Use of alloplastic implants for correction of deviated nasal septum: Systematic review and meta-analysis.

PURPOSE: To systematically reviews the safety and effectiveness of alloplastic implants (AI) in septoplasty. METHODS: We conducted a comprehensive search in Medline, EMBASE, SCOPUS, CINAHL, and Cochrane Library databases to identify articles on septoplasty using AI. We also manually searched reference lists of included articles. Inclusion criteria involved prospective or retrospective case-series studies of adults with deviated nasal septum (DNS) who underwent septoplasty with AI, with sufficient follow-up data. Two authors independently screened articles, reviewed full manuscripts, and extracted data. RESULTS: Out of 5370 articles, 16 met inclusion criteria, encompassing 884 patients from 14 eligible studies. Most studies had fair quality. AI materials included Polydioxanone (PDS), Polycaprolactone (PCL), Titanium, Macropore, and PolyMax. AI usage improved nasal obstruction in most patients, with 95.6 % (84.8 %-100 %) based on physical examination and 96.9 % (89.6 %-100 %) based on symptoms. AI-related complications occurred in 4.3 % (0 %-12.8 %) of cases, mostly non-serious. CONCLUSIONS: AI use can be considered as a useful adjunct in septoplasty, with uncommon complications similar to standard procedures. However, due to limited-quality evidence, further prospective controlled studies are needed.

Modified Alar Base Reduction: A Novel Technique.

BACKGROUND: Alar base reduction (ABR) surgery is one of the rhinoplasty techniques used to reduce alar flaring, nasal base width, or both. It is crucial for rhinoplasty surgeons to understand and analyze the type of nasal base deformity to achieve satisfactory results and avoid complications. OBJECTIVES: The objective of this study is to describe a novel technique of ABR that addresses alar flaring while avoiding violation of the nostril marginal rim. METHODS: This prospective cohort study included patients with alar flaring who underwent rhinoplasty or septorhinoplasty with ABR using our modified technique. Demographic data, clinical history, aesthetic concerns, and preoperative and postoperative photographs were collected for each patient. The surgical outcome was assessed using subjective scar evaluation scores at 3 and 6 months, the Stony Brook Scar Evaluation Scale at 6 months, and an overall appearance satisfaction score. RESULTS: A total of 8 patients were included in the study. Subjectively, the majority of patients (75%) reported satisfactory scar appearance at the 6-month follow-up. The mean Stony Brook score was 4.7 (SD=0.74). Nostril symmetry was achieved in all patients. Seventy-five percent of the participants expressed satisfaction with the overall appearance. CONCLUSIONS: Our modified ABR technique demonstrates promising results in correcting alar flaring while achieving nostril symmetry with an acceptable scar. Further studies with a larger sample size are needed to evaluate the feasibility of the technique and compare it to other classical techniques. LEVEL OF EVIDENCE: Level IV.

Evaluation of Chronic Rhinosinusitis Symptoms' Severity Following COVID-19 Infection: A Retrospective Analysis.

Objectives This study aims to compare the severity of chronic rhinosinusitis (CRS) symptoms pre- and post-COVID-19 infection and estimate the impact of the COVID-19 pandemic on the use of intranasal corticosteroids (ICS) among adult CRS patients. Methods This was an observational retrospective cohort study conducted at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between July 2022 and October 2022. Adult CRS patients with sino-nasal outcomes test-22 (SNOT-22) scores documented prior to March 2020, marking the occurrence of Saudi Arabia's initial reported case of COVID-19, were requested to complete the SNOT-22 questionnaire following COVID-19 infection. A comparison was subsequently made between the two scores obtained. Results The study enrolled a total of 33 patients, with 16 assigned to the control group and 17 with a history of COVID-19 infection. The mean age of the patients was 43 years, and the majority (52%) were males. Statistical analysis did not reveal any statistically significant differences in the total SNOT-22 scores or domain-level scores between the two groups. Furthermore, the use of ICS during the COVID-19 pandemic did not show any significant associations, except for patients with asthma, where 80% of them used ICS during the pandemic (p=0.0073). Conclusion There was no statistically significant disparity observed in the SNOT-22 scores between patients who tested positive for COVID-19 and those who did not. The use of corticosteroids during the COVID-19 pandemic was found to be more prevalent in this study compared to previous studies conducted before the pandemic, particularly among patients with asthma. The use of ICS during the pandemic was not associated with the presence of polyps, functional endoscopic sinus surgery (FESS), allergic rhinitis, or eczema.

Midline Facial Nerve Monitoring: Single-Center Experience and Review of Literature.

BACKGROUND: Facial nerve monitoring system has enabled facial muscle activity detection using electrodes placed over the target muscles. In an effort to enable the best and minimally invasive surgical approach, a midline facial nerve monitor was applied during bilateral cochlear implantation surgical intervention in our center and the feasibility of placing midline facial nerve monitor electrodes during bilateral cochlear implantation operations was evaluated. METHODS: The medical records and operative notes of all patients who underwent bilateral cochlear implantation surgery between January 2017 and April 2018 in a quaternary care center were retrospectively reviewed and divided into 2 groups based on the facial nerve monitoring methods: facial nerve monitoring with the midline (midline facial nerve monitor) or bilateral (bilateral facial nerve monitor) electrode placements. Basic demographic information, comorbidities, and facial nerve status (pre- and postoperatively) were collected from patient electronic medical charts. The operative notes were reviewed for abnormal facial nerve findings, as well as for any reported difficulties with the identification or stimulation of facial nerve. The primary outcome was facial nerve identification postoperative function. RESULTS: Seventy-eight patients met our inclusion criteria. Midline facial nerve monitor was used in 49 patients and bilateral facial nerve monitor was used in 29 patients. No documented difficulty was identified at the step of facial nerve identification in either group, and none of the patients developed facial nerve weakness postoperatively. CONCLUSION: Midline facial nerve monitor is a safe and reliable method that can be used in bilateral cochlear implantation surgeries and other surgeries requiring facial nerve monitoring.

