Cardiac rupture as a life-threatening outcome of Takotsubo syndrome: A systematic review.

BACKGROUND: Takotsubo syndrome (TS) is a reversible cause of heart failure; however, a minority of patients can develop serious complications, including cardiac rupture (CR). OBJECTIVES: Analyze case reports of CR related to TS, detailing patient characteristics to uncover risk factors and prognosis for this severe complication. METHODS: We conducted a systematic search of MEDLINE and Embase databases to identify case reports of patients with TS complicated by CR, from inception to October 2023. RESULTS: We included 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and an apical ballooning pattern was observed in all cases (100%). ST-segment elevation was reported in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery was attempted in 16 (36%) cases, and 28 (64%) patients did not survive. CONCLUSIONS: CR related to TS is a rare complication associated with high mortality and affecting elderly females, specially from White/Caucasian or East Asian/Japanese descent, presenting with anterior or lateral ST-segment elevation, and an apical ballooning pattern. Although data is limited and additional prospective studies are needed, the awareness of this life-threatening complication is crucial to early identify high-risk patients. CONDENSED ABSTRACT: Cardiac rupture is a rare complication of Takotsubo syndrome. We conducted a systematic review of cases complicated by cardiac rupture, and we identified 44 subjects (40 females and 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity, all with an apical ballooning pattern (100%). The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive.

Translation, cultural adaptation, and validation of the NOSE-Perf scale to Brazilian Portuguese.

OBJECTIVE: To perform the translation, cultural adaptation, and validation of the NOSE-Perf Scale to Brazilian Portuguese. METHODS: This study was divided into two stages. In the first stage, the questionnaire was submitted for translation and cultural adaptation, following the guidelines recommended by the ISPOR Task Force (International Society for Pharmacoeconomics and Outcomes Research). Then, the Brazilian Portuguese version of the NOSE-Perf scale was applied to a group with septal perforation and a control group. The group with perforation answered the questionnaire again after one month. Internal consistency, test-retest reliability, and discriminant validity were assessed. RESULTS: The Brazilian Portuguese version of the NOSE-Perf scale was applied to 32 participants, 16 from the group with septal perforations and 16 controls. The instrument obtained high internal consistency, with Cronbach's alpha scores of 0.986. High reliability was also obtained, with Spearman's correlation coefficient of 0.996 (p < 0.001) and the intraclass correlation coefficient of 0.965 with a 95% Confidence Interval (95% CI) of 0.886‒0.988. The NSP group obtained a mean total score of 13.8 ±â€¯12.6 and the control group a score of 2.3 ±â€¯1.8, with a statistical difference between the groups (p < 0.001), demonstrating good discriminant validity. CONCLUSION: The Brazilian Portuguese version of the NOSE-Perf scale is a reliable and valid instrument for measuring symptoms in patients with nasal septum perforations. LEVEL OF EVIDENCE: Level 2-Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.

Sandwich graft technique outcomes in medium and large size nasal septal perforations / Resultados da técnica de enxerto sanduíche em perfurações do septo nasal de médio e grande porte

Abstract Introduction: Surgical treatment of medium and large sized nasal septal perforation is challenging. Techniques with and without interposition grafts are used. Objective: The aim of this study is to explain how we apply the sandwich graft technique that we use in medium and large nasal septal perforations as well as to present the results. Methods: We retrospectively reviewed the patients who were operated with the sandwich graft technique between January 2014 to December 2018 and followed up for at least 6 months. The demographic data, symptom scores, examination, and surgical findings of the patients were taken from the hospital records. Surgical outcomes were presented according to both perforation etiologies (idiopathic or iatrogenic) and sizes (Group A: < 2cm, Group B: ≥ 2 cm). Results: We reviewed 52 cases and 56 surgeries. The average diameter of the perforations was 19.2 mm. The success rate after initial surgeries was 84.6% (44/52). After 4 revision surgeries, the perforation was closed in 88.5% of the cases (46/52). Success rates for Group A and Group B were 90.0% and 86.4%, respectively (p = 0.689). The success rates in idiopathic and iatrogenic cases were 93.3% and 86.5%, respectively (p = 0.659). Conclusion: This study showed that the success rate of sandwich graft technique was higher in medium-sized perforations than large-sized ones and in idiopathic perforations compared to iatrogenic ones, but the latter rate was not statistically significant. This demonstrated that perforation size was not as important in the sandwich graft technique as in flap techniques.

