Osmophobia and olfactory functions in patients with migraine.

Olfactory dysfunction and migraine has been associated for a long time. In this study, we planned to compare olfactory functions in patients with migraine and osmophobia with patients having migraine but no osmophobia, in addition with a normal control group using "Sniffin' Sticks" test. The main distinction of this study is that all qualitative and quantitative properties of olfactory functions; threshold, discrimination and identification, are evaluated separately and jointly. Thirty healthy person aged between 16 and 56 (18 women, 12 men) and 60 migraine patients aged between 15 and 54 (39 women, 21 man) were included in the study. All patients have been inquired about osmophobia and have been assessed with Hedonic tone assessment. Osmophobia has been tested for perfume, cigarette smoke, leather, stale food, soy sauce, fish, spices and coffee smells. Olfactory functions has been assessed with "Sniffin' Sticks" smell test. Thresholds, discrimination and identification have been determined for each patient. In migraine patients with osmophobia, threshold was 7.75 ± 2.3, in migraine patients without osmophobia threshold was 8.25 ± 1.5 and threshold was 10.75 ± 1.3 for the control group. Discrimination score was 6 ± 1.2 in migraine patients with osmophobia, 9 ± 0.8 in patients without osmophobia and was 12 ± 1.4 in the control group. In migraine patient with or without osmophobia Threshold/Discrimination/Identification (TDI) scores were lower than the control group. The most important parameter in our study is that discrimination scores were especially lower in patients with osmophobia. We believe that this decrease in discrimination in migraine patients with osmophobia; who claim that they smell everything and they are sensitive to all smells, is significant. Further studies about smell discrimination will help better understand some conditions; especially anosmia and hyposmia after upper respiratory tract infections and parosmia.

An Effective Technique for Nasal Radix Reduction in Septorhinoplasty: Procerus Muscle Resection.

In rhinoplasty patients radix position profoundly impacts the appearance of the nasal profile by influencing dorsal length, contour, angulation, and height. The authors wanted to introduce a new perspective to radix, and decided to focus on subcutaneous tissues, especially procerus muscle. Actually resection of procerus and corrugator supercilii is a part of browlift and endoscopic facelift techniques, with which the authors are already familiar.In this short report and video, the authors wanted to present a new technique to lower radix area. This technique is based on face anatomy, and muscles under radix area, and takes its roots from facelift techniques. Before introducing the authors' technique the authors wanted to show the effect of soft tissues on radix with lateral nasal x-rays. With this maneuver the soft tissue thickness of radix area is thinned.

Effect of controlled hypotension on regional cerebral oxygen saturation during rhinoplasty: a prospective study.

The aim of this study was to investigate the effect of controlled hypotension on cerebral oxygen saturation (rSO2) using near infrared spectroscopy (NIRS) and evaluation of postoperative cognitive function in patients undergoing rhinoplasty. Fifty adult patients who were scheduled for elective rhinoplasty surgery and required controlled hypotension were enrolled in this prospective study. Controlled hypotension was provided using a combination of propofol and remifentanil infusion supplemented with nitroglycerin infusion as necessary. rSO2 was evaluated during controlled hypotension by NIRS. Cerebral desaturation was observed in 5 out of 50 patients (10 %) during hypotensive anesthesia. The greatest decrease from baseline was 28 % when MAP was 57 mmHg. In both non-desaturated and desaturated patients, postoperative MMSE scores were significantly lower than preoperative scores. There was a 4 % decrease in the non-desaturated patients and a 7 % decrease in the desaturated patients when preoperative and postoperative MMSE scores were compared. A decline in cognitive function 1 day after surgery was observed in 23 patients (46 %) and in all patients with intraoperative cerebral desaturation. The current study showed that even if SpO2 is in the normal range, there might be a decrease of more than 20 % in cerebral oxygen saturation during controlled hypotension.

The evaluation of olfactory function in individuals with chronic halitosis.

