Assessment of Functional Outcomes of an Autospreader Flap and Spreader Graft in Rhinoplasty.

OBJECTIVE: Nasal obstruction after rhinoplasty occurs due to narrowing of the internal nasal valve. Narrowing is due to osteotomy performed to close the open roof of nose after dorsum hump resection. Spreader grafts and autospreader flaps are used to prevent such narrowing. in this study, we aimed to compare the effects of these 2 rhinoplasty techniques on olfactory function, nasal air passage opening, quality of life, and patient satisfaction. METHODS: In this prospective study, 48 rhinoplasty patients were randomly divided into 2 groups according to graft technique used, either spreader graft or autospreader flap. These 2 groups were compared for patient satisfaction. The sinonasal outcome test-22, peak nasal flowmetry, and Connecticut Chemosensory Clinical Research Center test were applied to all patients before and 8 weeks after surgery. RESULTS: The study enrolled 48 patients. Nasal airflow increased in both groups postoperatively. in the preoperative and postoperative comparison of odor functions, postoperative odor functions were similar in both groups. In the autospreader flap group, the preoperative rhinoplasty outcome evaluation questionnaire score was 4.1 ±â€Š2.2 versus 21.3 ±â€Š2.6 in the third postoperative month. The preoperative rhinoplasty outcome evaluation score was 3.9 ±â€Š2.1 in the spreader graft group and 19.7 ±â€Š1.9 in the third postoperative month. CONCLUSIONS: In the present study, postoperative nasal airflow improved in the patients in both the spreader graft and autospreader flap groups. in the patient satisfaction surveys after rhinoplasty, the satisfaction of the patients in the autospreader flap group was higher than that of the patients in the spreader graft group.

Comparison of Early and Long-Term Effects of Piezosurgery With Conventional Techniques for Osteotomies in Rhinoplasty.

OBJECTIVE: Osteotomy is a critical step of rhinoplasty. Various osteotomy techniques have been developed to reduce postoperative edema and ecchymosis and achieve optimal aesthetic results. In this study, we aimed to compare the early and long-term effects of piezoelectric surgery with conventional osteotomy. METHODS: In this prospective study, 72 rhinoplasty patients were randomly divided into 2 groups according to osteotomy technique used, either conventional osteotomy or piezosurgery. These 2 groups were compared for postoperative edema, ecchymosis, and pain on the first and seventh postoperative days. The sinonasal outcome test-22 (SNOT-22), peak nasal flowmetry, and Connecticut Chemosensory Clinical Research Center test were applied to all patients before and 8 weeks after surgery. RESULTS: The study consisted of 72 patients, 42 of whom were female and 30 were male. The mean age was 28.1 ±â€Š6.5 (range 18-49 years). On the first postoperative day, edema and ecchymosis were significantly less in the piezosurgery group (P < 0.001). VAS results showed that only the piezosurgery group experienced less pain on the first postoperative day (P < 0.001). Nasal airflow of the patients was evaluated preoperatively and postoperatively, nasal airflow decreased postoperatively in both groups, but this decrease was not statistically significant, and no significant difference was found between the groups. The preoperative and postoperative comparison of odor functions was similar in both groups after the operation, and there was no significant difference between the groups. CONCLUSION: Piezosurgery in the early period after rhinoplasty has been shown to decrease eyelid edema, periorbital ecchymosis, and pain compared to conventional osteotomy techniques. However, the superiority of piezosurgery in terms of nasal airflow, olfactory functions and quality of life were not found in the long term.

Puzzle-Formed Modified Turkish Delight for Nasal Dorsum Augmentation.

