Granulomatosis With Polyangiitis (Wegener's Granulomatosis) Nasal Reconstruction: Improved Outcomes With No Delay.

BACKGROUND: Granulomatosis with polyangiitis (Wegener's granulomatosis) causes progressive nasal collapse, nasal obstruction, and central face deformity. It is not known whether cartilaginous nasal reconstruction should be performed immediately or delayed until after disease "burnout." OBJECTIVES: The aims of this research regarding nasal collapse due to Wegener's granulomatosis were to (1) assess the functional and aesthetic outcomes following immediate vs delayed nasal reconstruction; and (2) measure the impact of psychosocial well-being (anxiety, depression, social isolation) in immediate vs delayed nasal reconstruction. METHODS: Wegener's patients with either immediate or delayed nasal surgery (n = 61) were compared. Functional and aesthetic severity were compared with the validated Standard Cosmesis and Health Nasal Outcome Survey (SCHNOS) score (t test). In addition, Patient-Reported Outcomes Measurement Information System (PROMIS) perioperative and 1-year follow-up surveys were analyzed. RESULTS: At initial consultation, SCHNOS score severity types were similar for both groups (immediate vs delayed): mild 15% vs 15%; moderate 59% vs 60%, and severe 26% vs 25%. Over a 30 ± 4 month period, delayed surgery patients' conditions deteriorated, with a shift from mild to more severe SCHNOS scores, from 25% severe at initial consultation to 85% before surgery. PROMIS scores at presentation were high compared to the general public; by the time of delayed surgery, patients had significantly worsened: anxiety from 28 to 73; depression from 18 to 62; and social isolation from 20 to 80. Although both immediate and delayed groups improved after surgery in functional and psychosocial scores, the immediate surgery group's improvement was superior. CONCLUSIONS: Data showed superior functional and aesthetic scores and superior psychosocial indicators with immediate cartilaginous nasal reconstruction, compared with waiting until disease burnout to undergo surgery.

Rhinoplasty for post-traumatic deviation of the nose with non-incisional external perforated osteotomy.

Osteotomy is often necessary for the repair of post-traumatic nasal bone deformities. Typically, tools such as chisels are used for osteotomies; however, we performed osteotomies using Kirschner wires without making a skin incision. Between April 2011 and July 2022, we performed rhinoplasty with external perforated osteotomy using Kirschner wires in 13 patients with post-traumatic nasal bone deformities (9 males and 4 females; mean age, 34 years, range 12-51 years), all of whom exhibited improvement, with only one case showing mild residual cosmetic deformity. None of the patients requested further revision, and all were satisfied with their functional results. The non-incisional external perforated technique is a reasonable method that allows for bone osteotomies along the fracture line and is well-controlled, predictable, and reproducible.

An often neglected area in crooked nose: middle turbinate pneumatization / Uma área frequentemente negligenciada no nariz torto: pneumatização da concha média

Abstract Introduction: Crooked or deviated nose is a deviation of the nose from the straight vertical position of the face. Extensive pneumatization of the middle turbinate, also called concha bullosa or bullous middle turbinate (BMT) is known to be one of the possible etiologic factors in nasal obstruction, recurrent sinusitis, and headache. There is no study concerning a link between BMT and crooked nose. Objective: To investigate the association between crooked nose and the presence of a BMT. Methods: A total of 199 patients who underwent open septorhinoplasty were retrospectively analyzed. Preoperative paranasal Computerized Tomography (CT) findings, preoperative photodocumentation, and anterior rhinoscopic examination findings were documented. Of the 199 patients, 169 were found to meet the criteria and were included in the study. CT scans were examined to note the presence of BMT, inferior turbinate hypertrophy, and septum deviation (SD). SDs and crooked noses were classified. Results: Ninety-four of 169 patients (56%) presented a crooked nose deformity and seventy-five of 169 patients (44%) presented a straight nose. While 49 (52%) crooked nose patients had a bulbous and extensive BMT, 20 patients with straight nose (26.6%) had a BMT. A statistically significant relationship was found between the presence of crooked nose and BMT, regardless of the side of the disease (p = 0.011). Conclusion: This study revealed a link between crooked nose and BMT.

