Effect of Functional Septorhinoplasty with Concha Bullosa Resection on Sinonasal Symptoms.

OBJECTIVE: To evaluate the impact of functional septorhinoplasty (SRP) with and without concha bullosa resection (CBR) on sinonasal symptoms and nasal obstruction severity using the Nasal Obstruction Symptom Evaluation (NOSE) and Sino-Nasal Outcome Test-22 (SNOT-22) scale. METHODS: Consecutive adult participants who underwent SRP were retrospectively analyzed. Patients were divided into two groups: Group 1 (SRPwCB) underwent SRP with CBR (bulbous or extensive type MTs), and Group 2 (SRPO) underwent SRP only (normal or lamellar-type MTs). The NOSE and SNOT-22 scales were assessed preoperatively and at the 3-month follow-up evaluation. Patient demographics, self-reported outcomes, nasoseptal angle (NSA), and Lund-Mackay scores (LMS) were analyzed. RESULTS: There were 119 participants (SRPwCB n = 57; SPRO n = 62). There were no statistically significant differences in age, sex, allergy, smoking, LMS, and NSA according to the presence of MTCB. Compared to SRPO, SRPwCB patients had significantly higher preoperative NOSE and SNOT-22 scores, whereas their postoperative NOSE and SNOT-22 scores were similar. SRPwCB patients also had significantly more postnasal discharge, ear fullness, facial pain/pressure, poor sleep, night waking, daytime fatigue, sense of taste/smell, and blockage symptoms before surgery compared with SRPO patients. CONCLUSION: SRPwCB patients had higher nasal obstruction and sinonasal symptom scores and greater improvement after surgery than SRPO patients. Therefore, evaluating the middle turbinate before functional SRP may be an important for surgical treatment of sinonasal symptoms. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:1375-1381, 2023.

Comparison of Rapid Absorbable Sutures with Nonabsorbable Sutures in Closing Transcolumellar Incision in Septorhinoplasty: Short-term Outcomes.

BACKGROUND: Following open rhinoplasty, a postoperative scar at the columellar incision line is a common morbidity. The aim of this study is to compare absorbable and nonabsorbable suture materials which had been used for closing the transcolumellar incision, in the aspect of risk of postoperative infection, wound healing, postoperative columellar scar and patient satisfaction. METHOD: A prospective, randomized, single-blind study was conducted between May 2017 and February 2018. Sixty-four rhinoplasty patients were randomly assigned to absorbable (n = 32) or nonabsorbable (n = 32) groups. The columellar incision was closed with 7 full-thickness skin sutures. Either nonabsorbable 6/0 polypropylene (Group 1) or absorbable 6/0 polyglytone 6211 (Group 2) sutures were placed at the columellar incisions. Polypropylene sutures were removed at the 7th postoperative day. A Mann-Whitney U test and Monte Carlo were used for statistical comparison. Photographs of the patients at the postoperative third month (Fig. 2) were evaluated and scored in terms of scarring, pigmentation, notching, level differences in the incision area by two different otorhinolaryngologists who did not know the randomization. Suture removing discomfort was assessed with visual analogue scale scores. A satisfaction survey was filled out by all the patients completing their third month after the operation. RESULTS: According to the results of both otorhinolaryngologists, there was no significant difference between the two groups in terms of pigmentation, level difference, notching, overall appearance and total score (p = 0.920, p = 0.498, respectively). The mean score on the Wong-Baker scale was 3.19 ± 1.67 in group 1. In the Satisfaction Survey, the average score of the group 1 was 6.90 ± 3.24, while the mean score of the group 2 was 7.062 ± 2.77. There was no statistically significant difference between the two groups (p = 0.715). CONCLUSIONS: Suturing inverted V transcolumellar incisions with rapid resorbable sutures caused significantly less discomfort but no difference in scarring compared to nonresorbable sutures as evaluated by patients and observers. LEVEL OF EVIDENCE III: 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 .

An Overlooked Landmark for the Crooked Nose: Eyebrow Position.

BACKGROUND: Rhinoplasty is one of the most unforgiving operations in facial plastic surgery. The correction of nasal deviation in an asymmetrical face can be challenging because known facial landmarks may mislead the surgeon. Eyebrows trimmed asymmetrically in an effort to create a more symmetrical facial appearance may be overlooked by surgeons. OBJECTIVE: To define the relationship between the eyebrow position and external nasal deviation in patients with a crooked nose. DESIGN, SETTING, AND PARTICIPANTS: Analysis was made of the preoperative and 6-month postoperative life-size photographs of female rhinoplasty patients who had been referred to the senior author's clinic between May 2014 and June 2019. The anthropometric landmarks on the life-size photographs were identifed. The most medial points of the eyebrows and most deviated part of the nose were marked and the distance from the mid-canthal point was measured. MAIN OUTCOMES AND MEASURE: The direction and amount of eyebrow shift were compared with the direction and amount of nasal deviation. RESULTS: Of the total 94 female rhinoplasty patients with at least one level external nasal deviation, 67 (71.2%) had ipsilateral eyebrow shift with external nasal deviation. The preoperative external nasal deviation amount was 1.81 ± 1.21 mm and preoperative eyebrow shift was 1.18 ± 1.06 mm (rS = 0.429, p < 0.001). The postoperative nasal deviation was 0.79 ± 0.92 mm, and the eyebrow shift was 0.54 ± 0.62 mm (rS = 0.570, p < 0.001). CONCLUSION AND RELEVANCE: Patients may tend to trim their eyebrows towards the side of the external nasal deviation. After centralization of the crooked nose with rhinoplasty, asymmetric eyebrow shaping tendencies of the patients were also seen to be improved. 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 .

Monotherapy for hepatitis B infection: a review of treatment options.

Chronic hepatitis B (CHB) is a global health problem, causing liver failure, cirrhosis and hepatocellular carcinoma. CHB treatment aims to prevent liver-related complication. The treatment of CHB infection includes monotherapy with either interferons (IFNs) or nucleos(t)ide (NUC) analogs. IFNs have moderate antiviral effects, and their use is limited by side effects. With the availability of NUCs, IFN-intolerant and decompensated cirrhotic patients began to be treated. Lamivudine and telbivudine, nucleoside analogs, have low genetic barrier to resistance. Adefovir, a nucleotide analog, has moderate potency and potential nephrotoxicity. Entecavir and tenofovir, with their high potency, high genetic barrier to resistance and favorable safety profile are the standard of care in CHB treatment. Long-term use of NUCs with maintained viral suppression results in a decrease in liver-related complications.