Proposal for Perioperative Pharmacological Protocol for the Reduction in Early Complications in Orthorhinoseptoplasty: Five Years of Experience.

Septorhinoplasty is a crucial intervention in functional and aesthetic facial surgery. Although rare and usually manageable, complications could lead to disfiguring consequences. There is no universal protocol for perioperative management in the literature. The aim of this article is to analyze the surgical complications in patients who underwent open rhinoseptoplasty and were treated in the perioperative period with the standardized protocol used in our department, in order to propose it as a standardized protocol for a more global application. METHODS: The patients included underwent rhinoplasty between 2017 and 2022 and were managed with the same treatment protocol. Perioperative and intraoperative data, as well as possible complications, were collected. RESULTS: A total of 129 patients were included, 73% of which reported either mild or no complications. Abnormal scar healing was the most frequent complaint (9%), followed by edema (6.2%), nasal dyspnea (3.9%), infection (2.3%), and bleeding (2.3%). No severe complications were reported. CONCLUSIONS: Our protocol appears to be effective in minimizing complications such as infection and bleeding, although it is very difficult to compare the results with the literature.

Secretory carcinoma of salivary glands with NTRK3 break-apart molecular rearrangement: Potential misdiagnosis with mucoepidermoid carcinoma.

A woman presented a right submandibular gland lesion with cytologic diagnosis of mucoepidermoid carcinoma. Patient underwent sialoadenectomy en bloc with supraomohyoid neck dissection. Positivity for ETV6-NTRK3 genes fusion on surgical sample led to final diagnosis of secretory carcinoma (SC). Secretory carcinoma has been renamed by WHO in 2017 from mammary-analogue-secretory carcinoma (MASC). Only 649 have been reported until 2019. While cytologic alteration are shared with other neoplasms as the acinic cell and mucoepidermoid carcinomas, ETV6-NTRK3 rearrangement is pathognomonic of SC. Although usually indolent and with low-stage presentation, SC has higher rate of local recurrences and nodal involvement than ACC. Surgical treatment represent the gold standard. Real prevalence of SC is probably underestimated due to the recent WHO 2017 reclassification. While cytologic analysis does not allow to discriminate SC from other malignancies, chromosomal examination is recommended. When low-grade SC is diagnosed, complete surgical resection assures good prognosis.

Posterior airways and orthognathic surgery: What really matters for successful long-term results?

INTRODUCTION: Although it is well known that orthognathic surgery modifies the upper airways, it is still unclear which are the determining factors to achieve adequate and predictable results in all the patients regardless of the initial malocclusion type and satisfying all the traditional orthognathic treatment objectives. This study aimed to correlate airway changes with surgical movements and other variables and the planning modalities to better understand how to control airway dimensions with treatment. METHODS: This study involved 61 patients requiring bimaxillary surgery to correct various dentoskeletal deformities without a history of obstructive sleep apnea syndrome. In all the subjects, the orthosurgical treatment was planned according to the same treatment principles and regardless of the initial airway dimension. The 3-dimensional volume and minimal axial area values generated by cone-beam computed tomography at the preoperative, 3-week, and 1-year postoperative controls were evaluated and correlated with surgical movements and other variables. RESULTS: Although the planning did not consider the initial size of the airways, a significant increase was found for volume and minimal axial area in both the short term (volume, 29.0%; area, 51.2%) and long term (volume, 18.2%; area, 39.8%) with no regard to the type of malocclusion. Only 3 of the variables examined were found to significantly affect the airway: the preoperative dimensions, gender, and the extent of mandibular advancement. These 3 explanatory variables combined can predict the 1-year postoperative volume and minimal area with an accuracy of 71% and 44%, respectively. CONCLUSIONS: According to this study, orthosurgical treatment can protect airways from unexpected unfavorable changes and satisfy the other treatment goals regardless of the initial malocclusion as long as the facial deformities are properly addressed for each patient. Furthermore, these results identified 3 main variables that influence postoperative airways dimensions the most. Keeping in mind that the relationship between airway dimensions and obstructive sleep apnea syndrome is not clearly explained, these considerations may prove to be a useful tool to help in preventing and managing this disease. Studies involving larger samples of patients and evaluating more variables are mandatory to better understand the correlation between airways and sleep function.