The lateral wall of the inferior meatus as a new graft source for rhinoplasty: radiological study and surgical technique.

Generally, revision rhinoplasty cases require use of stiff grafts to restore the lost support. However, the majority of patients indicated for revision surgery presents with lack of bony cartilaginous framework of the septum, especially after previous septoplasty. Thus, surgeons compel to harvest costal cartilage. At the same time rib graft harvesting is associated with additional trauma and risk of serious complications. Being ENT surgeons, we often resect a part of the lateral wall of inferior nasal meatus during extended endoscopic approach to the maxillary sinus. We supposed, that this bone plate can be used as a donor site for rhinoplasty graft harvesting. The aim of our study was radiological assessment of feasibility and limits of using the inferior meatus lateral wall (IMW) as a donor site for rhinoplasty bone graft. A retrospective evaluation of 100 CT scans of sinuses was conducted. Further measurments of the inferior meatus lateral wall were performed: average length and width (28.06 ± 4.03 mm and 19.73 ± 3.08 mm, respectively,) thickness (0.62 ± 0.21 mm), and average deviation from the sagittal plane (17.7 ± 9.53 degree). According to obtained measurements, described donor site is appropriate to harvest nice straight bony fragment. The IMLW bone graft was used in 4 revision rhinoplasty cases. There were no postoperative complications. During the long-term follow-up, patients reported significant improvement in esthetics, function, and social aspects according to ROE. Thus, described technique is an easy and safe method for bone harvesting for revision rhinoplasty. Our first experience demonstrated convenience and stability of IMLW grafts for revision rhinoplasty during the follow-up period of up to 2 years.

Posterior Septal Artery Flap for Endoscopic Repair of Large Nasal Septal Perforation: How I Do It.

Endoscopic repair of large nasal septal perforation (SP) remains a rather challenging procedure. The presented modification of vascularized flap, which is supplied with branches of posterior septal artery, has proven to be convenient and effective in closure of SPs larger than 2 cm. Laryngoscope, 2024.

Unilateral Fixation of the Bony Pyramid in Deviated Nose Correction.

Deviated nose correction is one of the most challenging procedures in rhinoplasty. Recent studies proposed effectiveness of preservation techniques even for patients with crooked nose deformity, although the long-term results are still controversial. Obviously, only addressing the blocking points is not enough to achieve stable midline position in crooked nose. To ensure consistent long-term results, we proposed a unilateral suturing of the bony pyramid along with unilateral resection of the excessive bone along the lateral osteotomy line. The first results of described surgical technique have proven its simplicity, reliability, and high efficiency both in primary and in revision surgeries. 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 .

Modification of Push-Down Rhinoplasty with Maxilla-Pyramid Sutures.

A key point, that determines the late outcome of push-down procedures, is a stable fixation of the bony pyramid in its new position. Therefore, rhinoplasty surgeons are consistently trying to find the effective technique for fixation of the osseocartilaginous vault that has been investigated. Nonetheless, all described techniques are less or non-effective in cases when simultaneous septoplasty is required. Thus, we have found more relevant a lateral fixation of the bony pyramid. Using a needle piezotome, two holes above and below lateral osteotomy lines should be performed bilaterally. The downward inserted pyramid is fixed with maxilla-pyramid sutures through these holes.Level of Evidence IV 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 .

Repair of postoperative and recurrent nasal septal perforations using L-strut overlay flap.

BACKGROUND: Despite the many described techniques, surgical repair of iatrogenic nasal septal perforations is still challenging. The authors present a novel technique for endoscopic closure of postoperative and recurrent nasal septal perforations. METHOD: The technique is based on the elevation of a vascularized flap from the L-strut area and the creation of the bed site without dissection of the surrounding septum. Seven patients were operated using "L-strut overlay" flap from June 2018 to October 2020. All patients had their perforations closed 12 months after surgery. CONCLUSION: Early results of our surgical technique have proven its simplicity and high effectiveness.

Chronic tympanic membrane perforation: Histopathological evidence of the experimental model.

