Rhinoplasty Training: An Innovative Learning Approach Using Chicken Breast.

Mastering rhinoplasty surgical techniques requires extensive learning involving theoretical studies, internships, cadaver laboratories, simulators, nonhuman models, and hands-on practice. A novel method using chicken breast simplifies skill development, offering flexibility and accessibility. Training on chicken breast allows surgeons to refine skills through various techniques and grafts. This study focuses on preservation techniques using chicken as a model. Surgical sequences simulate nasal structures using prepared chicken breasts. Documentation through media illustrates procedures from basic to advanced, using materials akin to traditional rhinoplasty but in reduced quantities. Chicken breast tissue, especially sternal cartilage, offers a suitable substrate for practicing techniques and grafting without live human or cadaveric tissue. This method provides an efficient, safe, and cost-effective approach to learning rhinoplasty.

Vision Quality Questionnaire Assessment in Patients After Topography-Guided Photorefractive Keratectomy for Irregular Astigmatism Secondary to Radial Keratotomy.

Aim: To evaluate the vision-related quality of life with the National Eye Institute Refractive Error Quality of Life (NEI-RQL) questionnaire in patients with astigmatism secondary to radial keratotomy surgery who underwent topography-guided photorefractive keratectomy. Methods: Prospective non-randomized clinical trial. This study included 15 patients (30 eyes) aged > 21 years, mean age 55.1 (SD, 3.5) years, 53.3% female, with astigmatism ≤ - 6.00 D resulting from radial keratotomy, which could have been associated with hyperopia ≤ + 6.00 D. Photorefractive keratectomy with topography-guided custom ablation treatment was used in all cases. The patients answered the NEI-RQL questionnaire preoperatively and at 4 and 48 months after topography-guided photorefractive keratectomy. The following data were collected: age, sex and education level, pre-operative refraction data, visual acuity with or without correction, pachymetry, and keratometry. Results: There was a significant difference between pre-and postoperative NEI-RQL scores for the domains clarity of vision, near vision, far vision, diurnal fluctuation, activity limitations, glare, symptoms, correction dependence, appearance, and satisfaction with correction (p < 0.001). Conclusion: Topography-guided photorefractive keratectomy improved vision-related quality of life in patients with a history of irregular astigmatism secondary to radial keratotomy.

Algorithm for the treatment of external nasal valve insufficiency.

INTRODUCTION: Nasal obstruction is one of the most prevalent complaints in the population. The main causes of nasal obstruction are inflammatory, infectious or anatomical alterations. Anatomical alterations include nasal septum deviation, turbinate hypertrophy, and nasal valve insufficiency (external and/or internal). The diagnosis of nasal valve insufficiency remains a clinical one and is based on inspection and palpation of the nose, evaluating both its static and dynamic functions. The literature presents several options for the correction of external nasal valve insufficiency. These are chosen according to the choice and experience of each surgeon. OBJECTIVE: To create a practical algorithm for the treatment of external nasal valve insufficiency that can guide nasal surgeons in their choice of treatment for the different anatomical alterations found in patients with these disorders. METHODS: We used the treatment options found in the literature and correlated them with our surgical options for each type of anatomical alteration found. Therefore, we used basically three parameters related to physical examination findings (degree of insufficiency and characteristics of the lower lateral cartilage) and the patient's complaint (present or absent aesthetic complaint regarding the nasal tip). RESULT: A practical algorithm was developed for the treatment of external nasal valve insufficiency according to the degree of insufficiency (mild-to-moderate or severe), aesthetic complaint of the nasal tip (present or absent) and characteristics of the lower lateral cartilage (size and orientation). CONCLUSION: Through this simple algorithm, one can use each type of graft and/or maneuver according to the patients' complaints and the anatomical alterations found.

Relationship Between the Bilateral Removal of the Middle Nasal Turbinate and the Olfactory Function in Endoscopic Skull Base Surgery.