Halitosis and olfactory dysfunction may disrupt an individual's quality of life remarkably. One may ask whether halitosis has effects on olfactory functions or not? Thus, the aim of this study was to evaluate the olfactory abilities of subjects with chronic halitosis evaluated using the measurements of volatile sulfur compounds. This study was carried out in 77 subjects, with a mean age of 40.1±13.3 years, ranging from 18 to 65 years. Forty-three participants were diagnosed as halitosis according to the gas chromatography results and constituted the halitosis group. Also, a control group was created from individuals without a complaint of halitosis and also who had normal values for volatile sulfur compounds. Each subject's orthonasal olfactory and retronasal olfactory functions were assessed using "Sniffin' Sticks" and retronasal olfactory testing. The results showed that odor threshold scores were lower in participants with halitosis compared with controls. Also, hyposmia was seen more common in the halitosis group than in controls. Moreover, a significant negative correlation was found between odor threshold scores and volatile sulfur compounds levels, particularly with hydrogen sulfide and dimethyl sulfide levels. The results suggest that the chronic presence of volatile sulfur compounds may have a negative effect on olfactory function.

Comparison of the anatomic and hearing outcomes of cartilage type 1 tympanoplasty in pediatric and adult patients.

As a graft material cartilage produces an excellent anatomical result with a low risk of re-perforation. However, there is a controversy among surgeons regarding its sound conduction properties, due to the thickness and stiffness of the cartilage. The aim of this study was to evaluate results of cartilage type I tympanoplasty and to compare anatomic and audiologic results in pediatric and adult patients. Patients with chronic otitis media who underwent cartilage type I tympanoplasty were evaluated retrospectively. Patient age, gender, pre and postoperative hearing levels, surgical technique and postoperative complications were recorded. Hearing outcomes of the patients were measured with tonal audiometry by comparing the pre and postoperative hearing threshold calculated at 0.5, 1, 2, and 4 kHz. Graft success rates and hearing outcomes of the pediatric and adult patients were compared. Of the 136 patients included in the study, 58 were male and 78 were female. The average age was 25.03. Forty-five patients were ≤16-year old and 91 patients were >16-year old. Intact graft was determined in 41 of 45 pediatric patients and 85 of 91 adult patients at the last follow-up visit. The overall graft success rate was 92.6 %. The mean pre and postoperative pure-tone average was 34.8 ± 8.5 and 23.4 ± 9.1 dB in adult patients, and 30.6 ± 7.7 and 17.8 ± 7.8 dB in pediatric patients. Cartilage graft provides a quite satisfactory anatomical result and perfect stability. Hearing outcomes of cartilage tympanoplasty are also acceptable in both children and adult patients.

Assessment of the correlation between nasal septal deviation and compensatory hypertrophy of the middle turbinate.

The aim of the study was to investigate the relationship between nasal septal deviation and the middle turbinate hypertrophy using computed tomography. In this retrospective analysis, we examined 77 patients with nasal septal deviation. The mucosal and bone structures of the middle turbinate and the angle of the septum were measured using radiological analysis. Measurements of the middle turbinate on the convex side were compared to those on the concave side. Measurements of the bony and mucosal structure area of the middle turbinate were significantly greater than those on the concave side. The dimensions of medial mucosa thickness and bone thickness were not significantly different between the convex and concave sides. No significant correlation was found between the angle of deviation and other parameters. The present findings suggest that compensatory middle turbinate hypertrophy was caused both by conchal bone growth and mucosal hypertrophy in patients with nasal septal deviation.

The comparison of the viability of crushed, morselized and diced cartilage grafts: a confocal microscopic study.

To compare the cellular viability of diced, crushed, and morselized cartilage used in nasal surgeries. In this study, cartilage was extracted from the ears of seven New Zealand rabbits and was subsequently either diced, crushed or morselized to an amorphous state, or left unmodified. The four types of grafts were then implanted in the back regions of the rabbits. After 3 months, the cellular viability from four groups was compared to a control group using confocal microscopy. Analysis of the data obtained from the enumeration of live cells showed no statistically significant difference between the unmodified graft group and the control group. The diced, crushed, and morselized cartilage groups did show a statistically significant difference in terms of live cell count with the highest number of live cells in diced cartilage group. A statistically significant decrease in live cell count was detected in crushed cartilage group. Our study shows that the viability of cells in diced cartilage grafts is greater than those in crushed or morselized cartilage grafts.

