Clinical and dosimetric predictors of radiation-induced rhinosinusitis following VMAT for nasopharyngeal carcinoma: A retrospective study.

Background: We aimed to investigate the clinical and dosimetric factors associated with radiation-induced rhinosinusitis, and further elucidate the optimal dose-volume constraints for nasopharyngeal cancer patients who underwent volumetric-modulated arc therapy (VMAT). Methods: A retrospective review of 196 nasopharyngeal carcinoma (NPC) patients who underwent definitive VMAT between August 2018 and May 2021 was conducted. Both clinical and dose-volume histogram (DVH) data of NPC patients without rhinosinusitis at baseline were selected for analysis. Results: The cumulative incidence of post-RT rhinosinusitis at the 3-, 6-, 9-, and 12-months, and >1 year were 29.6 %, 41.3 %, 42.9 %, and 45.4 %, and 47.4 %, respectively. Nasal irrigation was negatively associated with post-RT rhinosinusitis (p < 0.001). Higher cumulative incidences of maxillary and ethmoid sinusitis were associated with V70 > 1.16 % and >1.00 %, respectively (p = 0.027 and p = 0.002). Sphenoid sinusitis was more frequent when Dmax(maxillary sinus) exceeded 69.2Gy (p = 0.005). Conclusions: Regular nasal irrigation may reduce the development of rhinosinusitis. Dose-volume constraints of V70 and Dmax to the maxillary sinus are suggested for VMAT planning. Patients exceeding these thresholds should be closely monitored and potentially offered preventative interventions within 3-6 months post-RT.

Management of Wide Alar Lobule Using Preservation Rhinoplasty Philosophy: Alar Coring Technique.

A broad alar base disrupts nasal harmony and facial aesthetic balance and is an aesthetic concern for many patients. This wide appearance may be related to excessive nostril sill, alar flare, wide alar lobule, or a combination. Many techniques are described in literature to address the alar base with resultant scars to a variable degree. Management of alar lobule thickness is particularly challenging. Our technique presented here introduces a novel method to reduce the thickness of the alar lobule with excellent aesthetic outcome.

Facial Soft Tissue Augmentation With Bellafill: A Review of 4 Years of Clinical Experience in 212 Patients.

INTRODUCTION: Bellafill (Suneva Medical Inc) is a semipermanent injectable soft tissue filler composed of smooth and uniform polymethylmetacrylate (PMMA) microspheres suspended in a bovine collagen gel. It is a third generation PMMA filler, with more uniform shapes and sizes of the PMMA microspheres, which has been purported to decrease the incidence of granuloma formation. METHODS: We performed a retrospective review of our clinical experience from 2014 to 2017 with Bellafill as a soft tissue injectable filler in the following clinical scenarios: deep nasolabial folds, depressed facial acne scars, malar volume loss, temporal wasting, tear trough deformity, chin augmentation, angle of jaw augmentation, and lip augmentation. The primary outcome is the rate of adverse events, and the secondary outcome is subjective patient satisfaction. RESULTS: From 2014 to 2017, 842 syringes of Bellafill were administered to 212 patients, for a total of 417 procedures. Of the 417 procedures, 96 (23.0%) were for acne scars, 82 (19.7%) malar volume restorations, 65 (15.6%) nasolabial fold augmentations, 45 (10.8%) chin augmentations, 42 (10.1%) tear trough volume restorations, 28 (6.7%) temple volume restorations, 25 (6.0%) rhinoplasty touch-ups for small areas of nasal depression, 22 (5.3%) lip augmentations, and 12 (2.9%) jaw angle augmentations were performed. A range of 1 to 12 syringes were injected into each patient, over 1 to 3 sessions; 6 cases of adverse events occurred (1.4%). There were 4 cases of solitary nodules in the injection site, 1 case of lower eyelid oedema which persisted for 3 months and 1 case of lower lip oedema which resolved within hours. Patient satisfaction rates ranged from 83.3% for angle of jaw augmentation to 99.0% for improvement of acne scars. CONCLUSION: Bellafill is a safe and effective option for a semipermanent soft tissue filler, with high patient satisfaction and a good safety profile.

