ABSTRACT
Open and closed rhinoplasty are two main approaches to perform nasal modifications. According to current literature, there is no current consensus among plastic surgeons and otolaryngologists on which technique is preferred in terms of aesthetic result, complications, and patient satisfaction. This study uses published research to determine whether open or closed rhinoplasty leads to superior patient outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed and a literature search was conducted in four databases based on our search strategy. Articles were then imported into COVIDENCE where they underwent primary screening and full-text review. Twenty articles were selected in this study after 243 articles were screened. There were 4 case series, 12 retrospective cohort studies, 1 prospective cohort study, 1 case-control, and 2 outcomes research. There were three cosmetic studies, eight functional studies, and nine studies that included both cosmetic and functional components. Sixteen studies utilized both open and closed rhinoplasty and four utilized open rhinoplasty. Both techniques demonstrated high patient and provider satisfaction and no advantage was found between techniques. Based on available studies, we cannot conclude if there is a preference between open or closed rhinoplasty in terms of which technique leads to better patient outcomes. Several studies determined that open rhinoplasty and closed rhinoplasty leads to comparative patient satisfaction. To make outcome reporting more reliable and uniform among studies, authors should look to utilize the Nasal Obstruction and Septoplasty Effectiveness scale and the Rhinoplasty Outcome Evaluation.
ABSTRACT
BACKGROUND: Delayed inflammatory reactions (DIRs) in alloplast rhinoplasty are a rare complication that may occur several months to years after surgery. The exact causes and mechanisms are unclear, but several triggering factors, including infections, trauma, dental procedures, and vaccination, have been reported. CASE SUMMARY: A 39-year-old male patient who had undergone augmentation rhinoplasty 8 years ago had DIRs after the administration of the first dose of the mRNA Pfizer coronavirus disease 2019 (COVID-19) vaccine. He suddenly had tender, erythematous swelling on his face 6 d after vaccination. As there was no improvement in the patient's condition after the conservative treatment, surgical removal of an alloplastic nasal implant was performed. Immediately after the surgery, the DIRs and accompanying symptoms ameliorated rapidly. A histological study conducted during surgery was fibrosis and small fragments of the hyaline cartilage. CONCLUSION: The correlation between DIRs and COVID-19 vaccination has not been reported yet and the exact mechanism is unclear. Because the uncontrolled inflammatory reactions on the nose leave serious sequelae, surgeons should be conscious of the correlation between COVID-19 vaccines and DIRs associated with nasal alloplastic implants. And further histological or microbiological studies should be performed to determine the cause of DIRs.
ABSTRACT
Introduction: In our service experience, we found we had a high proportion of male patients undergoing septorhinoplasty. This encouraged us to research gender specific differences in anatomy, surgical techniques, expectations and outcomes. Methods: We performed a retrospective chart review of patients who have had rhinoplasty surgery under a single otolaryngology consultant with a special interest in rhinoplasty. Patient information and results of the 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey for Functional and Cosmetic Rhinoplasty pre and post-surgery were collected. Results: There was no statistically significant difference in the mean pre-operative symptom (29.31 vs 32.29 p = 0.559), change in symptom (23.25 vs 24.14 p = 0.827) or satisfaction scores (8.69 vs 7.29 p = 0.089) between male and female patients. A discussion on gender specific anatomical features and deformities is presented. Conclusion: All patients reported improved symptoms and high levels of satisfaction. Careful patient counselling and patient-specific surgical planning help to achieve optimal outcomes.
ABSTRACT
Background/Purpose: COVID-19 fundamentally changed cleft teams' ability to care for their patients. This study aims to study;1) the effect of COVID-19 on elective surgery timings and outcomes;2) preoperative screening and isolation protocols;3) the impact of operating with personal protective equipment (PPE). Methods/Description: Between the start of the first UK lockdown in March 2020 and April 2021 operative details from 651 cleft procedures performed in eight UK centres were entered into a secure REDCap database. Results: 651 records were entered (59% male, 41% female). 9% patients had a known syndrome. Operations were as follows: cleft palate repair (40%), unilateral cleft lip repair +/- vomer flap (23%), alveolar bone grafting (16%), secondary speech surgery (10%), fistula repair (3.7%), lip revision (1%) and rhinoplasty (1%). 39% of surgical cases were deemed delayed compared to normal protocol timings, with 80% of the delays attributable to COVID. Mean age at initial cleft lip repair was 230 days exceeding a previous representative mean of 137 days as well as breaching the UK national standards for upper age limit of 183 days. Mean age at cleft palate repair was 387 days compared to the UK national standard for upper age limit of 396 days, and previous representative mean of 320 days. 81% of patients undertook some form of pre-operative isolation;47% isolated for two weeks. COVID screening was performed in the 72 hrs prior to surgery in 89% of patients and 13% of parents/carers. Only one patient had a positive test. 69% surgeons wore an FFP3 (N99) mask to operate, and 64% of cases involved difficulty during the operation as a result of the PPE;most commonly communication difficulties (45%). No patients developed COVID in the early post-operative period. Conclusions: This data demonstrates that initial cleft lip and palate repair in the UK has been delayed as a direct result of the COVID-19 pandemic. Secondary surgery has been significantly affected and efforts will need to be made at national level to provide capacity to catch up. Isolation and testing protocols for COVID-19 vary from unit to unit, but appear safe. Routine cleft surgery can safely continuing through the pandemic, as long as appropriate infection control measures are followed and resources allow.
ABSTRACT
BACKGROUND: There are increasing reports of the effects of SARS-CoV-2 on olfactory function, with a significant number of patients reporting anosmia as a symptom. However, our knowledge and understanding of the virus's complete impact on the nose remains poor. This report describes a unique patient case to demonstrate how COVID-19 may be associated with rhinoplasty complications such as septal perforation. CASE REPORT: This is a case report of a previously healthy patient who underwent septorhinoplasty in 2018. She had frequent follow-up including intranasal examinations without evidence of the septal perforation for the 2 years following her operation. In March 2020, the patient was noted to have symptoms suggestive of COVID-19, but testing was not recommended by the pediatrician. Soon after her symptoms resolved, she experienced a sudden onset of whistling and physical examination revealed a perforation in the septum which rapidly enlarged over the ensuing weeks. She tested positive for the COVID-19 antibody. After confirming that she no longer had an active infection via antigen testing, she underwent repair of her septal perforation without complications. CONCLUSION: This case report illustrates a septorhinoplasty complication that may be associated with COVID-19. Further study into this virus's impact on vascularity and wound healing, specifically in the nose, is recommended. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.