Secondary Improvement in Static Facial Reanimation Surgeries: Increase of Nasal Function.

OBJECTIVE: The aim of this study was to measure the effect of the static reanimation operation administered to patients with facial paralysis on nasal function area by comparing patients' preoperative and postoperative subjective perception of the nasal airflow. MATERIALS AND METHOD: We applied the Nasal Obstruction Symptom Evaluation (NOSE) scale to 13 patients who underwent static reanimation because of facial palsies, both preoperatively and postoperatively, and results were compared statistically. The changes in nasal base angulation were recorded and compared based on the photographs of patients taken before and after the surgery. RESULTS: Following the static reanimation operation, 76% (10/13) of the patients reported a subjective improvement in the nasal airflow, whereas 24% (3/13) did not report any change. Mean preoperative and postoperative NOSE scale scores were 66.92 ± 9.90 and 36.15 ± 9.61, respectively. The change in mean NOSE scale score was statistically significant (P < 0.001). In the preoperative and postoperative comparison of the photographs taken from the front view of the patients, a decreased nasal base angulation compared with preoperative period was detected in 8 (61.6%) patients. CONCLUSIONS: A statistically significant increase in subjective perception about nasal function was observed after the static facial reanimation; however, it is not certain whether this effect can be considered persistent. Long-term studies conducted on a larger patient population will provide beneficial results.

A Novel Method for Smooth Contouring of Nasal Tip: Camouflaging Alar Tip Graft.

The aim of this article is to define a tip graft that provides camouflage for a smoothly contoured, natural-looking tip and that prevents long-term graft visibility. When traditional grafts are used to substantially increase tip projection, there is a possibility for thinning of the skin and subsequent graft visibility. To avoid such unwanted results, the authors have developed a novel graft: the camouflaging alar tip (CAT) graft. In this study, the authors provide a retrospective analysis of the long-term follow-up of 742 patients from 2003 to 2013 in whom a CAT graft was placed. This article is a synopsis of the authors' 10 years experience in nasal tip surgery.

A novel method for nasal dorsal reconstruction: permanent fixation using Kirschner wire-guided hidden sutures.

BACKGROUND: In this study, we aimed to present a novel application and use of Kirschner wire-guided suturing that is less invasive and allows permanent fixation for nasal dorsal reconstruction. METHODS: A total of 23 patients, who underwent surgery between 2009 and 2013, were included in this study: 19 with saddle nose deformity and 4 patients with keystone area damage, or collapse of the dorsal nasal support during primary septoplasty or rhinoplasty. The patients were asked to fill out a nasal obstruction symptom evaluation (NOSE) scale preoperatively and at the postoperative sixth month to assess breathing quality. The patients were followed up for complications such as nasal dorsal contour irregularity, dorsal collapse, as well as graft malposition and infections. The results of the surgeries were assessed on the basis of preoperative and postoperative examinations, septal support test, NOSE scale results, and photographic comparison. RESULTS: The mean (SD) NOSE scales were 78.91 (10.09) and 30.48 (10.71) in the preoperative and postoperative periods, respectively. The difference of mean NOSE scale was statistically significant (P < 0.001). None of the patients experienced nasal dorsal collapse or graft malposition. Two patients had nasal dorsal irregularity complaints owing to inadequate costal cartilage edge beveling. None of the patients had complications of suture reaction, suture visibility, or suture extrusion. All of the patients stated that they were happy with the cosmetic outcome. CONCLUSIONS: Permanent sutures introduced through channels made with the Kirschner wire provide a less invasive, cosmetically pleasing, and functional solution, promising more reliable results in the long term.

The Soft Triangle: An Often Neglected Area in Rhinoplasty.

