Does parental stress improve after pediatric tonsillectomy?

OBJETIVE: Parental stress is defined as a subjective perception that parenting demands are higher than their resources and is reportedly higher in parents who have children with both chronic and acute illnesses. Ear-nose-throat (ENT) disorders, such as recurrent infections and obstruction sleep disorders, are one of the most prevalent comorbidities in pediatric age. Worldwide, tonsillectomy stands as the surgical treatment for these conditions, associated with a significant burden on both the children and their parents. The purpose of this study is to determine parental stress levels before and after tonsillectomy and to ascertain whether these levels improve after the children's surgery. METHODS: This is a prospective cohort study enrolling 48 parents accompanying their children aged 3-10 for outpatient tonsillectomy surgery in a tertiary portuguese hospital. Consent for participation in this study was obtained and parental stress was determined using the portuguese version of Parental Stress Scale (PSS). All parents completed PSS before surgery and at the 6-month follow-up evaluation. RESULTS: Of the 48 surveys obtained, 38 were mothers aged from 24 to 45 years. The median age of children was 3 (3-9) years and half were girls. Surgery was performed due to obstruction sleep disorders in about 71 % of children. The overall average stress level was 29,19 (standard deviation 7,5), with higher scores being associated with male children. At the 6-month reevaluation PSS was significantly lower (26,98), with a prominent reduction in the parental stress subscale in mothers comparing to fathers. CONCLUSIONS: These results highlight the importance of prompt diagnosis and treatment of children requiring tonsillectomy, as this condition may affect not only their physical health, but also parental relations, reflecting on their upbringing.

The Spare Roof Technique as a New Approach to the Crooked Nose.

Background: The literature reporting outcomes in crooked nose patients submitted to surface dorsal preservation techniques is almost nonexistent. Objectives: To evaluate aesthetic and functional outcomes in crooked nose patients undergoing rhinoplasty with the Spare Roof Technique (SRT). Methods: Prospective, interventional, and longitudinal study performed on patients presenting a crooked nose undergoing primary rhinoplasty by SRT. The validated Portuguese version of the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty and a visual analog scale were used to assess aesthetic and functional outcomes, respectively. Patients completed the questionnaire preoperatively and again 3 and 12 months postoperatively. Results: The study population included 54 Caucasian Mediterranean patients (34 female), mean aged 34.5 years. The SRT resulted in a highly significant improvement in all questions regarding subjective body image in relation to nasal appearance and subjective nasal function. The mean preoperative aesthetic Utrecht Questionnaire sum score was 13.4 (standard deviation [SD] 0.5), which improved to 9.2 (SD 0.15) at 12 months postsurgery (p < 0.001). Conclusions: The SRTa is a reliable technique that can help deliver consistently good results in reduction rhinoplasty in patients with a crooked nose.

The Caucasian Hump: Radiologic Study of the Osteocartilaginous Vault versus Surface Anatomy. Clinical Implications in Structured and Preservation Rhinoplasty.

BACKGROUND: The relation between the osteocartilaginous nasal vault and nasal hump characteristics has not been fully investigated. METHODS: Measurements were collected from computed tomographic nasal scans in the midsagittal plane in adult Caucasian patients seeking rhinoplasty because of nasal hump from January of 2015 to December of 2018. Measurements were compared to those of sex- and age-matched patients not seeking rhinoplasty (control group). Patients with other significant nasal deformities were excluded. The correlations between nasal hump length, height, and osteocartilaginous nasal vault measurements were assessed. Distances from the beginning of the nasal hump to the kyphion and ethmoidal points were measured as well. The location of the nasal hump apex in relation to the keystone area structures was detailed. RESULTS: The study included 134 Caucasian patients, with 67 presenting nasal hump. The mean patient age was 32.9 years and 69.6 percent were female patients. Nasal hump measured a mean 17 ± 2.7 mm in length and 1.8 mm (range, 1.1 to 3.8 mm) in height. Nasal hump length correlated with nose length and nasal bone length. Nasal hump height correlated with nose length and the angle over the kyphion. In 97 percent of patients, the nasal hump began caudal to the ethmoidal point, and in all patients, the kyphion was underneath the nasal hump. The nasal hump is not a symmetric structure and, in all patients, its apex was situated above the septal cartilage. CONCLUSIONS: The nasal hump characteristics are mainly attributable to the septal cartilage, and this should be the cornerstone of any dorsal hump reduction strategy. The caudal aspect of the nasal bones contributes to the nasal hump, whereas the posterior ethmoidal plate rarely does.

Endoscopic sinus surgery: a safe procedure among the less experienced surgeons?

OBJECTIVES: To determine the incidence of complications in endoscopic sinus surgery (ESS), in a surgical centre with 20 years of experience, and whether or not the surgeon's experience can be a predisposing factor for them to happen. METHODS: The clinical data of the 667 patients who were submitted to EES between January of 2006 and December 2009, was reviewed, and the perioperative and postoperative complications were evaluated, with a minimum follow up period of 3 months. For each surgery, the surgeon's experience as well as surgery particularities, were correlated with the presence of complications. RESULTS: In the 677 surgeries, the incidence of complications was of 7.39% (5.91% minor and 1.48% major). There was no correlation between surgery complications and the years of experience of the main surgeon. When comparing the complication rate between residents and specialists, there were no statistically significant differences between them. Extensive surgeries, revision surgeries and the presence and grade of polyposis, were associated with a higher rate of complications. CONCLUSIONS: ESS is not a risk free procedure. Complications can happen regardless of the surgeons experience. Patients who are submitted to surgery by residents, under the supervision of a senior doctor, are not at greater risks of complications.