INTRODUCTION: Le Bellafill (Suneva Medical Inc.) est un produit de comblement injectable semi-permanent des tissus mous, composé de microsphères de polyméthymétracylate (PMMA) lisses et uniformes, suspendues dans un gel de collagène bovin. Il s'agit d'un produit de comblement de PMMA de troisième génération, dont les microsphères de PMMA, de formes et de dimensions plus uniformes, réduiraient l'incidence de granulomes. MÉTHODOLOGIE: Les chercheurs ont procédé à une analyse rétrospective de leur expérience clinique du Bellafill utilisé comme produit de comblement injectable des tissus mous dans les scénarios cliniques suivants entre 2014 et 2017: sillons nasogéniens profonds, cicatrices déprimées d'acné facial, perte de volume de l'os malaire, émaciation des tempes, dépression du rebord orbital inférieur, augmentation du menton, augmentation de l'angle des mâchoires et augmentation des lèvres. Le résultat primaire était le taux de réactions indésirables et le résultat secondaire, la satisfaction subjective des patients. RÉSULTATS: Entre 2014 et 2017, les plasticiens ont injecté 842 seringues de Bellafill à 212 patients, pour un total de 417 interventions. De ce nombre, 96 (23,0 %) visaient des cicatrices d'acné, 82 (19,7 %), la restauration du volume de l'os malaire, 65 (15,6 %), l'augmentation des sillons nasogéniens, 45 (10,8 %), l'augmentation du menton, 42 (10,1 %), la restauration du volume du rebord orbital inférieur, 28 (6,7 %), la restauration du volume des tempes, 25 (6,0 %), les retouches des petites zones de dépression nasale après une rhinoplastie, 22 (5,3 %), l'augmentation des lèvres, 12 (2,9 %), l'augmentation de l'angle de la mâchoire. Chaque patient s'est fait injecter de une à 12 seringues, réparties entre une et trois séances. Six cas de réactions indésirables se sont produits (1,4 %), soit quatre cas de nodules solitaires au point d'injection, un cas cas d'œdème de la paupière inférieure qui a persisté trois mois et un cas d'œdème de la lèvre inférieure qui a disparu en quelques heures. Le taux de satisfaction des patients a oscillé entre 83,3 % pour l'augmentation de l'angle de la mâchoire et à 99,0 % pour l'atténuation des cicatrices d'acnén. CONCLUSION: Le Bellafill est un produit de comblement des tissus mous à la fois sécuritaire et efficace, qui suscite une satisfaction élevée de la part des patients et possède un bon profil d'innocuitfi.

120 Years of Dorsal Preservation in Rhinoplasty.

Dorsal preservation techniques in rhinoplasty are experiencing a renaissance in recent years. New techniques and modifications to existing techniques are being described at an intensifying pace. Dorsal preservation, however, is not a new concept and was first described over 120 years ago. It is timely that we conduct a review of the key techniques and concepts of dorsal preservation in rhinoplasty that had been published over the past 120 years, at a moment in which we consider as a revival of this school of thought.

Lengthening of the Asian Nose.

The Asian nose has its unique morphology and forms a significant proportion of noses treated by the rhinoplasty surgeon not only in Asia but also in other countries where the Asian diaspora resides. The anatomical features and dimensions of the Asian nose differ from noses of persons of African, Caucasian, Indian, and Middle Eastern origins, poses its own challenges, and warrants a unique set of techniques for its aesthetic improvement. In this article, we present an overview of the approach to the lengthening of the Asian nose, drawing from our own experience with managing the Asian nose and referencing the published literature on the subject.

Anterior Nasal Spine Relocation for Caudal Septal Deviation: A Case Series and Discussion of Common Scenarios.

BACKGROUND: Deviation of the anterior nasal spine (ANS) is a common cause of caudal nasal septal deviation. In our experience, relocation of the deviated ANS is a useful technique in the correction of the caudal septal deviation. OBJECTIVES: To describe our experience with the ANS relocation technique in isolation and in combination with other techniques for correction of caudal septal deviation. METHODS: A retrospective chart review was performed on cases of ANS relocation. RESULTS: A total of 378 patients underwent ANS relocation over 4 years. Complete straightening of the septum occurred in 312 cases (82.5%), and significant improvement with mild remnant deviation occurred in 66 cases (17.5%). No patients had severe remnant deviation. None of the patients requested for revision surgery. A total of 351 patients (92.9%) experienced significant subjective improvement in bilateral nasal airflow, while 27 patients (7.1%) experienced mild improvement in bilateral nasal airflow. None of the patients had worsened airflow after surgery. CONCLUSION: The ANS relocation technique is a useful and effective technique which can be used in isolation or in combination of other techniques for the correction of caudal septal deviation. LEVEL OF EVIDENCE IV: 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.

Primary nasopharyngeal polyps: a case series on a rare clinical entity.

Primary non-neoplastic polyps originating from the nasopharynx have not been reported in the English language literature. We present the clinical and histopathological features of three primary nasopharyngeal polyps. Clinical data of three patients with primary nasopharyngeal polyps treated at the Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University between 2005 and 2015 were analyzed and presented. Three male patients from 45 to 63 years presented with nasopharyngeal masses. CT or MRI examination showed nasopharyngeal space-occupying lesions. Two patients were initially diagnosed with nasopharyngeal angiofibroma and one patient with nasopharyngeal carcinoma. After surgical excision, based on the histological examination, the tissue masses were all diagnosed as inflammatory polyps. Histologically, the polyps demonstrated significant oedema, collagen deposition, leukocytic infiltration, and epithelial remodelling. Primary nasopharyngeal polyps represent a distinct clinical entity and should be considered in the differential diagnosis of nasopharyngeal masses.

