Management of Traumatic Nasal Avulsion Injuries.

Soft tissue injuries to the midface (and nose) are common causes for seeking trauma care. As trauma patients, observing advanced trauma life support protocols is warranted given the risk of concomitant injuries. Here, options for optimizing tissue preservation, microvascular replantation, non-microvascular tissue replacement, and wound stabilization are discussed. Included in this discussion are data-driven predictors for successful replantation as well as technique descriptions with anatomic references to guide surgeons in choosing optimal donor vessels. In both partial and complete avulsion injuries, venous congestion is common. Several postoperative wound care protocols to maximize tissue perfusion and long-term viability are discussed.

[Management of ear, nose and throat emergencies]. / Management von Hals-Nasen-Ohren-Notfällen.

Emergency situations involving the ears, nose, and throat (ENT) area can pose considerable challenges for clinicians and often require an interdisciplinary approach due to the involvement of different organ systems. To avoid damage to highly relevant sensory and perception organs and life-threatening bleeding or respiratory complications, strategies that are as quick and targeted as possible are necessary. This article aims to provide an overview of ENT emergency management strategies. The entire spectrum from simple conservative to highly complex surgical measures plays a role here, both diagnostically and therapeutically. Aspects such as bleeding, respiratory problems, inflammation, hearing disorders, vertigo, facial palsy and injuries to the head and neck area are discussed. In addition, important topics such as preventive measures and possible complications are also addressed to ensure optimal patient care.

Mordedura humana em dorso nasal: relato de caso / Human bite on nasal dorsum: case report / Mordida humana en espalda nasal: reporte de caso

As lesões na face decorrentes de mordedura humana estão entre os tipos de trauma causados por violência interpessoal. Injúrias causadas nesta região podem gerar uma série de morbidades como perdas teciduais importantes, infecções, além de cicatrizes irreversíveis quando a ferida é passível de reparo, portanto, os cuidados pós-trauma devem visar à minimização de cura, além da funcionalidade, buscando o máximo de estética possível. Este trabalho tem como objetivo relatar um caso clínico de mordida humana em região de dorso nasal, com avulsão da ponta nasal, atendida no Hospital da Restauração Governador Paulo Guerra, Recife-PE, pelo serviço de Cirurgia Buco-Maxilo-Facial. Procedeu-se com reparo primário e antibioticoterapia profilática, no qual o resultado do tratamento foi considerado satisfatório, boa cicatrização tecidual e sem queixas funcionais e estéticas... (AU)

Injuries to the face resulting from human bite are among the types of trauma caused by interpersonal violence. The injuries caused in this region, can generate a series of morbidities such as major tissue loss, infection, and irreversible scarring when the wound is repairable, therefore, posttrauma care should aim to minimize healing, in addition to functionality, seeking maximum aesthetics as possible. This paper aims to report a clinical case of human bite in the nasal dorsum region, with avulsion of the nasal tip, attended at the Hospital da Restauração Governador Paulo Guerra, Recife-PE, by the service of Oral and Maxillofacial Surgery. It was proceeded with primary repair and prophylactic antibiotic therapy, in which the result of the treatment was considered satisfactory, good tissue healing and without functional and aesthetic complaints... (AU)

Las lesiones faciales producidas por mordeduras humanas se encuentran entre los tipos de traumatismos causados por la violencia interpersonal. Las lesiones causadas en esta región pueden generar una serie de morbilidades como la pérdida de tejidos importantes, la infección y la cicatrización irreversible cuando la herida es reparable, por lo tanto, los cuidados posttrauma deben tener como objetivo minimizar la cicatrización, además de la funcionalidad, buscando la máxima estética posible. Este trabajo tiene como objetivo reportar un caso clínico de mordedura humana en la región del dorso nasal, con avulsión de la punta nasal, atendido en el Hospital da Restauração Governador Paulo Guerra, Recife-PE, por el servicio de Cirugía Oral y Maxilofacial. Se procedió a la reparación primaria y a la terapia antibiótica profiláctica, en la que el resultado del tratamiento se consideró satisfactorio, con buena cicatrización de los tejidos y sin quejas funcionales y estéticas... (AU)

Delayed Reconstruction of Nasal Tip Amputation After a Dog Bite Using a Cartilage Graft and Paramedian Forehead Flap.

