How can periorbital oedema and ecchymose be reduced in rhinoplasty?

Oedema and ecchymose are frequent morbidities of septorhinoplasty, a facial surgical procedure for reforming the shape and functions of the nose. Periorbital oedema (PO) and periorbital ecchymose (PE) are normal occurrences, but are undesirable for patients undergoing the procedure for aesthetic purposes. The present study examined 65 patients who underwent open technique septorhinoplasty for aesthetic and functional complaints. Patients were divided into two groups: Group 1 patients underwent lateral osteotomy following tip plasty, at the end of the surgical operation; Group 2 patients underwent lateral osteotomy before tip plasty, at the beginning of the surgical operation. Patients were followed on the postoperative first, third and seventh days. PO and PE values of patients were scored from 0 to 4. The plastering time (Pt) was significantly shorter for Group I than Group II (p < 0.05). The total surgical time (T) showed no significant difference (p > 0.05). The PO value at the first, third and seventh days was significantly smaller for Group I than Group II (p < 0.05). The PE value at the first, third and seventh days was also significantly smaller for Group I than Group II (p < 0.05). The obtained data indicate that performing a lateral osteotomy in the final stages of surgery, and subsequently applying a nasal plaster and splint as rapidly as possible, decreases PO and PE in the postoperative period.

Effects of Use of a Continuous Positive Airway Pressure Device on Glaucoma.

BACKGROUND: The aim of this study was to investigate the prevalence of glaucoma in obstructive sleep apnea syndrome (OSAS) and to determine the efficacy of the equipment used in the treatment of this disease. MATERIAL AND METHODS: In this cross-sectional study, 38 patients with OSAS used the continuous positive airway pressure (CPAP) device (Group 1) and 32 patients with OSAS refused CPAP device (Group 2). Thirty-six patients did not have OSAS (Group 3). RESULTS: Patient age, gender, height, weight, and neck circumference did not differ among groups (p>0.05); and the apnea-hypopnea index (AHI) and respiratory disturbance index (RDI) values did not differ between Groups 1 and 2 (p>0.05). Vision and pachymetric values did not differ among groups (p>0.05). The IOP was significantly higher in Group 2 than in Group 1 (p<0.05) but did not differ between Groups 1 and 3 (p>0.05). The fundus C/D ratio was significantly higher (p<0.05) in Group 2 than in the other groups but did not differ between Groups 1 and 3 (p>0.05). In Group 1, 2, and 3, 5.2%, 12.5%, and 0%, respectively, of patients had glaucoma. CONCLUSIONS: OSAS should be considered a significant risk factor for glaucoma. Eye tests may help to identify individuals with undiagnosed OSAS, and such testing of patients with diagnosed OSAS may allow early detection of glaucoma and referral of such patients for CPAP therapy to prevent development of complications.

Does rhinoplasty reduce nasal patency?

OBJECTIVE: This study aimed to evaluate the effect of rhinoplasty on subjective and objective assessment of nasal patency in patients who underwent rhinoplasty for cosmetic reasons only. SETTING: Tertiary referral center. DESIGN: Prospective, clinical study. SUBJECT AND METHODS: A total of 50 adult patients who underwent rhinoplasty were included in the study. Preoperative and postoperative photographs of the nasal profile (frontal, lateral, and oblique) were obtained. The visual analog scale (VAS) was used for the subjective evaluation of nasal obstruction (0 being the minimum, 10 being the maximum amount of nasal patency). Objective evaluation of nasal obstruction was performed with a peak nasal inspiratory flowmeter (PNIF). RESULTS: Preoperative mean VAS scores and PNIF values of the patients were 7.36 ± 0.83 and 115.10 ± 17.45, respectively. Postoperative mean VAS scores and PNIF values of the patients were 7.42 ± 0.73 and 115.30 ± 16.7, respectively. There was no statistically significant difference between any of the pre- and postoperative subjective and objective parameters (P > .05). CONCLUSION: Reduction rhinoplasty has been shown not to reduce nasal patency.

Changing strategies in the treatment of maxillofacial fractures at thrace region: open vs closed reduction.

OBJECTIVE: We aimed to analyze etiological factors in patients with maxillofacial trauma, treatment modalities, complications related to surgical approaches and the changing patterns in over time. MATERIALS AND METHODS: A total of 126 patients diagnosed as maxillofacial fractures between August 1998 and June 2012 were investigated in Corlu State Hospital, Ear Nose Throat and Plastic Surgery Clinics, retrospectively. RESULTS: Of the patients, 92 male (73.01%) and 34 female (26.98%), the mean age was 26.4 (± 14.88). Traffic accidents as a cause of fracture were detected in 47 (37.3%) cases. The other causes were assaults in 34 (26.98%), sport injuries in 23 (18.25%), fall from high in 12 (9.52%) and work-related accidents in 10 (7.93%) patients, respectively. In patients with maxillofacial fractures, 65 (51.58%) of them were nasal, 37 of them were (29.36%) mandible, 6 of them were (4.26%) maxilla, 8 of them (% 6.34) were isolated zygomatic arch fractures. Multiple fractures were detected only 10 patients (7.93%). As a surgical method, closed reduction in 75 (59.52%), open reduction and internal fixation in 29 (23.01%), inter-maxillary fixation with open reduction and internal fixation in 13 (10.31%) and only inter-maxillary fixation in 9 (7.14%) cases were performed. Complications were detected as 10.31% of patients in postoperatively. CONCLUSION: Open and closed reduction techniques are safe and successful methods. While closed reduction of mandibular fractures was used as a surgical method previously, combined approaches are now being applied instead of it.

