Síndrome del incisivo central maxilar medio único en neonato / Solitary median maxillary central incisor syndrome in neonates / Síndrome do incisivo central maxilar médio solitário em neonatos

Introducción: el síndrome del incisivo central maxilar medio único (SMMCI) es un trastorno de etiología desconocida, con base genética heterogénea, que se caracteriza por la erupción de un único incisivo central en el maxilar y que se puede relacionar con multitud de patologías y síndromes, entre los que destacan las alteraciones de la línea media, obstrucción nasal congénita, disfunción hipofisaria, talla baja y holoprosencefalia. Caso clínico: neonato mujer con síndrome dismórfico no filiado y obstrucción nasal congénita, que es diagnosticada de SMMCI tras consultar en repetidas ocasiones por cuadros de dificultad respiratoria y problemas para alimentarse. Conclusiones: el conocimiento de este raro síndrome es fundamental para la realización de un diagnóstico precoz por parte del equipo pediátrico y obstétrico, ya que un diagnóstico temprano es posible, mejorando la evaluación prenatal ecográfica, así como el adecuado manejo posnatal multidisciplinar posterior de nuestros pacientes.

Introduction: the Solitary Median Maxillary Central Incisor Syndrome (SMMCI) is a disorder of unknown etiology, with a heterogeneous genetic basis, characterized by the eruption of a single central incisor in the maxilla and that can be linked to various pathologies and syndromes, among which the alterations of the midline, congenital nasal obstruction, pituitary dysfunction, short stature and holoprosencephaly stand out. Clinical case: female newborns with unknown dysmorphic syndrome and congenital nasal obstruction, diagnosed with SMMCI after repeated consultations due to respiratory distress and feeding problems. Conclusions: understanding this rare syndrome is essential for an early diagnosis to be carried out by the pediatric and obstetric team, since it will improve the ultrasound prenatal assessment, as well as the adequate subsequent multidisciplinary postnatal patient management procedures.

Introdução: a síndrome do incisivo central maxilar médio solitário (SICMMS) é uma desordem de etiologia desconhecida, com base genética heterogênea, caracterizada pela erupção de um único incisivo central na maxila e que pode estar relacionada a uma infinidade de patologias e síndromes. onde se destacam alterações da linha média, obstrução nasal congênita, disfunção hipofisária, baixa estatura e holoprosencefalia. Caso clínico: recém-nascida com síndrome dismórfica de origem desconhecida e obstrução nasal congênita, diagnosticada com SICMSS após várias consultas por desconforto respiratório e problemas de alimentação. Conclusões: o conhecimento desta rara síndrome é essencial para que a equipe pediátrica e obstétrica possa fazer um diagnóstico precoce, pois ele pode melhorar a avaliação ultrassonográfica pré-natal, bem como o adequado manejo pós-natal multidisciplinar pós-natal dos pacientes.

Rinoplastia de preservación dorsal, una nueva filosofía: Experiencia en el Hospital Naval Almirante Nef / Dorsal preservation rhynoplasty, a new philosophy: Experience in the Almirante Nef Naval Hospital

Resumen Introducción: La rinoplastia de preservación dorsal es una técnica innovadora en rinoplastias de reducción primaria, logrando una adecuada ventilación nasal y resultados estéticos naturales. Objetivo: Describir los resultados estéticos y funcionales en pacientes sometidos a rinoplastias de preservación dorsal. Material y Método: Se realiza un estudio de intervención no aleatorio "antes-después", donde se evaluaron las variables estética y funcional previo a la cirugía y luego a los seis meses. La variable estética se evaluó mediante el cuestionario de Utrecht (CU), escala visual análoga de apariencia nasal (EVA) y set de fotos clínicas. La variable funcional mediante el cuestionario de NOSE (Nasal Obstruction Symptoms Evaluation). Resultados: Un total de 15 pacientes fueron sometidos a rinoplastia de preservación dorsal. No hubo complicaciones tanto intra como posoperatorias. Ningún paciente intervenido presentó irregularidades dorsales, asimetrías, ni deformidades en "V" invertidas. Se observó una mejoría estadísticamente significativa (p < 0,01) en los resultados del CU, EVA y NOSE. Conclusión: La rinoplastia de preservación dorsal ofrece como resultado una nariz funcional, con líneas dorsales posoperatorias naturales. Esta técnica no presenta estigmas quirúrgicos, por lo que no es necesario la utilización de injertos para reparación del dorso nasal. Es rápida y fácil de realizar por cualquier cirujano especialista en rinoplastias.

Abstract Introduction: Dorsal preservation rhinoplasty is an innovative technique in primary reduction rhinoplasty, achieving adequate nasal ventilation and natural aesthetic results. Aim: To describe the aesthetic and functional results in patients undergoing dorsal preservation rhinoplasties. Material and Method: A non-randomized "before-after" intervention study was carried out, where the aesthetic and functional variables were evaluated before surgery and then at six months. The aesthetic variable was evaluated using the Utrecht questionnaire (CU), the visual analog scale of nasal appearance (VAS), and a set of clinical photos. The functional variable using the Nasal Obstruction Symptoms Evaluation (NOSE) questionnaire. Results: A total of 15 patients underwent dorsal preservation rhinoplasty. There were no intraoperative and postoperative complications. No patient who underwent surgery presented dorsal irregularities, asymmetries, or inverted "V" deformities. A statistically significant improvement (p < 0.01) was observed in the UC, VAS, and NOSE results. Conclusion: Dorsal preservation rhinoplasty results in a functional nose, with natural postoperative dorsal lines. This technique does not present surgical stigmata, so it is not necessary to use grafts to repair the nasal dorsum. It is quick and easy to perform by any rhinoplasty surgeon.