The timing and method of reconstruction of an amputated nose due to a dog bite are still controversial. Here, we describe a delayed reconstruction using the paramedian forehead flap with a simultaneous cartilage graft to address a contracted nose from a dog bite. A healthy, 52-year-old patient was attacked by his acquaintance's dog, resulting nasal tip amputation that included cartilage. The composite graft was performed, and secondary healing resulted in a short nose deformity. Five months after the injury, a conchal cartilage graft and paramedian forehead flap were performed simultaneously to correct the shape of the deformity. At 1 year postoperatively, the flap survived without complications, and the short nose deformity was successfully corrected. In summary, immediate composite graft after a dog bite could result in a contracted nose, but the deformity can be corrected by a simultaneous paramedian forehead flap and cartilage graft.

Prospective Study of Sinonasal Outcome Following Endoscopic Skull Base Surgery.

Background: Endoscopic endonasal surgery (EES) requires wide sinonasal dissection to achieve adequate visualisation of anatomical landmarks. This can also result in nasal sequelae like crusting, nasal discharge, and anosmia. Aim: To use the sinonasal outcome test (SNOT) 22 questionnaire to study the postoperative sinonasal morbidity and its recovery in patients who have undergone EES. Materials and Method: Prospective study conducted from November 2017 to May 2018. SNOT-22 questionnaire was administered on patients operated between before EES and then re-administered during outpatient visits at 1 month, 3 months, and 6-12 months following surgery. Results: Results of 46 patients were analyzed. The mean duration of follow-up was 11.8 months. The mean preoperative SNOT-22 score was 2.69 ± 4.95. SNOT-22 score at 1 month was 5.52 ± 6.77, at 3 months follow-up was 0.39 ± 1.02, and after 6 months was 0.30 ± 1.00. In 32 patients with a nasoseptal flap, mean preoperative score was 3.34 ± 5.68 (P = 0.18), one month following surgery it was 6.68 ± 6.88 and at 3 and 6 months following surgery it was 0.56 ± 1.19 and 0.38 ± 1.15. The mean preoperative nasal domain score was 1.022 (±2.13), the postoperative 1 month score was 2.3 ± 3.7, at 3 months following surgery was 0.22 ± 0.82 and after 6 months of surgery was 0.28 ± 0.96. Conclusion: Patients undergoing EES experienced transient worsening of SNOT 22 scores in the first month following surgery and recovered within 3 months of surgery. The improvement was sustained in follow-up visits beyond 6 months of surgery.

[Emergencies in ear, nose and throat medicine]. / Notfälle in der Hals-, Nasen- und Ohrenheilkunde.

Emergencies in ear, nose and throat medicine in the preclinical setting are common. Due to the narrow anatomical conditions, relocation or bleeding in this area can quickly lead to an emergency situation. In this article, the most important causes of bleeding, shortness of breath and trauma are to be presented and the corresponding treatment briefly outlined.

CT Diagnosis of the Fracture of Anterior Nasal Spine.