OBJECTIVE: To determine the impact of endonasal endoscopic access to the skull base on the olfaction sense, involving the harvest of a nasoseptal flap, with the removal of the middle nasal turbinate. METHODS: A study was performed on a prospective cohort of 50 patients who underwent transnasal endoscopic surgery of the anterior skull base, with the harvest of a nasoseptal and reverse flap. The patients were divided into 2 groups: partial unilateral removal of the middle nasal turbinate and bilateral removal. Connecticut Chemosensory Clinical Research Center tests were administered before surgery and in months 1, 3, and 6 after surgery. RESULTS: There was no difference in the olfactory sense, when comparing the partial removal of the middle nasal turbinate and the bilateral removal, as well as when comparing the side without the middle nasal turbinate and the side with this structure preserved. There was a worsening in olfaction (P < 0.001) in months 1 and 3 after surgery, returning to baseline in month 6 (P > 0.05). CONCLUSIONS: Bilateral removal of the middle nasal turbinate, compared with unilateral resection, showed no impact on the olfactory function 6 months after surgery. In both groups, there was a transitory decrease in the first month, but this normalized by the sixth postoperative month.

Experimental study on the influence of facial muscle activity on the facial mesostructure bones in rabbits.

UNLABELLED: Based on the functional matrix concept, scientists developed the hypothesis that soft tissue acting on certain bone pieces determines the process of facial growth. The possibility to modify muscle influence in the phase of facial development, or in postoperative of corrective surgery is of great preventive importance and it should be better investigated, since it could reduce the number and impact of these procedures. STUDY DESIGN: experimental in rabbits. AIM: to estimate the relevance of facial muscle activity on facial bones in lab rabbits. MATERIALS AND METHODS: 37 rabbits of two months of age were studied, divided in a study group and a control group, were followed up for a period of 4 months. The study group animals had their facial nerves cut at the cervical root in one side. The facial mesostructure of the animals was removed in block for later morphometric studies through computer graphics made out of the digital pictures of the specimens. Results were submitted for comparative statistical analysis. CONCLUSION: The lack of muscle activity in half of the face produces an ipsilateral shift of the facial mesostructure in developing rabbits.

Anthropometric study of the caucasian nose in the city of Curitiba: relevance of population evaluation.

INTRODUCTION: Norms and patterns of nasal esthetics are essential for an adequate preoperative evaluation and surgical programming. The esthetic nasal patterns used are a blend of artistic beauty ideals and tracings in models and celebrities. Because they do not consider population measures, they vary according to the period, and allow a discrepancy between the surgeon's preference and the patient's real desire for rhinoplasty. Not all populations wish to obtain an esthetic result according to these values, but prefer a natural result, that is, one with some of the nasal characteristics of the population to which they belong to. The Brazilian population lacks population studies to evaluate its nose measurements. OBJECTIVE: (1) To evaluate the anthropometric measures of Caucasian noses of people living in the city of Curitiba (state of Paraná), and to compare them to the ideal esthetic pattern of the literature; (2) To compare them between genders. METHODS: This is a prospective cohort study involving 100 Caucasian volunteers at a tertiary hospital in Southern Brazil. Through the frontal and lateral view photos, intercanthal distance, alar distance, nasal dorsum length, nasofrontal angle, nasolabial angle, and nasal tip projection (Goode's method) were obtained. A statistical analysis was performed to compare the measures obtained between genders and with the ideal patterns. RESULTS: Comparing the results obtained with those predicted by the esthetic ideals, the sample presented: similar nasolabial angle (p=0.07), alar width greater than intercanthal distance (p<0.001), higher nasal tip projection (p<0.001), larger width-length ratio (p<0.001), and more obtuse nasofrontal angle (p<0.001). The nasofrontal angle (p=0.0008) and the tip projection (p=0.032) were statistically different between the genders. Men had a smaller nasofrontal angle, and a larger Goode's ratio. CONCLUSION: Except for the nasolabial angle, the measures obtained in the population sample differed from the published esthetic ideals. Comparing the genders, men had a sharper nasofrontal angle, and higher tip projection than women.

Experimental comparative study in rabbits of three different ways of cartilage graft fixation: suture, gelatin-resorcin-formaldehyde and butyl-2-cyanoacrylate.