BACKGROUND: This study aims to focus on one of the lesser mentioned topics in discussions of aesthetic nose operations, the soft triangle. In addition to outlining the characteristics of the area, the various complications specific to the soft triangle are discussed along with methods and techniques utilized by the authors to avoid such complications. METHODS: One hundred twenty-seven of 841 (15 %) patients who were assessed both preoperatively and intraoperatively for the presence of an anatomical issue of the soft triangle were included in the study. Patients were divided into three groups according to their anatomical features that were identified intraoperatively. The preoperative and postoperative photographs of all patients were compared to assess the effects of the respective soft triangle grafts on both nostril length and the nostril/lobule harmony. RESULTS: The average follow-up time of the patients was 27 months (6-60). Postoperative notching (of various degrees) was found in six (6/127) total patients: one (1/31) patient in the first group, two (2/24) patients in the second group, and three (3/72) patients in the third group. CONCLUSION: Neglecting the soft triangle area might yield grim results in terms of cosmetic and functional aspects. To avoid these problems, incisions should be planned purposefully, and patients who have anatomically weak support should be identified so that additional precautions should be taken for these cases. 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 .

An Unexpected Otoplasty Complication: Temporal Nerve Paresis.

Otoplasty, for prominent ear correction, is the most common aesthetic surgery procedure done in children. While the outcome often has a positive impact on the psychological state of the patient, the procedure itself does have associated complications that must be considered. Common complications include hematomas, infection, necrosis, outer ear canal stenosis, extrusion of sutures, insufficient correction, overcorrection, keloids, and hypertrophic scars. This is the first case report of facial nerve palsy as a complication following otoplasty.

A novel flap technique for repairing large lower lip defects.

UNLABELLED: There are many well-established methods for the reconstruction of the lower lip. The selection of a particular method generally relies on the amount of lip resected and the amount of lip remaining. In cases of large defects (>50% of the lip length) where direct closure and lip-switch techniques are inadequate, a perioral flap is used. All techniques for perioral flaps described until now result in an unwanted decrease in circumoral opening. The only available method that keeps the circumoral opening the same is a distant or regional free flap, and this technique is usually reserved for more extreme defects because it is more radical, technically demanding, and can pose a greater risk of complications. In this study, we describe a novel technique for reconstruction of the lower lip using a perioral flap in which the circumoral opening is kept the same. 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.

Grade 4 tonsillar hypertrophy associated with decreased retronasal olfactory function: a pilot study.

Tonsillar hypertrophy is common in children, but it can also be present in adults. Enlarged tonsils, a significant anatomical barrier, may affect the flow of odor molecules from the oral cavity to the nasal passages, which has not yet been studied. Thus, we aimed to investigate the mass effect of palatine tonsillar hypertrophy on retronasal olfaction. This study was carried out in 146 subjects, with a mean age of 22.1 ± 2.2 years, ranging 20-29 years. An oropharyngeal examination of the participants was completed, and tonsillar hypertrophy was graded according to the subjective tonsil size scale. The participants were divided into four groups according to their tonsil size grading; then, each subject's orthonasal olfactory and retronasal olfactory functions were assessed using "Sniffin' Sticks" and retronasal olfactory testing. There were no differences observed between the groups in terms of age, gender, cigarette smoking, or alcohol consumption. In addition, there was no difference between the groups in terms of "Sniffin' Sticks" subtests and TDI scores. It was determined that the retronasal olfactory scores of the participants with grade 4 tonsil size were significantly lower than the retronasal olfactory scores of the participants with grade 1 tonsil size. The current investigation demonstrates that grade 4 tonsillar hypertrophy has significant negative effects on the retronasal route of olfactory sensing, when compared with grade 1 tonsillar hypertrophy.

Bifid inferior turbinate: a report of two cases.

Nasal turbinates are functionally important structures which extend from the lateral nasal walls to the nasal cavity. Lateral nasal wall anomalies are usually asymptomatic lesions which are incidentally detected. The most common variation of the lateral nasal wall is the pneumatization of turbinates. Anatomical variations of paranasal structures may present confusing intranasal landmarks. This may cause challenges in endoscopic sinus surgery. Bifid inferior turbinate is an extremely rare condition. In this article, we present two cases with bifid inferior turbinate. This variation should be kept in mind as a rare cause of nasal obstruction.

[Local flap reconstruction of resected non-melanoma malignant skin tumors: a case series of 57 patients]. / Melanom disi malign cilt tümörlerinin rezeksiyonu sonrasindaki defektlerin lokal cilt flepleri ile onarimi: 57 olguluk hasta serisi.