Resumo Introdução: O nariz torto ou o nariz com desvio é um nariz com um desvio da posição vertical reta da face. A pneumatização extensa da concha média, também chamada de concha bolhosa ou concha média bolhosa (CMB), é conhecida por ser um dos possíveis fatores etiológicos da obstrução nasal, sinusite recorrente e cefaleia. Não há estudo relativo a uma associação entre CMB e nariz torto. Objetivo: Investigar a associação entre o nariz torto e a presença de CMB. Método: Foram analisados retrospectivamente 199 pacientes que se submeteram a septorrinoplastia aberta. Achados pré-operatórios paranasais à tomografia computadorizada (TC), fotodocumentação pré-operatória e exame rinoscópico anterior foram registrados. Dos 199 pacientes, observou-se que 169 atendiam aos critérios e foram incluídos no estudo. As TC foram examinadas para observar a presença de CMB, hipertrofia de conchas inferiores e desvio de septo (DS). Os DS e narizes tortos foram então classificados. Resultados: Dos 169 pacientes, 94 (56%) apresentavam uma deformidade de nariz e 75 (44%) apresentavam nariz reto. Enquanto 49 (52%) pacientes com nariz torto tinham CMB extensa, 20 pacientes com nariz reto (26,6%) tinham CMB. Uma relação estatisticamente significativa foi encontrada entre a presença de nariz torto e CMB, independentemente do lado da doença (p = 0,011). Conclusão: Este estudo revelou uma relação entre o nariz torto e CMB.

Leg ulcer in lepromatous leprosy - Case report

Abstract: In Brazil, leprosy is a widespread infectious and contagious disease. Clinicians and specialists view leprosy broadly as a systemic infection, since, in its manifestations, it mimics many conditions, such as rheumatic, vascular, ENT, neurological and dermatological diseases. There are few studies that characterize the factors associated with ulcers in leprosy. These injuries should be prevented and treated promptly to avoid serious problems like secondary infections, sepsis, carcinomatous degeneration and amputations. We describe a patient with ulcers on his legs, involving late diagnosis of lepromatous leprosy.

Quiste de klestadt. Revisión de la literatura y presentación de un caso / Klestadt cyst. Review of the literature and presentation of a case

El quiste nasolabial es un quiste muy infrecuente, no odontogénico y que tradicionalmente se ha clasificado dentro de los llamados fisurados. Su etiología es desconocida, se supone que este origen puede estar en la línea de fusión de los procesos frontonasal y maxilares, por retención de restos ectodérmicos. Clínicamente se observa una tumefacción de crecimiento lento, consistencia blanda que produce elevación del ala de la nariz y es asintomático, a no ser que exista infección. En algunos casos de gran expansión se puede llegar a producir una reabsorción ósea del proceso alveolar. Para el diagnóstico son necesarias tomografías computerizadas o resonancias magnéticas, con la finalidad de estudiar los tejidos blandos. El tratamiento de la lesión habitualmente consiste en su resección quirúrgica a través de un acceso intraoral sublabial. Se preenta un caso clínico de una paciente de 66 años de edad que acude a consulta con un aumento de volumen de la narina izquierda y rinorrea derecha. A la exploración extraoral se observa un nódulo en el vestíbulo a nivel de la narina izquierda. Tras el estudio radiológico se conculye que la lesión es compatible con un quiste nasolabial, por lo que se procede asu exéresis mediante abordaje intraoral sublabial. Posteriormente, el análisis anatomopatlogico confirmó el diagnóstico de presunción

The nasolabial cyst is a very infrequent cyst, not odontogenic, that traditionally has been classified within those called fissured. Itsetiology is unknown and signifies that this origin can be in the fusion line of the frontonasal and maxillary processes, due to retention of ectodermal residue. Clinically, a swelling of slow growth and softconsistency is observed that produces the elevation of the lateral part of the nostril and it is asymptomatic, unless there is infection. In some cases of large expansion it can produce an osseous resorption of the alveolar process. For the diagnosis computerized tomographs or magnetic resonances are necessary, for the purpose of studying the soft tissues. The treatment of the lesion usually consists of surgical resection through an intraoralsublabial access. A clinical case is presented of a patient of66 years of age, who comes to the consultation with an increase of the volume of the left nostril and right rhinorrhoea. In the extraoral examination a nodule is observed in the vestibule at the level of the left nostril. After the radiological study it is concluded that the lesion is compatible with a nasolabial cyst, which was removed through a sublabial intraoral approach. Afterwards, the anatomopathological analysis confirmed the presumed diagnosis

Sobrepunta nasal como expresión de una comunicación septal / Supratip as expression of a septal communication

La deformidad del tercio medio nasal caracterizada por convexidad como resultado desafortunado de una rinoplastia estética, es una de las causas que con mayor frecuencia induce a una revisión quirúrgica. Se conoce con la denominación suprapunta, del inglés supratip y obedece a distintos orígenes. En su etiología, intervienen elementos anatómicos del dorso del tercio medio nasal. Mencionamos en este artículo una causa inédita: una comunicación interfosas nasales. Atribuimos su etiopatogenia a la síntesis insuficiente de la incisión intersep to-columelar; la insuficiente resección de la mucosa del tabique en su borde inferior y en su ángulo anterior, unida a la mucosa excedente contralateral, forman una comunicación que se torna definitiva. Hacemos hincapié en la necesidad de un examen clínico exhaustivo de las fosas nasales para descartar esta etiología. El tratamiento quirúrgico consistió en la resección de la comunicación y la cobertura del defecto creado con colgajos de vecindad del mismo tabique. Enumeramos las medidas preventivas para evitar este tipo de contratiempo (AU)