Resumo Introdução: O tratamento cirúrgico da perfuração do septo nasal de médio e grande porte ainda é um desafio. Várias técnicas são usadas, com e sem enxertos de interposição. Objetivo: Descrever o uso da técnica de enxerto sanduíche que usamos nas perfurações de septo nasal de médio e grande porte e apresentar os resultados. Método: Revisamos retrospectivamente os prontuários de pacientes que foram operados com a técnica de enxerto sanduíche entre janeiro de 2014 e dezembro de 2018, com acompanhamento por pelo menos seis meses. Os dados demográficos, escores de sintomas, exames e achados cirúrgicos dos pacientes foram extraídos dos registros hospitalares. Os resultados cirúrgicos foram apresentados de acordo com as etiologias (idiopática ou iatrogênica) e os tamanhos da perfuração (Grupo A: < 2cm, Grupo B: >2cm). Resultados: Revisamos 52 casos e 56 cirurgias. O diâmetro médio das perfurações foi de 19,2 mm. A taxa de sucesso após as cirurgias iniciais foi de 84,6% (44/52). Após quatro cirurgias de revisão, a perfuração foi fechada em 88,5% dos casos (46/52). As taxas de sucesso para os Grupos A e B foram, respectivamente, 90,0% e 86,4% (p = 0,689). As taxas de sucesso nos casos idiopáticos e iatrogênicos foram, respectivamente, 93,3% e 86,5% (p = 0,659). Conclusão: Este estudo mostrou que a taxa de sucesso da técnica de enxerto sanduíche foi maior nas perfurações de médio porte do que nas de grande porte e nas perfurações idiopáticas do que nas iatrogênicas, mas sem significância estatística. Esse dado demonstrou que o tamanho da perfuração não foi tão importante na técnica de enxerto sanduíche quanto nas técnicas com uso de retalho.

Sandwich graft technique outcomes in medium and large size nasal septal perforations.

INTRODUCTION: Surgical treatment of medium and large sized nasal septal perforation is challenging. Techniques with and without interposition grafts are used. OBJECTIVE: The aim of this study is to explain how we apply the sandwich graft technique that we use in medium and large nasal septal perforations as well as to present the results. METHODS: We retrospectively reviewed the patients who were operated with the sandwich graft technique between January 2014 to December 2018 and followed up for at least 6 months. The demographic data, symptom scores, examination, and surgical findings of the patients were taken from the hospital records. Surgical outcomes were presented according to both perforation etiologies (idiopathic or iatrogenic) and sizes (Group A: < 2 cm, Group B: ≥ 2 cm). RESULTS: We reviewed 52 cases and 56 surgeries. The average diameter of the perforations was 19.2 mm. The success rate after initial surgeries was 84.6% (44/52). After 4 revision surgeries, the perforation was closed in 88.5% of the cases (46/52). Success rates for Group A and Group B were 90.0% and 86.4%, respectively (p = 0.689). The success rates in idiopathic and iatrogenic cases were 93.3% and 86.5%, respectively (p = 0.659). CONCLUSION: This study showed that the success rate of sandwich graft technique was higher in medium-sized perforations than large-sized ones and in idiopathic perforations compared to iatrogenic ones, but the latter rate was not statistically significant. This demonstrated that perforation size was not as important in the sandwich graft technique as in flap techniques.

