Effect of lateral crural cut overlay and medial crural cut and overlay in creating and maintaining tip projection and rotation: a randomised single-blind trial.

Lateral crural cut and overlay (LCC) or medial crural cut and overlay (MCC) are two of the many techniques applied to ensure an adequate nasal tip projection and rotation, but little evidence supports their long-term efficacy. Fifty-four rhinoplasty candidates were studied prospectively in this randomised clinical trial. The subjects were randomly divided into two groups according to the use of LCC or MCC. The outcome measures were gaining and maintaining tip projection and rotation in the long term. Standardised photographs taken before and at three and 12 months after surgery were used to compare nasolabial angle and projection between groups. Patients' satisfaction with the cosmetic results and nasal obstruction were evaluated using the Standardised Cosmesis and Health Nasal Outcomes Survey (SCHNOS). LCC and MCC were each used in 26 cases. Preoperatively, the nasolabial angle, tip projection, and other characteristics were not significantly different between the groups. There was no significant difference in tip rotation stability (p = 0.624) and projection (p = 0.329) between the groups postoperatively, but patients' satisfaction with the cosmetic results was significantly higher in the MCC group (p = 0.046). It seems that both LCC and MCC are effective techniques in rhinoplasty. Compared with LCC, the use of MCC in qualified hands may increase the patients' satisfaction with the cosmetic results.

Occult level IV metastases in clinically node-negative patients with oral tongue squamous cell carcinoma.

OBJECTIVE: The present study was conducted to determine the rate of level IV lymph node involvement among node-negative (N0) necks in patients with squamous cell carcinoma of the tongue. METHODS: The study comprised 32 patients with squamous cell carcinoma of the tongue, with tumour-node-metastasis staging of T1-3N0M0, who were admitted to the Otolaryngology Department at Tehran University of Medical Sciences from March 2012 to March 2014. After a complete diagnostic evaluation, wide primary tumour excision (with 1.5-2 cm margins) and extended supraomohyoid neck dissection (levels I-IV) were accomplished. RESULTS: Occult metastasis was found in 28 per cent of the patients. Level I, II and III metastases were the most common (18.75, 18.75 and 15.62 per cent, respectively). Level IV metastasis was found in 6.25 per cent of patients. CONCLUSION: Supraomohyoid neck dissection appears to be an appropriate treatment for N0 tongue squamous cell carcinoma and there is no need for level IV lymph node dissection in a N0 patient.

Surgical outcomes of malignant sinonasal tumours: open versus endoscopic surgical approaches.

BACKGROUND: Sinonasal malignancies are rare tumours, which can be resected using an open or endoscopic approach. The current study evaluated the outcome of both approaches. METHODS: A total of 160 patients with malignant nasal tumours were evaluated in an academic tertiary care hospital. The patients were allocated to 'open' or 'endoscopic' surgery groups, based on the surgical approach employed. The following data were evaluated and compared: patient and tumour characteristics; oncological treatments; and oncological outcomes, including complications, surgical margin, recurrence, overall survival and disease-free survival. RESULTS: The maxillary sinus was the most common tumour location and squamous cell carcinoma was the most common histopathology-based diagnosis. Younger patients had lower grades of tumour. Higher survival rates were significantly related to lower tumour stages in both surgery groups. There were no differences between the two relatively similar groups in terms of surgical margin, the need for adjunctive therapy, and recurrence and survival rates. In addition, multivariate logistical regression analysis indicated no correlations between the type of surgical approach employed and the rates of recurrence and complications. CONCLUSION: Endoscopic surgery for sinonasal malignancies is comparable to the conventional open approach in carefully selected patients.

Endoscopy findings affect subjective smell rehabilitation in post-laryngectomy patients using the nasal airflow-inducing manoeuvre.

OBJECTIVE: To evaluate the characteristics of post-laryngectomy patients, including nasal endoscopy findings, that affect subjective smell improvement in the post-surgical period. METHODS: Thirty patients who had undergone total laryngectomy participated in at least three sessions of a smell rehabilitation programme involving the nasal airflow-inducing manoeuvre, under the supervision of a speech-language pathologist. Patient characteristics and nasal endoscopy findings were evaluated. RESULTS: Participants experienced a mean improvement in sense of smell of 61 per cent (p < 0.001) and a significant improvement in appetite (p = 0.002). Male patients and patients with a nasal discharge had a significantly better outcome. CONCLUSION: The nasal airflow-inducing manoeuvre is an effective method for improving smell perception and appetite in laryngectomy patients. There was no relationship between nasal endoscopy findings and outcome of the nasal airflow-inducing manoeuvre rehabilitation programme in our case series.

Impact of endoscopic sinus surgery on the quality of life of patients with nasal polyposis.