The supratip prominence is one of the most common deformity that requires a revision rhinoplasty. Their etiology can result from a variety of causes, that including poor management of skeletal tissue in the supratip region. The authors add an unpublished cause: septal fistula (septal communication). The overstepped mucosal at the inferior edge and the anteriorseptal angle, with the exceeding mucosal from opposite side, producing a permanent septal communication. The diagnosis is based on the clinical exploration; we recommend an exhaustive inspection of the nasal fosses (septum). Surgical procedure consist on surgical resection of the communication using local septal flaps for plastic repair. Finally we describe the preventive management (AU)

Reconstrucción de nariz y labios en secuela de quemadura eléctrica / Nose and lips reconstruction in electrical burn sequela

Presentamos el caso de un paciente joven, víctima de quemadura eléctrica en la cara, con complejas secuelas en la zona de boca y nariz, pérdida de sustancia de parte del componente cartilaginoso de dorso, punta, colemula y alas nasales, además de pérdida de labio superior e inferior, e importantes retracciones cicatriciales en áreas de vecindad. Fue sometido a reparación quirúrgica de la pérdida de sustancia nasal mediante colgajos supratrocleares y a reconstrucción de labio superior e inferior mediante colgajo cervical pediculado, según descripción de Tsur y col. El resultado fue una buena cobertura nasal y la reconstrucción de los labios preservando sus funciones masticatorias y de habla, mejorando además la imagen estética del paciente (AU)

We present a clinical case of a young man, victim of electrical burning to the face, with complex injuries to the mouth and nose. He presented cutaneous and framework damage to the nose and cutaneous damage to superior and inferior lips. He was submitted to nose repair with supratroclear flaps and mouth repair with bipedicular randomlybased cervical flap according to Tsur et al. The treatment allowed satisfactory nose cover and lips reconstruction, improvement on mastigatory function and speech as well as aesthetically accepted face (AU)

Defectos del dorso nasal tratados con injerto autólogo / Defects of the nasal dorsum treated with autologous graft

Se operaron 10 pacientes con defectos del dorso nasal, 9 catalogados de grandes (4 mm o más) y uno con menos de 1 mm. En la mayoría predominó el sexo masculino y el defecto fue adquirido. En 9 de los pacientes con defectos grandes se utilizó injerto de hueso de cresta ilíaca en forma de L descansando en huesos propios y espina nasal, y en uno con defecto pequeño se utilizó cartílago. El resultado es evaluado después de 8 años como satisfactorio estética y funcionalmente, sin evidencia clínica de reabsorción(AU)

T10 patients were operated on of the nasal dorsum. 9 were considered as large (4 mm or more) and 1 as small with less than a mm. It was observed a prevalence of males and the defect was acquired. In 9 of the patients with large defects, it was used L-shaped iliac crest bone graft, lying on own bones and nasal spine. Cartilage was used in one patient with smalldefect. The result was evaluated 8 years later as satisfactory from the aesthetical and functional point of view, without clinical evidence of reabsorption(AU)

Novos critérios para caracterizaçäo da facies leprosa / New criteria for the characterization of facies leprosa

As facies leprosa foi caracterizada pelo conjunto das alteraçöes nasais e reabsorçäo dos ossos nasais, da espinha nasal anterior, da regiäo alveolar supra-incisiva do processo alveolar anterior da maxila, associadas ainda a perda dos dentes incisivos superiores, de acordo com os critérios de interpretaçäo radiográfica

Trauma nasal en el recién nacido: valoración en 100 partos / Nasal trauma in newborn babies: study on 100 deliveries

Con el objeto de señalar la importancia del examen nasal neonatal, se evaluaron los recién nacidos de 100 partos consecutivos, en la unidad tocoquirúrgica del hospital ABC, durante un periodo de seis semanas. Se propone un protocolo de examen rinológico externo e interno que puede ser realizado por el personal de pediatría durante la evaluación neonatal rutinaria, con posibilidad de consulta al especialista otorrinolaringólogo, si fuese requerido. De un total de 58 niñas y 42 niños recién nacidos, el 48 por ciento presentó algún hallazgo positivo de trauma nasal. Los bebés se dividieron en tres grupos: nacidos por cesárea, por parto eutócico o por parto distócico. En cada grupo se cuantificaron los hallazgos para comparación. Solamente un caso presentó patología nasal lo suficientemente severa como para requerir reparación. Obviamente, es importante el seguimiento de los niños para determinar la posible repercusión de los hallazgos traumáticos en el crecimiento y desarrollo de la nariz

Treatment (ou management) of alar deformity in secondary rhinoplasty, upon external incision

The authors report their experience on treating 32 cases of postoperative alar deformit with external incision, and they conclude that the advantages, mainly represented by a wide exposure and the facility on execution of the correction's procedures, plainly justify the method