OBJECTIVE: To study anterior nasal spine fractures, including the incidence, missed diagnosis rates, and relationship with shapes using computed tomography (CT). METHODS: Two hundred cases of axial CT images performed for maxillofacial trauma were reviewed. The incidence, correct, and missed diagnosis rates of anterior nasal spine fractures were studied. The relationship between the fracture and the shape of the anterior nasal spine was also analyzed. RESULTS: The rate of anterior nasal spine fractures was 22.00% (44 of 200). The diagnostic accuracy was 4.55% (2 of 44) and the missed diagnosis rate was 95.45% (42 of 44). The fracture rates of the double rod, single rod, triangle, and irregular anterior nasal spine were 33.85% (22 of 65), 32.26% (10 of 31), 12.24% (12 of 98), and 0.00% (0 of 6), respectively. The double and single rod types of anterior nasal spine were most likely to be fractured than the type of triangle (χ2 = 11.05, 6.67, P < .0167). No fracture was found in the irregular type of anterior nasal spine. CONCLUSION: Anterior nasal spine fractures are not rare and the high missed diagnostic rate results from unfamiliarity with the structure. Double and single rod types of anterior nasal spines are easy to fracture. Bony reconstruction and thin thickness of CT images are necessary for diagnosis.

Fine Details That Improve Nasal Reconstruction.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Identify common negative outcomes that arise with conventional nasal reconstruction. 2. Understand the technical refinements that help avoid and reduce negative outcomes in nasal reconstruction. 3. Learn about the utility of regional axial island flaps for nasal reconstruction, in particular, the lateral nasal artery flap. SUMMARY: Nasal reconstruction has been a preoccupation of surgeons dating to before 600 bc. The nose is the central focal point of the face and a key identifying facial feature, and surgery to the nose can prove to be challenging to even the most experienced surgeon. The objective of this CME article is to outline the most commonly used surgical options for each nasal aesthetic subunit, and the specific complications observed for each. The best surgical options and technical refinements are highlighted, and principles that may help restore the nose are outlined.

Foliculitis pseudolinfomatosa de McNutt (localización nasal) / McNutt's pseudolymphomatous folliculitis (nasal located)

La foliculitis pseudolinfomatosa, descripta por McNutt en 1986, es una afección de etiología desconocida y poco frecuente, que simula un linfoma cutáneo tanto por su clínica como por su histología. Se presenta como una lesión nodular solitaria, eritematosa, de 0,5 hasta 3cm, de crecimiento rápido, sobre todo en la cara, en personas de 40 a 60 años, con una histopatología caracterizada por un infiltrado linfocitario B yT perifocular, y células dendríticas positivas en la inmunohistoquímica para S100yCD1a. Su curso es benigno, muchas veces autolimitado. Se expone el caso de una paciente con una particular forma clínica de pseudolinforma.

Pseudolymphomatous folliculitis, described by McNutt in 1986, is a non-frequent entity of unknown etiology that simulates a cutaneous lymphoma, both clinically and histologically. It shows as a solitary erythematous nodular lesion of 0.5 to 3 cm, with a rapid growth, mainly on the face, in people aged 40 to 60 years, and histopathology characterized by a perifollicular B and T lymphocytic infiltrate, and positive dendritic cells for immunohistochemistry S100 and CD1a. Its course is benign, often self-limited. The case of a patient with a particular clinical form of pseudolymphoma is presented.

Colgajo bilobulado para reconstrucción de defectos por tumores nasales del tercio inferior / Bilobed flap for reconstruction of tumoral defects on the lower third of the nose

Introducción. Los defectos de cobertura en la región nasal secundarios a resecciones oncológicas deben ser cubiertos con tejido de las mismas características que el resecado, idealmente con tejido vascularizado adyacente. El colgajo bilobulado reúne las condiciones doble transposición, con una estructura y diseño que permite una adecuada distribución de las fuerzas de tensión a lo largo de su eje de rotación, evitando deformidades y excedente cutáneo generados por otros colgajos o cierre primario, respetando las unidades estéticas de la nariz. Método. Se presentan 48 casos clínicos en el periodo abril 2018 - abril 2020 describiendo la técnica de realización del colgajo bilobulado para la reconstrucción de secuelas de resección oncológica nasal por los diferentes tipos de tumores de piel. Para defectos de dorso nasal 26, punta nasal 14 y alares 8 casos. Resultados. La vitalidad de los colgajos fue de un 100%, 6 casos presentaron dehiscencia en extremo distal que requirió revisión. Adecuado resultados estéticos con similitud de textura y color de piel del colgajo. Cicatrices resultantes en área dadora y receptora ocultas en líneas de sombra. Disminución de complicaciones agregando resección triangular adicional. Conclusiones. Los defectos de tegumento en región nasal deben ser cubiertos por tejido vascularizado. Las resecciones de hasta 3 cm de diámetro pueden ser cubiertas con colgajos bilobulados adyacentes. El adecuado planeamiento de las cicatrices tanto en área dadora como receptora permite mejores resultados estéticos. Siempre deben tenerse en cuenta las regiones estéticas para obtener mejores resultados.