CONCLUSION: The compound gelatin-resorcin-formaldehyde (GRF) was a better stabilizing material for cartilage grafts in rabbits than butyl-2-cyanoacrylate. GRF was also better than the suture when comparing fixation of cartilage to the periosteum and inflammatory reaction. OBJECTIVE: Cartilage grafting is an interesting option for refinements on rhinoplasties. The objective of this study was to compare butyl-2-cyanoacrylate to GRF and suture to determine the efficacy of these methods in restraining grafted cartilage in rabbits. MATERIALS AND METHODS: Fifteen male adult New Zealand rabbits underwent surgery with the aim of collecting six auricular cartilage grafts from each animal. Two of these grafts in each animal were glued together with butyl-2-cyanoacrylate, two were glued together with compound GRF, and two were sewn together with nylon suture. These sandwich grafts were then glued or sutured to the periosteum of the glabella. After 2, 6, and 12 weeks, groups of five animals were sacrificed and histological analysis for inflammation was performed. Cartilage graft migration, adhesion, and deformities of the grafts were also evaluated. RESULTS: There was less migration of the cartilages glued with GRF than with cyanoacrylate and suture. GRF showed statistically less inflammatory reaction and angiogenesis than the other two methods. The three methods showed a tendency to decrease of fibrosis, inflammation, and angiogenesis as weeks passed. There was no detachment or deformity in the cartilage sandwiches sutured to the glabella's periostium. The majority of detached and deformed cartilages were those glued with cyanoacrylate. The number of detached cartilages was directly related to the number of deformed cartilages. The data were statistically significant (p<0.05).

Comparison of butyl-2-cyanoacrylate, gelatin-resorcin-formaldehyde (GRF) compound and suture in stabilization of cartilage grafts in rabbits.

UNLABELLED: Cartilage grafting is an interesting option for rhinoplasties refinements. AIM: To compare butyl-2-cyanoacrylate, compound gelatin-resorcin-formaldehyde (GRF) and suture control to determine the efficacy of these tissue glue preparations in securing grafted cartilage. STUDY DESIGN: Experimental. METHODS: Fifteen male adult New Zealand rabbits were submitted to a surgical procedure to harvest 6 auricular cartilage grafts from each animal. 2 of these grafts in each animal were glued together with butyl-2-cyanoacrylate, 2 with compound gelatin-resorcin-formaldehyde and 2 sewn together with nylon suture. These sandwich grafts were then glued or sewn to the periosteum of the calvaria. After 2, 6 and 12 weeks, groups of 5 animals were sacrificed and histological analysis for inflammation was performed. Cartilage graft migration, adhesion and deformities of the grafts were also evaluated. RESULTS: There was less migration of the cartilages glued with GRF than with cyanoacrylate and suture. There was no statistical difference between the 3 materials of graft stabilization in relation to the inflammatory reaction in all evaluated periods. There wasn't detachment neither deformity in the cartilage sandwiches sewn with suture. The majority of detachment and deformed cartilages were found among those glued with cyanoacrylate. The number of deformed cartilages was directly related to the number of detached cartilages. The data were statistically significant (p< 0.05). CONCLUSION: The compound gelatin-resorcin-formaldehyde revealed to be a stabilization material for cartilage grafts in rabbits better than butyl-2-cyanoacrylate. The compound gelatin-resorcin-formaldehyde was also better than the suture when comparing its fixation to the periosteum.

Neuropeptide immunofluorescence in human nasal mucosa: assessment of the technique for vasoactive intestinal peptide (VIP).

UNLABELLED: Neuropeptides are important neurotransmitters in nasal physiology and the increasing knowledge of their role in nasal diseases brings new therapeutic perspectives. The investigation of human nasal mucosa neuropeptides is based mostly on immunocytochemistry, a complex approach whose resulting factors may be variable. Aiming to make this kind of research available, an immunofluorescence approach for vasoactive intestinal peptide (VIP) in human nasal mucosa is proposed and evaluated. STUDY DESIGN: Transversal cohort. MATERIAL AND METHOD: Human inferior turbinate samples were obtained at time of nasal surgery from eight patients. The samples were fixed in Zamboni solution (4% phosphate-buffered paraformaldehyde and 0.4% picric acid), snap-frozen and stored at -70 degrees C. 14 microm sections were then obtained. Immunofluorescence staining for VIP (Peninsula Laboratories) was performed and its images documented by conventional photography. The method's specificity, sensitivity and reproducibility of execution were evaluated. Additionally, the reproducibility of interpretation of results was evaluated through the comparison of staining scores (0 to 4) attributed to the images by six observers. RESULTS: The results showed the approach to be very specific and sensible, besides being reproducible in its execution. The interpretation of results may depend on the observer's accuracy in judging immunofluorescence images, but it showed uniformity. CONCLUSION: The proposed method was highly useful for research purposes in neuropeptides in human nasal mucosa.

