Sequential Assessment of External Nasal Deviation Angle Changes in Patients With a Deviated Nose Who Underwent Bilateral Osteotomy.

OBJECTIVE: A deviated nose is traditionally classified as bony, cartilaginous, or combined deviation. Osteotomy is commonly used to correct bony deviation, and accurate surgical techniques and postoperative patient management are important for favorable outcomes. The authors investigated the change in the external nasal deviation angle over time using sequential clinical photographs to identify the optimal postoperative follow-up duration. METHODS: Medical records and sequential standardized clinical photographs of 22 patients who underwent bilateral medial and lateral osteotomies without dorsal augmentation from January 1, 2014 to May 31, 2021, were retrospectively reviewed. Clinical photographs were classified into 4 periods: "a" preoperative, "b" postoperative day (POD) ≤3 weeks, "c" POD ≤9 weeks, and "d" POD >9 weeks. The angle of deviation (AoD) was measured in both frontal and chin-on-chest views for each period. Differences in AoD between temporally adjacent periods were analyzed. RESULTS: Nineteen men and 3 women (mean age: 28.8 y) were included. Thirteen patients showed rightward deviation, whereas 9 showed leftward deviation. Eleven patients underwent surgery through an endonasal approach, whereas the other 11 underwent surgery through an external approach. In the frontal view, AoD differences (mean ± SD) between periods "a" and "b," "b" and "c," and "c" and "d" were 5.79 ± 3.36 degrees (P < 0.001), 1.44 ± 1.14 degrees (P < 0.001), and 1.07 ± 1.24 degrees (P < 0.05), respectively. In the chin-on-chest view, the values were 5.17 ± 2.69 degrees (P < 0.001), 2.06 ± 2.63 degrees (P < 0.001), and 1.46 ± 1.31 degrees (P < 0.001), respectively. No statistically significant difference in AoD differences was observed between the two approaches. CONCLUSIONS: Angle of deviation can change even 9 weeks after bilateral osteotomy. Thus, long-term follow-up using sequential clinical photographs is mandatory. If needed, close follow-up with early postoperative interventions may be required. The chin-on-chest view showed better sensitivity for assessing AoD than the frontal view.

Palatopharyngeal muscle suspension suture technique for patients with obstructive sleep apnea.

PURPOSE: Palatal surgery remains a major option for patients with obstructive sleep apnea (OSA). We sought to evaluate the therapeutic outcomes of the palatopharyngeal muscle suspension suture technique (PSST) as a novel palatal surgery for patients with OSA. MATERIALS AND METHODS: Of the 816 patients who underwent polysomnography (PSG) from February 1, 2017, to June 30, 2020, 30 patients with OSA who underwent PSST were retrospectively reviewed. The medical records of the patients were also recorded. Among the 30 patients with OSA, nine who underwent preoperative and postoperative PSG were analyzed. RESULTS: Of the 30 patients with OSA, 28 (93.3 %) were male. The mean (SD, standard deviation) age was 43.3 (12.7) years, and the mean (SD) body mass index was 27.3 (3.2). As objective parameters, the mean (SD) apnea-hypopnea index was significantly decreased from 45.9 (21.20) to 29.03 (21.62) (p < 0.05) and the mean (SD) lowest oxygen saturation improved significantly from 77.6 % (7.14 %) to 84.6 (5.17 %) (p < 0.05). As a subjective parameter, the mean (SD) Epworth Sleepiness Scale score decreased significantly from 10 (4.95) to 6.9 (4.57) (p < 0.05), and the mean (SD) visual analog scale score for snoring decreased significantly from 6.3 (1.8) to 3.1 (1.9) (p < 0.001). No complications, such as upper airway obstruction, intractable postoperative bleeding, or velopharyngeal insufficiency, were observed in any of the patients postoperatively. CONCLUSIONS: A novel palatal surgery, PSST, has numerous advantages as a useful surgical option for patients with OSA. It is minimally invasive, easy, time-saving, and relatively reversible.

Comparing reliability between 3D imaging and 2D photography for external nasal anthropometry.

This study investigates and compares the reliability and reproducibility of two facial anthropometric methods about external nasal angles, 3D imaging and conventional 2D photography. 2D photograph images and 3D images about external nose of 30 volunteers were taken using digital camera and Morpheus 3D scanner. To evaluate intra-rater reliability, each images were taken over two different days for each subject by the same researcher. To evaluate inter-rater reliability, another researcher took each images for each subject on the first day. The reliability of each method for measuring 4 external nasal angle is obtained using intraclass correlation coefficient (ICC) and compared. Inter-rater and intra-rater reliability of both 3D imaging and 2D photography had excellent agreement in all 4 nasal angles. In the nasofacial angular parameter, Inter-rater ICC, 2D photography was significantly higher than 3D imaging. Result of intra-rater ICC also showed both 3D imaging and 2D photography had good reliability in all 4 nasal angles. Similar to those of inter-rater ICC, nasofacial angular parameter showed statistically significant differences between 3D imaging and 2D photography. In terms of reliability, both 2D and 3D showed appropriate anthropometric results and considering its own advantage, each methods can be used complementarily.