Rapid hemostasis: a novel and effective outpatient procedure using microwave ablation to control epistaxis of isolated mucosal bulge lesions / Hemostasia rápida: um procedimento ambulatorial novo e eficaz utilizando ablação por micro-ondas para controlar a epistaxe de lesões isoladas protuberantes da mucosa

Abstract Introduction Recurrent epistaxis is commonly encountered in the rhinology outpatient clinic. Under endoscopic guidance, both bipolar cautery and monopolar forceps (combined with suction) have been employed to control the bleeding. However, the use of monopolar forceps requires the placement of grounding pads. Most procedures are currently performed in operating rooms. Objective We investigated outcomes after the use of Microwave Ablation (MWA) to control epistaxis in adults with isolated mucosal bulge lesions. All procedures were performed with patients under local anesthesia in our outpatient clinic. Methods This is a retrospective cohort study. We included 83 adults with epistaxis of isolated mucosal bulge lesions. Microwave ablation was performed in the outpatient clinic to control bleeding, after induction of local anesthesia. The primary outcome was successful hemostasis. The secondary outcomes were the rebleeding rates at weeks 1 and 4 and month 6, and complications (crust or synechiae formation, septal perforation, and/or orbit or brain complications). Results All bleeding points were successfully ablated; hemostasis was achieved within 1-2 min. The mean pain score was 1.83 intra-operatively and 0.95 1 h postoperatively. No patient re-bled, and no severe MWA-related complication (septal perforation, synechiae formation, or orbit or brain complication) was recorded to 6 months of follow-up. Conclusions Endoscopic microwave ablation with patients under local anesthesia is a novel, safe, effective, rapid, well-tolerated, outpatient treatment for adults with epistaxis of isolated mucosal bulge lesions, especially those for whom general anesthesia might be risky, those with electrical implants, and those exhibiting contraindications for arterial embolization.

Resumo Introdução Epistaxe recorrente é comumente encontrada no ambulatório de rinologia. Sob orientação endoscópica, foram empregados tanto o cautério bipolar quanto a pinça monopolar (combinados à sucção) para controlar a condição. No entanto, o uso de pinças monopolares requer a colocação de placas de aterramento. Atualmente, a maioria dos procedimentos é feita em salas de cirurgia. Objetivo Investigamos os resultados após o uso da ablação por micro-ondas (MWA, do inglês Microwave Ablation) no controle da epistaxe em adultos com lesões isoladas protuberantes da mucosa. Todos os procedimentos foram feitos em nosso ambulatório com os pacientes sob anestesia local. Métodos Estudo de coorte retrospectivo. Foram incluídos 83 adultos com epistaxe de lesões isoladas protuberantes da mucosa. A ablação por micro-ondas foi feita no ambulatório para controlar o sangramento, após a administração de anestesia local. O desfecho primário foi uma hemostasia bem-sucedida. Os desfechos secundários foram as taxas de ressangramento, nas semanas 1 e 4 e no mês 6, e complicações (formação de crostas ou sinéquias, perfuração septal e/ou complicações orbitais ou cerebrais). Resultados Todos os pontos de sangramento foram contidos com sucesso; a hemostasia foi alcançada em 1-2 minutos. O escore médio de dor foi de 1,83 no intraoperatório e de 0,95 1 h no pós-operatório. Nenhum paciente apresentou ressangramento e nenhuma complicação grave relacionada à MWA (perfuração septal, formação de sinéquias ou complicações orbitais ou cerebrais) foi registrada em 6 meses de seguimento. Conclusões A ablação endoscópica por micro-ondas com pacientes sob anestesia local é um tratamento ambulatorial novo, seguro, eficaz, rápido e bem tolerado para adultos com epistaxe de lesões isoladas protuberantes da mucosa, especialmente aqueles para os quais a anestesia geral pode ser arriscada, indivíduos com implantes elétricos e aqueles com contraindicações para embolização arterial.

Rapid hemostasis: a novel and effective outpatient procedure using microwave ablation to control epistaxis of isolated mucosal bulge lesions.