Algorithm for the treatment of external nasal valve insufficiency / Algoritmo para o tratamento da insuficiência de válvula nasal externa

Abstract Introduction: Nasal obstruction is one of the most prevalent complaints in the population. The main causes of nasal obstruction are inflammatory, infectious or anatomical alterations. Anatomical alterations include nasal septum deviation, turbinate hypertrophy, and nasal valve insufficiency (external and/or internal). The diagnosis of nasal valve insufficiency remains a clinical one and is based on inspection and palpation of the nose, evaluating both its static and dynamic functions. The literature presents several options for the correction of external nasal valve insufficiency. These are chosen according to the choice and experience of each surgeon. Objective: To create a practical algorithm for the treatment of external nasal valve insufficiency that can guide nasal surgeons in their choice of treatment for the different anatomical alterations found in patients with these disorders. Methods: We used the treatment options found in the literature and correlated them with our surgical options for each type of anatomical alteration found. Therefore, we used basically three parameters related to physical examination findings (degree of insufficiency and characteristics of the lower lateral cartilage) and the patient's complaint (present or absent aesthetic complaint regarding the nasal tip). Result: A practical algorithm was developed for the treatment of external nasal valve insufficiency according to the degree of insufficiency (mild-to-moderate or severe), aesthetic complaint of the nasal tip (present or absent) and characteristics of the lower lateral cartilage (size and orientation). Conclusion: Through this simple algorithm, one can use each type of graft and/or maneuver according to the patients' complaints and the anatomical alterations found.

Resumo Introdução: A obstrução nasal é uma das queixas mais prevalentes na população. As principais causas de obstrução nasal são inflamatórias, infecciosas ou alterações anatômicas. As alterações anatômicas incluem: desvio do septo nasal, hipertrofia de conchas nasais e insuficiência da válvula nasal (externa e/ou interna). O diagnóstico da insuficiência de válvula nasal permanece clínico e baseado na inspeção e palpação do nariz, avaliado em funções estática e dinâmica. Temos na literatura diversas opções de correção da insuficiência de válvula nasal externa. Essas são escolhidas de acordo com a opção e experiência de cada cirurgião. Objetivo: Criar um prático algoritmo para o tratamento da insuficiência de válvula nasal externa, que oriente os cirurgiões de nariz na escolha do tratamento para as diferentes alterações anatômicas encontradas nos pacientes portadores dessas alterações. Método: Utilizamos as opções de tratamento encontradas na literatura e relacionamos com as nossas opções cirúrgicas para cada tipo de alteração anatômica encontrada. Dessa forma, utilizamos basicamente três parâmetros relacionados aos achados de exame físico (grau de insuficiência e características da cartilagem lateral inferior) e à queixa do paciente (queixa estética da ponta nasal presente ou ausente). Resultado: Um algoritmo prático para o tratamento da insuficiência de válvula nasal externa, de acordo com o grau da insuficiência (leve-moderada ou severa), a queixa estética da ponta nasal (presente ou ausente) e as características da cartilagem lateral inferior (tamanho e orientação). Conclusão: Através desse simples algoritmo, podemos utilizar cada tipo de enxerto e/ou manobra de acordo com as queixas dos pacientes e as alterações anatômicas encontradas.

In vitro antimicrobial activity of Luffa operculata.

