[Subjective patient satisfaction after nasal septumplasty]. / Subjektive Patientenzufriedenheit nach Nasenseptumplastik.

BACKGROUND: Septal surgery (SP) is one of the most frequently performed operations in Germany and thus represents a high cost burden for the health system. However, sufficient data on postoperative patient satisfaction and objective indication criteria for surgery are still lacking. OBJECTIVE: This study aimed to determine postoperative patient satisfaction and possible factors influencing the subjective success of SP, in order to optimize preoperative indication establishment. MATERIALS AND METHODS: A total of 600 questionnaires were sent by mail, resulting in inclusion of 238 patients (60 female, 178 male) who had received SP. The questionnaires were retrospectively evaluated using validated questionnaires (NOSE-D, SNOT-20-GAV) as well as a self-designed questionnaire regarding patients' subjective satisfaction after SP. Clinical data were collected from the electronic patient record. RESULTS: Follow-up was between 2 and 11 years. The main symptom for SP was difficult nasal breathing in 89% (212 of 238) of patients. In total, 68% (161) were satisfied with the outcome of surgery and 73% (172) of the patients would opt for SP again. The scores of the visual analog scales for nasal breathing, smell, nasal secretion, physical performance, use of nose drops, and headache were statistically significantly improved postoperatively. Additionally, the analysis of Nose-D and SNOT-20-GAV questionnaires presented a significant improvement in scores. Surprisingly, patients with a prolonged duration of septal splints were more satisfied. Previous nasal surgery had no significant influence. CONCLUSION: SP leads to a high degree of patient satisfaction, if the indication for surgery is correct. The main complaint of patients should be "difficult" nasal breathing. SP leads to a significant improvement in preoperative symptoms.

Loco-regional recurrence after surgical treatment of oral squamous cell carcinoma: Proposals for follow-up imaging based on literature, national guidelines and institutional experience.

The recurrence rate following the treatment of oral squamous cell carcinoma (OSCC) by primary surgery is about 10%-26%. The earliest possible diagnosis of residual tumour, recurrence of local tumour disease, and subsequent metastasis is essential for an improvement of the overall survival and of the survival period for affected patients. No international consensus exists for a post-therapeutic surveillance schedule for OSCCs. Based on a review of the literature, existing guidelines, and our institutional experience, we have established an algorithm for the follow-up of these patients regarding the timing and techniques of postoperative imaging. We recommend a follow-up interval of 6 weeks during the first half-year after discharge from hospital by single clinical and alternating clinical check-ups combined with computed tomography (CT) or magnetic resonance imaging (MRI), followed by an interval of 3 months in the second half-year, with clinical and radiological check-ups. In year 2, we recommend a follow-up interval of 3 months with single clinical and alternating clinical check-ups combined with CT or MRI. In year 3, we recommend screening every 6 months, both clinically and via imaging, because of the decreased risk of recurrence. From year 5 onwards, our recommendation is a clinical and imaging-based examination every 6-12 months, depending on patient risk factors and disease progression. Four standard imaging techniques, namely positron emission tomography (PET), CT, MRI, and ultrasound (US), are discussed concerning their range of application, sensitivity, and specificity. Furthermore, the technical aspects of our institutional protocols are described in detail. In highly frequented head and neck cancer centres, PET and US are of secondary importance, since CT and MRI are nowadays highly efficient tools in primary diagnostic and post-therapeutic surveillance.

Total reconstruction of the auricle: our experiences on indications and recent techniques.

INTRODUCTION: Auricular reconstruction is a great challenge in facial plastic surgery. With the advances in surgical techniques and biotechnology, different options are available for consideration. The aim of this paper is to review the knowledge about the various techniques for total auricular reconstruction based on the literature and our experience. METHODS: Approximately 179 articles published from 1980 to 2013 were identified, and 59 articles were included. We have focused on the current status of total auricular reconstruction based on our personal experience and on papers of particular interest, published within the period of review. We have also included a prospective view on the tissue engineering of cartilage. RESULTS: Most surgeons still practice total auricular reconstruction by employing techniques developed by Brent, Nagata, and Firmin with autologous rib cartilage. Within the last years, alloplastic frameworks for reconstruction have become well established. Choosing the reconstruction techniques depends mainly on the surgeon's preference and experience. Prosthetic reconstruction is still reserved for special conditions, even though the material is constantly improving. Tissue engineering has a growing potential for clinical applicability. CONCLUSION: Auricular reconstruction still receives attention of plastic/maxillofacial surgeons and otolaryngologists. Even though clinical applicability lags behind initial expectations, the development of tissue-engineered constructs continues its potential development.