Applied surgical methods and outcomes in crooked nose rhinoplasty.

OBJECTIVE: In this retrospective and multicentric study, we investigated applied surgical methods in rhinoplasty for crooked nose deformity. PATIENTS AND METHODS: The retrospective data for 300 crooked nose deformity cases (191 males and 109 females) were used in our study. Classification of the initial deformities was performed as (1) I-shaped crooked nose deformity, (2) C-shaped crooked nose deformity, (3) Reverse C-shaped crooked nose deformity, and (4) S-shaped crooked nose deformity. As an operation technique, L-strut septoplasty was performed. The applied surgical methods in rhinoplasty to correct the crooked nose are evaluated and classified. RESULTS: Our results showed that initial deformities in crooked nose patients were I-shaped crooked nose deformity (34%), C-shaped crooked nose deformity (28%), Reverse C-shaped crooked nose deformity (21.3%), and S-shaped crooked nose deformity (16.7%). L-strut septoplasty was performed, and the results of the applied methods to correct the crooked nose were evaluated and classified. It was noticed that more than one procedure was applied to each case: (1) double-side lateral osteotomy (86.6%), (2) wedge bone resection on one side of the osteotomy (7.3%), (3) single-side lateral osteotomy (6%), (4) symmetric spreader grafts (56%), (5) asymmetric spreader grafts (10.6%), (6) shaving of the transverse wing of dorsal septum (8%), (7) correction of deviated dorsal septum (16.3%), (8) displaced anterior nasal spine (12.6%), (9) clocking suture (dorsal septal rotation suture) (9%), (10) dorsal septal scoring and splinting graft (8.3%), and equalizing lateral cruses (12.6%). CONCLUSIONS: I-shaped and C-shaped crooked nose deformities were mainly detected in crooked nose deformity patients. Correcting the crooked nose, double-side lateral osteotomy, and symmetric spreader grafts were the most applied techniques to correct the crooked nose. Other rhinoplasty techniques were also applied to these patients; more than one technique was needed.

A new preservation technique for dehumping the dorsum.

OBJECTIVE: We aimed to offer a new preservation strategy for dehumping the dorsum by using a variation of the cartilage push-down (Ishida) technique. PATIENTS AND METHODS: Three hundred patients (42 males and 258 females) had surgical procedures. All procedures were closed-surgery-type, primary-case procedures performed through a closed incision. Low cartilaginous septal strip resection was performed on 269 individuals, whereas high septal strip resection was performed on the remaining 31 patients. The bony cap is shielded as a separate unit and preserved, so protected from any potential damage. The cartilage roof is separated from the bone roof and lowered while wearing the bony cap component. As a result, less concealment is required. However, it is ineffective on dorsal profiles that are sharp or S-shaped, as opposed to flat. Thus, the modified cartilage push-down with bony cap rasping procedure can be carried out. The sharp hump on the bony crown of the skull is smoothed out and filled. Therefore, the bony cap above the central cartilage roof is much thinner. Because the hump is less likely to appear again, concealment is unnecessary. A median of 8.5 months was spent following-up (6-14 months). RESULTS: According to our method, among men (n=42), the hump size ranged from minor (n=5) to medium (n=25) to big (n=12). There were 258 women, 88 of whom had a little hump, 160 had a medium hump, and 10 had a huge hump. Indicative of surgeon satisfaction with low cartilaginous septal strip excision vs. high septal strip resection include the following: with a total of 269 patients, 35 males, and 234 females had low cartilaginous septal strip resections, with 98 and 96% success rates, respectively, for the surgeons. There were 31 patients, seven men and 24 women, who all underwent high septal strip resections, with a 98% and 96% success rate for the surgeons. It was found that there was a correlation between the size of the hump and the level of satisfaction felt by its bearers. Rates of male satisfaction with humps ranged from 100% for little humps to 100% for medium humps to 99% for huge humps. Satisfaction percentages among women ranged from 98% in the case of little humps to 96% among medium humps and 95% among large humps. CONCLUSIONS: Our technique of modification of the cartilage push-down (Ishida)1 method is applied for dehumping the dorsum. High satisfaction percentages were obtained from the patients and surgeons. This technique may be a good option for patients who need dehumping.

