Epiphora drainage by DCR – Long-term results

Background: Dacryocystorhinostomy (DCR) refers to the surgical procedure that is used to relieve the chronic obstruction of the nasolacrimal duct obstruction (NLDO). In a maxillofacial setting, NLDO may arise subsequent to a facial trauma or orthognathic surgery. There is a dearth of literature from this part of the world. This article intends to provide a single maxillofacial center experience in DCR. Materials and Methods: This is a retrospective, noncomparative, noninterventional, record audit type of study of all consecutive patients fulfilling inclusion and exclusion criteria. All patients with epiphora and diagnosed with lacrimal apparatus damage between 1 January 2008 and 31 December 2017 requiring DCR were considered for the study. Details of demographics, phase of treatment (primary/retreatment), types of bones involved, age, complications, period suffering from epiphora, and follow-up were obtained. All data were entered and analyzed using the Statistical Package for the Social Service (version 16; IBM). Descriptive statistics of the frequency and mean ± standard deviation (SD) as appropriate were presented. Chi-square test and one-way analysis of variance were used appropriately. P ≤ 0.05 was taken to be statistically significant. Results: In all, 83 patients fulfilled the inclusion and exclusion criteria. It is more common in males (n = 56, 67.47%) with a mean ± SD of 32.24 ± 10.80 (18–59 years) with 27 (32.53%) of them presenting primarily after fractures. Fracture was the most common pathology seen in 81.93% (n = 68) of cases, while the rest were as a result of orthognathic cases. Le Fort II and III set of bones contributed to 59% of cases, while the orbitonasal complex contributed to only three cases. NLD obstruction was seen in 68 (81.9%) of cases. On an average, the patients suffered for 9.3 ± 6.74 months (range 0.5–22 months) before seeking treatment and the average follow-up was 31.07 ± 11.69 months (range 15–54 months). Discussion and Conclusion: Fractures and surgeries involving nasal bones carry an innate risk of damaging the NLD system. The pattern of need for DCR and occurrence of NLDO in this part of the world have been described. The extent of the anatomical variations and need for proper surgical planning are highlighted.

To Compare the Efficacy and Complication of Nasal Prongs vs Nasal Mask CPAP in Neonates

CPAP refers to the application of positive pressure to the airway of a spontaneously breathing infant throughout the respiratory cycle

Heated Humidified High Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure as Primary Mode of Respiratory Support for Respiratory Distress in Preterm Infants.

Objective: To compare the outcomes of preterm infants with respiratory distress initiated on either Heated Humidified High Flow Nasal Cannula or Nasal Continuous Positive Airway Pressure as a primary mode of respiratory support. Study Design: Prospective observational cohort study Setting : Tertiary care level III neonatal intensive care unit Participants : 88 preterm infants between 28 to 34 weeks of gestation with mild to moderate respiratory distress within 6 hours of birth. Intervention: Eligible infants were treated either with Heated Humidified High Flow Nasal Cannula (n=46) or Nasal Continuous Positive Airway Pressure (n=42). Primary outcome : Need for mechanical ventilation within 72 hrs of initiating support. Results: Baseline demographic characteristics were comparable between the two groups. There was no difference in the requirement of mechanical ventilation between Heated Humidified High Flow Nasal Cannula (19.5%) and Nasal Continuous Positive Airway Pressure (26.2%) groups [RD – 0.74 (95% CI 0.34-1.62; P =0.46)]. Moderate or severe nasal trauma occurred less frequently with Heated Humidified High Flow Nasal Cannula (10.9%) in comparison to Nasal Continuous Positive Airway Pressure (40.5%) (P= 0.004). Conclusion: Heated Humidified High Flow Nasal Cannula was comparable to Nasal Continuous Positive Airway Pressure as a primary respiratory support for preterm infants with respiratory distress, with lesser incidence of nasal trauma.

An initial survey of septorhinoplasty in crooked nose deformities

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> Crooked  nose  deformity  is  a  commonly  seen  reason  for  septorhinoplasty  in  the otolaryngology clinic. The purpose of this study is to initially determine the different etiologies of  patients  with  crooked  nose  deformities  who  underwent  septorhinoplasty,  and  to  describe the different types of crooked nose by their level of deviation and surgical management in our institution.<br /><strong>METHODS:</strong><br /> <strong>  Design:</strong> Case Series<br />  <strong> Setting:</strong> Tertiary Public University Hospital<br /> <strong> Participants:</strong> A chart review of all patients with a crooked nose deformity who were admitted  at the otorhinolaryngology ward of the National University Hospital and underwent septorhinoplasty from January 2012 to January 2015 was conducted, and data consisting of age, sex, etiology of crooked nose deformity, level of deviation, cartilage source, and surgical intervention were obtained and analyzed.<br /><strong>RESULTS:</strong> A total of 21 patients underwent septorhinoplasty for crooked nose deformity  in  the study period. The most common etiology for crooked nose was physical violence (13/21 or 62%), followed by sports injury (4/21 or 19%), vehicular accidents (2/21 or 9%), and accidental fall (1/21 or 5%). There were more upper and middle third deviations than lower third deviations. Sixteen out of 21patients  (76%) underwent  open  rhinoplasty,  while  the  rest underwent an endonasal approach. Twelve (57%) underwent intervention  on  the  nasal  fracture after at least a year (old or  neglected  fracture) as compared to the 9 (43%) who had  immediate intervention after less than two weeks. Thirteen used septal cartilage, while 4 used conchal cartilage, and 1 used tragal cartilage. The most common grafts used were spreader  and camouflage, followed closely by dorsal onlay, and columellar strut grafts.<br /><strong>CONCLUSION:</strong> The majority of crooked nose deformities that were subjected to septorhinoplasty in our department were secondary to old nasal bone fractures caused by physical violence. Upper and middle  third level deviations were more common, and most underwent open rhinoplasty with autologous cartilage grafts. Future studies may increase our understanding of, and improve our techniques in septorhinoplasty for crooked nose deformities in Filipino noses in particular, and Asian noses in general. </p>