Allergic rhinitis improvement after septorhinoplasty in a sample of allergic rhinitis patients with septal deviation: a quasi-experimental study

ABSTRACT BACKGROUND: Allergic rhinitis (AR) is a chronic inflammatory disease that affects almost 30% of the adult population. OBJECTIVE: To describe and compare the evolution of symptoms in patients diagnosed with AR and septal deviation prior to and following septoplasty (STP). DESIGN AND SETTING: Quasi-experimental study developed in A Coruña University Hospital. METHODS: Patients aged 18-65 years who had been diagnosed with AR and septal deviation were recruited. Obstruction airflow was evaluated before and after surgery, by means of anterior rhinomanometry (RNM). Severity symptoms and quality of life were assessed using a visual analogue scale (VAS) and the ESPRINT questionnaire, respectively. RESULTS: A total of 50 subjects underwent STP and 42 were included in this study. Their mean age at the time of surgery was 34.16 ± 9.74 years (range 18-64). Significant reductions in mean VAS and ESPRINT were observed after surgery (P < 0.01). These outcomes were considered to represent an overall improvement in quality of life. The RNM results also improved significantly, from mean values of 478.07 ± 165.4 cm3/s before STP to 826.4 ± 175.5 cm3/s afterwards (P < 0.01). CONCLUSIONS: The negative correlations of VAS and ESPRINT with RNM, from before and to after STP, demonstrate the efficacy of scales and questionnaires as objective methods for determining obstruction in the absence of rhinomanometry. Patients with allergic rhinitis and septal deviation showed improvements in obstruction severity and medication use after STP.

Early clinical outcomes of ınferior turbinate radiofrequency and lateralization combined with septoplasty / Resultados clínicos iniciais da utilização de radiofrequência e lateralização das conchas nasais inferiores combinadas à septoplastia

Abstract Introduction: Mechanical obstruction is the most common form of nasal obstruction. Among the types of mechanical obstructions, septum deviation and inferior turbinate hypertrophy are the most prevalent. Objective: This study evaluated the early clinical outcomes of inferior turbinate radiofrequency and inferior turbinate lateralization combined with septoplasty in the treatment of nasal obstruction symptoms. Methods: The research retrospectively evaluated data from 33 patients (24 male, nine female) undergoing septoplasty and inferior turbinate radiofrequency (RF group) and 32 patients (24 male, eight female) treated with septoplasty and inferior turbinate lateralization (LAT group), who were admitted, with complaints of nasal obstruction, to the University of Health Sciences, Department of Otorhinolaryngology, between January 1, 2017 and January 1, 2018. The patients' preoperative and 6-month postoperative symptoms were evaluated via the Nasal Obstruction Symptom Evaluation, the NOSE scale. Results: The mean preoperative NOSE scores were 10.3 ± 4.2 in the RF group and 10.9 ± 4.9 in the LAT group, and the mean six-month postoperative scores were 1.09 ± 1.3 in the RF group and 1.2 ± 1.3 in the LAT group. There was no significant difference in NOSE scores between the two groups (p > 0.05). Conclusion: The data obtained in this study show that both methods result in similar outcomes in terms of relieving nasal obstruction symptoms in patients requiring inferior turbinate intervention. Therefore, the researchers believe that, in each case, the intervention method should be selected at the discretion of the patient and surgeon(s).

Resumo Introdução: A obstrução mecânica é a forma mais comum de obstrução nasal. Entre os tipos de obstruções mecânicas, o desvio do septo e a hipertrofia de conchas inferiores são os mais prevalentes. Objetivo: Avaliar os resultados clínicos iniciais da aplicação de radiofrequência nas conchas inferiores e a lateralização delas combinada com septoplastia no tratamento dos sintomas de obstrução nasal. Método: O estudo avaliou retrospectivamente dados de 33 pacientes (24 homens, nove mulheres) que foram submetidos a septoplastia e aplicação de radiofrequência no concha inferior (grupo RF) e 32 pacientes (24 homens, oito mulheres) submetidos a septoplastia e lateralização de concha inferior (grupo LAT), que foram admitidos com queixas de obstrução nasal na University of Health Sciences, Departamento de Otorrinolaringologia, entre 1° de janeiro de 2017 e 1° de janeiro de 2018. Os sintomas pré-operatórios e pós-operatórios de 6 meses dos pacientes foram avaliados pela escala NOSE, do inglês Nasal Obstruction Symptom Evaluation. Resultados: Os escores médios pré-operatórios da escala NOSE foram 10,3 ± 4,2 no grupo RF e 10,9 ± 4,9 no grupo LAT e os escores médios pós-operatórios de seis meses foram 1,09 ± 1,3 no grupo RF e 1,2 ± 1,3 no grupo LAT. Não houve diferença significante nos escores da escala NOSE entre os dois grupos (p > 0,05). Conclusão: Os dados obtidos neste estudo mostram que ambos os métodos têm resultados semelhantes em termos de alívio dos sintomas de obstrução nasal em pacientes que necessitam de intervenção nas conchas inferiores. Portanto, os pesquisadores acreditam que, em cada caso, o método de intervenção deve ser selecionado a critério do paciente e do cirurgião.

