Can Oblique Sliced Method Avoid Warping?

Warping is the most important problem of costal cartilage grafts used in secondary rhinoplasties. The aim of this study is to show that costal cartilage grafts prepared with oblique sliced method (OSM), can solve the warping problem and provides successful results in both functional and aesthetic appearance. There are 42 patients who had previous nose surgery and dissatisfied with their facial appearance included in the study to perform secondary rhinoplasty with costal cartilage graft OSM technique. The outcomes of the operations were performed objectively using facial measurements and subjectively using rhinoplasty outcomes evaluation (ROE) scale, before and 12 months after the operation. The mean of total ROE score was 8.171 ±â€Š3.285 on the pre-operative period and it was increased to 19.11 ±â€Š3.652 where the P value was found to be <0.0001. And the post-operative 12th month period all values of nasal dorsal angulation was lower then 1° and the mean of angulation degrees was 0.224° with the minimum value 0.000° and maximum value 0.801°. The study revealed the outcome of rhinoplasty which done by OSM was statically significant both subjective patient's satisfaction and objective facial measurements. The authors suggest using of OSM in secondary rhinoplasties because the graft can be easily prepared with the desired thickness and carved into different shape without risk of warping.

Fascia lata: for the repairment of post-intubation tracheoesophageal fistula.

Tracheoesophageal fistulas are challenging formations for surgeons which can be treated with various surgical procedures. In an acquired tracheoesophageal fistula, fascia lata grafting can be accepted as a safe, easy accesible and a promising procedure, which can be one of the treatment options. We present a case of post-intubation tracheoesophageal fistula in which fascia lata was used as a reinforcement graft for the repairment in an adult patient.

Giant Epidermoid Cyst of the Maxillary Sinus: A Postoperative Complication?

Epidermoid cysts are benign lesions, which are usually detected on the floor of the mouth in the head and neck region. They can develop from abnormal epithelial components of an ectoderm tissue during the embryological life or alternatively they can arise from the implanted epithelium after trauma or surgery. The diagnosis of an epidermoid cyst in the maxillary sinus can be challenging and it could be easily mistaken for any benign or malign lesion of the nasal cavity and paranasal sinuses. In this case, we present a 44-year-old man with a giant epidermoid cyst in the right maxillary sinus with a previous history of paranasal sinus surgery. We present a very rare case of epidermoid cyst and also discuss the importance of radiological imaging modalities in differential diagnosis of a unilateral expansile mass in the maxillary sinus.

Nasal obstruction following septorhinoplasty: how well does acoustic rhinometry work?

Septorhinoplasty aims to improve not only the esthetic appearance but also breathing function of the nose. Although the esthetic improvement can be judged by the patient and the surgeon easily, evaluation of nasal breathing is more complicated. Besides the subjective symptom scores given by the patient, some objective methods have been developed. One of the most widely used of these objective methods is acoustic rhinometry, which gives valuable information about the cross-sectional areas and volumes of the nasal airway as a function of distance from the nostril. Since the introduction of acoustic rhinometry, many papers were reported regarding its efficiency with some conflicting conclusions. Septorhinoplasty has the potential to narrow the nasal airway, especially if it includes lateral osteotomies and hump reduction. We aimed to evaluate the role of rhinoplasty on nasal obstruction with the help of subjective symptom scores and acoustic rhinometry. The study consisted of 26 patients who underwent septorhinoplasty. Before and after surgery, the symptom scores and findings of acoustic rhinometry were collected both before and after decongestion of the nasal mucosa. Symptom scores decreased on both sides, which were statistically significant (p < 0.05), however, the changes in cross-sectional areas of the nasal airway were not statistically significant (p > 0.05). The correlation between the symptom scores and acoustic rhinometry findings was not significant for all levels. The effect of septorhinoplasty on nasal airway and some important maneuvers to protect against nasal obstruction are discussed.

Management of mild to moderate rhinophyma with a radiofrequency.

