Use of alloplastic implants for correction of deviated nasal septum: Systematic review and meta-analysis.

PURPOSE: To systematically reviews the safety and effectiveness of alloplastic implants (AI) in septoplasty. METHODS: We conducted a comprehensive search in Medline, EMBASE, SCOPUS, CINAHL, and Cochrane Library databases to identify articles on septoplasty using AI. We also manually searched reference lists of included articles. Inclusion criteria involved prospective or retrospective case-series studies of adults with deviated nasal septum (DNS) who underwent septoplasty with AI, with sufficient follow-up data. Two authors independently screened articles, reviewed full manuscripts, and extracted data. RESULTS: Out of 5370 articles, 16 met inclusion criteria, encompassing 884 patients from 14 eligible studies. Most studies had fair quality. AI materials included Polydioxanone (PDS), Polycaprolactone (PCL), Titanium, Macropore, and PolyMax. AI usage improved nasal obstruction in most patients, with 95.6 % (84.8 %-100 %) based on physical examination and 96.9 % (89.6 %-100 %) based on symptoms. AI-related complications occurred in 4.3 % (0 %-12.8 %) of cases, mostly non-serious. CONCLUSIONS: AI use can be considered as a useful adjunct in septoplasty, with uncommon complications similar to standard procedures. However, due to limited-quality evidence, further prospective controlled studies are needed.

Comparing the piezoelectric and conventional osteotome in rhinoplasty.

IMPORTANCE: Edema affects outcomes in Rhinoplasty. Edema and bruising influences patient satisfaction in the perioperative period. OBJECTIVE: A qualitative analysis of edema comparing piezoelectric and conventional osteotome, and a qualitative comparison of bruising between these methods. DESIGN: A prospective cohort study of 31 aesthetic Rhinoplasty cases. Participants act as their own control measure. An osteotome is used on one side of the nasal bone and a piezoelectric is used contralaterally. MAIN OUTCOMES AND MEASURES: Edema is calculated by comparing a pre and post-operative 3-D image with volumetric analysis. Ecchymosis is scored and compared. RESULTS: The mean volume of the piezoelectric was 1.37 cc (SD 0.87) and the mean volume of the osteotome was 1.17 cc (SD 0.70) (0.19 absolute difference [95 % CI 0.3 to 0.35], p = 0.02). Bruising scores were 0.35 points lower for the piezoelectric arm (-0.35 absolute difference [95%CI -0.7 to 0.06], p < 0.01). This corresponded to 26 % of lateral piezo osteotomies having significant bruising compared to 38 % of the lateral osteotomies using the conventional technique. CONCLUSION: There is a difference in postoperative edema and bruising with the piezoelectric and conventional osteotome for lateral osteoetomy in Rhinoplasty. There is more edema with the piezoelectric and more ecchymosis with the conventional osteotome.

Correcting a bent septum by a k-wire stabilization during an extracorporeal septal reconstruction.

BACKGROUND: Extracorporeal septoplasty has been successfully employed in difficult cases of septal deviation. A novel technique of wire fixation during extracorporeal septoplasty is presented. METHODS: All patients had complete or near complete nasal airway blockage. The quadrangular cartilage was entirely removed through an open approach. The bent areas were scored, and K-wires were placed to fix the cartilage in the straightened position. The cartilage was replaced and fixated to the bony septum, upper lateral cartilages, and anterior maxillary crest. The K-wire was removed after 6 weeks. RESULTS: Fifteen of 17 patients retained straightness of the septum, and 13 of 17 achieved subjective improvement in nasal breathing. There was one skin infection which was treated with oral antibiotics with complete resolution. Two wires required a percutaneous incision to remove. CONCLUSIONS: The presented technique of extracorporeal septoplasty with wire fixation can be successfully employed for extreme septal deviations. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Pilot study to determine barriers to accessing sinus surgery.