Comparison of septoplasty with three high / 中南大学学报(医学版)

OBJECTIVES@#To compare the operation time, subjective and objective outcomes of septoplasty with three high-tension line resection and two high-tension line resection.@*METHODS@#A prospective randomized controlled study was conducted to identify patients with septal deviation and symptomatic nasal obstruction. The patients were classified into a three high-tension line resection and senior physician group (Group A), a two high-tension line resection and senior physician group (Group B), a three high-tension line resection and junior physician group (Group C), a two high-tension line resection and junior physician group (Group D). In addition, according to whether there were the anterior deviation, some of patients were also divided into a three high-tension line resection and anterior deviation group (Group E) and a two high-tension line resection and anterior deviation group (Group F). The operation time was recorded. The patients completed the Nasal Obstruction Symptom Evaluation (NOSE) Scale (subjective symptom), nasal endoscopy (bodily sign) and rhinomanometry (objective examination) before and 6 months after septoplasty. The operation time and the efficacy were compared between three high-tension line resection operation and two high-tension line resection operation.@*RESULTS@#There was no significant difference in the operation time between the Group A and the Group B (@*CONCLUSIONS@#The effect of septoplasty with two high-tension line resection is as good as septoplasty with three high-tension line resection. The septoplasty with two high-tension line resection is more suitable to junior physician because it is easier and the operation time is shorter.

Rinoplastía y rinoseptoplastía funcional: mejorando la función nasal más allá de la cirugía del tabique y los cornetes nasales / Functional rhinoplasty and septorhinoplasty: improving nasal function beyond septal and turbinate surgery

Resumen La obstrucción nasal es una de las causas más frecuentes de consulta otorrinolaringológica general. Diversas estructuras juegan un rol en la mantención de una adecuada función respiratoria nasal, incluyendo el tabique, los cornetes, las paredes laterales y las alas nasales. La cirugía del tabique y de los cornetes inferiores son los procedimientos más comúnmente realizados y aunque son efectivos en un gran porcentaje de los casos, en ocasiones se deben intervenir otras estructuras nasales para corregir adecuadamente la obstrucción. La cirugía con fines primariamente funcionales de las válvulas nasales externa e interna, de la punta y/o de la pirámide ósea se ha denominado "rinoplastía funcional". Dada la importancia de estas estructuras para la recuperación de una adecuada permeabilidad nasal estática y dinámica, el diagnóstico y manejo quirúrgico de estas condiciones debe ser de dominio del otorrinolaringólogo.

Abstract Nasal obstruction is one of the most frequent complaints in general otorhinolaryngology practice. Different structures have a role in maintaining an adequate nasal breathing function, including the septum, turbinates, lateral sidewalls and nasal alae. Surgery of the nasal septum and inferior turbinates are the most commonly performed procedures and, although effective in most cases, occasionally other nasal structures must be intervened to correctly address the sites of obstruction. The term "functional rhinoplasty" has been coined for surgery of the external and internal nasal valves, nasal tip and/or bony pyramid, with primarily functional objectives. Given the importance of these structures for restoring an adequate static and dynamic nasal patency, diagnosis and management of these conditions must be dominion of the otorhinolaryngologist.

Computed tomography evaluation of internal nasal valve angle and area and its correlation with NOSE scale for symptomatic improvement in rhinoplasty / Avaliação do ângulo e da área da válvula nasal interna por tomografia computadorizada e sua correlação com a escala NOSE na melhora sintomática pós rinoplastia

Abstract Introduction: Nasal obstruction is one of the most frequent otolaryngologic complaints; and the collapse of the internal nasal valve is one the main causes of the nasal air flow obstruction. Objective: We aimed to evaluate internal nasal valve by using reformatted CT-scans pre- and post- rhinoplasty at 3 months and to assess its correlation to symptomatic improvement of nasal obstruction using the NOSE scale. Methods: A prospective observational study was conducted between March 2017-May 2018 in a tertiary care otorhinolaryngology center. We included patients suffering from nasal obstruction secondary to internal nasal angle collapse and nasal deformity. Patients with sinusitis, nasal polyposis, and nasal masses were excluded. Results: Twenty consecutive patients underwent rhinoplasty, with a mean age (22.2 ± 2.8), with majority of males (n = 14; 70%). There was no significant correlation between pre- and post- CT-scans of the internal nasal valve angle/area and NOSE scores. A high significant difference was detected between mean pre- and post- NOSE scores (p < 0.0001), which was absent in CT-scan results. Conclusion: Reformatted CT-scans measurements of internal nasal valve area and angle were not of value. NOSE scores pre- and post- rhinoplasty had a significant value to determine degree of obstructive symptom improvement.

Resumo Introdução: A obstrução nasal é uma das queixas otorrinolaringológicas mais comuns, e o colapso ou obstrução da válvula nasal interna é a principal causa da obstrução das vias aéreas nasais. Objetivo: Objetivamos avaliar a válvula nasal interna pré, e 3 meses pós-rinoplastia utilizandotomografias computadorizadas reformatadas e avaliar sua correlação com a melhora do sintoma obstrutivo utilizando a escala NOSE, do Inglês Nasal Obstruction Symptom Evaluation. Método: Um estudo observacional prospectivo foi realizado entre março de 2017 e maio de 2018 em um centro de otorrinolaringologia de atenção terciária. Foram incluídos pacientes que apresentavam obstrução nasal secundário a colapso da valva nasal interna e deformidade nasal. Pacientes com sinusite, polipose nasal e tumores nasais foram excluídos. Resultados: Vinte pacientes consecutivos, a maioria do sexo masculino (n = 14; 70%) com média de idade de 22,2 ± 2,8 anos, foram submetidos a rinoplastia eincluídos no estudo. Não houve correlação significante entre as avaliações tomográficas pré / pós cirúrgicas do ângulo/área da valva nasal interna e os escores NOSE. Foi detectada uma diferençã altamente significante entre os escores médios da escala NOSE entre o pré e pós-operatório (p < 0,0001), mas não nos resultados da avaliação por tomografia computadorizada. Conclusão: As medidas reformatadas de tomografias computadorizadas da área e ângulo da valva nasal interna pré e pós cirúrgicas não tiveram valor. Entretanto, os escores da escala NOSE pré e pós-rinoplastia mostraram uma diferença significante ao determinar o grau de melhora do sintoma obstrutivo.

Angiofibroma nasoseptal: reporte de un caso y revisión / Nasal septal angiofibroma: case report and review

RESUMEN Paciente de 32 años que acudió a consultas por epistaxis intermitente. A la exploración, se evidenció una masa proveniente del septum en fosa nasal izquierda no sospechosa, que a la biopsia demostró ser un angiofibroma. Se describe el abordaje terapéutico de un angiofibroma extranasofaríngeo septal y una revisión de la literatura.

ABSTRACT A 32-year-old patient attended our department for intermittent epistaxis. Upon examination, a non-suspicious mass coming from the septum was found in the left nostril, which at biopsy proved to be an angiofibroma. We describe the therapeutic approach of a septal extranasopharyngeal angiofibroma and a review of the literature.

Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients / Efeitos da turbinoplastia versus fratura lateral e cauterização bipolar no volume da concha inferior hipertrófica compensatória em pacientes submetidos a septoplastia

Abstract Introduction: The most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those. Objective: In this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization. Methods: This retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0 ± 12.4 years, range 17-61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography. Results: The transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p = 0.004). In both groups the lower turbinate volumes were significantly decreased (p = 0.002, p < 0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p = 0.033). Conclusion: Both turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization.

Resumo Introdução: A causa mais comum de falha da septoplastia é a hipertrofia das conchas inferiores não tratada adequadamente. Diversas técnicas foram descritas até o momento: turbinectomia total ou parcial, ressecção da submucosa (cirúrgica ou com microdebridador) e a fratura lateral. Objetivo: Neste estudo, comparamos os volumes pré e pós-operatório da concha inferior com hipertrofia compensatória com o uso de tomografia computadorizada entre pacientes submetidos a septoplastia e turbinoplastia ou fratura lateral com cauterização bipolar. Método: Este estudo retrospectivo incluiu 66 pacientes (37 homens e 29 mulheres) internados em nosso serviço de otorrinolaringologia entre 2010 e 2017 por obstrução nasal e submetidos à cirurgia por desvio de septo nasal. Os pacientes submetidos à turbinoplastia devido à hiperplasia compensatória da concha inferior formaram o grupo turbinoplastia; aqueles submetidos à fratura lateral e cauterização bipolar foram separados, formaram o grupo fratura lateral. Os volumes compensatórios da concha inferior de todos os pacientes que participaram do estudo (idade média de 34,0 ± 12,4 anos, faixa de 17 a 61 anos) foram avaliados por tomografia computadorizada dos seios paranasais nos planos axial e coronal no pré-operatório e aos dois meses do pós-operatório. Resultados: As dimensões transversais e longitudinais do grupo turbinoplastia no pós-operatório foram significantemente menores do que as do grupo de fratura lateral (p = 0,004). Em ambos os grupos, os volumes da concha inferior diminuíram significantemente (p = 0,002, p < 0,001, respectivamente). O volume pós-operatório da concha do lado do desvio aumentou significantemente no grupo turbinoplastia (p = 0,033). Conclusão: Tanto a turbinoplastia como a fratura lateral são técnicas efetivas de redução de volume. No entanto, a turbinoplastia causa maior redução do volume da concha inferior do que a fratura lateral com cauterização bipolar.

Does the reduction of inferior turbinate affect lower airway functions? / A redução da concha nasal inferior afeta as funções das vias aéreas inferiores?

Abstract Introduction: Although the nose and lungs are separate organs, numerous studies have reported that the entire respiratory system can be considered as a single anatomical and functional unit. The upper and lower airways affect each other either directly or through reflex mechanisms. Objective: In this study, we aimed to evaluate the effects of the radiofrequency ablation of persistent inferior turbinate hypertrophy on nasal and pulmonary function. Methods: Twenty-seven patients with bilateral persistent inferior turbinate hypertrophy without septal deviation were included in this study. All of the patients were evaluated using anterior rhinoscopy, nasal endoscopy, acoustic rhinometry, a visual analogue scale, and flow-sensitive spirometry on the day before and 4 months after the radiofrequency ablation procedure. Results: The post-ablation measurements revealed that the inferior turbinate ablation caused an increase in the mean cross-sectional area and volume of the nose, as well as in the forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow of the patients. These differences between the pre- and post-ablation results were statistically significant. The post-ablation visual analogue scale scores were lower when compared with the pre-ablation scores, and this difference was also statistically significant. Conclusion: This study demonstrated that the widening of the nasal passage after the reduction of the inferior turbinate size had a favorable effect on the pulmonary function tests.

Resumo Introdução: Embora o nariz e os pulmões sejam órgãos separados, numerosos estudos relataram que todo o sistema respiratório pode ser considerado como uma única unidade anatômica e funcional. As vias aéreas superiores e inferiores afetam uma à outra diretamente ou através de mecanismos reflexos. Objetivo: Avaliar os efeitos da ablação por radiofrequência em conchas nasais inferiores com hipertrofia persistente sobre a função nasal e pulmonar. Método: Foram incluídos neste estudo 27 pacientes com hipertrofia persistente bilateral de conchas inferiores sem desvio septal. Todos os pacientes foram avaliados com rinoscopia anterior, endoscopia nasal, rinometria acústica, escala visual analógica e espirometria sensível ao fluxo no dia anterior e quatro meses após o procedimento de ablação por radiofrequência. Resultados: As medidas pós-ablação demonstraram que a ablação das conchas nasais inferiores resultou em um aumento da área transversal média e do volume do nariz, bem como do volume expiratório forçado em um segundo, da capacidade vital forçada e do fluxo expiratório máximo dos pacientes. Essas diferenças entre os resultados pré e pós-ablação foram estatisticamente significantes. Os escores da escala visual analógica pós-ablação foram menores quando comparados com os escores pré-ablação e essa diferença também foi estatisticamente significante. Conclusão: O alargamento da passagem nasal após a redução do tamanho das conchas nasais inferiores teve efeito favorável nos testes de função pulmonar.

Revision rhinoplasty: physician-patient aesthetic and functional evaluation / Revision rhinoplasty: physician-patient aesthetic and functional evaluation

Abstract Introduction: Approximately 5-15% of patients submitted to rhinoplasty operations undergo revision surgery. Those patients have varied functional and aesthetic complaints that should receive a detailed assessment that includes all the expectations the patient had before the previous procedure. Objective: To draw the profile of the main aesthetic-functional complaints reported by patients to be submitted to revision rhinoplasty and to correlate them with the internal and external objective nasal evaluation performed by the surgeon. Methods: A prospective study was conducted with 43 patients to be submitted to revision rhinoplasty and their respective surgeons, by applying a questionnaire about the patients' epidemiological questions and subjective aesthetic-functional complaints as well as the respective functional deformities observed by the surgeons. Subsequently, these data were correlated with the purpose of observing the frequency of congruent reports between physicians and patients. Results: The presence of drooping tip and residual bridge hump were the patients' main complaints, confirmed by the surgeons. The correlation between subjective obstructive symptoms and the intranasal evaluation performed by surgeons was shown to be present in 87.5% of the cases. Among the patients with respiratory symptoms, the main deformity identified was residual septal deviation in 56.25% of the cases. Conclusion: The drooping tip followed by residual hump were the main complaints reported by the patients and confirmed by the objective examination by the physicians. The presence of nasal obstructive complaints in 37.2% of the patients shows that greater attention needs to be paid to functional deformities during the first surgical procedure. The differences observed between patients' complaints and surgeons' evaluations confirm the need for detailed assessment and clarification to the patients regarding their expectations and actual surgical possibilities.

Resumo: Introdução: As rinoplastias possuem índice de revisão em torno de 5% a 15% dos pacientes operados. Tais pacientes possuem queixas funcionais e estéticas variadas e a avaliação detalhada é de extrema importância, tendo em vista todas as expectativas em torno de um procedimento já anteriormente realizado. Objetivo: Traçar o perfil das principais queixas estético-funcionais referidas pelo paciente a ser submetido à rinoplastia revisional e correlacioná-las a avaliação nasal objetiva interna e externa realizada pelo cirurgião. Método: Foi realizado um estudo prospectivo com 43 pacientes a serem submetidos à rinoplastia revisional e com seus respectivos cirurgiões, através da aplicação de questionário acerca de questões epidemiológicas e queixas estético-funcionais subjetivas dos pacientes e as respectivas deformidades funcionais observadas pelos cirurgiões. Após, esses dados foram correlacionados com a finalidade de observar a frequência de relatos concomitantes entre os médicos e pacientes. Resultados: A presença de ponta caída e giba óssea residual foram as principais queixas dos pacientes confirmadas pelos cirurgiões. Já a correlação entre sintomas subjetivos obstrutivos e a avaliação intranasal realizada pelos cirurgiões demonstrou estar presente em 87,5% dos casos. Dentre os pacientes com sintomas respiratórios, a principal deformidade encontrada foi o desvio septal residual em 56,25% dos casos. Conclusão: A ponta caída seguida de giba óssea residual foram as principais queixas relatadas pelos pacientes e confirmadas ao exame objetivo pelos médicos. A presença de 37,2% dos pacientes com queixas obstrutivas nasais demonstra que maior atenção deve ser dada a deformidades funcionais já durante o primeiro procedimento cirúrgico. As diferenças observadas entre as queixas dos pacientes e avaliações dos cirurgiões comprovam a necessidade da avaliação pormenorizada e esclarecimento ao paciente com relação as suas expectativas e reais possibilidades cirúrgicas.

Disease-specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction / Qualidade de vida específica da doença após septoplastia e fratura bilateral de concha inferior em pacientes com obstrução nasal

Abstract Introduction: Septal deviations might cause nasal obstruction and negative impact on the quality of life of individuals. The efficacy of septoplasty for treatment of septal deviation and the predictors of satisfactory surgical outcomes remain controversial. Technical variability, heterogeneity of research samples and absence of a solid tool for clinical evaluation are the main hindrances to the establishment of reliable statistical data regarding the procedure. Objective: To evaluate the clinical improvements in the disease-specific quality-of-life between patients submitted to septoplasty with bilateral outfracture of the inferior turbinate under sedation and local anesthesia in a tertiary hospital and to assess possible clinical-epidemiological variables associated with functional outcome. Methods: Fifty-two patients consecutively submitted to septoplasty with bilateral outfracture of the inferior turbinate for treatment of nasal obstruction filled in forms regarding clinical and epidemiological information during enrollment and had their symptom objectively quantified using the Nose Obstruction Symptom Evaluation (NOSE) scale preoperatively and one and three months after the procedure. Statistical analysis aimed to determine overall and stratified surgical outcomes and to investigate correlations between the clinical-epidemiological variables with the scores obtained. Results: Statistically significant improvement in the preoperative NOSE questionnaire compared to the scores obtained three months after surgery was demonstrated (p < 0.001, T-Wilcoxon), with strong correlation between the preoperative score and the postoperative improvement during this period (r = −0.614, p < 0.001, Spearman). After one month, patients reached in average 87.15% of the result obtained at the study termination. Smokers and patients with rhinitis and/or pulmonary comorbidity showed increased average preoperative NOSE scores, although without statistical significance (p > 0.05). Gender, age, history of rhinitis and presence of pulmonary comorbidity did not influence significantly surgical outcomes (p > 0.05). Smokers presented greater reduction in NOSE scores during the study (p = 0.043, U-Mann-Whitney). Conclusion: Septoplasty with bilateral outfracture of the inferior turbinate has proven to significantly improve disease-specific quality-of-life and this favorable outcome seems to occur precociously.

Resumo Introdução: Os desvios septais podem causar obstrução nasal e impacto negativo na qualidade de vida dos indivíduos. A eficácia da septoplastia para o tratamento do desvio septal e os preditores de resultados cirúrgicos satisfatórios continuam controversos. A variabilidade técnica, a heterogeneidade das amostras de estudo e a ausência de uma ferramenta sólida para avaliação clínica são os principais obstáculos ao estabelecimento de dados estatísticos confiáveis sobre o procedimento. Objetivo: Avaliar a melhora clínica na qualidade de vida específica da doença entre pacientes submetidos a septoplastia e fratura bilateral da concha inferior sob sedação e anestesia local em um hospital terciário e possíveis variáveis clínico-epidemiológicas associadas ao desfecho funcional. Método: Cinquenta e dois pacientes consecutivamente submetidos a septoplastia e fratura bilateral da concha inferior para o tratamento da obstrução nasal preencheram formulários com informações clínicas e epidemiológicas durante a inclusão no estudo e tiveram seus sintomas quantificados objetivamente utilizando a escala de Avaliação de Sintomas de Obstrução Nasal (Nose Obstruction Symptom Evaluation - NOSE) no pré-operatório e um e três meses após o procedimento. A análise estatística objetivou determinar resultados cirúrgicos globais e estratificados e investigar correlações entre as variáveis clínico-epidemiológicas e os escores obtidos. Resultados: Foi demonstrada uma melhora estatisticamente significativa nos escores obtidos no questionário NOSE três meses após a cirurgia (p < 0,001, T-Wilcoxon), quando comparado com os escores obtidos no pré-operatório, com uma forte correlação entre o escore pré-operatório e a melhora pós-operatória durante esse período (r = -0,614, p < 0,001, Spearman). Após um mês, os pacientes atingiram em média 87,15% do resultado obtido ao término do estudo. Fumantes e pacientes com rinite e/ou comorbidade pulmonar apresentaram valores médios pré-operatórios do escore NOSE aumentados, embora sem significância estatística (p > 0,05). Sexo, idade, história de rinite e presença de comorbidade pulmonar não influenciaram significativamente os resultados cirúrgicos (p > 0,05). Os fumantes apresentaram maior redução nos escores de NOSE (p = 0,043, U-Mann-Whitney). Conclusão: A septoplastia e a fratura bilateral da concha inferior demonstraram melhorar significativamente a qualidade de vida específica da doença e este resultado favorável parece ocorrer de forma precoce.

The Middle Turbinate Resection and Its Repercussion in Olfaction with the University of Pennsylvania Smell Identification Test (UPSIT)

Abstract Introduction Nasal obstruction is a common complaint, and, for some, the middle turbinate resection is still a controversial issue among the surgical options due to the possibility of deleterious effects on olfaction. The University of Pennsylvania smell identification test (UPSIT) is considered the gold standard of smell identification tests, but data about it is still incipient in Brazil. Objective To evaluate if the middle turbinectomy has any repercussion on the sense of olfaction by using the UPSIT as an assessment tool. Methods A prospective study performed between 2013 and 2015 with 27 patients who were treated with middle turbinectomy by the same surgeon and tested with the UPSIT pre- and post-surgery, with a minimum interval of 3 months. Results Twenty-five patients completed the study. The mean age was 27.9 years. There was no statistical correlation betweenmiddle turbinectomy and the UPSIT score, or between gender and the UPSIT score. Conclusion There was no clinical repercussion on olfaction from partial middle turbinectomy.

Long-Term Evaluation of Nasal Septoplasty Followed by Inferior Turbinate Cauterization for the Treatment of Nasal Obstruction Using Objective and Subjective Methods

Abstract Introduction Nasal septoplasty is considered the treatment of choice for nasal obstruction due to septal deviation. An ongoing discussion among rhinologists is whether it is reasonable to perform objective measurements of nasal patency pre or postoperatively routinely. Objective The primary aim of this study was to identify the short- and long-term functional benefits for patients undergoing septal surgery, as assessed by acoustic rhinometry (AR). The secondary goal was to evaluate the short- and long-term perception of symptom relief and disease-specific quality of life (QoL) outcomes on the part of the patients. Methods This was a prospective observational study in which AR was utilized for the assessment of nasal patency preoperatively and 1, 6 and 36months after septoplasty. Total 40 patients who underwent septoplasty filled out the Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire and the Glasgow Benefit Inventory (GBI) to assess their subjective improvement in nasal obstruction symptoms and the changes in their QoL. Results There were statistically significant improvements in nasal patency, mean postoperative NOSE and GBI scores postoperatively. However, there was no correlation between the mean NOSE and GBI scores and the AR measurements. Furthermore, the GBI scores tended to decrease as the postoperative period increased. Conclusion The present study confirms that septoplasty significantly increases nasal patency and causes a significant subjective improvement in nasal obstruction symptoms. The absence of a statistically significant correlation among the objective measurements, the symptom scores, and the patients' low GBI scores indicates that factors other than the anatomical findings may also contribute to the patients' perception of QoL.