Structural deficiencies of the nasal dorsum are most commonly of congenital, traumatic, or iatrogenic etiology. Various grafts, including autografts, homografts, and synthetic materials, have been used to this end and are described in the literature.Autologous septal cartilage is the most commonly used graft material when limited augmentation rhinoplasty is planned. However, it is difficult to retain sufficient cartilage to allow of such augmentation in instances where most of the septal cartilage has been used. The authors place moderately crushed cartilage beneath a monolayer of surgicel when performing limited nasal dorsum augmentation. The aim of the present study is to describe authors' approach and its utility by reviewing other methods reported in the literature.

The Importance of Soft Triangle in Rhinoplasty.

The soft triangle is a basic, yet delicate and vulnerable, subunit of the nose that is under-rated both academically and surgically. The soft triangle is located at the apex of the nostril, at the point where the dermis is in direct contact with dermis that contains no intervening subcutaneous tissue and it may be unintentionally harmed during rhinoplasty.The authors suggest using a modified incision and closure and filling with significantly or severely crushed cartilage to prevent notching and to provide support for the soft triangle. The more the authors understand the nature of the soft triangle, the more they will be able to obtain superior surgical results in the nasal tip area.

The Benefit of a Complete Cephalic Trim and the Importance of the Scroll Area.

Cephalic trimming of the lower lateral cartilage (LLC) of the nose is often performed to refine a broad nasal tip in the horizontal dimension. The focus of cephalic trimming remains the preservation of the width of the lateral crura and the cartilage remnant at the cephalic end of the LLC is usually left intact, which leads to inadequate cephalic trimming.The authors suggest that cephalic trimming should continue all the way to the cephalic end of the LLC and no remnant cartilage should be left in the scroll area. This would make it possible to reduce the bulk of the nasal tip in an acceptable manner. Trimming of the whole cephalic side of the LLC would disrupt the scroll area, allowing authors to assess rhinoplasty as a 2-stage surgical procedure: that is, nasal tip and middle vault.In conclusion, complete cephalic trimming without leaving any remnant cartilage in the scroll area is necessary for adequate nasal tip refinement, and disruption of the scroll area allows the rhinoplasty to be compartmentalized to achieve more desirable results in the middle vault and the nasal tip.

[Subcutaneous emphysema after septoplasty: a case report]. / Septoplasti sonrasi subkutan amfizem: Olgu sunumu.

Subcutaneous emphysema is characterized by the presence of air in the connective tissue within the fascial planes. The etiology of subcutaneous emphysema includes trauma, iatrogenic causes, or spontaneous development. Head and neck subcutaneous emphysema is a well-defined and life-threatening condition. In case of a large amount of air leaks into the fascial planes, the air can also extend into the retropharyngeal, mediastinal, pleural, and retroperitoneal spaces beyond the subcutaneous layers. Although numerous maxillofacial surgical procedures can cause subcutaneous emphysema, septoplasty has not been reported previously. In this unique case, subcutaneous emphysema developed after elective septoplasty and involved the maxillofacial, retropharyngeal, deep cervical, and orbital regions. The patient was treated conservatively with antibiotic prophylaxis and the condition completely resolved by day 10 spontaneously. Herein, we discuss the available literature data and optimal management strategies for unusual cases of head and neck subcutaneous emphysema.

Prognostic factors in type I tympanoplasty.

