Nasal fibrosis: long-term follow up of four cases of eosinophilic angiocentric fibrosis.

Eosinophilic angiocentric fibrosis is a rare, benign cause of submucosal thickening and fibrosis within the upper respiratory tract. It predominantly affects the nose although cases have been reported in the subglottis. We describe four cases of the disease centred around the nasal cavity, with widespread infiltration of the facial soft tissues and orbit in three of the four patients. Each underwent long term follow up. Multiple surgical resections were required with two of our patients and, to date, medical therapy has been of limited help. The disease process, with its clinical and characteristic histopathological findings, is described. We also discuss the management of the disease following a comprehensive review of, and comparison with, the few prior reported cases.

Endonasal spreader graft placement as treatment for internal nasal valve insufficiency: no need to divide the upper lateral cartilages from the septum.

OBJECTIVE: To describe and evaluate results of a surgical procedure to treat internal nasal valve insufficiency with the use of spreader grafts placed via an endonasal approach without division of the upper lateral cartilages from the nasal septum. DESIGN: Eighty-nine patients with complaints of nasal obstruction, at least partially due to internal nasal valve insufficiency, underwent this operation on 120 sides in a private practice setting. Only autologous material was used, and 3 different techniques for fixating the grafts were evaluated. All patients were prospectively studied, and subjective self-assessment was used to quantify the result of the operation. RESULTS: On 53 sides (44%) nasal breathing was described as "optimal," and on 53 sides (44%) the result was deemed "improved." On 13 sides (11%) no change was noted, and on 1 side (1%) the postoperative situation was judged to be worse. CONCLUSIONS: When opting for spreader grafts to treat internal nasal valve insufficiency, one does not necessarily need to perform an external approach, nor is separation of the upper lateral cartilages from the septum required. The endonasal technique presented herein is less invasive and can be used in conjunction with other procedures aimed at improving nasal patency.

Assessing day-case septorhinoplasty: prospective audit study using patient-based indices.

The objective of this study was to evaluate the safety, efficacy and acceptability to patients of day-case septorhinoplasty. Twenty-nine patients undergoing elective septorhinoplasty in a dedicated teaching hospital day-case unit were asked to complete day surgery questionnaires (DSQ) at six weeks post-operatively. Details of surgery performed, demographic data, readmission rates and complications were collected prospectively. No major complications were recorded. One patient had to be admitted for overnight observation following post-operative bleeding. The DSQ showed that the great majority of patients were satisfied from the day-case setting (satisfaction score 81). This preliminary study showed that day surgery septorhinoplasty was acceptable to the patient and was associated with a very low re-admission rate. We believe that in carefully selected young healthy patients it is an acceptable alternative to an in-patient procedure.

Revision rhinoplasty: an overview of deformities and techniques.

This article provides an overview of assessment, planning, and correction of deformities in revision rhinoplasty surgery. Common deformities are described with tips for preventing such postoperative problems, and corrective strategies are suggested. Assessment remains the key to successful rhinoplasty surgery, and its importance in revision operations is emphasized. The external approach is preferred for complex revision surgery due to its unparalleled exposure of the underlying anatomy, but closed approaches are still used for dorsal correction or minor tip deformities. The use of and options for graft material in reconstruction are detailed.