Evaluation of pre- and post-pyriform plasty nasal airflow / Avaliação do fluxo aéreo nasal pré e pós-piriformeplastia

Abstract Introduction: Nasal obstruction is a frequent complaint in otorhinolaryngology outpatient clinics, and nasal valve incompetence is the cause in most cases. Scientific publications describing surgical techniques on the upper and lower lateral cartilages to improve the nasal valve are also quite frequent. Relatively few authors currently describe surgical procedures in the piriform aperture for nasal valve augmentation. We describe the surgical technique called pyriform plasty and evaluate its effectiveness subjectively through the NOSE questionnaire and objectively through the rhinomanometry evaluation. Objective: To compare pre- and post-pyriform plasty nasal airflow variations using rhinomanometry and the NOSE questionnaire. Methods: Eight patients submitted to pyriform surgery were studied. These patients were screened in the otorhinolaryngology outpatient clinic among those who complained of nasal obstruction, and who had a positive response to Cottle maneuver. They answered the NOSE questionnaire and were submitted to preoperative rhinomanometry. After 90 days, they were reassessed through the NOSE questionnaire and the postoperative rhinomanometry. The results of these two parameters were compared pre- and postoperatively. Results: Regarding the subjective measure, the NOSE questionnaire, seven patients reported improvement, of which two reported marked improvement, and one patient reported an unchanged obstructive condition. Regarding the rhinomanometry assessment, of 96 comparative measurements between the preoperative and postoperative periods, we obtained 68 measurements with an increase in nasal airflow in the postoperative period, 26 negative results, and two cases that remained unaltered between the preoperative and postoperative periods. Conclusion: When analyzing the results obtained in this study, we can conclude that the piriform plasty surgical procedure resulted in nasal airflow improvement in most of the obtained measurements.

Resumo Introdução: A obstrução nasal é queixa frequente nos ambulatórios de otorrinolaringologia, e a incompetência da válvula nasal é responsável em grande parte dos casos. São bastante frequente também as publicações de trabalhos científicos descrevendo técnicas cirúrgicas sobre as cartilagens laterais superiores e inferiores para melhorar a válvula nasal. Relativamente poucos autores descrevem atualmente procedimentos cirúrgicos na abertura piriforme para incremento da válvula nasal. Descrevemos a técnica cirúrgica chamada piriformeplastia e avaliamos a sua eficácia de forma subjetiva através do questionário NOSE e de forma objetiva através do exame rinomanometria. Objetivo: Comparar as variações do fluxo aéreo nasal pré e pós-piriformeplastia através da rinomanometria e do questionário NOSE. Método: Foram estudados 8 pacientes submetidos à piriformeplastia. Estes pacientes foram triados no ambulatório de otorrinolaringologia, pacientes estes que se queixavam de obstrução nasal, e que apresentavam resposta positiva a manobra de Cottle. Responderam ao questionário NOSE e foram submetidos a rinomanometria no pré-operatório. Após 90 dias foram reavaliados pelo questionário NOSE e pela rinomanometria pós-operatória. Os resultados desses dois parâmetros foram comparados pré e pós-operatoriamente. Resultados: Em relação a medida subjetiva, questionário NOSE, sete pacientes referiram melhora, sendo que dois deles referiram melhora acentuada, e um paciente referiu quadro obstrutivo inalterado. Em relação ao exame rinomanometria, de 96 medidas comparativas entre o pré e o pós-operatório, obtivemos 68 medidas com incremento ao fluxo aéreo nasal no pós-operatório, 26 resultados negativos, e dois casos inalterados entre pré e pós-operatório. Conclusão: O procedimento cirúrgico piriformeplastia conferiu melhoria do fluxo aéreo nasal na maioria das medidas obtidas.

Functional results in airflow improvement using a "flip-flap" alar technique: our experience / Resultados funcionais na melhora do fluxo de ar utilizando uma técnica alar em flip-flap: nossa experiência

Abstract Introduction Pinched nasal point can be arising as congenital malformation or as results of unsuccessfully surgery. The nasal valve alteration due to this problem is not only an esthetic problem but also a functional one because can modify the nasal airflow. Several surgical techniques were proposed in literature, we proposed our. Objective The purpose of the study is the evaluation of nose airway flow using our flip-flap technique for correction of pinched nasal tip. Methods This is a retrospective study conducted on twelve patients. Tip cartilages were remodeled by means of autologous alar cartilage grafting. The patients underwent a rhinomanometry pre and post-surgery to evaluate the results, and they performed a self-survey to evaluate their degree of satisfaction in term of airflow sensation improvement. Results Rhinomanometry showed improved nasal air flow (range from 25% to 75%) in all patients. No significant differences were showed between unilateral and bilateral alar malformation (p = 0.49). Patient's satisfaction reached the 87.5%. Conclusion Our analysis on the combined results (rhinomanometry and surveys) showed that this technique leads to improvement of nasal flow in patients affected by pinched nasal tip in all cases.