OBJECTIVES: Chronic sinusitis with polyposis (CSWP) is associated with high direct and indirect annual costs. This condition affects several aspects of daily life, and CSWP patients usually suffer from decreased quality of life (QOL). Treatment with functional endoscopic sinus surgery (FESS) is reported to improve the QOL of patients with CS. Here we evaluated the factors that affected QOL improvement in CSWP patients who were candidates for FESS. METHODS: All patients with CSWP who were treated at the Imam Khomeini Hospital Complex in Tehan, Iran that were candidates for FESS were recruited. Patients with systemic or neurologic diseases that could affect their QOL were excluded. Clinical signs were recorded before and after FESS using the sinonasal outcome test (SNOT-22) and QOL questionnaires. The patient's history of allergic rhinitis, aspirin sensitivity, asthma and smoking was recorded. QOL and associations with clinical features were evaluated within twelve months after FESS. RESULTS: The study included 47 patients with a mean age of 39.5 +/- 15.4 years (61.7% women). FESS resulted in significant improvements in QOL based on the SNOT-22 and QOL questionnaires (p = 0.0001 for both). Septal deviation was the only single characteristic that was significantly associated with QOL improvements. CONCLUSION: FESS significantly improved the QOL of patients with CSWP. However, patients with septal deviation benefited the most from FESS.

Postrhinoplasty acne formation: a case-control study.

BACKGROUND: Acne formation is a common dermatological problem which, if left untreated, may lead to severe facial scars, a consideration that may be particularly important for patients who seek cosmetic surgery. Postrhinoplasty acne development has not yet been discussed in the literature. We therefore decided to evaluate the occurrence of acne in nasal plastic surgery in a case-control study. SUBJECTS & METHODS: One hundred and twenty patients were selected for this case-control study and were then assigned to case and control groups, each consisting of 60 patients. None of the participants was a known case of acne and those with any specific skin condition were excluded from the study. The cases were patients whose external nasal structures had been affected by the procedure; the control group consisted of matched patients who were candidates for closed septoplasty. After the operation, acne formation was evaluated in all participants and a comparison was made between cases and controls looking at the surgical method employed, and at the patients' personal and family backgrounds. RESULTS: Twelve patients, all from the case group, developed postsurgical acne; all these patients had undergone open rhinoplasty. Age, gender, family history for acne and recent medication use prior to the surgery showed no significant correlation with acne formation. CONCLUSION: The incidence of acne after nasal plastic surgery was significantly higher than in the control group, especially when the method of surgery was open rhinoplasty.

Transient threshold shift after gunshot noise exposure.

BACKGROUND: Many people, such as soldiers, are routinely exposed to gunshot noise during target practice. It is suspected that this high-intensity noise may affect audition through repeated Transient Threshold Shifts (TTS); it can also mechanically alter auditory components such as waves. This study investigates the scope of gunshot noise from the AK-47 rifle (Kalashnikov) and the impact on the shooters' audition. METHODS: Forty soldiers (80 ears) were recruited in this study. They were all young and being exposed to gunshot noise for the first time. Gunshot characteristics were measured before exposure. The soldiers underwent auditory evaluation with Pure Tone Audiometry (PTA) and Oto-Acoustic Emission (OAE) once before exposure and immediately (less than one hour) after exposure. RESULTS: The AK-47 gunshot noise pressure level varied between L(AIm) = 73.7 dBA to L(AIm) = 111.4 dBA. Fourteen participants had subclinical hearing impairment in their pre-exposure evaluation; this number increased to 16 after the exposure. Six months post-exposure and later, the number of cases with impairment had fallen to eight (improvement in 50%). Both pre- and post-exposure OAE results were within normal values, while PTA results indicated a significant threshold alteration only at 6 kHz. CONCLUSION: The results of this study confirm that exposure to gunshot noise with no ear protection can represent a significant hazard for auditory function, especially at higher frequencies.

Olfactory function after nasal plastic surgery.

OBJECTIVE: Nasal plastic surgery is a common procedure, which may cause complications. Many patients are concerned about possible changes in the ability to smell. This study aimed to investigate the impact of nasal surgery, by itself, on the sense of smell in a group of patients with minimal endonasal pathologies and no pre-operative olfactory alterations. METHODOLOGY: In this prospective study from January 2009 until January 2011, we evaluated post-rhinoplasty olfactory changes in a series of 100 rhinoplasty candidates. Olfactory evaluation was performed both subjectively and objectively. The subjective evaluation contained a 0-to-100 Visual Analogue Scale and a five-choice qualitative questionnaire; while, the objective evaluation was performed using the same odor variant of the University of Pennsylvania Smell Identification Test (UPSIT40). Then, the results were analyzed by age, sex, operation method, symptoms, and time-interval groups. RESULTS: Subjective and objective scoring revealed no significant change in terms of postsurgical olfactory outcome. According to subjective grading, 26 patients had improvement, 61 had no change, and 13 had deterioration of the smell sense. Closed rhinoplasty resulted in a better smell outcome after surgery according to the Visual Analogue Quantitative Score (P = 0.034). CONCLUSION: Rhinoplasty does not appear to significantly change the preexisting olfactory status.

Anatomical variations in sinus imaging in sinusitis: a case control study.

