Nasal Crust-Related Morbidity and Debridement After Endoscopic Skull Base Surgery

Abstract Introduction: Nasal crust after endoscopic skull base surgery can cause nasal congestion, obstruction, and pain, which can affect quality of life. The use of debridement aims to provide symptomatic relief and improve quality of life. Generally, most adult patients tolerate office-based debridement, except in a few select patients that require further sedation in the operating room for a debridement. The study sought to determine the rate of symptomatic crust-related morbidity and the rate of debridement in both the office and the operating room. Methods: Premorbid, operative, and postoperative data of adult patients who had endoscopic skull base surgery in our institution from 2014 to 2018 were reviewed retrospectively. The characteristics of nasal symptoms in the postoperative period were determined and the numberofdebridementsin theoffice and the operatingroomwere analyzed. Results: Two hundred and thirty-four (234) patients with 244 surgeries were included in the study. The majority, 68.9%, had a sellar lesion and a free mucosa graft (FMG) was the most common skull base reconstruction at 53.5%. One hundred and twenty (49.0%) had crust-related symptoms during the postoperative period and 11 patients (4.5%) required the operating room for debridement. The use of a pedicled flap, anxiety, and preoperative radiotherapy were significantly associated with intolerance to in-office debridement (p-value=0.05). Conclusions: The use of a pedicled flap or anxiety may predispose patients to require an OR debridement. Previous radiotherapy also influenced the tolerance to the in-office debridement.

The effect of different nasal irrigation solutions following septoplasty and concha radiofrequency: a prospective randomized study / Efeito de diferentes soluções para irrigação nasal após septoplastia e radiofrequência das conchas nasais: estudo prospectivo e randomizado

Abstract Introduction Nasal irrigation solutions are widely used following endonasal surgery. These irrigation solutions remove infective debris and crusts, reducing the probability of synechia formation, and accelerate mucosal healing. Objective The aim of the present study was to compare the effects of nasal irrigation solutions with different contents following septoplasty and concha radiofrequency. Methods The present study was a prospective, randomized, controlled simple blind study of 120 patients who underwent septoplasty and bilateral concha radiofrequency. Patients were divided into four groups according to the nasal irrigation solution used: tap water, buffered isotonic saline, saline with xylitol, and hypertonic sea water. Patients were examined on the 7th and 15th postoperative days. A saccharine test was applied to determine mucociliary activity preoperatively and on the 7th and 15th postoperative days. Patients were asked about drying and obstruction using a 10 cm visual analog scale. In addition, patients were examined to determine the crusting score. Results There was no significant difference found in the preoperative and 7th and 15th postoperative days' mucociliary clearance times among the four groups. The crusting score was found to be significantly lower in the hypertonic sea water group (p < 0.001). Drying and obstruction on the 7th and 15th postoperative days were found to be significantly more comfortable in the hypertonic sea water group (p < 0.001). Conclusion Hypertonic sea water is the recommended irrigation solution, as it is associated with less crusting, drying, and obstruction in the nose for the postoperative period following septoplasty and concha radiofrequency.

Resumo Introdução Soluções para irrigação nasal são amplamente usadas após cirurgias endonasais. Essas soluções removem os resíduos e crostas, reduzem a probabilidade de formação de sinéquias e aceleram a cicatrização da mucosa. Objetivo O objetivo do presente estudo foi comparar os efeitos das soluçoes para irrigaçao nasal com diferentes conteudos apos septoplastia e turbinoplastia com radiofrequencia. Método O presente estudo foi um estudo cego simples, randomizado, controlado e prospectivo de 120 pacientes submetidos a septoplastia e turbinoplastia bilateral com radiofrequencia. Os pacientes foram divididos em quatro grupos de acordo com a soluçao nasal utilizada: agua da torneira, soluçao salina isotonica tamponada, soluçao salina com xilitol e agua do mar hipertonica. Os pacientes foram examinados no 7° e 15° dias do pos-operatorio. O teste de sacarina foi utilizado para determinar a atividade mucociliar pre-operatoria e no 7° e 15° dias do pos-operatorio. Os pacientes foram questionados sobre a sensaçao de secura e obstruçao nasais utilizando uma escala visual analógica de 10 cm. Alem disso, os pacientes foram examinados para determinar o escore em relaçao a crostas. Resultados Não houve diferença significativa entre o pré-operatório e o sétimo e 15° dias do pós-operatório dos tempos de clearance mucociliar entre os quatro grupos. Verificou-se que o escore em relação a crostas foi significativamente menor no grupo que usou água do mar hipertônica (p < 0,001). As sensações de secura e obstrução nasais no sétimo e 15° dias do pós-operatório mostraram-se significativamente mais confortáveis no grupo água do mar hipertônica (p < 0,001). Conclusão A água de mar hipertônica é a solução de irrigação recomendada, pois está associada a menor incidência de crostas, secura e obstrução nasais no pós-operatório de cirurgia de septoplastia e das conchas nasais com radiofrequência.

Application of Modified Pie-crusting Technique in Releasing Medial Tightness During Primary Total Knee Arthroplasty / 中国微创外科杂志

Objective To analyze and evaluate the safety and efficacy of modified Pie-crusting ( PC) technique for releasing medial tightness during primary total knee arthroplasty ( TKA) . Methods We completed primary TKA by the same performer with modified PC technique in 30 patients (34 knees) with genu varus from March 2014 to June 2016.By using a special curved scalpel with width limit of 3 mm and depth limit of 5 mm to poke the tension parts , we released the anterion bondle of superficial medial collateral ligament ( sMCL) and posteromedial corner structures ( PMCS) during tension happened in extension , and we released the posterior bondle of sMCL during tension happened in flexion .According to the gap value measured intraoperatively , we divided these cases into three groups: extension with flexion tension group ( 10 knees ) , extension tension group ( 13 knees ) , and flexion tension group (11 knees).The difference between medial and lateral gap value no more than 1 mm was defined as gap balance.We calculated the gap balance rate of each group .Series of weighted frontal X-ray were conducted at fixed period to evaluate the varus angle of the knee postoperatively.The range of motion (ROM), HSS scores and WOMAC scores were also recorded at the same time . Results Among the 34 knees , 31 knees reached the medial and lateral gap balance at both extension and flexion .There was a difference of 2 mm in medial and lateral gap value at extension in 1 knee and the same difference at flexion in the other 2 knees.The total postoperative gap balance rate was 91.2%( 31/34 ).The constrained inserts were implanted in 3 cases.No technical-related complications happened after the surgery.After the releasing procedure, the flexion gap value had an increase of 1 mm (range, 1-3mm) in the extension tension group , and the extension gap value had an increase of 1 mm ( range, 1-2 mm) in the flexion tension group, without significant difference (Z=-1.118, P=0.264).The ROM was 83.3°±14.7°preoperatively and 100.7°±14.2° postoperatively (t=-7.714, P=0.000).The median alignment of the knee was 11.5°(range, 7°-32°) preoperatively and 1° (range, 0°-4°) postoperatively (Z=-5.092,P=0.000).The HSS scores were (42.7 ±16.3) points preoperatively and (88.1 ± 9.9) points postoperatively (t=-21.868, P=0.000).The WOMAC scores were (76.2 ±8.2) points preoperatively and (11.4 ± 9.7) points postoperatively (t=31.726, P=0.000).All of them were significantly improved in comparison with those before the surgery. Conclusions Using modified PC technique is safe and effective in medial releasing during primary TKA .Both extension and flexion gap value will be affected by releasing tensed fiber at extension or flexion position .

Application of pie-crusting the medial collateral ligament release in arthroscopic surgery for posterior horn of medial meniscus in knee joint / 中南大学学报(医学版)

Objective:To explore the effectiveness and safety of pie-crusting the medial collateral ligament release (MCL) in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint.Methods:Thirty-two consecutive patients with PHMM tear in tight medial tibiofemoral compartment of knee joint were admitted to our department from January,2013 to December,2014.All patients were performed pie-crusting the MCL release at its tibial insertion with 18-gauge intravenous needle.All patients were evaluated by valgus stress test and bilateral valgus stress radiograph at postoperative 1st day,4th week and 12th week.Visual Analogue Scales (VAS),Lysholm scores,Tegner scores and International Knee Documentation Committee (IKDC) scores were recorded at the 1st,3th,6th month follow-up,then follow-up every 6 months.Results:The mean follow-up was 28 (24-36) months.All cases were negative in valgus stress test.MCL rupture,femoral fracture,articular cartilage lesion and neurovascular injury were not found at the last follow-up.The median medial joint space width of affected side and unaffected side for valgus stress radiographs were 6.8 mm and 4.3 mm (P＜0.05) at the 1st day,5.5 mm and 4.2 mm (P＜0.05) in the 4th week and 4.8 mm and 4.3 mm (P＞0.05) at the 12th week,respectively.VAS scores was changed from 4.5±1.5 preoperatively to 1.7±1.0 at the final follow-up (t=16.561,P＜0.05).Lysholm scores was changed from 52.3±5.8 preoperatively to 93.2±6.3 at the final followup (t=-41.353,P＜0.05).Tegner scores was changed from 4.1±1.1 preoperatively to 5.5±0.6 at the final follow-up (t=-18.792,P＜0.05).IKDC scores was changed from 54.5±6.2 preoperative to 93.8±4.5 at the final follow-up (t=-38.253,P＜0.05).Conclusion:Pie-crusting the medial collateral ligament release is a safe,minimal invasive and effective surgical option for posterior horn of medial meniscus tear in tight medial tibiofemoral compartment of knee joint.