measurements were taken at baseline and after placement of either a DBS or HTS. A total of 36 ASSA measurements were obtained. The median baseline ASSA prior to suture placement was 142 degrees (interquartile range [IQR]: 131.5–145 degrees), following DBS placement was 141 degrees (IQR: 33–150.5 degrees), and following HTS placement was 112 degrees (IQR: 108–117 degrees). There was no statistically significant difference of ASSA measurements between baseline and DBS placement (p = 0.24), but there was a statistically significant difference between baseline and HTS (p < 0.0001) and between DBS and HTS (p < 0.0001). The HTS technique creates a more favorable rotational axis of the lateral crus as compared with the DBS, as measured by the ASSA. This study provides objective data to support the use of the HTS for nasal tip contouring.

Nasal Obstruction in Children With Cleft Lip and Palate: Results of a Cross-Sectional Study Utilizing the NOSE Scale

2018 ◽  
Vol 56 (2) ◽  
pp. 177-186 ◽  
Author(s):  
Rosaline S. Zhang ◽  
Lawrence O. Lin ◽  
Ian C. Hoppe ◽  
Oksana A. Jackson ◽  
David W. Low ◽  
...  
Keyword(s):  
Nasal Obstruction ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Symptom Evaluation ◽  
Significant Difference ◽  
History Of ◽  
Nasoalveolar Molding

Objective: To characterize the epidemiology and risk factors for nasal obstruction among subjects with cleft lip and/or cleft palate (CL/P) utilizing the well-validated Nasal Obstruction Symptom Evaluation (NOSE) survey. Design: Retrospective cross-sectional study. Setting: Cleft Lip and Palate Program, Children’s Hospital of Philadelphia. Patients, Subjects: One thousand twenty-eight surveys obtained from 456 subjects (mean age: 10.10 (4.48) years) with CL/P evaluated between January 2015 and August 2017 with at least 1 completed NOSE survey. Interventions: Nasal Obstruction Symptom Evaluation surveys completed at each annual visit. Main Outcome Measures: Composite NOSE and individual symptom scores. Results: Sixty-seven percent of subjects had nasal obstruction at some point during the study period, with 49% reporting nasal obstruction at latest follow-up. subjects aged 14 years and older reported the most severe symptoms ( P = .002). Subjects with cleft lip and alveolus (CL+A) and unilateral cleft lip and palate (CLP) reported more severe nasal blockage than other phenotypes ( P = .021). subjects with a history of either posterior pharyngeal flap (PPF) or sphincter pharyngoplasty (SP) had significantly higher NOSE scores than subjects with no history of speech surgery ( P = .006). There was no significant difference ( P > .050) in NOSE scores with regard to history of primary tip rhinoplasty, nasal stent use, or nasoalveolar molding. Conclusions: There are more severe nasal obstructive symptoms among subjects older than 14 years of age, with CL+A or unilateral CLP, and with a history of PPF or SP. Future studies utilizing the NOSE are needed to evaluate and address this prevalent morbidity in the CLP population.

scholarly journals Introducing Nasal Obstruction Symptom Evaluation (NOSE) scale in clinical practice in Serbia: Validation and cross-cultural adaptation

2020 ◽  
Vol 77 (7) ◽  
pp. 704-709 ◽  
Author(s):  
Natasa Janovic ◽  
Gorica Maric ◽  
Marija Dusanovic ◽  
Aleksa Janovic ◽  
Tatjana Pekmezovic ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Nasal Obstruction ◽  
High Sensitivity ◽  
Control Group ◽  
Study Group ◽  
Good Reliability ◽  
Nose Scale ◽  
Symptom Evaluation ◽  
Significant Difference ◽  
Serbian Version