INTRODUCTION: Luffa operculata is probably one of the most popular herbal medicines used in the treatment of rhinitis and rhinosinusitis. However, its specific mechanism of action is still unknown. OBJECTIVE: To evaluate in vitro antibacterial activity of L. operculata against three ordinary agents of upper respiratory tract infection: Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes. METHODS: Different concentrations of L. operculata alcoholic extract were applied to bacterial broth containing reference and community strains of the three described agents. After a 24-h incubation period, the bacterial culture turbidity was measured. The samples were then inoculated onto Mueller-Hinton and human blood agar plates. Bacterial growth was analyzed after 24- and 48-h incubation period. The test was considered negative when there was no environmental turbidity, confirmed by the absence of bacterial growth into the inoculated plates. Tests were considered positive when either turbidity changes were observed on the bacterial broth or when bacterial growth was detected on inoculated plates. Appropriate statistical analysis of the data was performed. RESULTS: L. operculata extracts showed antibacterial activity mainly to S. pyogenes followed by S. pneumoniae and S. aureus. CONCLUSIONS: L. operculata extract showed promising antibacterial activity in vitro against the studied agents.

Osteitis and mucosal inflammation in a rabbit model of sinusitis.

INTRODUCTION: Several experimental studies have shown osteitis after the onset of sinusitis, supporting the idea that bone involvement could participate in the dissemination and perpetuation of this inflammatory disease. However, procedures commonly performed for the induction of sinusitis, such as antrostomies, can trigger sinusitis by themselves. OBJECTIVE: To evaluate osteitis in an animal model of sinusitis that does not violate the sinus directly and verify whether this is limited to the induction side, or if it affects the contralateral side. METHODS: Experimental study in which sinusitis was produced by inserting an obstructing sponge into the nasal cavity of 20 rabbits. After defined intervals, the animals were euthanized and maxillary sinus samples were removed for semi-quantitative histological analysis of mucosa and bone. RESULTS: Signs of bone and mucosal inflammation were observed, affecting both the induction and contralateral sides. Statistical analysis showed correlation between the intensity of osteitis on both sides, but not between mucosal and bone inflammation on the same side, supporting the theory that inflammation can spread through bone structures, regardless of mucosal inflammation. CONCLUSION: This study demonstrated that in an animal model of sinusitis that does not disturb the sinus directly osteitis occurs in the affected sinus and that it also affects the contralateral side.

Experimental study of the use of auricular cartilage with and without Gelfoam® on the nasal dorsum of rabbits.

INTRODUCTIONS: There are several materials for reconstruction of nasal dorsum deformities, which are divided into four categories: autologous, homologous, heterologous, and alloplastic grafts. OBJECTIVE: To compare experimental conditions through inflammatory time reactions in ear cartilage grafts with and without Gelfoam® when grafted on the nasal dorsum of rabbits. METHODS: This study included 30 rabbits, divided into two groups of 15 rabbits each (Gelfoam® and cartilage group and cartilage group), and then divided into three sub-groups of 7, 30, and 60 days of follow-up, where the 1.5 cm long and 0.5 wide grafts were placed in the stock grafting on the nasal dorsum of rabbits, half with and half without Gelfoam®. After the specified period, the rabbits in each group were euthanized, and the grafts were then submitted to a histological study. RESULTS: The experimental group revealed more neovascularization and granulation tissue formation; in terms of the presence of acute and chronic inflammatory process, the results were virtually identical in rabbits from both the control and experimental models in all three groups. CONCLUSION: There was no statistical difference to justify the use of Gelfoam® surrounding cartilage graft for nasal dorsum reconstruction.

Evaluation of the ability of an experimental model to induce bacterial rhinosinusitis in rabbits.

INTRODUCTION: For decades, animals have been used in sinonasal experimental models, and the practice has increased substantially in the last few years. This study aimed to assess the pathogenesis of infectious process and medication efficiency to treat rhinosinusitis. OBJECTIVE: To evaluate the efficiency of the proposed experimental model to induce an acute bacterial sinonasal infectious process through histological analysis and sinus secretion cultures. METHODS: This was an experimental study with 22 New Zealand rabbits, divided into: group A (six rabbits), group B (seven rabbits), group C (seven rabbits), and group D (control group with two rabbits). Rhinosinusitis was induced by the insertion of a synthetic sponge into the right nasal cavity of 20 animals (study groups), followed by the instillation of bacterial strains (50% Staphylococcus sp. and 50% Streptococcus sp.). The groups were euthanized within 10 days (group A), 17 days (group B), and 30 days (groups C and D). RESULTS: All the rabbits of the study group developed acute bacterial rhinosinusitis, which was diagnosed through macroscopic evaluation, histological analysis, and sinus secretion culture. CONCLUSION: The proposed model is technically simple to perform, it is similar to the rhinogenic model in human beings, and it is highly efficient to reproduce an acute bacterial sinus infection.