OBJECTIVE: Rhinophyma is characterized by an enlarged, bulbous, and red nose resulting from the enlargement of the sebaceous glands beneath the surface of the skin on the nose. Its etiology remains unclear. Treatment of the disease is controversial. In this study, we discussed the treatment of rhinophyma by radiofrequency in 5 patients. CLINICAL REPORT: We presented 5 patients with rhinophyma. The patients' median age was 57.4 years. A radiofrequency unit was used in cut/coagulate mode at 10 U. A 0.38-in loop electrode was placed ensuring symmetry until the nose's shape was re-created. All patients achieved a good cosmetic result, which was defined as a near-to-normal nasal contour without clinical scarring or minimal scarring. CONCLUSIONS: Rhinophyma is a disease that can badly deform the nose and can be treated by radiofrequency. We described radiofrequency treatment of large rhinophymas with good aesthetic outcomes.

Lateral osteotomies in rhinoplasty: a safer and less traumatic method.

BACKGROUND: Osteotomies are required to mobilize the bony pyramid for infracture, outfracture, or realignment. Using traditional techniques and instruments, mobilization of the bony pyramid often results in serious edema and ecchymosis. OBJECTIVE: The authors evaluate how the use of micro-osteotomes in lateral osteotomy influence postoperative healing. METHODS: A series of 36 rhinoplasties were evaluated to determine the postoperative effect on edema and ecchymosis of micro-osteotomes used in the lateral osteotomy. In the last stage of the operation, right lateral osteotomy was performed with a 2-mm, V-shaped osteotome and left lateral osteotomy with a 4-mm straight Cottle osteotome. Patients were assessed based on postoperative photos taken after 24 and 48 hours. RESULTS: There was a marked reduction in edema and ecchymosis in the micro-osteotome series compared with the series in which a 4-mm straight Cottle osteotome was used. CONCLUSIONS: 2-mm V-shaped osteotomes reduce postoperative edema and ecchymosis and can be maneuvered cephalically to the medial oblique osteotomy with the best cosmetic results.

[Hyperbaric oxygen treatment in sudden hearing loss after unsuccessful medical treatment]. / Medikal tedavinin basarisiz oldugu ani isitme kayipli olgularda hiperbarik oksijen tedavisi.

OBJECTIVES: We evaluated the efficacy of hyperbaric oxygen (HBO) treatment in patients with sudden hearing loss unresponsive to medical treatment. PATIENTS AND METHODS: Fifty-one patients (37 males, 14 females; mean age 37 years; range 9 to 63 years) with sudden hearing loss were treated with HBO following unsuccessful medical treatment. Time elapsed from the occurrence of sudden hearing loss ranged between 15 to 45 days. Treatment included two sessions daily for the first three days, followed by a single daily session, to make 20 sessions of 90 minutes. Treatment was discontinued because of early recovery in two patients. Audiometric examinations were made at the end of every five sessions. The patients were classified according to age, gender, and audiogram curves. RESULTS: The mean hearing thresholds were 75.3 dB and 65.6 dB before and after treatment, respectively. Recovery was rated as complete in two patients (3.9%), moderate in two patients (3.9%), mild in 19 patients (37.25%), and as no recovery in 28 patients (54.9%). No significant differences were found between the patient groups in terms of improvement and hearing gain (p>0.05). CONCLUSION: We propose that HBO be resorted to when other means of medical treatment prove unsuccessful in patients with sudden hearing loss.

Aneurysmal bone cyst of the sphenoid bone.

Aneurysmal bone cyst (ABC) is an uncommon benign lesion that rarely presents in the craniofacial region. Aneurysmal bone cysts represent nearly 1.4% of all bone tumors, and among those, only 3% are located in the cranium. In this study, we report on an ABC located in the sphenoid bone with superior nasal cavity and ethmoid extension. The presenting symptom of our patient was headache, followed by diplopia, loss of visual accuracy, and abduction restriction. We successfully resected the lesion by a combined subcranial-midfacial degloving approach without any complications or recurrence.

Multiple plaques on the face and neck of a middle-aged man. Diagnosis: secondary syphilis.

Syphilis is an unusual diagnosis in an ENT practice. We evaluated a 55-year-old man who had generalized plaques on his face, neck, and upper extremities. Analysis of skin biopsy and serology specimens revealed that the patient had secondary syphilis. He responded rapidly to treatment. The purpose of this article is to remind otolaryngologists of the signs and symptoms of syphilis so that it can be recognized and treated in a timely fashion.