Background/Aim. The Nasal Obstruction Symptom Evaluation (NOSE) scale is widely used in clinical practice for assessment of quality of life in patients with nasal obstruction. It has been validated in several countries up to date. The aim of this study was to validate and crossculturally adapt the NOSE scale for Serbian population. Methods. The Serbian version of the NOSE scale (NOSEs) was prepared through forward and backward translation, committee review, and pretesting. Validation process was carried out on 50 patients diagnosed with the nasal septal deviation (the study group) and 50 ear, nose and throat (ENT) patients with other non-rhinological diagnosis (the control group). Results. The NOSE-s instrument demonstrated good reliability (Cronbach ? coefficient 0.81). Stability and reliability of the NOSE-s questionnaire were confirmed by test-retest procedure showing no statistically significant difference in obtained responses (Goodman- Kruskal gamma coefficient 0.83). Item and total scores were significantly higher in the study group than in the control group indicating the very good inter-group discrimination (p < 0.001). Inter-item and item-total correlations were similar to the original NOSE instrument. Three months after septoplasty, a mean NOSE-s score in patients was 19.2 ? 12.8. Calculated standardized response mean of 1.7 showed high sensitivity to change. Conclusion. The Serbian version of the NOSE scale is simple, valid and reliable instrument for estimating the nasal obstruction. Therefore, it can be recommended for application in rhinological practice and research in Serbian speaking population.

Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽  
2021 ◽  
pp. 1-8
Author(s):  
Lifeng Li ◽  
Demin Han ◽  
Hongrui Zang ◽  
Nyall R. London
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Nasal Surgery ◽  
Subjective Sleep Quality ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

<b><i>Objective:</i></b> The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. <b><i>Methods:</i></b> Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. <b><i>Results:</i></b> By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (<i>p</i> &#x3c; 0.05), while the Apnea-Hypopnea Index (AHI) changed little (<i>p</i> = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all <i>p</i> &#x3c; 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (<i>p</i> &#x3c; 0.05), except with the AHI (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

scholarly journals Surgery to relieve nasal obstruction: outcome for 366 patients operated on by one senior surgeon

2021 ◽  
Author(s):  
Lars Aksel Pedersen ◽  
S. Dölvik ◽  
K. Holmberg ◽  
C. Ahlström Emanuelsson ◽  
H. Johansson ◽  
...  
Keyword(s):  
Beneficial Effect ◽  
Nasal Obstruction ◽  
General Health ◽  
Surgical Skills ◽  
Nasal Endoscopy ◽  
Experienced Surgeon ◽  
Senior Surgeon ◽  
Significant Difference ◽  
Before And After ◽  
The Mean

Abstract Background Studies of patient-rated outcome in septoplasty and turbinoplasty most frequently involve several surgeons with varying surgical skills, techniques and experience. The aim of the present study was to evaluate outcome based on one experienced surgeon. Methods Three hundred and sixty-six consecutive patients referred for nasal obstruction were included. All the patients were examined with nasal endoscopy before and after decongestion, they filled out a nose VAS and rated their overall general health before and three to six months after surgery. The patients underwent septoplasty, septoplasty plus turbinoplasty or turbinoplasty. Results The mean nose VAS for nasal obstruction (0–100) preoperatively was 64.7 for all patients. Patients undergoing septoplasty (n = 159) were younger than patients undergoing septoplasty + turbinoplasty (n = 79) or patients undergoing turbinoplasty alone (n = 128). The nose VAS for nasal obstruction improved significantly in all three groups and 25% had a normal nose VAS after surgery in the septoplasty and septoplasty + turbinoplasty groups compared to only 8% in the turbinoplasty alone group. There was no significant difference in the improvement in nasal obstruction between septoplasty and septoplasty + turbinoplasty, but the septoplasty + turbinoplasty group experienced a significantly greater improvement in general health. Conclusions In 366 patients operated on by one experienced surgeon, septoplasty and septoplasty + turbinoplasty were more effective at relieving nasal obstruction than turbinoplasty alone. Septoplasty + turbinoplasty resulted in a greater improvement in general health than septoplasty alone, despite the same improvement in nasal obstruction, indicating a beneficial effect of additional turbinoplasty in septoplasty.

scholarly journals Can Sex Improve Nasal Function?—An Exploration of the Link Between Sex and Nasal Function

2021 ◽  
pp. 014556132098144
Author(s):  
Olcay Cem Bulut ◽  
Dare Oladokun ◽  
Burkard M. Lippert ◽  
Ralph Hohenberger
Keyword(s):  
Sexual Activity ◽  
Sexual Intercourse ◽  
Nasal Obstruction ◽  
Nasal Breathing ◽  
Post Intervention ◽  
Nasal Decongestant ◽  
Symptom Evaluation ◽  
Nasal Function ◽  
Nasal Flow ◽  
The Impact

