Measurement of Nasal Skin Thickness and Body Mass Index in Preoperative Rhinoplasty Patients Utilizing Computed Tomography Scanning and Ultrasound Techniques: A Prospective Comparative Study.

One of the most important indicators of rhinoplasty success is nasal skin thickness. Nasal thickness can lead to irregularities over the osseocartilaginous framework among patients with thin nasal skin and difficulty making tip work changes in patients with thick nasal skin. This study aimed to compare different objective methods. These include computed tomography (CT) and ultrasound (US) techniques, and report the relationship between nasal skin thickness and body mass index (BMI). A prospective cross-sectional study that included all patients at the rhinoplasty clinic (King Abdul-Aziz University Hospital), Riyadh, Saudi Arabia, between December 2022 and March 2023. Age, sex, and Fitzpatrick skin type were collected from the patients' histories and physical examinations. Body mass index was calculated for the subjects. The study sample included 29 patients. The median age of the patients was 25 years (interquartile range: 20-32 y). Most of the included patients were Saudi (89.7%, n = 26). Females represented 62.1% of the study sample. The average BMI was 25.6 ± 4.95 kg/m 2 . The highest correlation was observed between the US and CT tip ( r = 0.544, P < 0.01) and rhinion ( r = 0.525, P < 0.01) measurements. Body mass index was not associated with any US or CT measurements when BMI was used as a continuous or ordinal variable. The correlation between the US and CT measurements was highest for rhinoin and tip measurements, whereas supratip measurements were not correlated ( r = -0.029, P = 0.88). The correlation between mid-dorsum and nasion measurements was low (~0.3). The correlation between nasal skin thickness using CT and US varies depending on the nasal point and location. Body mass index was not associated with nasal skin thickness.

Acute Vision Loss in Patients With Allergic Fungal Rhinosinusitis: A Case Series.

Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic noninvasive sinusitis accounting for 7.8% (0.2%-26.7%) of all chronic rhinosinusitis cases. A definitive diagnosis is usually made after sinus surgery. Successful treatment requires a combination of surgical and medical management. Although orbital involvement is relatively common, reports on optic neuropathy and acute vision loss are limited. Herein, we present a series of 3 patients with AFRS who presented with acute visual loss as the chief complaint. All 3 patients were otherwise healthy adults in their early 20s with extensive nasal polyps on endoscopic nasal examination and bone erosion in the bilateral orbits and lateral wall of the sphenoid sinus on the affected side on imaging. One of the 3 patients had bilateral cranial nerve IV defects in addition to cranial nerve III defects. All patients underwent endoscopic sinus surgery with orbital decompression and were followed up postoperatively by both otolaryngology and ophthalmology services with endoscopic and radiologic evaluation. Unfortunately, no meaningful improvement in vision was observed in any patient despite successful nerve decompression. Prompt diagnosis and early medical and surgical intervention are warranted to prevent complications in patients with AFRS with orbital extension.

Demographic and clinical profile of patients with chronic rhinosinusitis in Saudi Arabia.

OBJECTIVES: To determine the clinical features of patients with chronic rhinosinusitis at a tertiary hospital in Riyadh, Saudi Arabia. METHODS: A cross-sectional study was carried out at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. We enrolled 660 male and female participants with medical records indicating a history of chronic rhinosinusitis between 2021 and 2022. Quantitative and descriptive analyses of age, gender, nationality, presence of polyps, aspirin sensitivity, presence of urticaria, asthma, and allergies were performed. RESULTS: Of the 660 enrolled patients, 60% (n=396) were male and 40% (n=264) were female. Additionally, 67.7% (447) had nasal polyps, 32% had a history of asthma, 10% had hypersensitivity to aspirin, 1.4% reported a history of urticaria, 9.7% reported allergies to medications, 7.9% reported food allergies, 26% reported multiple allergies, and 1.8% reported environmental allergies. CONCLUSION: Our study revealed the following: Samter's triad was present in 6.9% of participants with chronic rhinosinusitis; the greatest prevalence of chronic rhinosinusitis with nasal polyps was observed among those older than 50 years. The prevalence of urticaria was not significantly different among groups; a higher rate of environmental allergies was observed among those with CRSwNP than among those without nasal polyps; and a higher prevalence of aspirin hypersensitivity was observed among those with CRSwNP than among non-polyps group.

Facial Angles in Arabian Women Seeking Rhinoplasty.

The purpose of this study is to determine the average values of the angular nasal anthropometric variables in Arabian women seeking rhinoplasty and compare them with the normal values. A total of 150 female patients, who underwent rhinoplasty between January 2018 and November 2021, were enrolled in this study. The exclusion criteria were a history of nasal trauma, previous rhinoplasty, and a cleft nose. Data were obtained from standardized digital photographic images. Lateral and basal views were analyzed using landmarks defined by a single observer and measurements were performed using Adobe Photoshop Software SC6. All data were analyzed using SPSS version 21 software (IBM) and compared with the normal values obtained from a previous study. All facial angles, except for the nasofrontal angles, were significantly different between the surgical and nonsurgical normal groups. The values (means±SDs) in the surgical group were as follows: nasofacial angle, 29.7±3.4 degrees; nasofrontal angle, 146.2±2.8 degrees; glabella-nasal angle, 169.8±5.8 degrees; nasolabial angle, 113.5±11 degrees; nasomental angle, 130.6±6 degrees; nasal tip angle, 102.3±8 degrees; ala-slope angle, 95.4±13.6 degrees. The nose characteristics of Arabian women seeking rhinoplasty were as follows: (1) shallow radix, (2) under the projected tip, and (3) normal tip rotation. Surgical planning is important upon consideration of any procedure or modification of the nose among Arabian women.

Pregnancy-Related Giant Nasal Mass: A Diagnostic Dilemma.

SIGNIFICANCE STATEMENT: Pregnancy-related giant nasal masses often present a diagnostic challenge and clinical dilemma due to the obvious restrictions in utilizing imaging and general anesthesia during pregnancy. Therefore, we highlight the importance of clinical judgment, especially during pregnancy, and should not disregard certain clinical cues. In addition, we recommend an in-office polypectomy for giant nasal polyps worsening during pregnancy and nasal steroids to optimize their quality of life while avoiding systemic medications or further interventions.

Glycine Transporter 1 Encephalopathy From Biochemical Pathway to Clinical Disease: Review.

Glycine transporter 1 encephalopathy (OMIM# 617301; glycine encephalopathy with normal serum glycine, GLYT1 transporter dysfunction, and nonketotic hyperglycinemia) is caused by mutations in the SLC6A9 gene. To date, 6 cases have been reported in the literature, characterized as having neonatal onset, respiratory failure that required mechanical ventilation, severe hypotonia at birth that progressed to limb hypertonicity, and startle-like responses provoked by sudden loud noises and tactile stimulation. Additional characteristics included dysmorphic features, musculoskeletal abnormalities, and abnormal antenatal findings. Initial diagnosis include elevated levels of glycine in cerebrospinal fluid and an elevated cerebrospinal fluid to plasma glycine ratio. Abnormal magnetic resonance imaging findings included white matter abnormalities, thin corpus callosum, dilatation of the lateral and third ventricles, caudate atrophy, and tiny cysts. Patients reported so far showed normal electroencephalogram results. Treatment was supportive and appeared severe as 50% of the patients died between 2 days and 7 months of age, while surviving children had global developmental delay. In this report, we reviewed the published cases having glycine transporter 1 encephalopathy and retrospectively characterizing the disease phenotypes, affected biochemical pathways, neuroradiological abnormalities, diagnosis, genetic issues, and treatment; additionally, key discussion points are also presented.