Safety and cost-effectiveness of outpatient thyroidectomy: A retrospective observational study.

OBJECTIVES: To investigate the safety and cost-effectiveness of outpatient thyroidectomy and provide a systematic postoperative protocol for safe discharge. METHODS: In this retrospective review, the medical records of all patients who underwent total, hemi, or completion thyroidectomy from July 2017 to April 2019 at 2 tertiary care hospitals were reviewed. Multivariable analysis was performed on the potential predictors of postoperative complications. Healthcare costs were calculated by the type of admission based on the average costs at the 2 centers. RESULTS: One hundred twenty-two patients were enrolled in this study. The majority of cases were in the outpatient group (n=76, 62.3%). Total thyroidectomy was the most prevalent type of surgery (n=90, 73.7%). There were a total of 20 complications in 18 patients (inpatient=9 versus [vs.] outpatient=9). No cases of cervical hematoma or bilateral vocal cord paralysis were encountered. No significant difference was found between the type of admission (outpatient vs. inpatient) and postsurgical complications (p=0.24). The multivariable regression model retained significance for male gender and American Society of Anesthesiologists Classification III as potential predictors of postoperative complications. Healthcare costs would be reduced by at least 15.5% with the implementation of outpatient surgery. CONCLUSION: Outpatient thyroidectomy is as safe as inpatient thyroidectomy given the proper selection of cases. We project cost containment of over $711 thousand per 1,000 cases for outpatient thyroid surgeries.

Maxillary sinus schwannoma.

Schwannoma (neurilemmoma) is a benign tumour that arises from the Schwann cells which cover the nerve sheaths of the peripheral or autonomic nervous system especially the sympathetic system. Reported cases of schwannoma arising from the sinonasal tract are rare. We report a case of a 28-year-old man who presented to otolaryngology-head and neck surgery clinic with left cheek swelling and left-sided nasal obstruction for 1-year period. Endoscopic examination and high-resolution CT scan revealed a homogenous expansile mass occupying the left maxillary antrum extending to the left orbit and left ethmoidal air cells. The mass was excised through endoscopic endonasal approach followed by Caldwell-Luc approach for the residual tumour. Postoperative histopathological examination revealed benign type Antoni A schwannoma.

Spontaneous recovery of bilateral congenital idiopathic laryngeal paralysis: systematic non-meta-analytical review.

OBJECTIVES: To systematically review the frequency and time to spontaneous recovery in pediatric patients with bilateral congenital idiopathic laryngeal paralysis (BCILP). METHODS: The databases of Medline, EMBASE, Scopus, CINAHL, Cochrane Library and Proquest Dissertations were searched for English language articles reporting on laryngeal paralysis in pediatric patients. A bibliography search of the selected studies was done to identify additional articles. We included prospective or retrospective case-series studies of children and neonates diagnosed with BCILP at age <60 days and confirmed by direct laryngoscopy, with sufficient follow up and objective assessment for recovery. Two authors independently extracted the data and assessed the quality of each study. Discrepancies were resolved by consensus and adjudication by a third author. RESULTS: Of the 4229 articles identified by the search, only one study met our inclusion criteria. The study was a retrospective case series, and was of low quality. The mean age at diagnosis was fourteen days. Sixty-five percent of the patients recovered spontaneously, and the mean time to recovery was twenty-five months. Tracheostomy was performed in 71% of the patients. CONCLUSIONS: The available literature is of low quality and provides weak evidence on the natural history of BCILP in pediatric population.

Acquired bilateral adductor laryngeal paralysis in neonates and children: a case series and a systematic review.

OBJECTIVES: To present a series of acquired bilateral adductor laryngeal paralysis (BAdLP) and review the literature on clinical manifestations and management. METHODS: A retrospective review of a single tertiary care practice of pediatric otolaryngology was conducted. Patients were identified from a surgical database spanning twelve years of practice (2002-2013). The variables documented included gender, age at presentation, co-morbid conditions, documented laryngeal findings on endoscopy, management and outcome. A systematic review of the literature was conducted to identify reports on BAdLP in children and associated conditions. RESULTS: Five cases (four girls and one boy) ranging from 3 months to 16 years of age were identified. All cases were documented using rigid and/or flexible laryngoscopy. In four cases, the onset was after major cardiac surgery complicated by cerebral vascular accidents, while one followed a thalamic stroke. Four were managed with tube feeding. Only three papers reported BAdLP in children. CONCLUSIONS: The cases identified were all acquired after a central neurological insult. The profile is distinct from the congenital adductor form of laryngeal paralysis previously described. However, the symptom complex is identical. We believe this is the largest case series from one center to be reported.

Grading adenoid utilizing flexible nasopharyngoscopy.

BACKGROUND AND OBJECTIVES: To assess the possibility of adenoid size asymmetry in both nasal sides by nasopharyngoscopy. DESIGN AND SETTINGS: This is a prospective study involving 100 children, with age ranging between 1 and 12 years, performed in Saudi Arabia between January 2010 and December 2011. METHODS: Adenoid was examined and graded I-IV in relation to posterior choana bilaterally by flexible nasopharyngoscopy. The adenoid grade was compared with the other side in each child. RESULTS: The findings from endoscopy were analyzed: there was a high degree of agreement in grading both sides, that was 92% with kappa=0.868. Moreover, there was grade asymmetry in 8% of the cases. CONCLUSION: Adenoid grading using flexible nasopharyngoscopy through one side of the nose may not represent the adenoid grade of the other side in all cases.