Septorhinoplasty by disarticulation: early assessment of a new technique for morphological correction of crooked noses.

OBJECTIVE: This study was aimed to assess the early morphological results of a new septorhinoplasty technique based on disarticulation (SRD) between bony and cartilaginous nose structures. METHODOLOGY: A retrospective, multi-judge, blind comparison of pre- and post-operative photographs displayed on Google documents was designed. A nasal morphology analysis grid based on 10 items was fulfilled independently by 6 judges to assess pre- and post-operatively, two times with a 15 day interval, the severity of each deformity by a score between 0 and 2. The sum of all deformities in a single patient produced the individual global score of nasal deformity, which was set between 0 and 20 for each patient. Pre- and post-operative individual global scores were compared using Student`s t test on paired samples. Percentages of post-operative improvement and deterioration were calculated for each item. RESULTS: Thirty-five SRD were analyzed. Before surgery, 80% of noses were humped and 86% were crooked; three months after surgery, 64% of noses had a rectilinear nasal crest on profile and 57% on facial view. The mean global score of deformities drop- ped from 11.1 before surgery to 5.8 after surgery, an improvement of 47% . Improvement rates of 82% and 74.3% were obtained, respectively, for hump profiles and orbitonasal lines. DISCUSSION: The early morphological results of SRD allow to propose this technique as a possible solution to correct crooked noses with humps.

[Vestibular neurotomy by a retrosigmoid approach: functional results. Evaluation through a triple clinical approach (otoneurologic, orthoptic and physical medicine)]. / La neurotomie vestibulaire par voie rétrosigmoïde: résultats fonctionnels. Evaluation au travers d'une triple approche clinique (otoneurologique, orthoptique et médecine physique).

Vestibular neurotomy remains the surgical procedure of choice in the management of peripheral vertigo resistant to the usual medical treatment, for patients with preserved hearing. Menière's disease generally sums up most of the surgical indications. The authors report a personnel series of patients who underwent vestibular neurotomy during the last five years, from January to December 1998. The aim of this study was to assess with a 6 months to 3.5 years follow-up, postoperative complications and functional results, particularly the improvement of dizziness, residual unsteadiness and its impact on quality of life, and the recovery of socio-professional and physical activities. Of a total of 41 patients, 21 were evaluated by both an otoneurologic and physical medicine approach, to analyze the main sensory components of equilibrium (vestibular, proprioceptive, cervical, visual). In most of the cases, the results show disappearance of vertigo which was the main complaint. However, disabling residual instability is common in those patients who was present both a cervical pathology and binocular visual impairment or a defect in convergence, often unrecognised. The authors emphasise the necessity of a cervical examination and orthoptic investigations in addition to the vestibular assessment. This multi-disciplinary approach allows better identification of the different factors (vestibular, cervical, orthoptic) and lead to specific rehabilitation which can permit the patient with residual unsteadiness to return to work and lifestyle, the real measure of success of vestibular neurotomy.

[Minor functional disorders after surgery of acoustic nerve neuroma]. / Les troubles fonctionnels mineurs après chirurgie du neurinome du nerf acoustique.

UNLABELLED: Acoustic neuromas must be removed surgically, otherwise serious complications may occur. Removal of an acoustic neuroma most often leads to disorders of balance, hearing, and sometimes facial motor function. Many earlier studies have approached the hearing and facial motor function. However, the facial nerve also comprises sensory and secretory fibers which, when injured, may produce minor disorders affecting patient's quality of life. The purpose of this work was to evaluate the quality of life, secretory and taste disorders after acoustic neuroma surgery. PATIENTS AND METHOD: Among patients operated on between May 1985 and May 1996, we selected only those who presented a normal facial function 3 months after surgery. We thus selected 93 patients and sent them a questionnaire in December 1997. We received 74 answers. RESULTS: The period between the operation and the dispatch of the questionnaire was on an average 5.5 years (range 19 months-12 years 9 months). Impairment of quality of life was frequent (59% of cases), and changing way of life less so (30%). 74% of the patients described balance disorders. One-quarter of the patients indicated they experienced disorders of facial mobility. Only 3 patients had no disorder. CONCLUSION: Secretory and taste disorders are frequent after neuroma surgery. Despite their mildness, patients should be advised accordingly because of possible impact on quality of life. This study also points out the lack of precision in the estimation of facial mobility. A better evaluation of patient complaints would be useful.