INTRODUCTION: Recurrent epistaxis is commonly encountered in the rhinology outpatient clinic. Under endoscopic guidance, both bipolar cautery and monopolar forceps (combined with suction) have been employed to control the bleeding. However, the use of monopolar forceps requires the placement of grounding pads. Most procedures are currently performed in operating rooms. OBJECTIVE: We investigated outcomes after the use of Microwave Ablation (MWA) to control epistaxis in adults with isolated mucosal bulge lesions. All procedures were performed with patients under local anesthesia in our outpatient clinic. METHODS: This is a retrospective cohort study. We included 83 adults with epistaxis of isolated mucosal bulge lesions. Microwave ablation was performed in the outpatient clinic to control bleeding, after induction of local anesthesia. The primary outcome was successful hemostasis. The secondary outcomes were the rebleeding rates at weeks 1 and 4 and month 6, and complications (crust or synechiae formation, septal perforation, and/or orbit or brain complications). RESULTS: All bleeding points were successfully ablated; hemostasis was achieved within 1-2min. The mean pain score was 1.83 intra-operatively and 0.95 1h postoperatively. No patient re-bled, and no severe MWA-related complication (septal perforation, synechiae formation, or orbit or brain complication) was recorded to 6 months of follow-up. CONCLUSIONS: Endoscopic microwave ablation with patients under local anesthesia is a novel, safe, effective, rapid, well-tolerated, outpatient treatment for adults with epistaxis of isolated mucosal bulge lesions, especially those for whom general anesthesia might be risky, those with electrical implants, and those exhibiting contraindications for arterial embolization.

Resultados posoperatorios de cierre quirúrgico de perforación septal con injertos de cartílago / Surgical outcomes of nasal septal perforation repair with cartilage grafts

Introducción: las perforaciones septales y su corrección quirúrgica constituyen un reto para los otorrinolaringólogos. En la literatura se describen diferentes técnicas para el cierre de las perforaciones septales; sin embargo, sus resultados en términos de efectividad son muy variables y con pocos pacientes. Desde hace 8 años se viene realizando la técnica de cierre de perforación septal con injertos de cartílago en el servicio de otorrinolaringología del Hospital de San José, y se ha observado una respuesta clínica exitosa. El objetivo del presente estudio fue describir los resultados posoperatorios de los pacientes manejados con la técnica de cierre quirúrgico de perforación septal con injertos de cartílago, en términos de aparición de complicaciones y frecuencia de perforación septal residual. Materiales y métodos: mediante un estudio de cohorte descriptiva se presentan los pacientes manejados con la técnica de cierre quirúrgico de perforación septal con injertos de cartílago de banco o cartílago autólogo. Se incluyen pacientes a partir enero de 2014 a junio 2018. De la historia clínica se extrajeron los datos demográficos, clínicos, complicaciones y presentación de perforación septal residual. Resultados: la tasa de éxito de cierre de perforación septal fue de 78,3 %; siendo las etiologías más frecuentes antecedente de cirugía e idiopática. La complicación más común fue epistaxis en el 26 % de los pacientes, seguida de dolor en el 21,7 % en el posoperatorio mediato, el cual mejoró en los controles posteriores. Conclusión: los resultados con la técnica de cierre de perforación septal con injerto de banco fueron satisfactorios en esta población.

Introduction: septal perforations and surgical correction are a challenge for ENT specialists. Several techniques for closing septal perforations are described in the literature; however, its results in terms of effectiveness are variable and with small sample sizes. The technique of closure of septal perforation with cartilage grafts has been performed for 8 years in the ENT department of Hospital de San José with a successful clinical response. Aims: to describe the postoperative results of patients managed with the technique of surgical closure of septal perforation with cartilage grafts, in terms of complications and frequency of residual septal perforation. Design: descriptive cohort study. Methods: a cohort of patients managed with the surgical closure technique of septal perforation with grafts of bank cartilage or autologous cartilage are described. Patients were included from January 2014 to June 2018. Demographic, clinical data, complications and presentation of residual septal perforation were extracted from the clinical history. