Improvement in Nasal Obstruction and Quality of Life after Nasal Septoplasty with Turbinoplasty: A Pre- and Post-study

Abstract Introduction Septoplasty and turbinoplasty are common surgical interventions used to relieve nasal obstructive symptoms. Since it is difficult to measure the degree of nasal blockage, current literature wonders about the frequent performance of these procedures. Objective To evaluate the perceived change in the nasal obstruction and the quality of life (QoL) of patients that underwent a septoplasty along with a turbinoplasty by applying subjective scales, to describe the correlation between those scales, and to study the impact of clinical factors in the postoperative outcomes. Methods Prospective observational study. The Nasal Obstruction Symptom Evaluation (NOSE), the Visual Analog Scale (VAS), and the Glasgow Benefit Inventory (GBI) were assessed. The paired sample Wilcoxon test was used to evaluate the difference between the pre- and postoperative surveys. The correlation coefficient between the subjective scales was calculated. A quantile regression was performed to evaluate the effect of surgery on the results adjusted for clinical and demographic variables. Results A total of 115 patients were interviewed. Postoperative NOSE scores were 45 points lower (95% confidence interval [CI]: - 53.53-- 35.46; p < 0.001) in comparison with the NOSE preoperative scores. Obesity was the only statistically significant factor associated with worse outcomes. Additionally, we found a high correlation between the NOSE and VAS scores and a negative correlation between the GBI and postoperative VAS scores. Conclusion Nasal septoplasty, when paired with a turbinoplasty, decreases nasal obstruction and improves QoL. Obesity was associated with worse results. There was a strong correlation between the NOSE and the VAS results and between the GBI and postoperative VAS results.

Reconstruction of the nasal columella using bilateral nasolabial flaps: case report / Reconstrução da columela nasal com utilização de retalhos nasolabiais bilaterais: relato de caso

Introduction: The columella is an important subunit of the nose, essential for nasal architecture and facial aesthetics. The total reconstruction of the nasal columella becomes a great challenge after repairing trauma, carcinomas, and necrosis in this region. There are descriptions in the literature of numerous reconstruction techniques using different flaps, such as a frontal region flap, an infraclavicular region flap, and a unilateral and bilateral nasolabial flap. Case Report: A total reconstruction of the nasal columella after resection of basal cell carcinoma (BCC) using a bilateral nasolabial flap is reported. Conclusion: The technique proved effective for correcting the complex defect after BCC resection, with technical ease for resolution and good aesthetic and functional results.

Introdução: A columela é uma importante subunidade do nariz, sendo essencial para a arquitetura nasal e estética facial. A reconstrução total da columela nasal torna-se, portanto, um grande desafio após reparação de traumas, carcinomas e necroses nesta região. Há na literatura a descrição de inúmeras técnicas de reconstrução com uso de diferentes retalhos, como retalho da região frontal, retalho da região infraclavicular, retalho nasolabial unilateral e bilateral. Relato de Caso: Reporta-se uma reconstrução total da columela nasal pós-ressecção de carcinoma basocelular (CBC) utilizando retalho nasolabial bilateral. Conclusão: A técnica utilizada mostrou-se eficaz para correção do defeito complexo pós-ressecção de CBC, apresentando facilidade técnica para resolução e bom resultado estético-funcional.

Dolor y edema posquirúrgico en la regeneración cutánea nasal con fibrina rica en plaquetas y leucocitos

Introducción: La reconstrucción de defectos cutáneos nasales requiere del uso de procedimientos orientados a obtener la menor probabilidad de complicaciones posoperatorias en el menor período de tiempo posible. Novedosas técnicas utilizan los concentrados plaquetarios por sus propiedades moduladoras del dolor y el edema posoperatorio. Objetivo: Determinar el comportamiento del dolor y el edema posquirúrgico en la regeneración de defectos cutáneos nasales con el uso de la membrana de fibrina autóloga, rica en plaquetas y leucocitos. Método: Se realizó una investigación cuasiexperimental, con diseño antes-después, sin grupo control en el Servicio de Cirugía Maxilofacial del Hospital Universitario "Arnaldo Milián Castro" de la ciudad de Santa Clara, Villa Clara, Cuba, desde septiembre de 2015 a junio de 2019. La muestra seleccionada aleatoriamente fue de 46 pacientes. A partir de una autodonación de sangre del paciente se obtuvo una membrana de fibrina rica en plaquetas y leucocitos, la cual fue suturada en el defecto quirúrgico nasal. Resultados: La edad media fue 62,71 años y el 60,87 % de la muestra correspondió al sexo masculino. Se presentaron el dolor en el 23,91 % y el edema en el 28,26 % de la muestra estudiada. Conclusiones: Se encontraron escasas complicaciones posoperatorias como el dolor y el edema, las que se manifestaron predominantemente de intensidad leve. Existió asociación entre estas complicaciones y la edad, la cantidad de subunidades anatómicas afectadas, la diabetes mellitus y el tabaquismo.

Introduction: The reconstruction of nasal skin defects requires the use of procedures aimed at obtaining the lowest probability of postoperative complications in the shortest period of time possible. Novel techniques use platelet concentrates for their modulating properties of pain and postoperative edema. Objective: To determine the behavior of pain and post-surgical edema in the regeneration of nasal skin defects with the use of autologous platelet- and leukocyte-rich fibrin membrane. Method: A quasi-experimental research was carried out, with a before-after design, without a control group, in the Maxillofacial Surgery Service at Arnaldo Milián Castro University Hospital in Santa Clara, Villa Clara, Cuba, from September 2015 to June 2015. 2019. The randomly selected sample was 46 patients. A fibrin membrane rich in platelets and leukocytes was obtained from a patient's blood self-donation, which was sutured in the nasal surgical defect. Results: The mean age was 62.71 years and 60.87% of the sample was male. Pain was present in 23.91% and edema in 28.26% of the studied sample. Conclusions: Few postoperative complications such as pain and edema were found, showing to be mild predominantly. There was association between these complications and age, the number of affected anatomical subunits, diabetes mellitus and smoking habit.

Resultados estéticos en defectos nasales posquirúrgicos regenerados con fibrina autóloga rica en plaquetas y leucocitos / Aesthetic results in post-surgical nasal defects regenerated with autologous platelet- and leukocyte-rich fibrin

Introducción: En la reconstrucción de los defectos cutáneos nasales se han utilizado varias técnicas a nivel mundial. Novedosas prácticas utilizan los concentrados plaquetarios por sus propiedades moduladoras y favorecedoras de la regeneración tisular. Objetivo: Determinar los resultados estéticos asociados al uso de la membrana de fibrina autóloga rica en plaquetas y leucocitos, para la regeneración de defectos cutáneos nasales posquirúrgicos. Métodos: Se realizó un estudio cuasiexperimental, longitudinal y prospectivo en el Servicio de Cirugía Maxilofacial del Hospital Universitario "Arnaldo Milián Castro" de la ciudad de Santa Clara, Villa Clara, Cuba, desde septiembre de 2015 hasta junio de 2019. Se efectuó un muestreo intencional, no probabilístico, de 31 pacientes. A partir de una donación de sangre del paciente, se obtuvo una membrana de fibrina rica en plaquetas y leucocitos, la que fue suturada en el defecto nasal posquirúrgico. Se estudiaron variables como el resultado estético, evaluado sobre la base de parámetros como la elasticidad, el color, el volumen y la superficie. Resultados: La edad media fue 62,71 ± 11,09 años y el 61,29 por ciento de la muestra correspondió al sexo masculino. Mostraron un buen resultado estético el 90,32 por ciento de los pacientes, lo que se asoció de forma significativa al grado de epitelización. Conclusiones: Se obtuvo un buen resultado estético en los pacientes donde se utilizó la membrana de fibrina autóloga rica en plaquetas y leucocitos, con independencia de la presencia de diabetes mellitus y hábitos tóxicos. El resultado estético estuvo asociado significativamente al grado de epitelización y a la edad(AU)

Introduction: In the reconstruction of nasal skin defects, several techniques have been used worldwide. Innovative practices use platelet concentrates for their modulating properties and favoring tissue regeneration. Objective: Determine the aesthetic results associated with the use of autologous fibrin rich in platelets and leukocytes, for the regeneration of post-surgical nasal skin defects. Methods: A quasi-experimental, longitudinal and prospective study was conducted in the Maxillofacial Surgery Service of "Arnaldo Milián Castro" University Hospital in the city of Santa Clara, Villa Clara province, Cuba, from September 2015 to June 2019. An intentional, non-probabilistic sampling of 31 patients was carried out. From a blood donation from the patient, a fibrin membrane rich in platelets and leukocytes was obtained, which was sutured in the post-surgical nasal defect. Variables such as the aesthetic result were studied, evaluated on the basis of parameters such as elasticity, color, volume and surface. Results: The mean age was 62.71 ± 11.09 years and 61.29 percent of the sample corresponded to the male sex. A good aesthetic result was shown by 90.32 percent of the patients, which was significantly associated with the degree of epithelialization. Conclusions: A good aesthetic result was obtained in patients where the fibrin membrane rich in leukocytes and autologous platelets was used, regardless of the presence of diabetes mellitus and toxic habits. The aesthetic result was significantly associated with the degree of epithelialization and age(AU)

Rinoplastia mediante reubicación de autoinjertos en pacientes con deformidades nasales. Cienfuegos, 2009-2019 / Rhinoplasty by relocation of autografts in patients with nasal deformities. Cienfuegos, 2009-2019

RESUMEN Fundamento En la rinoplastia moderna existen nuevos conceptos orientados al logro del modelo ideal de una nariz. Muchas técnicas han envejecido, pero han surgido otras nuevas, menos invasivas. Objetivo describir los resultados de la rinoplastia mediante la técnica de reubicación de autoinjertos en pacientes con deformidades nasales. Métodos estudio descriptivo, de serie de casos, realizado en el Hospital General Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos. Se incluyeron 25 pacientes que acudieron a la consulta de Cirugía Maxilofacial por deformidades nasales, entre 2009 y 2019, a los cuales se aplicó la técnica quirúrgica de rinoplastia (la técnica de Joseph modificada). Se analizó edad, sexo, color de la piel, tipo de injerto, técnica empleada (endonasal, abierta) y tipo de anestesia. Resultados predominó el sexo femenino y el color blanco de la piel. La técnica quirúrgica más utilizada fue la endonasal (20 pacientes). Todos fueron operados con anestesia local. El grupo de edad más numeroso fue el de 15-30 años. La giba osteocartilaginosa fue el injerto empleado en el 72 % de los casos. Conclusión con la técnica de reubicación de autoinjertos se obtuvieron resultados favorables en la serie de casos descrita. Esta resulta de las más avanzadas en el contexto de la cirugía estética nasal.

ABSTRACT Background In modern rhinoplasty there are new concepts aimed at achieving the ideal model of a nose. Many techniques have become old, but new, less invasive ones have emerged. Objective to describe the results of rhinoplasty using the autograft relocation technique in patients with nasal deformities. Methods a descriptive case series study conducted at the Dr. Gustavo Aldereguía Lima General University Hospital, in Cienfuegos. 25 patients were included in the research, who attended the Maxillofacial Surgery consultation due to nasal deformities, between 2009 and 2019, to whom the rhinoplasty surgical technique (the modified Joseph technique) was applied. Age, sex, skin color, type of graft, technique used (endonasal, open) and type of anesthesia were analyzed. Results female sex and white skin color predominated. The most used surgical technique was endonasal (20 patients). All were operated under local anesthesia. The largest age group was 15-30 years old. The osteocartilaginous hump was the graft used in 72% of the cases. Conclusion with the autograft relocation technique, favorable results were obtained in the case series described. This is one of the most advanced in the context of nasal cosmetic surgery.

Avaliação da Obstrução Nasal em Pacientes Submetidos à Septoplastia com Cirurgia das Conchas Nasais Inferiores Utilizando o Questionário NOSE / Evaluation of Nasal Obstruction in Patients Undergoing Septoplasty with Inferior Nasal Turbinate Surgery Using the NOSE Questionnaire

Introdução: O desvio septal e a hipertrofia das conchas nasais inferiores são as principais causas de obstrução nasal. Uma forma de avaliarmos o grau de obstrução nasal é através do questionário NOSE, o qual é baseado em cinco perguntas com nota de 0 a 04, podendo alcançar 100 pontos. Esse pode ser aplicado no pré-operatório e pós-operatório, servindo para comparação do grau de melhora do paciente em relação à obstrução nasal. Objetivo: O trabalho teve como objetivo aplicar o questionário NOSE para avaliação de grau de satisfação dos pacientes no pós-operatório de cirurgia de septoplastia, associado à técnica cirúrgica das conchas nasais inferiores. Métodos: Os pacientes eletivos para septoplastia e cirurgia das conchas nasais inferiores foram avaliados com o questionário NOSE no pré-operatório e no pós-operatório (07 e 30 dias, 3 e 06 meses e 01 ano). Para análise estatística, foi utilizado o teste de Friedman e de Mann-Whitney. Foram excluídos os pacientes menores de idade e presença de alterações sinusais. Resultados: Um total de 64 pacientes preencheu os critérios de inclusão, sendo excluídos 13 pacientes por perda de seguimento, permanecendo com 51 pacientes. A média de idade foi de 31,33 anos. A maioria dos pacientes era do gênero masculino, 72,5%, e 27,5% do gênero feminino. Houve diferença estatística entre o pré-operatório e o seguimento de 06 meses e 01 ano. Conclusão: O questionário NOSE mostrou que a septoplastia associada à cirurgia das conchas nasais inferiores demonstrou melhora do sintoma de obstrução nasal no pós-operatório, tendo como parâmetro o próprio paciente.

Introduction: Septal deviation and inferior nasal turbinate hypertrophy are the primary causes of nasal obstruction. One way to assess the degree of nasal obstruction is through the NOSE questionnaire, which bases itself on five questions with a score from 0 to 04, and may reach 100 points. Its application can be preoperatively and postoperatively to compare the degree of patient improvement regarding nasal obstruction. Objective: This study aimed to apply the NOSE questionnaire to evaluate the degree of patient satisfaction in the post-operative period of septoplasty associated with the surgical technique of inferior nasal concha. Methods: Elective patients for septoplasty and inferior nasal concha surgery were evaluated with the NOSE questionnaire preoperatively and postoperatively (7 and 30 days, 3 and 6 months, and one year). The Friedman and Mann-Whitney tests were used for statistical analysis. Exclusion of underage patients and the presence of sinus changes. Results: A total of 64 patients met the inclusion criteria, eliminating 13 patients due to loss of follow-up, remaining only 51 cases. The mean age was 31.33 years. Most patients were male, 72.5% and 27.5% were female. There was a statistical difference between the preoperative and the follow-up of 6 months and one year. Conclusion: The NOSE questionnaire showed that septoplasty associated with inferior nasal concha surgery showed improvement of nasal obstruction symptoms postoperatively, using the patient's parameters.

Tumores de Fosa Pterigopalatina: Tipos de abordajes quirúrgicos y complicaciones / Pterygopalatine Fossa Tumors: Types of surgical approaches and complications

INTRODUCCIÓN. La fosa pterigopalatina es una zona anatómica de difícil acceso, que al presentar masas tumorales genera un alto riesgo de morbimortalidad en población juvenil y adulta, que precisa determinar las complicaciones asociadas a cirugía. OBJETIVO. Evaluar los tipos de abordaje quirúrgico, complicaciones e identificar la estirpe histológica de los tumores de fosa pte-rigopalatina. MATERIALES Y MÉTODOS. Estudio transversal retrospectivo. Población y muestra conocida de 29 Historias Clínicas de pacientes con hallazgos de imagen e histopatológico de tumores con invasión a fosa pterigopalatina divididos en dos grupos: A) resección de masa tumoral y B) biopsia de masa tumoral, operados en el Hospital de Especialidades Carlos Andrade Marín en el período de enero 2017 a diciembre de 2020. RESULTADOS. El 82,76% (24; 29) fueron hombres, con promedio de edad de 30,6 años. El 82,76% (24; 29) de las masas tumorales se originaron en nasofaringe; no se reportaron casos primarios. El tumor más frecuente fue el Angio-fibroma Nasofaringeo Juvenil 68,97% (20; 29), seguido por los tumores malignos con el 20,69% (6; 29), siendo usual el carcinoma adenoideo quístico. En el 62,07% (18; 29) el tumor invadió Fosa Infratemporal y en el 44,83% (13; 29) hacia esfenoides. En el grupo A, el abordaje quirúrgico empleado en el 20,83% (5; 24) fue mediante técnica abierta y en el 79,17% (19; 24) con técnica endoscópica, tanto uni 31,58% (6; 19) como multiportal 68,42% (13; 19). La complicación fue la hiposensibilidad facial en el 12,5% (3; 24), todos en abordajes abiertos. CONCLUSIÓN. Se evaluó los tipos abordaje quirúrgico y se identificó la estirpe histológica de los tumores de fosa pterigopalatina

INTRODUCTION. The pterygopalatine fossa is an anatomical area of difficult access, which when presenting tumor masses generates a high risk of morbimortality in the juvenile and adult popula-tion, which needs to determine the complications associated with surgery. OBJECTIVE. To eva-luate the types of surgical approach, complications and identify the histologic type of pterygopala-tine fossa tumors. MATERIALS AND METHODS. Retrospective cross-sectional study. Population and known sample of 29 Clinical Histories of patients with imaging and histopathological findings of tumors with invasion to pterygopalatine fossa divided into two groups: A) resection of tumor mass and B) biopsy of tumor mass, operated at the Carlos Andrade Marín Specialty Hospital in the period from january 2017 to december 2020. RESULTS. The 82,76% (24; 29) were men, with an average age of 30,6 years. 82,76% (24; 29) of the tumor masses originated in nasopharynx; no primary cases were reported. The most frequent tumor was juvenile nasopharyngeal angiofibroma 68,97% (20; 29), followed by malignant tumors with 20,69% (6; 29), being usual the adenoid cystic carcinoma. In 62,07% (18; 29) the tumor invaded the Infratemporal Fossa and in 44,83% (13; 29) into the sphenoid. In group A, the surgical approach used in 20,83% (5; 24) was by open technique and in 79,17% (19; 24) by endoscopic technique, both uni 31,58% (6; 19) and multiportal 68,42% (13; 19). The complication was facial hyposensitivity in 12,5% (3; 24), all in open approaches. CONCLUSION. The types of surgical approach were evaluated and the histologic type of pterygo-palatine fossa tumors was identified.

Análisis facial en la rinoseptoplastia funcional. Estudio descriptivo / Facial analysis in functional rhinoseptoplasty. Descriptive study

Objetivo: analizar las características del perfil facial como herramienta fundamental en la rinoseptoplastia funcional de los pacientes que consultan en la Unidad de Rinología del Servicio de Otorrinolaringología del Hospital Militar Dr. Carlos Arvelo, entre enero y abril de 2016. El rostro está formado por estructuras anatómicas que le proporcionan características determinadas. La nariz ocupa un lugar central, el diagnóstico preciso de las alteraciones nasales es el paso más importante y complejo de una rinoseptoplastia funcional. El propósito de la restauración quirúrgica de la nariz es asegurar el buen funcionamiento y la armonía en la forma, por lo que los ángulos del perfil facial son relevantes en la valoración prequirúrgica. Materiales y métodos: estudio descriptivo ­ observacional de corte transversal. La muestra estuvo conformada por 25 pacientes que accedieron voluntariamente a realizar estudio fotográfico y rinomanometría. Resultados: predominio del sexo femenino con 72% de la muestra total. El grupo etario preponderante estuvo conformado en un 92% por adultos jóvenes. En cuanto a los ángulos nasolabial y nasofacial, presentaron alteraciones el 56% y el 24% respectivamente. Se practicó rinomanometría a la población evidenciando 100% alteración (factor valvular), de los cuales un 80% presentaron modificación de los ángulos nasofacial y nasolabial. Conclusiones: la correlación entre la variación de los ángulos nasofacial y nasolabial con la permeabilidad nasal, establece que el análisis facial puede considerarse como herramienta fundamental para la determinación de correcciones estéticas y funcionales en la rinoseptoplastia funcional..Au

Objective: to analyze the characteristics of the facial profile as a fundamental tool in functional rhinoseptoplasty of patients who consult in the Rhinology Unit of the Otolaryngology Service of the Hospital Militar Dr. Carlos Arvelo, between January and April 2016. The face is made up of structures anatomical that provide certain characteristics. The nose occupies a central place, the precise diagnosis of nasal alterations is the most important and complex step of a functional rhinoseptoplasty. The purpose of the surgical restoration of the nose is to ensure proper function and harmony in shape, so the angles of the facial profile are relevant in the presurgical assessment. Materials and methods: descriptive-observational cross-sectional study. The sample consisted of 25 patients who voluntarily agreed to carry out a photographic study and rhinomanometry.Results: prevalence of the female sex with 72% of the total sample. The preponderant age group was made up of 92% young adults. Regarding the nasolabial and nasofacial angles, 56% and 24% presented alterations respectively. Rhinomanometry was performed on the population showing 100% alteration (valvular factor), of which 80% presented modification of the nasofacial and nasolabial angles. Conclusions: the correlation between the variation of the nasofacial and nasolabial angles with nasal patency establishes that facial analysis can be considered as a fundamental tool for determining aesthetic and functional corrections in functional rhinoseptoplasty..Au

Complicaciones posquirúrgicas del manejo del dorso nasal con la técnica cartílago en puente / Post-surgical complications of the management of the nasal dorsum with the cartilage-bridging technique

Introducción: en Cartagena, desde hace aproximadamente una década, se está realizando una nueva técnica de injerto dorsal denominada cartílago en puente (CEP), realizada en rinoplastias cerradas por un solo otorrinolaringólogo. No obstante, no existen estudios que caractericen las complicaciones de esta técnica. Objetivo del estudio: caracterizar las complicaciones posquirúrgicas del manejo del dorso nasal con CEP en pacientes sometidos a una rinoplastia. Metodología: estudio observacional descriptivo, de corte transversal y de carácter retrospectivo, que abarca los registros clínicos de pacientes sometidos a una rinoplastia cerrada con la técnica CEP entre 2013 y 2016. Se midieron variables sociodemográficas, características del procedimiento y se registraron las complicaciones detectadas durante el seguimiento posoperatorio: aparición de infección, extrusión, desplazamiento y reabsorción del injerto Resultados: se identificaron 882 historias clínicas. La mediana de edad fue de 28 años, siendo el 81 % del género femenino. La rinoplastia fue primaria en 80,6 %, el material del injerto dorsal fue solo cartílago en 80,6 %, Gore-Tex® en 1,7 % y una combinación de cartílago y Gore-Tex® en 17,7 %. La mediana de duración de las rinoplastias fue de 78 minutos (rango intercuartílico [RIC]: 72-85), siendo el principal procedimiento adicional la septoplastia en 82,2 %. El 18,2 % de los pacientes presentaron complicaciones. El desplazamiento fue la principal complicación reportada (14,7%), seguida de la reabsorción (4,0 %) e infección (0,1 %). Conclusiones: la técnica CEP mostró como principales complicaciones el desplazamiento y la reabsorción del injerto, con una frecuencia similar a la descrita en otros estudios.

Introduction: In Cartagena, a new dorsal graft technique called Cartilage in Bridge (CEP) has been carried out for approximately a decade, performed in rhinoplasties closed by a single otorhinolaryngologist. However, there are no studies that characterize the complications of this technique. Objective: To characterize postoperative complications of the management of the nasal dorsum with bridge cartilage in patients undergoing rhinoplasty. Methodology: Retrospective, descriptive, observational cross-sectional study, covering clinical records of patients who underwent closed rhinoplasty with the bridge cartilage technique between 2013 and 2016. Sociodemographic variables, characteristics of the procedure, and complications detected during follow-up were recorded postoperative: appearance of infection, extrusion, displacement, and reabsorption of the graft Results: 882 medical records were identified. The median age was 28 years, being 81 % female. Rhinoplasty was primary in 80.6 %, the dorsal graft material was only cartilage in 80.6 %, Gore-Tex® in 1.7 % and combination of cartilage and Gore-Tex® in 17.7 %. The median duration of the rhinoplasties was 78 minutes (ICR: 72-85), with the main additional procedure being septoplasty in 82.2 %. 18.2 % of the patients presented complications. Displacement (14.7 %) was the main complication reported, followed by reabsorption (4.0 %) and infection (0.1 %). Conclusions: The cartilage bridge technique showed graft displacement and reabsorption as main complications, with a frequency similar to that described in other studies.

Clinical efficacy of composite subcutaneous pedicled flaps in repairing full-thickness nasal alar defects of 11 patients: a clinical observation / 中华皮肤科杂志

Objective:To investigate clinical efficacy of composite subcutaneous pedicled flaps in repairing full-thickness nasal alar defects.Methods:Clinical data were collected from 11 patients with basal cell carcinoma of nasal ala in Department of Dermatologic Surgery, the Third People′s Hospital of Hangzhou from August 2019 to September 2020, and analyzed retrospectively. There were 6 females and 5 males, aged 70 years in average (range, 56-87 years) . After tumor resection, full-thickness nasal alar defects were formed, a flap was designed along the inner side of the cheek and turned by 180 degrees to repair the nasal mucosal lining; then, a subcutaneous pedicled flap was designed along the ipsilateral nasolabial fold to repair the outer secondary defects and postoperative defects.Results:The mean diameter of postoperative defects was 1.8 cm (range, 1.5-2.5 cm) , and the mean diameter of the nasal lining was 0.9 cm (range, 0.6-1.5 cm) . Seven days after the operation, stitches were removed, wounds healed without complications, and all flaps survived with a satisfactory appearance. The follow-up period ranged from 1 to 13 months (average, 6 months). After scar maturation, all patients were satisfied with the aesthetic outcome. No tumor recurrence was observed during the follow-up period.Conclusion:The composite subcutaneous pedicled flap is safe and effective for the repair of full-thickness nasal alar defects, and has advantages of a well-hidden donor site, good color match, and stage-I operation for reconstruction.

Atresia congénita bilateral de coanas en una adolescente: reporte de un caso / Congenital bilateral choanal atresia in an adolescelent: a case report

La atresia congénita de coanas se caracteriza por la presencia de placas que obliteran la comunicación entre la cavidad nasal y la nasofaringe desde el nacimiento. Se considera como incompatible con la vida cuando la condición es bilateral. El siguiente es el caso de una paciente femenina, de 17 años, sin síndromes asociados, con obstrucción y descarga nasal anterior bilateral, asociado a respiración oral desde el periodo neonatal. El diagnóstico de atresia bilateral de coanas fue confirmado por medio de endoscopía nasal y tomografía computarizada (TC). La imagen confirmó la presencia de placas atrésicas de composición mixta. La paciente recibió tratamiento quirúrgicamente por vía transnasal con resección de las placas y modelado de neocoana.

Congenital choanal atresia is characterized by the presence of plates obliterating the communication between the nasal cavity and the nasopharynx from birth. If bilateral, this condition is incompatible with life. This following is the case of a 17-year-old female patient, without associated syndromes, with bilateral nasal obstruction and anterior discharge, associated to oral breathing, starting in her neonatal period. The diagnosis of bilateral choanal atresia was confirmed by nasal endoscopy and computed tomography (CT) scan, due to the presence of atretic plates of mixed composition. The patient was surgically treated with plate resection and modeling of a neochoana by means of a transnasal surgical approach.

Retalho de pedículo subcutâneo em formato de tubarão na região perialar / Subcutaneous pedicle flap shaped like a shark on perinasal region

A região nasal é frequentemente acometida por neoplasias cutâneas, especialmente em indivíduos de fototipos baixos, em quem a incidência de carcinoma basocelular é elevada. Defeitos cirúrgicos na asa nasal e região perinasal constituem desafio à sua reconstrução, uma vez que envolve várias unidades cosméticas e preservação do sulco nasal. A preservação dos limites entre essas unidades mostra-se fundamental, portanto, para o bom resultado funcional e estético. Este artigo tem como objetivo mostrar a aplicação do retalho de pedículo subcutâneo em formato de tubarão para correção de defeitos em asa nasal e região perinasal.

The nasal region is often affected by cutaneous neoplasm, especially in individuals of low phototypes, where the incidence of basal cell carcinoma is high. Surgical defects in the nasal wing and perinasal region constitute a challenge to its reconstruction since it involves several cosmetic units and preservation of the nasal groove. The preservation of the limits between these units is thus fundamental for good functional and aesthetic results. This article aims to show the application of the Shark Island Flap for the correction of defects in the nasal and perinasal regions.

Osteoma cutis em couro cabeludo: tratamento cirúrgico com retalho em rotação tipo "S" itálico para exérese de lesão rara / Osteoma cutis on the scalp - Surgical treatment with a rotation flap "S" italic for the removal of a rare lesion

O osteoma cutis é um tumor raro, caracterizado pela presença de tecido ósseo na derme e/ou hipoderme. A seguir, iremos descrever o caso de um paciente com diagnóstico de osteoma cutis no couro cabeludo há cerca de 10 anos, com crescimento progressivo e área de alopecia local. O paciente foi submetido à excisão cirúrgica da lesão com técnica de retalho em rotação tipo "S" itálico para reconstrução da área visando ao melhor resultado estético possível.

Osteoma cutis is a rare tumor characterized by the presence of bone tissue in the dermis and/or hypodermis. We describe the case of a patient diagnosed with osteoma cutis on the scalp for approximately ten years with progressive growth and local alopecia area. The patient underwent surgical excision of the lesion using the rotation flap "S" italic technique to reconstruct the area aiming at the best possible aesthetic result.

Evaluación de los desenlaces posoperatorios de los pacientes sometidos a septoplastia y turbinoplastia entre los años 2016 a 2018 de la Fundación Santa Fe de Bogotá / Evaluation of postoperative outcomes of septoplasty and septoturbinoplasty patients of Fundación Santa Fe de Bogota between the years 2016 to 2018

Introducción: La tasa de infección después de la cirugía nasal electiva es muy baja, lo que hace que la profilaxis antibiótica de rutina sea redundante. En Colombia no disponemos de información acerca de la tasa de infección de septoplastia; por esta razón, en este artículo se busca describir la tasa de infección posquirúrgica en los pacientes llevados a septoplastia o septoplastia y turbinoplastia de la Fundación Santa Fe de Bogotá, entre los años 2016-2018. Metodología: se realizó un estudio observacional, descriptivo y retrospectivo mediante la revisión de la base de datos del servicio. Se calculó la proporción de infección para todos los individuos participantes del estudio de manera general y estratificada por el uso de antibiótico profiláctico y posoperatorio, y se describió la frecuencia de las complicaciones. Resultados: encontramos 255 pacientes en la base de datos de la sección de otorrinolaringología, de los cuales 206 cumplieron con los criterios de inclusión. El 23,3 % de los pacientes recibió un antibiótico profiláctico y el 24,76 % recibió un antibiótico postoperatorio. La tasa de infección posoperatoria fue de 2,91 % (intervalo de confianza [IC] del 95 %: 1,07-6,23). El 96,6 % de los pacientes no presentaron complicaciones. Conclusiones: nuestros hallazgos se correlacionan con la literatura global

Introduction: infection rate after elective nasal surgery is very low which makes routine antibiotic prophylaxis redundant. In Colombia we do not have information about postoperative infection in septoplasty. A study was designed to determine the postoperative infection rate in patients undergoing septoplasty or septoplasty and turbinoplasty at Fundación Santa Fe de Bogotá between 2016 to 2018. Methods: an observational, descriptive and retrospective study was conducted. The database of the Otolaryngology Section was reviewed. The proportion of infection for all individuals participating in the study was calculated in a general and stratified manner by use of prophylactic and postoperative antibiotic and the frequency of complications was described. Results: we found 255 patients in the patient database of which 206 patients met the inclusion criteria. 23.3 % of patients received prophylactic antibiotic and 24.76 % received postoperative antibiotic. The percentage of postoperative infection was 2.91 % (95 % CI: 1.07-6.23). 96.6 % of the patients did not present any complications. Conclusion: septoplasty has a low risk of infection which was in accordance to the findings found in the present study.

Lacrimal Diversion Devices (Sinopsys Lacrimal Stent): Sharing our Experience with Patients with Chronic Rhinosinusitis without Polyposis

Introduction: Chronic rhinosinusitis (CRS) is a highly prevalent pathology in our society. Due to the prevalence of this condition and to the persisting symptoms despite an appropriate medical treatment, surgical techniques are often required. Lately, minimal invasive techniques have been described, such as lacrimal diversion devices (LDDs). This technique offers a fast and convenient choice for delivery of sinus irrigation and topical medication. Objective: We aimed to describe our experience with LDDs and evaluate the safety and effectiveness of the procedure in patients with moderate to severe CRS without nasal polyposis (CRSsNP) and persistent symptomatology despite medical therapy. Methods: A total of 7 patients underwent bilateral lacrimal stents placement in the operating room. A retrospective observational study was conducted. The Sino-Nasal Outcome Test-20 (SNOT-20) survey was performed and the score obtained was compared before and 1 month after the procedure. Results: The LDDs were used for an average of 80 days. During the follow-up, only three patients had a mild complication with the device (granuloma in the punctum, obstruction, and early extrusion). The mean baseline SNOT-20 score dropped significantly ( p = 0.015) from 25.85 to 11.57 (mean: - 14.29) 1 month after the procedure. Conclusion: According to our experience and results, the use of LDD is a novel, feasible, and less invasive technique to treat refractory CRS. It reduces the risk of mucosal stripping, provides short-term outcomes, and the surgical procedure does not require advanced training in endoscopic sinus surgery. Moreover, it can be performed in-office under local anesthesia or sedation (AU)

Expanding the limits of endoscopic intraorbital tumor resection using 3-dimensional reconstruction / Expandindo os limites da ressecção endoscópica de tumor intraorbital utilizando reconstrução tridimensional

Abstract Introduction: Endoscopic orbital surgery is a nascent field and new tools are required to assist with surgical planning and to ascertain the limits of the tumor resectability. Objective: We purpose to utilize three-dimensional radiographic reconstruction to define the theoretical lateral limit of endoscopic resectability of primary orbital tumors and to apply these boundary conditions to surgical cases. Methods: A three-dimensional orbital model was rendered in 4 representative patients presenting with primary orbital tumors using OsiriX open source imaging software. A 2-Dimensional plane was propagated between the contralateral nare and a line tangential to the long axis of the optic nerve reflecting the trajectory of a trans-septal approach. Any tumor volume falling medial to the optic nerve and/or within the space inferior to this plane of resectability was considered theoretically resectable regardless of how far it extended lateral to the optic nerve as nerve retraction would be unnecessary. Actual tumor volumes were then superimposed over this plan and correlated with surgical outcomes. Results: Among the 4 lesions analyzed, two were fully medial to the optic nerve, one extended lateral to the optic nerve but remained inferior to the plane of resectability, and one extended both lateral to the optic nerve and superior to the plane of resectability. As predicted by the three-dimensional modeling, a complete resection was achieved in all lesions except one that transgressed the plane of resectability. No new diplopia or vision loss was observed in any patient. Conclusion: Three-dimensional reconstruction enhances preoperative planning for endoscopic orbital surgery. Tumors that extend lateral to the optic nerve may still be candidates for a purely endoscopic resection as long as they do not extend above the plane of resectability described herein.

Resumo Introdução: A cirurgia orbital endoscópica é um campo emergente e são necessárias novas ferramentas para auxiliar no planejamento cirúrgico e determinar os limites da ressecabilidade tumoral. Objetivo: Usar a reconstrução radiográfica tridimensional para definir o limite lateral teórico de ressecabilidade endoscópica de tumores orbitais primários e aplicar essas condições de limites a casos cirúrgicos. Método: Um modelo orbital tridimensional foi aplicado a quatro pacientes representativos com tumores orbitais primários utilizando o software de imagem de fonte aberta OsiriX. Um plano bidimensional foi propagado entre a narina contralateral e uma linha tangencial ao eixo longo do nervo óptico que reflete a trajetória de uma abordagem transeptal. Qualquer volume de tumor situado medialmente ao nervo óptico e/ou dentro do espaço inferior a esse plano de ressecabilidade foi teoricamente considerado ressecável, independentemente de quão longe ele se estendia até o nervo óptico, pois a retração do nervo seria desnecessária. Os volumes reais do tumor foram então sobrepostos sobre esse plano e correlacionados com os resultados cirúrgicos. Resultados: Entre as quatro lesões analisadas, duas eram totalmente mediais ao nervo óptico, uma se estendia lateralmente ao nervo óptico, mas permaneceu inferior ao plano de ressecabilidade, e uma se estendia lateralmente ao nervo óptico e superior ao plano de ressecabilidade. Conforme previsto pelo modelo tridimensional, uma ressecção completa foi obtida em todas as lesões, exceto uma, que transgrediu o plano de ressecabilidade. Nenhuma nova diplopia ou perda de visão foi observada em qualquer paciente. Conclusão: A reconstrução tridimensional melhora o planejamento pré-operatório para a cirurgia orbital endoscópica. Os tumores que se estendem lateralmente ao nervo óptico podem ainda ser candidatos à ressecção puramente endoscópica, desde que não se estendam além do plano de ressecabilidade aqui descrito.

Effect of Pharyngeal Pack on Postoperative Nausea and Throat Pain in Patients Undergoing Rhinoplasty

Objective: To evaluate the effect of pharyngeal pack on postoperative throat pain and nausea in rhinoplasty patients. Material and Methods: Twenty-eight patients were randomly selected and divided into two groups (n=14). The participants were randomly divided into two groups: G1 - the pharyngeal pack was used (Intervention group) and G2: not used (Control group). Both groups were anesthetized by the same protocol. Throat pain was measured by visual analog scale and nausea by presence / absence. Fischer's exact test, ANOVA, Friedman and Wilcoxon test were used. Results: There was no significant difference in mean pain and presence or absence of nausea between the two groups (p>0.05). But there was a significant difference in mean pain and the presence or absence of postoperative nausea with the intervals (p<0.05). Mean pain had a significant difference 2 hours postoperatively with other times, 6 hours postoperatively with 24 and 72 hours postoperatively, and 24 hours postoperatively with 72 hours (p<0.05). There was no significant difference in the presence or absence of postoperative nausea, between 2 hours and 6 hours postoperatively (p>0.05). The presence or absence of postoperative nausea had a significant difference between 2 hours postoperatively with 24 and 72 hours postoperatively and 6 hours postoperatively with 24 and 72 hours postoperatively (p<0.05). There was no significant difference in nausea between 24 hours and 72 hours postoperatively (p>0.05). Conclusion: None of the two groups were significantly superior in terms of reduction of pain and nausea, but because of the possible effectiveness of the pharyngeal pack in preventing aspiration of objects and tissues during the operation, the use of pharyngeal pack is recommended in patients.

Abordaje multidisciplinario del papiloma invertido nasal asociado con mucopiocele frontoetmoidal orbitario: técnica endoscópica y abierta por otorrinolaringología, neurocirugía y oftalmología / Multidisciplinary approach of nasal inverted papilloma associated with frontoethmoidal orbitary mucopiocele: endoscopic and open technique by otorhinolaryngology, neurosurgery and ophthalmology

Introducción: el papiloma invertido nasal es un tumor nasosinusal primario de comportamiento intermedio, con potencial de malignización y capacidad de recidiva en asociación con mucocele. El manejo quirúrgico de ambas patologías se ha descrito de manera independiente. Caso clínico: paciente con diagnóstico de papiloma invertido nasal Krause III y mucopiocele frontoetmoidal orbitario derecho con destrucción de techo de órbita y pared posterior del seno frontal en quien se realizó el manejo multidisciplinario mediante abordaje endoscópico y abierto sin recidiva luego de un año de seguimiento. Discusión: a la luz de la evidencia actual, el tratamiento del papiloma nasal invertido es quirúrgico recomendando abordajes endoscópicos en estadios I, II y III, y técnicas combinadas en estadio IV. En nuestro caso se realizó una resección endoscópica completa del tumor con frontoetmoidoesfenoidotomía + maxilectomía medial y fresado de inserciones óseas. Para el mucocele frontal, el abordaje debe permitir la remoción de la mucosa sinusal y la secuestrectomía ósea. Teniendo en cuenta la localización lateral y el compromiso osteolítico del techo de la órbita y la pared posterior del seno frontal, se optó por un abordaje abierto mediante un colgajo osteoplástico con cranealización de seno frontal. El manejo de las secuelas orbitarias consistió en la reconstrucción del techo de la órbita y dacriocistorrinostomía endoscópica.

Introduction: Nasal inverted papilloma is a primary nasosinusal tumor of intermediate behavior, with potential for malignancy and relapse capacity in association with mucocele. The surgical management of both pathologies has been described independently. Case report: Patient with a diagnosis of Krause III nasal inverted papilloma and right frontoethmoidal orbitary mucopiocele with destruction of the orbital roof and posterior wall of the frontal sinus is performed using a multidisciplinary approach with an endoscopic and open approach without relapse after one year of follow-up. Discussion: The treatment of inverted nasal papilloma is surgical recommending endoscopic approaches in stages I, II and III, and combined techniques in stage IV. In our case, a complete endoscopic resection of the tumor was performed with frontoethmoidosphenoidotomy + medial maxillectomy and milling of osseous insertions. For the frontal mucocele, the approach should allow the removal of the sinus mucous membrane and the bone sequestractomy. Considering the lateral location, the osteolytic involvement of the orbital roof and the posterior frontal sinus wall, we opted for an open approach using an osteoplastic flap with frontal sinus cranialisation. The management of the orbital sequelae consisted of reconstruction of the orbital roof and endoscopic dacryocystorhinostomy.

Concha bullosa gigante: reporte de un caso / Giant concha bullosa: a case report

La concha bullosa es una variante anatómica del cornete medio nasal. Se reporta un caso de una mujer de 21 años con síntomas de obstrucción nasal severa de ambas fosas nasales. Al examen físico se aprecia gran masa que ocupa la fosa nasal izquierda y una severa desviación septal a la derecha. La tomografía computarizada muestra una concha bullosa gigante izquierda, con neumatización del cornete superior izquierdo y una desviación y adelgazamiento septal severos hacia la fosa nasal derecha. Se realiza cirugía endoscópica con resección de la concha bullosa y corrección de la neumatización del cornete superior, antrostomía maxilar derecha y se lleva a cabo septoplastia como reto quirúrgico, por su grado de dificultad y por la posibilidad de causar complicaciones como la perforación septal.

Concha bullosa is an anatomical variant of the middle nasal conchae. This is a clinical report of a case of a 21 year old woman with severe bilateral nasal fossa obstruction symptoms. During the examination, a large mass was occupying the left nasal fossa. There was also a severe deviation to the right. CT scans showed a giant left Concha bullosa, pneumatization of the superior left Concha with septal thinning and deviation towards the right nasal fossa. Endoscopic surgery is performed including resection of the Concha bullosa, correction of the pneumatization of the superior turbinate, and maxillary antrostomy, in addition, septoplasty is performed as a surgical challenge, due to its degree of difficulty and the possibility of causing complications such as septal perforation.

Clinical Effect and Safety of Endoscopic Sinus Surgery in Patients over Seventy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis (CRS) is common in the elderly. There are increasing evidence that endoscopic sinus surgery (ESS) can be used to manage geriatric patients safely, although there are still concerns about complications after ESS. Therefore, the clinical effect and the safety of ESS in old patients was evaluated in the present study. SUBJECTS AND METHOD: Retrospective observational studies were performed based on medical records of patients over the age of 70 and who underwent ESS for CRS from January 2009 to December 2017. The clinical effect of ESS was assessed by comparing the sino-nasal outcome test (SNOT-22) scores before and 3 months after surgery. The safety of the operation was evaluated by the occurrence of postoperative major surgical (skull base, orbital and hemorrhage) and medical (ventricular fibrillation, ischemic attack, primary cardiac arrest, cerebrovascular accident, pneumonia, other organ failure and death) complications. RESULTS: Seventy three subjects were enrolled in this study. Bilateral disease was observed in 37 cases (50.7%), and CRS with nasal polyp was found in 31 cases (42.5%). Eight patients (11.0%) had revision cases. The majority (93.2%) had at least one comorbid condition and got prescribed related medicine (87.7%). There was a significant decrease in SNOT-22 score after surgery. Furthermore, there were no major surgical or medical complications except two cases with epistaxis. CONCLUSION: CRS in geriatric patients can also be treated effectively and safely by ESS as it is done for younger adults. However, as the incidence of comorbidities is high in elderly subjects, it is important to evaluate the risk factors preoperatively.