Background. Coverage defects in the nasal region secondary to oncological resections should be covered with tissue of the same characteristics as the resected, ideally with adjacent raised vascular tissue. The bilobed flap meets the conditions, is a double transposition flap, with a structure and design that allows an adequate distribution of the tension forces along its axis of rotation, avoiding deformities and excess skin generated by other flaps or primary closure. Respecting the aesthetic units of the nose. Methods. 48 clinical cases are presented in the period April 2010- April 2020 describing the technique of making the bilobed flap for the reconstruction of the sequelae of nasal oncological resection by the different types of skin tumors. For dorsal defects 26, nasal tip 14 and alares 8 cases. Results. The vitality of the flaps was 100%, 6 cases presented dehiscence in the distal end that required revision. Adequate aesthetic results with similarity of texture and skin color of the flap. Resulting scars in donor and recipient area hidden in shadow lines. Decrease complications by adding additional triangular resection. Conclusions. Integument defects in the nasal region should be covered by vascularized tissue. Resections up to 3 cm in diameter can be covered with adjacent bilobed flaps. The adequate planning of the scars in both the donor and recipient areas allows for better aesthetic results. Aesthetic regions should always be taken into account to obtain better results

A Strategy for Integrative Reconstruction of Midface Defects Using an Extended Forehead Flap.

Background: Midface reconstruction is challenging because the structures and deformities involved are complicated. In this study, we present a strategy for integrally reconstructing nasal and midface defects, including hair-bearing defects, using extended forehead-expanded flaps. Methods: From 2015 to 2018, a total of 22 patients with midface defects underwent reconstruction with extended forehead-expanded flaps. The far end of the expanded flap, which included scalp hair, was used to cover the upper lip defect (Type 1). In cases with large perioral defects (Type 2), we designed two separate supratrochlear artery flaps, one with a shorter pedicle for nasal reconstruction and the other with a longer pedicle for partial reconstruction. The pedicle of the longer flap was saved for upper lip recovery after pedicle interruption. Results: Among the 22 patients (13 male and 9 female), 17 were caused by burns and 5 by trauma. Nineteen patients had Type 1 defects, and three had Type 2 defects. The average postoperative follow-up was 17.6 ± 4.3 months. Patient satisfaction was excellent in most patients. Conclusions: Our extended forehead flap strategy can achieve aesthetic recovery of nasal and perioral defects with a single expansion treatment. The expanded flap can be flexibly designed to fit diverse midface defects.

Presentation and management of nasal foreign bodies in a Chinese metro area.

ABSTRACT: Nasal foreign bodies in children are common complaints encountered by pediatric otolaryngologists. We investigated clinical features, diagnosis, and treatment of nasal foreign bodies in children in a Chinese metro area.Six hundred sixty eight children with nasal foreign bodies presented to Shenzhen Children's Hospital, diagnosed and treated by the authors were enrolled from January 2016 to October 2019, causes for medical consultation, age, sex, duration, types, locations, removal, and complications were recorded and analyzed.Nasal foreign bodies were common in children between 1 and 5 years of ages (96.8%). The right nasal cavity (61.4%) was the most common site for foreign body insertion (61.4%). Most of the children (89.4%) presented for a complaint of nasal discomfort or foreign body insertion themselves, or for foreign body impaction discovered by the caregivers. Most of the foreign bodies (85.0%) were discovered within 1 day. The most nasal foreign bodies were the whole toys and toy parts (34.1%). The majority of nasal foreign bodies (99.1%) located in the antero-inferior portion of the nasal cavities and could be removed with simple instruments. The occurrence of complications in nasal foreign bodies (10.2%) was not common.The present study objectively exhibited clinical features, diagnosis, and treatment of nasal foreign bodies in a Chinese metro area.