Objectives: This study was conducted to examine the impact of sexual activity on nasal breathing and compare such effect to that of a nasal decongestant. Methods: We evaluated nasal breathing at 5 different times: (1) before sexual activity (baseline), (2) immediately after sexual activity, (3) 30 minutes, (4) 1 hour (5), and 3 hours after sexual climax. Same measurements were taken on the second day following application of nasal decongestant spray. For evaluation of nasal breathing, we used a visual analogue scale (VAS). Additionally, we used a portable rhinometric device to measure resistance and nasal flow. Results: Nasal breathing improved significantly after sexual intercourse with climax to the same degree as after application of nasal decongestant for up to 60 minutes, as measured subjectively with the VAS (sex −3.6, P < .001; spray −3.2, P < .001). This was confirmed in the objective rhinometric data as mean nasal flow (mL/s) increased while resistance decreased immediately (flow sex +214, P < .001; flow spray +235, P < .001), 30 (flow sex +249, P < .001; flow spray +287, P < .001), and 60 minutes (flow sex +180, P < .001; flow spray +287, P < .001) post-intervention. Nasal breathing was back to the baseline level after 3 hours following sexual intercourse, while it continued to be improved for longer after application of nasal decongestant. Only participants having nasal obstruction (Nasal Obstruction Symptom Evaluation score >30) showed nasal function improvement after sex. Conclusions: Sexual intercourse with climax can improve nasal breathing to the same degree as application of nasal decongestant for up to 60 minutes in patients having nasal obstruction.

scholarly journals Metacarpal shaft fixation: a biomechanical comparison of dorsal plating, lag screws, and headless compression screws

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Felix G. E. Dyrna ◽  
Daniel M. Avery ◽  
Ryu Yoshida ◽  
David Lam ◽  
Simon Oeckenpöhler ◽  
...  
Keyword(s):  
Peak Load ◽  
Rigid Fixation ◽  
Advantages And Disadvantages ◽  
Shaft Fractures ◽  
Metacarpal Shaft ◽  
Significant Difference ◽  
Load To Failure ◽  
Headless Compression Screws ◽  
Diaphyseal Fractures ◽  
Dorsal Plating

Abstract Background Metacarpal shaft fractures are common and can be treated nonoperatively. Shortening, angulation, and rotational deformity are indications for surgical treatment. Various forms of treatment with advantages and disadvantages have been documented. The purpose of the study was to determine the stability of fracture fixation with intramedullary headless compression screws in two types of metacarpal shaft fractures and compare them to other common forms of rigid fixation: dorsal plating and lag screw fixation. It was hypothesized that headless compression screws would demonstrate a biomechanical stronger construct. Methods Five matched paired hands (age 60.9 ± 4.6 years), utilizing non-thumb metacarpals, were used for comparative fixation in two fracture types created by an osteotomy. In transverse diaphyseal fractures, fixation by headless compression screws (n = 7) and plating (n = 8) were compared. In long oblique diaphyseal fractures, headless compression screws (n = 8) were compared with plating (n = 8) and lag screws (n = 7). Testing was performed using an MTS frame producing an apex dorsal, three point bending force. Peak load to failure and stiffness were calculated from the load-displacement curve generated. Results For transverse fractures, headless compression screws had a significantly higher stiffness and peak load to failure, means 249.4 N/mm and 584.8 N, than plates, means 129.02 N/mm and 303.9 N (both p < 0.001). For long oblique fractures, stiffness and peak load to failure for headless compression screws were means 209 N/mm and 758.4 N, for plates 258.7 N/mm and 518.5 N, and for lag screws 172.18 N/mm and 234.11 N. There was significance in peak load to failure for headless compression screws vs plates (p = 0.023), headless compression screws vs lag screws (p < 0.001), and plates vs lag screws (p = 0.009). There was no significant difference in stiffness between groups. Conclusion Intramedullary fixation of diaphyseal metacarpal fractures with a headless compression screw provides excellent biomechanical stability. Coupled with lower risks for adverse effects, headless compression screws may be a preferable option for those requiring rapid return to sport or work. Level of evidence Basic Science Study, Biomechanics.

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