Traumatismo nasal con arpón de pesca / Nasal trauma caused by fishing harpoon

Paciente masculino de 60 años de edad con trauma nasal accidental, producido por un arpón de pesca que penetra a través de la fosa nasal izquierda. Este fue atendido de urgencia y se le removió el arpón mediante una rinoscopia anterior. El paciente evolucionó de forma satisfactoria y no hubo afectación de gravedad ni secuelas. Los traumatismos en el macizo facial y craneoencefálico, producidos por armas diferentes a las de fuego, son poco frecuentes. El tipo de lesión presentada es algo excepcional y no existen informes similares en la literatura.

A sixty-year old male patient, who suffered nasal trauma caused by a fishing harpoon that penetrated his left nasal cavity. He was immediately assisted to remove the hapoon by performing anterior rhinoscopy. He recovered satisfactorily and there were no side effects or sequelae. The facial and cranioencephalic traumas caused by weapons different from firearms are rare. The type of lesion presented in this article is unique and there is no similar reports found in literature.

Rendimiento de la evaluación clínica en el diagnóstico de fractura de huesos propios nasales / Clinical assessment in the diagnosis of bone fractures in patients with nasal trauma

Introduction: The aim of this study was to evaluate the performance of clinical assessment in the diagnosis of bone fractures in patients with nasal trauma. Methods: Retrospective review of medical records of 220 patients with nasal trauma treated at the Maxillofacial Surgery Department of Hospital Workers in Santiago was performed. Eight clinical criteria were evaluated: epistaxis, ecchymosis, swelling, nasal injury, airway obstruction, nasal deviation, irregular nasal dorsum, and acute septal injury. The gold standard for diagnosis of nasal fracture was the radiological evaluation. The sensitivity, specificity, and positive/negative predictive value (PPV/NPV) were calculated for each separate clinical criteria (8), for all possible combinations of 2 clinical criteria (28) and 3 clinical criteria (56). Results: For any of the 8 criteria, the average sensitivity and negative predictive values for nasal fracture was very low (< 35 percent). However, the specificity and positive predictive values were relatively high (> 90 percent) and increased, respectively, when at least one criterion was present (92 percent and 94 percent respectively), when 2 clinical criteria were present (98 percent and 96 percent, respectively), and when at least 3 clinical criteria were present (100 percent for both). Conclusion: The presentation of the clinical criteria can be a valuable method for diagnosis of nasal fracture, however, when these clinical criteria are absent, the possibility of nasal fracture cannot be excluded, although the possibility is remote.

Introducción: El objetivo del presente trabajo fue conocer el rendimiento de la evaluación clínica en el diagnóstico de fractura de huesos propios en pacientes con trauma nasal. Material y Método: Revisión retrospectiva de fichas clínicas de 220 pacientes con trauma nasal atendidos en el Servicio de Cirugía Maxilofacial del Hospital del Trabajador de Santiago. Ocho criterios clínicos fueron evaluados: epistaxis, equimosis, inflamación, herida nasal, obstrucción de vía aérea, laterorrinia, dorso nasal irregular, y lesión aguda del tabique nasal. El estándar de oro para el diagnóstico de fractura nasal fue el estudio radiológico. La sensibilidad, especificidad, y positivo/valor predictivo negativo (VPP/VPN) se calcularon para cada criterio clínico por separado (8), para todas las combinaciones posibles de 2 criterios clínicos (28) y 3 criterios clínicos (56). Resultados: Para cualquiera de los 8 criterios, el promedio de sensibilidad y valor predictivo negativo para la fractura nasal fue muy baja (< 35 por ciento). Sin embargo, la especificidad y valores predictivos positivos fueron relativamente altas (> 90 por ciento) y aumentó, respectivamente, cuando al menos un criterio estuvo presente (92 por ciento y 94 por ciento, respectivamente), cuando 2 criterios clínicos estaban presentes (98 por ciento y 96 por ciento, respectivamente), y cuando al menos 3 criterios clínicos estaban presentes (100 por ciento para ambos). Conclusiones: La presentación de los criterios clínicos puede ser un método valioso para el diagnóstico de fractura nasal, sin embargo, cuando estos criterios clínicos están ausentes, la posibilidad de la fractura nasal no se puede descartar, aunque la posibilidad es remota.