Soft Tissue Trauma to the Nose: Management and Special Considerations.

The nose is one of the most common sites of facial injury due to its prominence and anatomical placement. Given its intricate anatomy, function, and high visibility, it also proves to be one of the most complex regions for repair. We provide a review of the management of soft tissue injuries to the nose, including the various reconstructive tools available and adjunctive wound care measures. We also discuss special considerations based on mechanism of injury and treatment of this condition in the pediatric population. The main goals of reconstruction should be to preserve function while achieving optimal cosmetic results in this highly visible region of the face.

Sustained Reduction of Nasal Pressure Injuries in the Neonatal Intensive Care Unit With the Use of Bubble Continuous Positive Airway Pressure: A Quality Improvement Project.

PURPOSE: The purpose of this interprofessional team-driven quality improvement project was to implement a Bubble continuous positive airway pressure (CPAP) Skincare Protocol proactively to prevent potential device-related pressure injuries. PARTICIPANTS AND SETTING: The setting was a level 3, 60-bed single patient room neonatal intensive care unit (NICU) located within a Midwest urban academic medical center with more than 200 healthcare providers. Prior to the beginning of this project, the NICU had been using the CPAP apparatus that had documented 6 nasal pressure injuries over a 6-month period. Because of ease of use, the NICU moved to using Bubble CPAP (BCPAP), which is known to place patients at a higher risk of nasal pressure injuries due to the way the apparatus sits inside the nares. APPROACH: An evidence-based practice model provided the guiding framework for the development of our BCPAP Skincare Protocol. Knowing that the unit had already documented nasal pressure injuries, the interprofessional-devised protocol was developed to decrease the risk of nasal injuries with the use of BCPAP in premature infants. The protocol was disseminated via an all-healthcare provider educational program. OUTCOMES: During the first 3 months postprotocol implementation period, one stage 2 nasal injury was noted and immediately treated and healed without incident. During the next 24-month, postimplementation period, there were zero nasal pressure injuries reported. IMPLICATIONS FOR PRACTICE: The healthcare providers found that using an interprofessional team approach in developing and implementing an evidence-based BCPAP Skincare Protocol reduced the incidence of nasal pressure injuries associated with the use of BCPAP in the NICU.

Nasal Trauma: Who Nose what happens to the non-manipulated?

BACKGROUND: Nasal trauma is the most common facial injury worldwide. Prompt assessment allows for recognition of injuries requiring surgical intervention in the form of nasal bone manipulation. The literature is unclear to what extent patients undergoing conservative management subsequently require surgical intervention. METHODS: A retrospective chart review of all patients presenting with nasal injury between July 2017 and July 2018 who underwent conservative and surgical management was undertaken. Re-referral and subsequent surgical intervention were documented. RESULTS: In a cohort of 390 patients with nasal injury 229 patients underwent conservative management. Average age was 29 years. Males comprised 60% of our conservative cohort and 81% of the manipulated cohort. 8.3% of patients managed conservatively and 12% of those undergoing manipulation were re-referred. CONCLUSION: Nasal trauma assessment is a significant workload for an ENT unit. Conservative management is appropriate following clinical assessment and does not lead to increased intervention compared with those who are surgically manipulated.

L-Strut Graft: A Very Versatile Graft in the Management of Crooked and Traumatic Noses.

