Spreader Graft for Severe Deviation of Nasal Septum with Obstruction of the Internal Nasal Valve: Clinical and Functional Results.

Difficulty in nasal ventilation is one of the most frequently occurring problems in otorhinolaryngology and its correct diagnosis is the key step to solve it. The dysfunctions in the valve area are a frequent cause of chronic nasal obstruction, though commonly ignored. The objective of the study is to analyze the clinical and functional outcomes in a group of patients with septal deviations and valve compromise treated with spreader graft with endonasal approach. Thirty-five patients with septal deviation with compromise of the internal nasal valve (INV; area II of Cottle), treated with spreader graft and a minimum follow-up of 12 months, were included for analysis. Patients were evaluated with video nasosinusal endoscopy, photography, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and rhinomanometry (RM). Postoperative complications were recorded. The results obtained in the pre- and postoperative NOSE scores showed significant differences (p = 0.001), as also in pre- and postoperative RM tests (p < 0.001). Two complications were reported in the 35 patients; thus the complication rate in our sample was 6%. The use of spreader grafts, with endonasal approach, as nasal septum's tutors improved perpendicular septal deviations with compromise of the INV (area II), reaching an effective functional improvement in the nasal airway, with low rate of complications.

Cervicofacial rhytidectomy without notorious scars: experience of 29 years.

OBJECTIVES: Presentation and evaluation of results of the surgical technique of cervicofacial rhytidectomy used by the senior author (F.P.), using the classification of facial aging to determine the stage of pre- and postsurgical age. METHODS: The surgical technique was used in 1,181 patients operated on in the past 29 years, starting in 1983. We analyzed retrospectively 318 patients operated on between the years 2001 and 2008, of whom 71 patients met the selection criteria. Postoperative follow-up period was from 6 months to 5 years. RESULTS: All patients in stage I showed clinically visible rejuvenation postoperatively. Significant improvement in facial rejuvenation in stages II and III of aging was shown, with a postoperative change of stage. CONCLUSION: The technique of cervicofacial rhytidectomy with short flap, facial superficial musculoaponeurotic system (SMAS) imbrication, cervical SMAS plication, inconspicuous incisions, and postauricular z-plasty allows for successful and sustainable results over time, with short recovery time and minimal complications. The classification of facial aging pre- and postsurgery has been useful for the assessment of surgical results.

Actividad terapéutica de la asociación amoxicilina-sulbactam administrada cada 12 horas en niños con otitis media aguda: estudio multicéntrico / Therapeutic activity of the amoxicillin-sulbactam association adminstered every 12 hours in children with acute inflamation of the middle ear: multicentric study

La otitis media aguda (OMA) es motivo de consulta frecuente en la práctica pediátrica y otorrinolaringológica. Los antibióticos betalactámicos son agentes de elección para el tratamiento de la OMA de etiología bacteriana, pero la creciente aparición de cepas productoras de betalactamasas obliga a asociarlos con un inhibidor de las mismas. Objetivos: evaluar efectividad y tolerabilidad de amoxicilina + sulbactam, administrada cada 12 horas en lactantes y niños portadores de OMA de etiología presumiblemente bacteriana. Material y métodos: estudio abierto, multicéntrico. Los pacientes recibieron amoxicilina + sulbactam (50/50 mg/kg/d) en dosis repartida en dos tomas diarias durante 10 días. Se evaluó (días 1, 4, 10 y 40): otalgia, hipertermia, irritabilidad y otorrea. Se efectuó otomicroscopía; en casos necesarios miringotomía terapéutica y para rescate de gérmenes, y se controló la aparición de eventos adversos. Se determinó efectividad clínica y tolerabilidad. Resultados: siete centros incorporaron a 222 pacientes evaluables. En 41 se efectuó miringotomía, aislándose con mayor frecuencia S. pneumoniae, H. influenzae, y M. catarrhalis. Se produjo una reducción de la otalgia entre el día 0 y el 10, de 6.8 ñ 0.11 a 2.3 ñ 0.09 (p< 0.001), así como también una mejoría significativa de la curva térmica. Se presentaron eventos adversos en 76 pacientes, la mayoría vinculados al aparato digestivo, en todos los casos de intensidad leve a moderada. Al finalizar el periodo de tratamiento todos los pacientes se habían curado o mejorado clínicamente. Conclusiones: Amoxicilina/sulbactam en dosis fraccionada cada 12 horas fue eficaz y segura para el tratamiento de la OMA en niños.