Do products containing menthol exacerbate allergic rhinitis? A narrative review.

The aim of this paper is to review whether products containing menthol exacerbate allergic rhinitis. A literature survey was performed on PubMed, Google and Google Scholar concerning allergic rhinitis (AR). Allergic rhinitis is an inflammatory condition of the nasal mucosa characterized by wheeze, congestion, nasal pruritus and discharge, or any combination thereof. Menthol is a naturally occurring phytochemical, with the formula C10H20O. The L-isomeric form creates the typical odor of peppermints and causes a sensation of coolness when applied to the skin or mucosae. Inhaling menthol vapor is known to affect the respiratory system in a number of different ways. The cooling agent, menthol, is also recognized as a trigger for asthma, AR and urticaria. The menthol molecule stimulates the TRPM8 receptor and may stimulate histamine release in a dose-dependent manner from RBL-2H3 cell cultures. The addition of menthol to products produces symptomatic relief in some patients by providing an impression of freer nasal air flow. It does this by stimulating cold receptors on branches of the fifth cranial nerve. Menthol is capable of provoking allergic hypersensitivity reactions and disorders, including asthma, AR and urticaria. It may also trigger an anaphylactic response. The use of menthol-containing products is best avoided in cases where an allergic disorder exists.

Evaluation of ciprofloxacin used as an intranasal antibiotic.

OBJECTIVE: The objective of this research was to examine the effects of topical ciprofloxacin on cultured nasal epithelial cells of human origin. MATERIALS AND METHODS: Human nasal epithelial cells were collected from patients who voluntarily donated tissue left over following septorhinoplasty. The samples were from individuals without any indication of rhinosinusitis. An assay that may be employed to investigate toxic effects at the cellular level is MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide). This test reveals where DNA becomes fragmented, the nuclei condense, the outer cell membrane is altered, or the cytoskeleton appears disrupted. The present study employed this technique. Nasal epithelium in cell culture was exposed to ciprofloxacin for 24 hours at a temperature of 37°C, following which the MTT assay was undertaken before examining the cells by confocal microscopy to look for alterations indicating cytotoxicity. Another test of toxicity, the artificial scratch technique, was also used. Cells treated in this way were assessed using a light microscope. RESULTS: The nasal epithelial cells in culture that were exposed to topical ciprofloxacin for 24 hours were less viable than controls and this result was statistically significant. For this length of exposure, the IC50 was calculated as 1.565 mg/mL. The peak reductions in cellular viability occurred with exposure at a concentration of 1.25 mg/mL and 0.625 mg/mL. These was only a mild decrease in viability at other concentrations, but these results were of statistical significance. The MTT assay and confocal microscopy confirmed this result. Cultured nasal epithelium not exposed to ciprofloxacin (i.e., controls) exhibited a compact morphological appearance when examined with confocal microscopy. The epithelial cells had a regular fusiform boundary, and the nuclei were intact. By contrast, the cultures with exposure to the antibiotic were of decreased size and their outline changed from fusiform to round. The epithelial cells cultures where scratch injury was induced were examined by light microscopy, the extent of closure of the denuded area being assessed after 24 hours. It was noted that the area opened up by the experimental scratch was not closed completely by 24 hours later. This result shows that ciprofloxacin decreases the viability of nasal epithelial cells. CONCLUSIONS: Topical application of ciprofloxacin to the nasal lining is not recommended, since this resulted in decreased cellular viability, cellular shrinking and alteration in outline from fusiform to round in cultured nasal epithelial cells. These changes indicate that topically applied ciprofloxacin is toxic to nasal epithelial cells. The outcomes of this study should be studied and correlated in vivo models.