Functional Role of Scroll Reconstruction in Open Rhinoplasty.

BACKGROUND: The scroll area of the nose is important for breathing; thereby, its reconstruction can improve the nasal patency. OBJECTIVE: To evaluate the effect of scroll reconstruction on breathing in patients following open rhinoplasty. METHODS: Using the prospective controlled study design, we enrolled a cohort of patients undergoing open rhinoplasty. The patients were randomly divided into two groups (each group with n = 14). The predictor variable was scroll reconstruction (yes/no). The main outcome variables include pre- and postoperative third-month peak nasal inspiratory flowmeter (PNIF) value (ml/min) and 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). Appropriate statistics were computed, and a P < 0.05 was considered significant. RESULTS: There was no demographic difference between both groups. Scroll reconstruction was associated with significantly improved PNIF post-surgery (P = 0.047). However, postoperative mean SCHNOS-O and SCHNOS-C was not different between the study and control groups (P = 0.58) CONCLUSIONS: This study suggests that scroll reconstruction helps improve nasal patency during forced inspiration in open rhinoplasty patients and provides a similar aesthetic outcome compared to the non-scroll-reconstructed group. Future research works should be done in a larger patient cohort. 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 .

The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty.

The basic aim of our study is to compare the results of the conventional and piezoelectric osteotomy in rhinoplasty by complete subperiosteal degloving of nasal bone to minimize soft-tissue injury. The study was designed as a prospective, double-blind, randomized, and controlled study. Setting is a tertiary referral hospital in Turkey. Ninety patients who underwent primary open rhinoplasty with osteotomy, performed by either the conventional instruments or the piezoelectric device. The complete subperiosteal degloving of the entire nasal bone was done up to the nasal maxillary sulcus, medial canthus, and nasion in all patients, independent of the type of osteotomy device used. Patients subsequently underwent median-oblique and lateral osteotomy, either with an ultrasonic device or a conventional 2-mm guarded, straight osteotome. The postoperative edema and ecchymosis were evaluated by another surgeon who was blinded to the osteotomy procedure on postoperative days 2 and 7. The edema scores were significantly increased on the second day compared with the seventh day in both groups 1 and 2. However, there was no significant difference between groups. The ecchymosis scores were slightly higher in postoperative day 2, compared with day 7, in both groups 1 and 2, but statistically not significant. This study showed that the main reason edema and ecchymosis are seen post-rhinoplasty is related to soft-tissue injury during osteotomy.

Nasal Bacterial Colonization in Pediatric Epistaxis: The Role of Topical Antibacterial Treatment.

BACKGROUND: Epistaxis is a common problem in childhood. It has been shown that children with recurrent epistaxis are more likely to have nasal colonization with Staphylococcus aureus. It has been suggested that low-grade inflammation, crusting and increased vascularity due to bacterial colonization contributes to the development of epistaxis in children. AIMS: This study aimed to investigate the nasal colonization and treatment outcome in pediatric epistaxis patients. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Charts of the pediatric patients referred to our university hospital otolaryngology outpatient clinics for the evaluation of epistaxis were reviewed. The patients whose nasal cultures had been taken at the first clinical visit comprised the study group. RESULTS: Staphylococcus aureus was the most common bacteria grown. The presence of crusting and hypervascularity was not dependent on the type of bacterial growth and there was no relation between hypervascularity and crusting of the nasal mucosa. Thirty-six patients were evaluated for the outcome analysis. Resolution of bleeding was not dependent on nasal colonization; in patients with colonization, there was no difference between topical antibacterial and non-antibacterial treatments. CONCLUSION: Despite the high colonization rates, topical antibacterial treatment was not found superior to non-antibacterial treatment. Our study does not support the belief that bacterial colonization results in hypervascularity of the septal mucosa causing epistaxis since no relation was found between nasal colonization, hypervascularity and crusting. The role of bacterial colonization in pediatric epistaxis need to be further investigated and treatment protocols must be determined accordingly.

[The comparison of preoperative examination, computed tomography and peroperative macroscopic inspection in the determination of anterior commissural involvement in laryngeal cancer]. / Larenks kanserinde anteriyor komissür tutulumunun belirlenmesinde ameliyat öncesi muayene, bilgisayarli tomografi ve ameliyat sirasi makroskopik incelemenin karsilastirilmasi

OBJECTIVES: In this study preoperative examination, computed tomography and the peroperative macroscopic examination of the specimen were compared in the determination of anterior commissural involvement in laryngeal cancer. PATIENTS AND METHODS: Twenty-two male patients (mean age 59.6 ± 9.9 years; range 46 to 78 years) who underwent total laryngectomy for laryngeal cancer between January 2007 and May 2010 in our clinic were enrolled into this study. The anterior commissures were evaluated in all patients by preoperative examination, computed tomography and peroperative macroscopic examination of the specimens. For the preoperative evaluation, examination with a 70-degree rigid endoscope and microscopic examination under general anesthesia using suspension laryngoscopy were used. The tomographic sections of the neck and the comments were analyzed and the status of the anterior commissure was evaluated. After the removal of the laryngectomy sample, the larynx was vertically incised on its posterior aspect and anterior commissure was examined peroperatively. All the data obtained were statistically interpreted on the basis of the histopathological results of the anterior commissure. RESULTS: According to the histopathological assessments, the rate of invasion of the anterior commissure by the tumor was determined to be 72.7%. In the preoperative examination, the anterior commissure was found to be invaded by the tumor in 56.3% of the patients. This ratio was 50% with neck computed tomography and 93.8% by the peroperative examination of the samples. CONCLUSION: In laryngeal cancer, anterior commissure involvement is a very important factor in selecting the surgical technique and in predicting the behavior of the tumor. Preoperative examination and classical axial computed tomography have limited a role in the detection of the anterior commissural involvement. Computed tomography reconstructed by a highly experienced radiologist may be more helpful for us in the evaluation of the anterior commissure.

[Incudostapedial bridging ossiculoplasty with bone cement hearing results]. / Kemik çimentosu ile inkudostapedial köprüleme ossiküloplasti isitme sonuçlari.

OBJECTIVES: This study describes the hearing results of patients whose ossicles were reconstruction using bone cement. PATIENTS AND METHODS: The medical records of 19 patients (11 males, 8 females; mean age 35,6 years; range 12 to 64 years) who underwent surgery for chronic otitis media at Istanbul Education and Research Hospital Otorhinolaryngology Department between January 2006 and December 2009 were evaluated. Bone cement reconstruction of the ossicular chain was performed from incus to stapes in the absence of a long arm or lenticular process of the incus. The clinical data of the patients were evaluated by otoscopic examination and audiometry. RESULTS: After incudostapedial rebridging ossiculoplasty we performed; out of 19 patients, 10 had 20 dB gain while two patients had 15-20 dB gain another two patients had 10-15 dB gain. The remaining five patients didn't have any significant gain. The mean pre- and postoperative air-bone gaps of all the patients were 36.5 and 20.4 dB respectively. CONCLUSION: Incudostapedial rebridging ossiculoplasty with bone cement is a cost-effective and safe procedure that yields good hearing results in selected patients.