Resumo Introdução A ponta nasal comprimida pode surgir como malformação congênita ou como o desfecho de uma cirurgia malsucedida. A alteração da válvula nasal devido a esse problema não é apenas um problema estético, mas também funcional, porque pode modificar o fluxo aéreo nasal. Várias técnicas cirúrgicas têm sido propostas na literatura; aqui, propomos a nossa. Objetivo O objetivo do estudo é a avaliação do fluxo das vias aéreas nasais utilizando nossa técnica de flip-flap para correção da ponta nasal comprimida. Métodos Este é um estudo retrospectivo realizado em doze pacientes. As cartilagens da ponta nasal foram remodeladas através de enxerto de cartilagem alar autóloga. Os pacientes foram submetidos à rinomanometria pré e pós-cirúrgica para avaliar os resultados, e realizaram uma auto-avaliação para avaliar seu grau de satisfação em termos de melhora da sensação do fluxo aéreo. Resultados e conclusão Nossa análise dos resultados combinados (rinomanometria e autoavaliação) mostrou que essa técnica melhora o fluxo nasal em pacientes afetados por ponta nasal comprimida em todos os casos. A satisfação do paciente atingiu os 87,5%.

Válvula nasal en rinoplastía / Nasal valve in rhinoplasty

RESUMEN La obstrucción dependiente de la vía aérea nasal representa un gran impacto en la calidad de vida de los pacientes. Las causas de ésta son múltiples, donde aquellas de tipo estructural son las que requieren frecuentemente cirugía. La obstrucción nasal debido a la disfunción de la válvula nasal puede ser olvidada como única causa de una obstrucción nasal. La decisión sobre qué técnica quirúrgica utilizar para solucionar una insuficiencia valvular es compleja y muchas veces la bibliografía utiliza conceptos anatómicos muy variados que no ayudan a seleccionar una técnica en particular. Se realizó una revisión bibliográfica del tema destacando anatomía, diagnóstico y tratamiento; las técnicas quirúrgicas más frecuentemente utilizadas son descritas.

ABSTRACT Nasal airway obstruction represents a major impact on patients' quality of life. The causes are multiple, where those of a structural type, frequently require surgery. Nasal obstruction due to nasal valve dysfunction may be overlooked as a cause of nasal obstruction. The decision about which surgical technique to use in order to solve a valvular insufficiency is complex and often the literature uses diverse anatomical concepts that do not help to select a particular technique. A literature review of the subject was carried out, highlighting anatomy, diagnosis and treatment; The most frequently used surgical techniques are described.

Evaluation of aesthetic and functional outcomes in rhinoplasty surgery: a prospective study / Avaliação dos desfechos estéticos e funcionais em cirurgia de rinoplastia: um estudo prospectivo

Abstract Introduction: Evaluation of surgery outcome measured by patient satisfaction or quality of life is very important, especially in plastic surgery. There is increasing interest in self-reporting outcomes evaluation in plastic surgery. Objective: The aim of our study was to determine patient satisfaction in regard to nose appearance and function with the use of a validated questionnaire, before and after rhinoplasty surgery. Methods: A prospective study was realized at a tertiary centre. All rhinoplasty surgeries performed in adults between February 2013 and August 2014 were included. Many patients underwent additional nasal surgery such as septoplasty or turbinoplasty. The surgical procedures and patients' characteristics were also recorded. Results: Among 113 patients, 107 completed the questionnaires and the follow-up period. Analysis of pre-operative and post-operative Rhinoplasty Evaluation Outcome showed a significant improvement after 3 and 6 months in functional and aesthetic questions (p < 0.01). In the pre-operative, patients anxious and insecure had a worse score (p < 0.05). Difference in improvement of scores was not significant when groups were divided on basis of other nasal procedures, primary or revision surgery and open versus closed approach. Conclusion: We found that patients with lower literacy degree were more satisfied with the procedure. Rhinoplasty surgery significantly improved patient quality of life regarding nose function and appearance.

Resumo Introdução: A avaliação do desfecho de cirurgia medido pela satisfação ou qualidade de vida do paciente é muito importante, especialmente em cirurgia plástica. Existe um interesse crescente na autoavaliação de desfechos nesta especialidade cirúrgica. Objetivo: O objetivo deste estudo foi determinar a satisfação do paciente em relação à aparência e função do nariz com o uso de um questionário validado, antes e depois da cirurgia de rinoplastia. Método: Estudo prospectivo realizado em um centro terciário. Todas as cirurgias de rinoplastia feitas em adultos entre fevereiro de 2013 e agosto de 2014 foram incluídas. Muitos pacientes foram submetidos à cirurgia nasal adicional, como septoplastia ou turbinoplastia. Os procedimentos cirúrgicos e as características dos pacientes também foram registrados. Resultados: Entre 113 pacientes, 107 completaram os questionários e o período de acompanhamento. A análise da avaliação do desfecho de rinoplastia (ADR) no pré-operatório e pós-operatório mostrou uma melhoria significativa após 3 e 6 meses em questões funcionais e estéticas (p < 0,01). No pré-operatório, os pacientes ansiosos e inseguros apresentaram um escore pior (p < 0,05). A diferença na melhoria dos escores não foi significativa quando os grupos foram divididos com base em outros procedimentos nasais, cirurgia primária ou revisão e abordagem aberta versus fechada. Conclusão: Verificou-se que pacientes com menor grau de alfabetização estavam mais satisfeitos com o procedimento. A cirurgia de rinoplastia melhorou significativamente a qualidade de vida do paciente quanto à função e ao aspecto do nariz.