Histopathological features of sinonasal inverted papillomas in chinese patients.

OBJECTIVES/HYPOTHESIS: Nasal inverted papilloma (IP) is a benign tumor with high recurrence rates. Evidence of inflammation has been reported in IP in Caucasian studies. This study aimed to investigate the histopathological patterns and their associations with clinical characteristics in Chinese patients with IP. STUDY DESIGN: Basic science study. METHODS: IP tissues were obtained from 50 Chinese patients with unilateral IPs. Biopsies of inferior turbinate mucosa from 17 healthy subjects were used as controls. The histological patterns and severity of epithelial remodeling and inflammatory cell infiltration were evaluated and analyzed for associations with clinical characteristics. RESULTS: Thirty-one percent of IP specimens were classified as grade I (mild remodeling) and 49% as grade II (moderate and severe remodeling). Concomitant inflammatory nasal polyps were found in 14 patients (28%). Recurrent IP was strongly associated with grade II (odds ratio: 5.81, 95% confidence interval: 1.34-25.18). Except CD4(+) T cells, quantities of neutrophils, macrophages, eosinophils, CD8(+) T cells, and FoxP3(+) T-reg cells were significantly elevated in IP. Of these, neutrophils were the predominant cell type in IP. CONCLUSIONS: Inflammation may have potential roles in IPs and the higher grade of epithelial remodeling was associated with the recurrence of IPs. LEVEL OF EVIDENCE: NA.

Smoking is an independent association of squamous metaplasia in Chinese nasal polyps.

BACKGROUND: Nasal polyposis demonstrates histological features of epithelial remodeling and variable inflammatory cellular infiltration. We studied a large series of Chinese nasal polyp (NP) samples to characterize these histological features and their associations with clinical characteristics. METHODS: A detailed histological study of nasal polyposis was performed employing various histopathological techniques. A total of 153 intraoperative NP biopsies were analyzed histologically. Sections were examined under microscopy to determine the percentages of different types of inflammatory cells, and types of epithelial remodeling. Two systems of subtyping NPs based on inflammatory cell infiltration were assessed. These were correlated with patient characteristics. RESULTS: Epithelial remodeling patterns include epithelial hyperplasia (87.8% of specimens), goblet cell hyperplasia (53.2%), and squamous metaplasia (44.6%). Smoking was a strong independent association of squamous metaplasia (adjusted odds ratio [OR] 9.9; 95% confidence interval [CI], 4.2 to 22.9; p < 0.01). The most common inflammatory cells were neutrophils (median of 12.8%) and CD8+ T cells (12.8%), followed by macrophages (11.0%), CD4+ T cells (9.7%), eosinophils (8.6%), and mast cells (7.6%). We defined 2 systems to classify NPs based on proportions of eosinophils and neutrophils. The majority of NP samples were neutrophilic. The first classification system has greater histological correlation. Based on the first classification, eosinophilic nasal polyposis was associated with epithelial hyperplasia (OR 3.7, p = 0.019) and goblet cell hyperplasia (OR 3.4, p < 0.001). CONCLUSION: The majority of Chinese NPs are neutrophilic and epithelial hyperplasia is the most common pattern of epithelial remodeling. We show for the first time that smoking has a strong association with squamous metaplasia in nasal polyposis.

An Innovative 3-dimensional Model of the Epitympanum for Teaching of Middle Ear Anatomy.

OBJECTIVE: To facilitate teaching of the anatomy of the epitympanum, we developed and evaluated the effectiveness of an interactive 3-dimensional (3D) computer model that can be viewed from all angles. STUDY DESIGN: Questionnaire-based prospective randomized controlled trial. SETTING: Undergraduate medical education program. SUBJECTS AND METHODS: The model was created using Google Sketchup, a 3D modeling software. We recruited 72 graduating medical students and randomized them into 2 groups. One group was given the 3D model and reading materials on the epitympanic anatomy (3D group), while the other group relied on reading material and pictures (2-dimensional [2D] group). A questionnaire and anatomy quiz assessed the utility of the 3D model in learning the anatomy of the epitympanum. RESULTS: The mean age of the participants was 22 years. There were no statistically significant differences in demographics and previous experience with 3D models. The 3D group was significantly more confident in its ability to identify structures of the epitympanum on pictures and computed tomography scans when compared to the 2D group. Most participants were in favor of the model as a useful learning tool and preferred to use it with an instructor. In the anatomy quiz, the 3D group fared significantly better, achieving a mean score of 65.1% compared to 32.4% in the 2D group (P < .001). CONCLUSION: The 3D teaching model of the epitympanum is efficacious in short-term recall. By allowing the learner to visualize relations of the epitympanum from all directions, the model aids in appreciation of anatomy and identifications of structures of this region.