Anthropometric study of the caucasian nose in the city of Curitiba: relevance of population evaluation / Estudo antropométrico do nariz caucasiano na cidade de Curitiba: importância da avaliação populacional

Abstract Introduction Norms and patterns of nasal esthetics are essential for an adequate preoperative evaluation and surgical programming. The esthetic nasal patterns used are a blend of artistic beauty ideals and tracings in models and celebrities. Because they do not consider population measures, they vary according to the period, and allow a discrepancy between the surgeon's preference and the patient's real desire for rhinoplasty. Not all populations wish to obtain an esthetic result according to these values, but prefer a natural result, that is, one with some of the nasal characteristics of the population to which they belong to. The Brazilian population lacks population studies to evaluate its nose measurements. Objective (1) To evaluate the anthropometric measures of Caucasian noses of people living in the city of Curitiba (state of Paraná), and to compare them to the ideal esthetic pattern of the literature; (2) To compare them between genders. Methods This is a prospective cohort study involving 100 Caucasian volunteers at a tertiary hospital in Southern Brazil. Through the frontal and lateral view photos, intercanthal distance, alar distance, nasal dorsum length, nasofrontal angle, nasolabial angle, and nasal tip projection (Goode's method) were obtained. A statistical analysis was performed to compare the measures obtained between genders and with the ideal patterns. Results Comparing the results obtained with those predicted by the esthetic ideals, the sample presented: similar nasolabial angle (p = 0.07), alar width greater than intercanthal distance (p < 0.001), higher nasal tip projection (p < 0.001), larger width-length ratio (p < 0.001), and more obtuse nasofrontal angle (p < 0.001). The nasofrontal angle (p = 0.0008) and the tip projection (p = 0.032) were statistically different between the genders. Men had a smaller nasofrontal angle, and a larger Goode's ratio. Conclusion Except for the nasolabial angle, the measures obtained in the population sample differed from the published esthetic ideals. Comparing the genders, men had a sharper nasofrontal angle, and higher tip projection than women.

Resumo Introdução Normas e padrões de estética nasal são essenciais para uma adequada avaliação pré-operatória e programação cirúrgica. Os padrões estéticos nasais usados são uma mistura dos ideais artísticos de beleza e traçados em modelos e celebridades. Por não considerar medidas populacionais, variam conforme o período e permitem uma discrepância entre o desejo do cirurgião e o real desejo do paciente com a rinoplastia. Nem todas as populações desejam obter um resultado estético conforme esses valores, mas um resultado natural, ou seja, com algumas das características nasais da população a que pertencem. A população brasileira carece de estudos populacionais que avaliam as suas medidas nasais. Objetivo 1) Avaliar as médidas antropométricas de narizes caucasianos da cidade de Curitiba (Paraná) e compará-los com o padrão estético ideal da literatura; 2) Compará-los entre os sexos. Método Estudo prospectivo, coorte, envolveu 100 voluntários caucasianos em um hospital terciário no Sul do Brasil. Através de fotografias na vista frontal e lateral, foram obtidas: distância intercantal, distância alar, comprimento do dorso nasal, ângulo nasofrontal, ângulo nasolabial e projeção da ponta nasal (método do Goode). Análise estatística foi realizada para comparar as medidas obtidas: entre os gêneros e com os padrões ideais. Resultados Comparando os resultados obtidos com o apregoado pelos ideais estéticos, a amostra apresentou: ângulo nasolabial similar (p = 0,07), largura alar maior do que distância intercantal (p < 0,001), maior projeção da ponta nasal (p < 0,001), relação largura-comprimento maior (p < 0,001) e ângulo nasofrontal mais obtuso (p < 0,001). Diferiram estatisticamente entre os sexos o ângulo nasofrontal (p = 0,0008) e a projeção da ponta (p = 0,032). Homens apresentaram o ângulo nasofrontal menor e a razão de Goode maior. Conclusão Com exceção do ângulo nasolabial, as medidas obtidas na amostra populacional diferiram dos ideais estéticos publicados. Na comparação dos sexos, homens apresentaram um ângulo nasofrontal mais agudo e uma projeção da ponta maior do que as mulheres.