Importance: Numerous techniques have been described on the correction of nasal septum in crooked nose or badly deviated septum. To our knowledge, no previous study has been published solely on the value of using an L-strut graft for straightening the nasal septum. Objective: To investigate the use of L-strut graft technique for septal reconstruction in patients with a crooked nose or badly deviated septum. Design: A retrospective study was performed in patients with crooked nose or badly deviated septum who underwent correction by using an L-strut graft from the 1st of January 2000 to 1st of May 2019 at a tertiary referral center and a private hospital by the senior author. Intervention: All patients with crooked noses or badly deviated septums who underwent L-strut graft repair were taken into the study group. Main Outcomes and Measures: Straightening the deviated septum was the primary outcome. Secondary outcomes were getting rid of crookedness: mean deviation angles and distances from the midline in perioperative/postoperative pictures in three main landmarks: rhinion, supratip, and tip; and resolution of presenting symptoms of nasal obstruction. Results: One hundred nineteen patients were included: 65 men and 54 women (mean age 30.7 years). Septorhinoplasty was performed in 71 and septoplasty in 48 cases. The material for L-strut graft was cartilaginous in 100, bony cartilaginous in 11, and bony in 8 patients. The pictures of 21 rhinoplasty patients (10 women and 11 men; mean age 33.48 years) were uploaded into Rhinobase 1.1 for measurements. There was a decrease in the mean and median values in all measurements from the midline between pre- and postoperative measurements. Conclusions: In selected cases of crooked and traumatic noses, the L-strut graft can be helpful to splint and correct the deviated L-strut framework and it can act as a caudal septal extension graft to support the tip.

Management of foreign bodies in the ear, nose and throat in children: a review of 829 cases from Northern Anatolia.

<b>Objective:</b> The aim of this study was to evaluate cases of of ear, nose and pharyngeal (ENT) foreign body (FB) in pediatric patients referred to the pediatric emergency department of the Department of Otorhinolaryngology in Tokat State Hospital (Turkey). <br><b>Methods:</b> The paper comprises a retrospective study of all ENT foreign bodies presented to the pediatric emergency Department of Otorhinolaryngology in Tokat State Hospital (Turkey) between January 1, 2012 and December 31, 2018. Subject to evaluation were also demographic and clinical characteristics of the patients, types and anatomic locations of FBs, locations of FB by age groups, the method used to remove FBs and the distribution of FB cases by months. <br><b>Results:</b> A total of 829 FB cases were evaluated in this study. The mean age of patients was 47.8 ± 31.4 months. Of all patients, 404 (48.5%) were male, and 425 (51.2%) were female. The nose (58.7%) and the ear (20.2%) were the most common anatomical locations followed by mouth/pharynx/tonsil (12.3%), esophagus (6.2%) and the laryngotracheobronchial tree (2.4%). The most common FBs in different locations were beads in the nose (30.8%), beads in the ear (32.1%), fishbones in the mouth/pharynx/tonsil (56.8%), nuts and peanuts in laryngotracheobronchial tree (70%) and a coin/disc battery in the esophagus (80.7%). <br><b>Conclusion:</b> FB in ENT is among the emergency conditions that require different diagnostic and treatment approaches based on anatomic localizations. Proper vision, adequate equipment and immobilization are important in the removal of ENT foreign bodies in children.

Novel technique using surgical scrub sponges to protect the nose and face during prone ventilation for coronavirus disease 2019.

BACKGROUND: Coronavirus disease 2019 is an international pandemic. One of the cardinal features is acute respiratory distress syndrome, and proning has been identified as beneficial for a subset of patients. However, proning is associated with pressure-related side effects, including injury to the nose and face. METHOD: This paper describes a pressure-relieving technique using surgical scrub sponges. This technique was derived based on previous methods used in patients following rhinectomy. CONCLUSION: The increased use of prone ventilation has resulted in a number of referrals to the ENT team with concerns regarding nasal pressure damage. The described technique, which is straightforward and uses readily available materials, has proven effective in relieving pressure in a small number of patients.