OBJECTIVES: This study aims to compare the effectiveness of three different models of chronic tympanic membrane perforations. MATERIALS: The experimental study included 18 male chinchillas, divided into 3 equal groups. Group 1 perforations were performed with infolding technique myringotomy. Laser myringotomy was performed for perforation creation in Group 2. Group 3 perforations were performed with infolding myringotomy combined with ventilation tube insertion. At the end of the follow-up period, which lasts 8 weeks, all tympanic membranes with patent perforations were examined histologically. RESULTS: Although, the mean perforation patency in Group 2 was significantly higher than in Group 1 (5 vs. 2.4 weeks, p < 0.01), both of them failed in creation of chronic perforation according to time parameters. Group 3 demonstrated the longest mean perforation patency among investigated models (8 weeks). In Group 3, histological examination of perforations, which were considered to be chronic, revealed, that stratified squamous epithelium continued from the lateral surface around the perforation edge to join with the medial mucosal layer of TM. CONCLUSION: Our findings demonstrated that the combination of infolding technique and ventilation tube insertion seems to be a potential candidate for an effective animal model of tympanic membrane perforation. Further large-scale studies are required to verify our promising results.

Smell Status in Children Infected with SARS-CoV-2.

OBJECTIVES/HYPOTHESIS: This study aimed to evaluate the olfactory status in children with laboratory confirmed SARS-CoV-2 using subjective and psychophysical methods. STUDY DESIGN: Prospective clinical cross-sectional study. METHODS: This is a prospective clinical cross-sectional study of 79 children with COVID-19. The 21st item of SNOT-22 questionnaire and odor identification test were used for smell assessment. Children were examined twice during the hospitalization, and a telephone survey was conducted 60 days after hospital discharge. RESULTS: Immediately after confirmation of COVID-19, smell impairment was detected in 86.1% of children by means of the Identification test and in 68.4% of children by means of the survey (P = .010). After 5 days survey revealed a statistically significant decrease in the number of patients with hyposmia (41 out of 79, 51.9%). On the first visit, the mean Identification test score corresponded to "hyposmia" (9.5 ± 2.7), while on the second visit, the average value was 13.1 ± 1.9, which corresponded to "normosmia." According to the telephone survey, recovery of the olfactory function occurred within 10 days in 37 of 52 patients (71.2%), 11 to 29 days - in 12 children (23.1%), and later than 30 days - in three cases (5.7%). CONCLUSIONS: In the pediatric population, olfactory dysfunction is an early and common symptom of COVID-19. There is a trend to quick recovery of olfactory function in children with COVID-19. The overwhelming majority of patients (94.3%) had no subjective olfactory complaints by the end of the first month. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2475-E2480, 2021.

Endoscopic repair of septal perforation in children.

OBJECTIVE: Being increasingly faced with the problem of pediatric nasal septal perforations, we have found that the surgical management of nasal septal perforations in children is not widely described in the litrature. The objective of our study was to demonstrate the results of different surgical techniques, including two original endoscopic techniques, in the septal perforation repair in children. METHODS: 24 children, ranging between 6 and 17 years of age, with nasal septal perforations were operated using different endoscopic techniques from February 2015 to May 2019 at the special tertiary referral clinic. Apart from well-known techniques, such as anterior ethmoidal artery flap, intranasal bipedicled advancement flap, sublabial flap, free temporal fascia graft, we used two original techniques - inverted edges technique and cross-septal returned flap. RESULTS: The total rate of complete perforation closure was 79% (19 of 24 patients). Regarding the reduction of symptoms, the efficacy of surgery was approaching 100%. The combination of inverted edges technique and anterior ethmoidal artery septal flap demonstrated the best results with no reperforations in all 10 cases. Using cross-septal returned flap, we achieved complete closure of perforation in 5 (83%) of 6 patients. The remaining techniques were performed rare and showed relatively low rates of success. There were 2 cases of complications (oronasal fistula), both developed in patients with sublabial mucosal flap. CONCLUSION: Use of endoscopic assistance, vascularized mucoperichondrial flaps and bilateral closure demonstrates high effectiveness in septal perforation surgical repair in children. LEVEL OF EVIDENCE: 4.