Accuracy of predissection assessment of the lower lateral cartilage configuration: a cadaveric study.

BACKGROUND: Preoperative planning of nasal tip surgery requires an accurate assessment of the nasal tip cartilages configuration. The current literature lacks any evidence on the accuracy of preoperative assessment of the lower lateral cartilages (LLC) shape. OBJECTIVE: This study was designed to determine the accuracy of the LLC shape and configuration assessment prior to dissection. METHODS: The configuration of the lateral, middle, and medial crura was assessed on 42 LLC (21 cadavers) prior to dissection by way of observation and palpation. The findings were then compared with those observed after LLC exposure through an open-approach dissection. RESULTS: The accuracy of predissection LLC shape assessment was 42 of 42 (100%), 32 of 42 (76%), and 12 of 42 (29%) for medial, middle, and lateral crus, respectively. CONCLUSIONS: The configuration of the lateral crus of LLC cannot be accurately assessed prior to exposure of the cartilage. A rhinoplastic surgeon who embarks on nasal tip surgery should be familiar with a number of techniques to address any tip deformity encountered after exposure, as the preoperative clinical and photographic assessments cannot reliably demonstrate the type of LLC deformity.

Prospective study to assess vocal cord palsy investigations.

OBJECTIVES: To assess the investigation and clinical outcome of patients presenting with unexplained vocal cord palsy (VCP). STUDY DESIGN AND METHODS: A prospective cohort study designed to evaluate 86 patients with unexplained VCP presenting to our tertiary referral center. RESULTS: Twenty-four (36%) patients had positive findings on CT scanning. Twenty-one (24%) cases showed mediastinal adenopathy +/- pulmonary mass. The other three cases were a thoracic aneurysm, prostatic metastasis below the skull base, and a postcricoid tumor. Follow-up period was 18 to 66 months. Fifteen (24%) of the 62 patients with negative radiology recovered full vocal cord movement. CONCLUSION: CT neck +/- chest plays an important role in the evaluation of VCP patients. The majority of pertinent radiologic findings involve malignant neoplasm.

Predictive value of sleep nasendoscopy in the management of habitual snorers.

Sleep nasendoscopy (SN) is claimed to identify the site of obstruction in habitual snoring and is used to select patients for palatal surgery. The validity of SN is, however, unproven. This is the first prospective blind assessment of the role of SN in the management of habitual snorers. Fifty-five consecutive patients listed for laser-assisted uvulopalatoplasty (LAUP) for simple snoring on clinical criteria underwent SN immediately before surgery. Snoring severity and Epworth Sleepiness Scales were completed before the operation and at least 3 months after the operation. The postoperative scores on the snoring severity scale had significantly improved after LAUP, for each SN grade: grade 1 (palatal obstruction; p = .04) and grade 2 (multisegmental obstruction; grade 2A, p = .003, and grade 2B, p = .01). The Epworth Sleepiness Scale showed significant improvement in the whole group (p = .02). We conclude that SN grading of sites of pharyngeal collapse is an insufficient basis to exclude patients from LAUP. Sleep nasendoscopy is thus not of value in the management of habitual snoring, as the measure is a poor predictor of favorable outcome after palatal surgery.