The Use of a Unilateral Curved Spreader Graft in the Management of Crooked Nose Deformity.

AIM OF WORK: The aim of this study is to present a new technique of using spreader grafts in the correction of crooked nose deformity with C-shaped deviation of the middle third of the nose. PATIENTS AND METHODS: This is a prospective case series study conducted on 18 patients with crooked nose deformity with C-shaped deviation of the middle third of the nose. All of the patients were managed by open septorhinoplasty. During surgery, a curved spreader graft was harvested from the nasal septum and placed on the convex side of the C-shaped deviation of the dorsal part of the nasal septum. Objective measurements of the angles of external nasal deviation (END) and the internal nasal valve (INV) angles were performed before and 6 months after the surgery. Subjective assessment of aesthetic satisfaction by the visual analog scale and nasal function by the nasal obstruction symptom evaluation scale was also performed before and 6 months after surgery. RESULTS: Eighteen patients were enrolled in the study and completed the minimum follow-up period of 6 months. The mean follow-up period was 17.3 months. Objectively, there was highly significant ( P < 0.00001) improvement of the END angle and INV angle. Subjectively, there was also highly significant ( P < 0.00001) improvement of both the nasal obstruction symptom evaluation score and the visual analog scale score for aesthetic satisfaction. CONCLUSIONS: The insertion of a curved unilateral spreader graft over the convexity of the deviated nasal dorsum can correct the END, improve the collapsed INV on both sides, and consequently achieve satisfactory aesthetic and functional outcomes.

Post COVID-19 Head and Neck Mucormycosis: MR Imaging Spectrum and Staging.

OBJECTIVE: To develop a systematic approach for magnetic resonance imaging (MRI) analysis, imaging spectrum, and classification system for the staging of post-COVID-19 head and neck mucormycosis. METHOD: The study included 63 post-COVID-19 patients with pathologically proven mucormycosis who underwent head and neck MR imaging. Three independent radiologists assessed the imaging spectrum of mucormycosis, MRI characteristics of sino-nasal mucormycosis, and extra-sinus extension, and submitted a final staging using a systematic approach and a proposed categorization system. A consensus reading was considered the reference imaging standard. The kappa statistics were used to assess the categorization system's diagnostic reliability. RESULTS: The overall interreader agreement of the MR staging system was very good (k-score = 0.817). MR imaging spectrum involved localized sino-nasal mucormycosis (n = 7 patients, 11.1%), sino-nasal mucormycosis with maxillo-facial soft tissue extension (n = 28 patients, 44.5 %), sino-nasal mucormycosis with maxillo-facial bony extension (n = 7 patients, 11.1%), sino-naso-orbital mucormycosis (n = 13 patients, 20.6%), and sino-nasal mucormycosis with cranium or intracranial extension (n = 8 patients, 12.7%). Extra-sinus extension to the orbit and brain did not have significant association with involvement of the posterior ethmoid/sphenoid sinuses and maxillo-facial regions (p > 0.05). MRI-based staging involved four stages: stage 1 (n = 7, 11.1%); stage 2 (n = 35, 55.6%), and stage 3 (n = 13, 20.6%), and stage 4 (n = 8, 12.7%). Involvement of the bone and MR-based staging were significant predictors of patients' mortality p = 0.012 and 0.033, respectively. CONCLUSION: This study used a diagnostic-reliable staging method to define the imaging spectrum of post-COVID-19 head and neck mucormycosis and identify risk variables for extra-sinus extension.

Simple Endoscopic Application of Laryngeal Keel Stent.

This study describes a simple extraendolaryngeal technique to apply laryngeal keel in dealing with anterior commissure web/fibrosis. Standard extraendolaryngeal punctures were applied via 20-gauge needles, 30° from the skin surface, in midline through the cricothyroid and thyrohyoid membranes. These needles were used as a conduit for the passage of 2/0 Prolene threads, which were retrieved through the laryngoscope by crocodile forceps. Both laryngoscopic ends of the Prolene threads were passed through a fabricated silastic sheet (keel stent) via a 22-gauge free needle, and these ends were tied to have a secure internal knot. Steady traction was applied on the other 2 external threads until there was appropriate application of this keel stent within the vicinity of anterior commissure. Finally, these external ends were tied to have a secure external knot. A keel stent could be applied without the need for special instrumentation and with reasonable outcomes (proper healing of anterior commissure, satisfied voice outcome, and patent airway).

External Nasal Valve Repair in Children: Alar Batten Graft Reinforced by External Temporary Suspensory Suture.

BACKGROUND: The nasal valve area is the narrowest point in the nasal airway. External nasal valve (ENV) collapse during inspiration occurs if external valve area is too narrow or its lateral component is too floppy. PATIENTS AND METHOD: Twelve patients (7 males, 5 females) aged 8 to 12 years complaining of nasal obstruction due to ENV dysfunction underwent surgical intervention using alar batten graft assisted by temporary external suspensory suture. RESULTS: All patients showed subjective and objective improvement of the nasal airway. The mean Nasal Obstructive Symptom Evaluation (NOSE) was 14 ± 1.71 before surgery and 7.83 ± 1.47 1 year after surgery (significant improvement, p ≤ .0001). The mean Peak Inspiratory Flow Rate was 29.92 ± 4.46 before surgery and 42.58 ± 4.93 1 year after surgery (significant improvement, P ≤ .0001). CONCLUSION: External nasal valve collapse in children can be managed surgically by using alar batten graft. Temporary suspension suture can be helpful for supporting of the graft until complete healing occurs.