OBJECTIVE: To compare anatomical variations in sinusitis patients and control subjects. SUBJECTS AND METHODS: We reviewed and compared the computed tomography (CT) scans of 87 sinusitis patients after adequate medical treatment and scans of 103 healthy subjects. All images were scored for sinusitis severity using the Lund-Mackay scoring system. Anatomical variations such as septal deviation, concha bullosa, presence of the Haller's cell, paradoxical middle turbinate, prominent agger nasi cell, and Onodi cell were also recorded. RESULTS: Of the 190 evaluated CT images, 55.2% of the cases and 47.6% of the controls had septal deviation (p > 0.05). The prevalence of concha bullosa was 68% in patients and 61% in controls (p > 0.05). CONCLUSION: There were no significant differences in the evaluated anatomical variations between cases and controls in this study. Mucosal inflammation may play a more essential role than anatomical variation in the development of sinusitis.

Meticulous endoscopic sinus surgery to prevent recurrence of massive nasal polyposis.

OBJECTIVE: To evaluate the effect of meticulous endoscopic surgery, including opening of all involved sinus cells, on the subsequent symptoms and endoscopic findings of patients with massive nasal polyposis. STUDY DESIGN AND METHOD: One hundred patients with massive nasal polyposis resistant to medical treatment were selected. We documented each patient's demographic data, associated diseases, endoscopic findings, Lund-Mackay score and Sino-Nasal Outcome Test 22 (SNOT22) symptom score. All patients were followed up for at least two years to evaluate any recurrence. RESULTS: Of the 100 patients, 20 per cent had a history of asthma and 27 per cent had undergone previous surgery. All underwent endoscopic sinus surgery. After two years of follow up, 8 per cent had recurrence requiring surgery. Recurrence was significantly associated with a history of asthma (p < 0.001) and the histopathological presence of eosinophilia (p = 0.014). CONCLUSION: Meticulous endoscopic opening of all involved sinus cells can be a safe and effective means of controlling massive nasal polyposis, with an acceptable recurrence rate.

Effect of polyvinyl acetal sponge nasal packing on post-operative care of nasal polyposis patients: a randomised, controlled, partly blinded study.

OBJECTIVE: To compare the effects of routine nasal packing with polyvinyl acetal sponge (Merocel) versus no packing, after endoscopic sinus surgery for nasal polyposis. SUBJECTS AND METHODS: This clinical, randomised, controlled trial was performed in an academic tertiary referral centre between 2008 and 2011. Sixty patients with resistant nasal polyposis underwent endoscopic sinus surgery, and were then randomly divided into two groups: packed and non-packed. The amount of bleeding and pain in each group during pack removal was documented. RESULTS: There was no significant difference between the two groups in the outcome of surgery and complications. One patient in each group needed extra packing. In the packed group, the mean ± standard deviation pain score on pack removal was 61 ± 3 (using a visual analogue scale in which 0 = no pain and 100 = worst pain imaginable). CONCLUSION: This study found no significant difference between polyvinyl acetal packed and non-packed groups, following endoscopic sinus surgery for nasal polyposis. This confirms the findings of similar studies, and supports the reconsideration of routine post-operative packing in selected cases.

Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin B.

OBJECTIVE: Mucormycosis is an aggressive fungal infection which may still cause fatal complications. However, the rarity of this disease has made optimal treatment a controversial issue. This study aimed to evaluate the use of topical amphotericin B in endoscopic management of rhinocerebral mucormycosis. SUBJECTS AND METHODS: Thirty patients with infection limited to the nose and sinuses were selected. Patients underwent endoscopic debridement of all necrotic tissue; cottonoid pledgets soaked in amphotericin B solution were then placed in the nasal cavity. Subsequently, long-term antifungal therapy was administered. RESULTS: The overall survival rate was 60 per cent (18 cases); survival rates in the diabetic and malignancy groups were 70.58 and 40 per cent, respectively. Apart from predisposing factors, orbital and maxillary sinus involvement also had a significant correlation with patient outcome. CONCLUSION: Topical use of amphotericin B combined with endoscopic surgical debridement, followed by intravenous amphotericin B treatment, may constitute acceptable management for selected patients, with less morbidity than conventional treatments.

Effect of embolisation on endoscopic resection of angiofibroma.

OBJECTIVE: To determine the effect of embolisation on endoscopic resection of angiofibroma. SUBJECTS AND METHOD: A partially blinded trial was undertaken. Twenty-three patients with angiofibroma (nine embolised and 14 not embolised) underwent endoscopic resection between January 2007 and August 2008 in two tertiary referral centres. Demographic data were collected, the pre-operative tumour extent was assessed by computed tomography, and tumours were staged according to their computed tomography appearance (Radkowski scale). In addition, we evaluated the duration of surgery, amount of haemorrhage, blood pressure during surgery, duration of hospitalisation, complications of surgery and embolisation, cost of treatment, and number of post-operative recurrences, as well as the angiographic characteristics in the embolisation group. RESULTS: There was no significant difference between the general characteristics of both groups. At the end of the study period, we could find no significant difference between the two groups regarding haemorrhage, number of recurrences or complications. The only significant difference was cost of treatment, which was significantly higher in the embolisation group. CONCLUSION: Endoscopic resection is a feasible and safe method for angiofibroma surgery. The current evidence does not support obligatory embolisation in every case of endoscopic angiofibroma resection.