OBJECTIVE: Given that anecdotal evidence has suggested that certain groups of patients have difficulty accessing sinus surgery, this study aimed to discover the characteristics and access factors that deter patients from surgery. SETTING: Patients were recruited from a community, academic otolaryngology-head and neck surgery practice serving a diverse community. DESIGN: In this cross-sectional study, patients with chronic sinusitis completed a pilot-tested questionnaire. We compared patients who already had sinus surgery to those who had not. MAIN OUTCOME MEASURES: The measured outcomes were descriptive statistics regarding patient demographics and direct ability to obtain sinus surgery. RESULTS: Of those surveyed, 26 patients had undergone surgery, whereas 18 patients had not. There were no differences between groups in terms of ability to speak English; however, there was a smaller component of employed patients in the presurgery group compared to the postoperative group. Age and ethnicity differed between groups, with more North American-born, younger patients in the presurgery group. The ability to afford medications postoperatively or to take time off work for surgery did not differ between groups. Eighty percent of all patients said that they would not be able to take 2 weeks off work. CONCLUSIONS: We found that ethnicity and work status differed between patients offered surgery and those who have already undergone sinus surgery. Given that many patients reported difficulties in several access areas despite undergoing surgery, it seems that there are barriers to patients scheduling surgery that are being overcome by some.

Evaluating postoperative pain in monopolar cautery versus harmonic scalpel tonsillectomy.

OBJECTIVES: To compare postoperative pain between monopolar cautery tonsillectomy and harmonic scalpel tonsillectomy (HST). STUDY DESIGN: Randomized controlled trial using paired organs. SETTING: Community hospital with academic affiliation. SUBJECTS: One hundred and fourteen consecutive patients six years of age or older undergoing tonsillectomy for indications of hypertrophy or recurrent infection. METHODS: For each subject, monopolar cautery tonsillectomy was performed by four senior surgeons on one side and HST was performed on the other side. Allocation of technique to side was randomized and revealed to the surgeon at the start of the operation. Validated visual analog pain scales were used to quantify pain at rest and with swallowing for each side and were completed daily for 14 days. All subjects were prescribed weight-equivalent doses of analgesics. Secondary outcome measures included postoperative complications (hemorrhage and readmission). RESULTS: Pairwise comparisons of pain scores revealed no significant difference between monopolar cautery tonsillectomy and HST (P < 0.05). CONCLUSIONS: Subjects undergoing monopolar cautery tonsillectomy do not experience increased postoperative pain in comparison to HST.

Clinical experience with angulated, hand-activated, wireless instruments in an optical tracking system for endoscopic sinus surgery.

OBJECTIVES: Image-guided surgery of the paranasal sinuses has become a valuable tool in endoscopic sinus surgery. Optical image-guided systems using infrared tracking technology are widely used. We present our experience with new angulated, hand-activated, wireless instruments in an optical tracking system for endoscopic sinus surgery. DESIGN: Case series. SETTING: Community university teaching hospital. METHODS: Sixty-five consecutive patients underwent computer-assisted endoscopic sinus surgery using a Stryker Navigation System (Stryker Canada LP, Burlington, ON). Patients underwent preoperative fine-cut axial computed tomography. At the time of surgery, anatomic fiducials were registered and the measured fiducial registration error (FRE), which is an indicator of the accuracy of the optical system, was recorded. Angulated battery-powered active instrumentation was used during the surgery. MAIN OUTCOME MEASURES: FRE, the number of anatomic fiducials used, complication rates pre- and postuse of computer-assisted sinus surgery. RESULTS: The mean FRE was 2.02 +/- 0.48 mm. The mean number of anatomic fiducials used for registration was 5.98. There were no major orbital or intracranial complications. Use of angulated instruments rarely caused a line of sight problem. CONCLUSIONS: The new optical system has a measured FRE comparable to that of other image guidance systems. Our clinical experience shows that the instrumentation decreases the "line of sight" problem and is easy to navigate and manipulate without a wire attachment to the main computer.