Vertical dome division: a quality-of-life outcome study.

OBJECTIVE: To assess quality-of-life outcomes in patients undergoing nasal tip surgery with the vertical dome division technique using validated instruments (Rhinoplasty Outcome Evaluation [ROE] and Nasal Obstruction Symptom Evaluation [NOSE]). STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary university center. SUBJECT AND METHODS: Patients undergoing primary cosmetic and functional rhinoseptoplasty using vertical dome division were consecutively evaluated. The ROE, NOSE, and 100-mm visual analog scale (VAS) were administered pre- and postoperatively. RESULTS: Forty-four patients were included and completed pre- and postoperative questionnaires. Their median age was 28 years, 27 (61%) were female, and the median duration of follow-up was 5 months (range, 3-9 months). Median postoperative ROE, NOSE, and VAS scores (79 [66; 87], 20 [15; 23], and 88 [61; 97], respectively) showed significant improvement compared with preoperative scores (29 [16; 41], 75 [60; 95], and 65 [46; 82], respectively; P < .001). The change in median ROE score was significantly greater in normal- and thin-skinned patients than in thick-skinned patients (54 vs 33; P = .033). Median changes in NOSE-p (-48.5 vs -68.0; P = .10) and VAS (69.0 vs 48.0; P =.083) scores did not differ between normal-/thin- and thick-skinned patients. CONCLUSION: Vertical dome division is a versatile technique for nasal tip refinement that resulted in significant improvement in quality-of-life outcomes related to rhinoplasty and nasal obstruction, as well as satisfaction with nasal appearance in a short-term follow-up period. The vertical dome division technique does not seem to be indicated only in patients with thick skin.

Effect of turbinate surgery in rhinoseptoplasty on quality-of-life and acoustic rhinometry outcomes: a randomized clinical trial.

OBJECTIVES/HYPOTHESIS: To evaluate the role of inferior turbinate reduction during rhinoseptoplasty in quality-of-life outcomes and nasal airway cross-sectional area. STUDY DESIGN: Randomized clinical trial. METHODS: Individuals over 16 years with nasal obstruction, candidates to functional and aesthetics primary rhinoseptoplasty, were evaluated from December 2010 though January 2012 at a tertiary University Hospital, Brazil. Eligible participants were randomly allocated to rhinoseptoplasty with or inferior turbinate reduction through submucosal diathermy. OUTCOMES: Relative changes ([postop-preop]/preop score) in specific (Nasal Obstruction Symptom Evaluation; NOSE) and general quality-of-life instruments (WHOQOL-bref), nasal obstruction visual analogue scale (NO-VAS) and nasal area measurements in acoustic rhinometry. OUTCOMES were blindly assessed 3 months postoperatively. Protocol was registered at ClinicalTrials.gov (NCT01457638). RESULTS: 50 patients were included, mainly Caucasians with moderate/severe allergic rhinitis symptoms. Mean age was 32 ± 12 yr and 58% were female. Rhinoseptoplasty improved specific and general quality-of-life scores irrespective of turbinate intervention (P < 0.001).There was no difference between subjects submitted or not to inferior turbinate reduction in NOSE score (-75% vs. -73%; P = 0.893); all WHOQOL-bref score domains (P > 0.05), NO-VAS (-88% vs. -81%; P = 0.89) and acoustic rhinometry recordings (P > 0.05).During follow-up less patients in the rhinoplasty with inferior turbinate reduction group were using topical corticosteroids (6[24%] vs. 13[54%]; P = 0.03). Multivariable analyses, adjusting for postoperative topical corticosteroid use and previous nasal fracture, had no effect on these results. CONCLUSIONS: Turbinate reduction through submucosal diathermy during primary rhinoseptoplasty did not improve short-term general and specific quality-of-life outcomes and acoustic rhinometry recordings. The role of turbinate reduction in sparing chronic corticosteroid use should be confirmed in long-term follow-up studies.