OBJECTIVES: In our study, we present a case series of 57 patients with non-melanoma malignant skin cancer involving the face who were treated with local flap reconstruction with literature review. PATIENTS AND METHODS: Between February 2010 and September 2011, 57 patients (37 males, 20 females; mean age 63.1 years; range 38 to 87 years) who were admitted to Ünye State Hospital Otolaryngology and Head and Neck and Dermatology Clinic with a preliminary diagnosis of non-melanoma skin cancer were retrospectively analyzed in terms of tumor histopathologically, location and treatment plan. RESULTS: The tumor distribution of the patients included basal cell carcinoma (n=39, 68.4%) and squamous cell carcinoma (n=18, 31.4%). The mean follow-up was 14.2 (range 8-23 months). The most common involvement site of the skin tumor was the nose (n=23, 40.3%), followed by forehead (n=8, 14%), lips (n=7, 12.2%), ears (n=6, 10.5%), cheeks (n=6, 10.5%), eyes (n=3, 5.2%), chin (n=2, 3.5%) and neck (n=2, 3.5%). CONCLUSION: Local flap reconstruction applied following surgical excision of skin cancer is an effective treatment method which can easily be used by ear nose throat surgeons.

Prolene mesh mentoplasty.

Augmentation mentoplasty is a cosmetic surgical procedure to correct chin retrusion or microgenia which usually requires placement of an alloplastic material over the pogonion, and which results in increased chin projection and a more aesthetically balanced facial profile. Polypropylene mesh is easy to purchase, widely available in a general hospital and most commonly used by general surgeons. In this series of 192 patients, we wanted to demonstrate our simple mentoplasty technique using prolene mesh that can easily be combined with a rhinoplasty procedure, with possible causes of infection and the rationale for using prolene mesh in such procedures.

Auricular Lobuloplasty.

OBJECTIVE: To evaluate surgical outcomes of auricular lobuloplasy. METHODS: In total, 13 patients (10 females and 3 males; average age, 32.3±8.48 years; range 21-44 years) who underwent auricular lobuloplasty were included in this study. Demographic characteristics, cause of surgery, presence of complications, and patient satisfaction were evaluated. RESULTS: The mean follow-up was 16.5±9.6 months with the shortest and the longest follow-up being 6 and 34 months, respectively. Surgeries were performed under local anesthesia in 10 cases (76.9%) and under general anesthesia in three cases (23.1%). Lobuloplasty were performed in eight cases (61.5%) with a diagnosis of partial lobule cleft, four cases (30.7%) with a diagnosis of elongated lobule, and one case (7.8%) with a diagnosis of congenital earlobe cleft. There were no postoperative complications and revision surgery was not necessary for any of the patients. CONCLUSION: Multiple surgical techniques exist for repairing earlobe deformities. Auricular lobuloplasty is a surgical procedure that has several advantages including safety, ease of use, and effectiveness.

Assessment of Approaches of Otorhinolaryngologists in Facial Plastic and Nasal Surgery: A Survey Study.

OBJECTIVE: To assess approaches and experiences of otorhinolaryngologists in facial plastic and nasal surgery. METHODS: In total, 234 surgeons (191 males and 43 females; average age, 37.22±8.4 years; age range, 26-63 years) were included. All participants were given a questionnaire comprising 22 multiple choice and closed-ended questions. All responses to the questionnaires were analyzed. RESULTS: Of 234 participants, 42 (17.9%) were residents and 192 (82.1%) were specialists in otorhinolaryngology. The most challenging cases in rhinoplasty were crooked nose (33.8%), ideal nasal dorsum (18.8%), revision cases (13.2%), and skin deformities (11.1%). The photodocumentation rate by surgeons before and after procedures of facial plastic surgery was 86.3%, whereas the intraoperative photodocumentation rate by surgeons was 47%. The most common facial plastic surgery procedures other than rhinoplasty were otoplasty (68.4%), filler-Botox-fat injections (20.5%), and mentoplasty (18.4%). CONCLUSION: This survey study is quite important because it assesses approaches of otorhinolaryngologists in facial plastic surgery. Although this study provides more valuable data for determining the current status, further studies with larger number of surgeons are required.