Reasons for rejection of rhinoplasty seeking patients: a multicentre observational study.

BACKGROUND: To date, research on preoperative patient selection has mainly focused on patient personality, with body dysmorphic disorder (BDD) being the most studied. Despite the many reasons for not planning a rhinoplasty, no data are available on the nature of these reasons. Our aim is to conduct a multicentre international observational study on the reasons for rejection of patients seeking rhinoplasty in 5 tertiary rhinoplasty care centres. METHODS: Surgeons documented the reasons for not scheduling a rhinoplasty in consecutive patients who consulted them between January 2021 and March 2022 using a predefined list of reasons for rejection. Surgeons were also asked to report on the patient attitudes after rejection, and about the advice given to patients in the event of refusal. RESULTS: 186 patients seeking rhinoplasty were included. Multiple reasons for rejection were present in 76% of patients, with a mean of 2.9 reasons for rejection per patient. Overall, patient-related factors were most frequently associated with rejection (64.3%), followed by nose-related factors (28.4%), surgeon-related factors (6.0 %) and surgery-related factors (1.3%). The presence of severe BDD symptoms was reported in only 11.3% of the rejected patients. Patients rejected for rhinoplasty were advised to reconsider the surgery (32.8 %) and/or were referred to another surgeon (32.8%). No further action was taken in 39.8% of the patients. Of the patients who were rejected, most had a neutral (39.2 %) or positive (37.1 %) attitude in relation to the lack of rhinoplasty planning. CONCLUSION: This study highlights the variety of reasons for which patients seeking rhinoplasty are not considered good candidates for a rhinoplasty, with patient-related factors being more prevalent than nose-related and other factors. Increasing awareness on the impact of adequate patient selection for rhinoplasty may contribute to better outcomes in rhinoplasty.

EUFOREA Rhinology Research Forum 2016: report of the brainstorming sessions on needs and priorities in rhinitis and rhinosinusitis.

The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016.

Managing nasal valve compromise patients with nasal dilators: objective vs. subjective parameters.

INTRODUCTION: Patients suffering from nasal obstruction due to nasal valve compromise may benefit from a nasal dilator. Several devices for widening of the external/internal nasal valve region can be applied endonasally (Airmax, Nasanita, Nozovent) or externally (Breathe Right). MATERIALS AND METHODS: 100 patients suffering from nasal obstruction due to external or internal nasal valve compromise were involved in this study. All patients were evaluated for nasal obstruction with visual analogue scores (VAS) and peak nasal inspiratory flow (PNIF) measurements before and after the application of 4 nasal dilators. They were offered to choose 2 out of 4 for a trial period of 1 month. Subsequently, patients were reassessed and asked about their willingness to continue using the dilators, as well as the reasons for discontinuation. RESULTS: There was a significant decrease of VAS scores and improvement in PNIF with the dilators in situ compared to baseline. After 4 weeks, 67% of patients were willing to continue using at least one of the chosen dilators. The reasons for discontinuation were local irritation, inappropriate fit, preference for a permanent solution like surgery, and no relief of symptoms. CONCLUSION: Nasal dilators represent a valuable option in the therapeutic approach of nasal valve compromise, with endonasal dilators achieving higher increase in PNIF in comparison with external nasal dilators.

Wound related complications following full thickness skin graft versus split thickness skin graft on patients with bone anchored hearing aids.

OBJECTIVES: The aim of this study was to review complications occurring in bone anchored hearing aid (BAHA) patients in relation to wound healing following full thickness skin graft versus split thickness skin graft. DESIGN: Retrospective study. The medical notes of 22 patients who underwent insertion of BAHA over 24 months were reviewed. SETTING: ENT Department at a District General Hospital in the UK. PARTICIPANTS: All patients were adults and underwent one stage procedure following the standard Branemark technique. In 11 cases the skin abutment interface was established by use of full thickness skin graft inset around the implant, and in the other 11 by use of split thickness skin graft. MAIN OUTCOMES MEASURES: The incidence of delayed wound healing resulting in an increase of number of visits for change of wound dressings. In addition the degree of soft tissue reactions around the interface was examined. RESULTS: There was a clear difference between the split and full thickness skin graft groups in relation to the severity of adverse skin reactions and number of visits required for change of dressings. The split thickness group required from three minimum to 13 maximum (median 4) visits in outpatients during the initial observation period until healing was complete. The full thickness group demonstrated one minimum and three maximum (median 2) visits. CONCLUSIONS: In our hands the full thickness skin graft is superior to a split thickness graft.

Philipp Friedrich Arnold, Ludvig Levin Jacobson and their contribution to head and neck anatomy.

Philipp Friedrich Arnold and Ludvig Levin Jacobson were two of the greatest anatomists of the 19th century. Within this paper their backgrounds and their contribution to the development of various aspects of head and neck anatomy are considered.

Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy.

Skull base osteomyelitis classically presents as a complication of severe external otitis, middle ear, mastoid or sinus infection and can lead to multiple lower cranial nerve palsies when the jugular foramen is involved as a consequence of widespread involvement of the skull base. Bilateral skull base osteomyelitis is a recognized phenomenon, but has not previously been reported secondary to pseudomonal infection in the absence of a clinically obvious focus of infection. We report the case of a 77-year-old diabetic patient who presented with dysphonia and dysphagia and had a bilateral Xth cranial nerve palsy. No focus of infection was evident on presentation. Subsequent radiological investigation confirmed the diagnosis of bilateral skull base osteomyelitis.