OBJECTIVE: To identify the preoperative factors that influence the success rate of type I tympanoplasty. METHODS: A total of 247 type I tympanoplasty procedures were included in the present study. We determined the effects of the following preoperative variables on the anatomical and functional outcomes of type I tympanoplasty in order to identify prognostic preoperative factors: age (<16 years vs. >16 years), history of ear surgery, state of the contralateral ear (healthy vs. diseased), size of perforation, presence of septal pathology, presence of adenoid disease and history of smoking. Additionally, we stratified the surgical procedures according to the type of graft materials used and analyzed the effects of the above preoperative variables on the success rates of each type of procedure separately in order to eliminate the confounding effect of surgical technique. RESULTS: The study was conducted on 217 subjects (130 females, 87 males) who underwent a total of 247 surgical procedures. The graft take rate was significantly higher after tympanoplasty with perichondrium-cartilage island flap (PCIF) grafts than after tympanoplasty with temporalis fascia (TF) grafts (87.8% vs. 72.3%, p=0.008). Young age (p=0.013), presence of adenoid hypertrophy (p=0.001) and abnormality of the contralateral ear (p=0.027) were associated with lower success rates after tympanoplasty with TF grafts. The success rate of tympanoplasty with PCIF grafts was not affected by any of the preoperative variables we tested. Postoperative audiometry showed that the improvement in hearing ability did not differ between patients who received TF grafts and those who received PCIF grafts (p=0.325). CONCLUSION: Tympanoplasty with cartilage grafts was associated with better graft takes and comparable hearing outcomes than those associated with tympanoplasty with TF grafts. In patients with risk factors such as contralateral ear disease, a young age or adenoid disease, cartilage-perichondrium grafts are preferable to TF grafts.

Advanced oxidation protein product level in children with chronic otitis media with effusion.

OBJECTIVE: To determine the level of advanced oxidation protein products (AOPPs) in children with chronic otitis media with effusion (COME), in an effort to elucidate the multifactorial etiology of this disease. METHODS: This study involved 25 COME patients and 30 healthy children (control group) recruited from the Ear, Nose and Throat (ENT) and Pediatric Departments, respectively, of the Haseki Research and Training Hospital. In the COME group, blood samples were collected before a middle ear operation, and middle ear fluid was sampled during the operation. Blood samples were also obtained from the control subjects. AOPP levels in the plasma and effusion fluid were measured by the spectrophotometric method. RESULTS: In the COME group, the mean AOPP levels in plasma and effusion fluid were 168.08 µmol/l and 412.75 µmol/l, respectively. In the control group, the mean plasma AOPP level was 141.54 µmol/l. The plasma AOPP levels did not significantly differ between the COME and control groups (p>0.05). In the COME group, however, the effusion fluid AOPP level (412.75 ± 204.54 µmol/l) was significantly higher than the plasma AOPP level (168.08 ± 68.45 µmol/l; p<0.01). CONCLUSION: We found that AOPP levels were elevated in the effusion fluid, but not in the plasma, of COME patients. Thus, COME was associated with protein oxidation abnormalities. Oxidative stress may play a role in the etiopathogenesis of COME, and AOPPs may be used as markers of oxidative stress; however, further studies are required to confirm these findings.

Repair of symptomatic nasoseptal perforations using mucosal regeneration technique with interpositional grafts.

Over the past 60 years, many surgical techniques have been developed for the repair of nasoseptal perforations. This study describes a safe and practical technique involving the 5-layer repair of symptomatic nasoseptal perforations without mucosal flaps. The present study involved 23 patients (17 men and 6 women) who had symptomatic nasoseptal perforations in the Otorhinolaryngology and Head Neck Surgery Department of Haseki Research and Training Hospital. Patients were treated using the mucosal regeneration technique. Follow-up examinations were performed at 3 and 6 months postoperatively. The surgery was considered successful if total closure was achieved. Nasal mucosal physiology was also assessed preoperatively and at 3 and 6 months postoperatively by measuring the nasal mucociliary clearance time by means of the saccharin test. The most common etiological factor was former nasal surgery (56.5%), followed by nasal trauma (26%). In 4 patients (17.5%), the perforations were idiopathic. The average preoperative perforation size was 1.74 ± 0.87 cm. Total closure of the perforation was achieved in 21 patients (91.3%), and only 2 patients had subtotal healing. The mean preoperative mucociliary clearance time was 19.3 ± 4.15 minutes, which significantly improved to 12.4 ± 3.53 minutes and 10.1 ± 3.21 minutes at 3 and 6 postoperative months, respectively. Mucosal regeneration technique with interpositional grafts can be used to safely and reliably repair medium-to-large nasoseptal perforations.