The effect of duration of merocel in glove finger with tetracaine solution on septoplasty morbidity.

OBJECTIVE: We aimed to decrease the postseptoplasty morbidities depending on nasal packing by using Merocel within glove finger moistened with tetracaine 0.25% solution. STUDY DESIGN: The study was designed as a randomized prospective study. SETTING: A university hospital in Turkey. SUBJECTS AND METHODS: Our study consisted of 80 patients who underwent septoplasty. The Merocel nasal tampon within glove finger was inserted after surgery in the study group and removed after 24 or 48 hours. Merocel was moistened with tetracaine 0.25% solution after insertion into the nasal cavity and just before removal. The morbidities and normal breathing time were recorded and compared with those of the control group. RESULTS: The postseptoplasty morbidities were significantly decreased in the study group compared with those in the control group. The morbidities were also improved after removal of tampons after 24 hours compared with 48 hours. However, the normal breathing time was prolonged when the nasal tampons were removed after 24 hours. CONCLUSIONS: The glove finger provides comfortable removal of nasal packing. The Merocel tampons might be safely removed just after 24 hours postoperatively without any complication.

Effect of thermal welding tonsillectomy on emergence agitation.

: This study sought to examine the effect of thermal welding tonsillectomy that reduces pain and length of anesthesia on emergence agitation. A total of 60 patients (age range, 3­6 years) with chronic recurrent tonsillitis with an indication for tonsillectomy were included. Patients were randomly assigned to 2 groups. The control group (the CD group) was composed of patients undergoing cold dissection (CD) tonsillectomy. The study group (TW group) included patients undergoing thermal welding (TW) tonsillectomy. All patients were given sevoflurane as an anesthetic agent. For all patients, anesthesia time, operation time, extubation time, Pediatric Anesthesia Emergence Delirium scale, pain scale, nausea/vomiting score, and delivery time were recorded. The duration of anesthesia, operation, and delivery was significantly lower in the TW group as compared with the CD group (P = 0.000 < 0001). The pain and agitation scores were significantly lower in the TW group as compared with the CD group (P = 0.000 < 0001). We assume that, besides reducing pain and allowing surgery without bleeding, the TW tonsillectomy method diminishes emergence agitation induced by anesthetic agents, such as sevoflurane.

A rare tumor of the parapharyngeal space: angiomyxolipoma.

Parapharyngeal space tumors are uncommon, most are salivary gland tumors (50%), and they are often pleomorphic adenomas. Neurogenic tumors are the second most common primary tumors of all neoplasms in the parapharyngeal space (30%). Angiomyxolipoma is a very rare form of lipoma. Up until now, only 12 cases located on different sides of the body were reported. Presented here is a case report of a patient with an angiomyxolipoma of the parapharyngeal space. A 17-year-old boy had a slowly growing, painless mass on the left side of the neck. During the oropharyngeal examination, medial displacement of the left tonsilla palatina was observed. Magnetic resonance imaging findings were of a 6 × 5.5 × 3-cm "dumbbell"-shaped parapharyngeal mass. A fine needle aspiration of the mass showed no specific histopathology. The patient underwent a transparotid-transcervical approach for the excision of the tumoral mass under general anesthesia. Although an angiomyxolipoma is a rare form of lipoma, it is a pathology that should be kept in mind for the differential diagnosis of parapharyngeal tumors.

The effect of the duration of merocel in a glove finger on postoperative morbidity.

We examined the effects of the duration of keeping a Merocel nasal packing in the nose and the application technique (packing applied either directly or inside a glove finger) on postoperative morbidity and complications. The study included 129 patients (67 males and 62 females; age range 18 to 56 years) undergoing nasal septoplasty without turbinate intervention. The patients were randomly assigned into 4 groups. In group 1 and group 2, Merocel was directly applied in the nasal cavity for 24 hours and 48 hours, respectively; in group 3 and group 4, Merocel was kept in the nasal cavity in a powder-free glove finger for 24 hours and for 48 hours, respectively. Pain and discomfort scores were evaluated by a visual analog scale. The time taken between removal of the tampon and when the patients began to breathe comfortably was called the nasal obstruction time. The differences in mean discomfort score between the groups were not statistically significant (P > 0.05), while the mean pain scores were statistically higher in groups 1 and 2 than in groups 3 and 4 (P < 0.05). The nasal obstruction time was statistically shorter in groups 2 and 4 than in groups 1 and 3 (P < 0.05). Therefore, keeping Merocel inside a glove finger in place for 48 hours notably reduces the pain occurring during the removal of the nasal tampon. It also reduces nasal obstruction time and prevents synechia, leakage, bleeding, and septal hematoma, without compromising patient comfort.

Oto-toxic effect of gastric reflux.

The reflux of gastric content from the nasopharynx into the middle ear via the Eustachian tube may disrupt inner ear functions. The purpose of this study was to investigate the effect of experimental gastric reflux on the cochlear function of rats. Twelve rats were included in this study. Acidified gastric pepsin was prepared by the addition of HCl and deionized water to pepsinogen from porcine stomach. The left ears were designated as the experimental ears, and the solution was delivered daily for 30 days. The control ears received an equal amount of a saline solution. Distortion product otoacoustic emissions were recorded at baseline (before the injection) and on days 3, 10, and 30. When the mean baseline distortion product otoacoustic emission measurements were compared with the final mean measurements on day 30, the acidified gastric pepsin caused statistically significant (P < 0.05) hearing loss in the experimental ears. There was no significant change in the hearing of the control ears. This is the first study on the ototoxicity of acidified gastric pepsin. Our results demonstrate that acidified gastric pepsin causes hearing loss due to inner ear ototoxicity in a rat animal model.