Post-Rhinoplasty Acne, Frequency and Role Players.

INTRODUCTION: Acne is a common complain among post rhinoplasty patients. While rhinoplasty is done for aesthetic reasons and acne expressively affects the individual's appearance, we aimed to study its incidence and role players. MATERIALS AND METHODS: A descriptive cross-sectional study was performed on 152 (143 females and 9 males) patients admitted for rhinoplasty during January 2016 to March 2017. Patients were examined by a dermatologist prior to surgery and 7, 30 and 90 days after rhinoplasty using the Global Acne Grading System and responded to a list of questions on the probable risk factors of acne. Psychological status was examined by the perceived stress scale-14 and the Hospital Anxiety and Depression Scale. RESULTS: The patients' mean age was 28.9±3.82 yrs. Mild and moderate acne were observed in 21.7% (n=33) of the cases in the preoperative visit. The incidence of mild and moderate acne was 36.1%, 42.8% and 23% after 7, 30 and 90 days of surgery, respectively. One week after rhinoplasty, acne manifested in 14.9% of cases with no history of acne. Mean age significantly differed between those with and without post-surgical acne at all post-surgical visits (P> 0.001 and P=0.001 and P=0.015, respectively). Hospital anxiety and depression and perceived stress levels were significantly higher in patients who presented with acne on the first post-surgical visit compared to those with no acne presentations (P=0.04 and P=0.02, respectively). CONCLUSION: External psychological stress may be the main role player in post-rhinoplasty acne. Consultation or referral of patients to an experienced psychologist is highly recommended for a better outcome and fewer complications.

Epidemiological Survey of Sinonasal Malignancy in North-East Iran.

INTRODUCTION: Sinonasal malignancies are uncommon neoplasms with several histological subtypes. These malignancies have a poor prognosis and, because of the nonspecific nature of the symptoms, most patients are diagnosed late when the disease is already at an advanced stage. Therefore, most sinonasal malignancies tend to be treated with surgery and postoperative radiotherapy. Understanding the incidence and prevalence of clinical symptoms, pathology, diagnosis, and subsequent prognosis of the disease is important for early diagnosis. MATERIALS AND METHODS: Medical records of patients with a confirmed diagnosis of sinonasal malignancy in a tertiary referral center from 1998 to 2009 were retrospectively investigated by chronological examination. Information relating to symptoms, pathology, and treatment of patients were collected from the checklists and used to generate tables and graphs, while descriptive statistical tests were used to compare data. RESULTS: The records of 69 patients were examined, including 45 (65.2%) male and 24 (34.8%) female patients with a combined mean age of 54.07±16.04 years. Twenty-one patients (30.4%) were aged less than 45 years and 48 (69.6%) were more than 45 years of age. The most common symptom was facial swelling in 46 (66.6%) patients and the most common kind of tumor was squamous cell carcinoma in 28 (40.6%) patients. The primary location of the tumor in most patients was the maxillary sinus (54 patients; 78.3%). A majority of patients present in advanced stage (stage III or more) with intraorbital (39.1%) or intracranial (4.3%) involvement, or regional lymphatic (28.99%) or distance metastasis (7.2%). The most common treatment was surgery (17 patients; 24.6%). CONCLUSION: Due to their nonspecific symptoms, most sinonasal malignancies are diagnosed at an advanced stage of the disease. Therefore, all patients with nonspecific symptoms, especially older males, should be evaluated for sinonasal malignancies in order to eliminate this diagnosis.

Congenital agenesis of all the nasal cartilages.

UNLABELLED: With the exception of septal deviation, congenital anomalies of the nasal cartilages constitute a small fraction of all congenital nasal anomalies. This report presents a patient with isolated agenesis of all the nasal cartilages, which has never been recorded previously. 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.

Outcome of stapes surgery for tinnitus recovery in otosclerosis.

INTRODUCTION: Stapes surgery is mainly used to improve hearing in otosclerosis; however, many patients report alleviation of tinnitus after surgery. OBJECTIVE: to evaluate the effectiveness of stapes surgery for improving tinnitus symptoms. MATERIALS AND METHODS: This prospective study included 29 patients with surgically proven otosclerosis, who had undergone stapedectomy or stapedotomy. We compared symptomatic (tinnitus, hearing loss, and vertigo) and audiological findings obtained before and after surgery. Using Newman's method the level of discomfort caused by tinnitus was scored from grade I to V pre- and postoperatively. RESULTS: The mean preoperative tinnitus discomfort grade was 2.72, at day 1 after surgery it was 1.29, and after 1 month it had decreased to 0.96, indicating a significant improvement in the level of tinnitus discomfort (p < 0.0001). One month after surgery 82.8% of patients had a complete or partial absence of tinnitus. CONCLUSION: We conclude that stapes surgery is quite effective for treatment of tinnitus as well as improvement of hearing. When deciding upon management in patients with otosclerosis the presence of tinnitus should be considered as well as hearing level.

Pulp necrosis during septorhinoplasty.

OBJECTIVES/HYPOTHESIS: Bony manipulation near the nasal spine or maxillary crest trimming can predispose teeth to injury during septorhinoplasty, especially when there is an aberrant vascular supply or a highly situated root apex in the premaxilla. STUDY DESIGN: Prospective cross-sectional study. METHODS: A prospective cross-sectional study was carried out on 438 teeth (maxillary incisors and canines) that were supposedly affected and 73 control teeth (mandibular lateral incisors) in 73 candidates of septorhinoplasty before and after surgery to determine the frequency of pulp necrosis using electrical, heat, and cold pulpal tests. Those with difficult intubation, history of root canals or orthodontic procedures, history of dental trauma, or a positive preoperative test were excluded from the study. Patients were followed up 2 weeks, 3 months, and 6 months postoperatively, and test results were compared before and at three intervals after the surgery. RESULTS: Seventy-three consecutive patients, including 11 males and 62 females, met the study criteria. Septoplasty with anterior maxillary crest trimming and anterior nasal spine manipulation was performed in 63 and 52 cases, respectively. Only 10 cases underwent septoplasty without manipulation of the maxillary crest or the anterior nasal spine. Based on pulp testing, no case of pulp necrosis was seen during the 6-month follow-up. CONCLUSIONS: Considering there are very few reports of dental problems during septorhinoplasty, it is an unlikely cause of serious dental complications such as pulp necrosis. An abnormal anatomy might be a good explanation for rare cases.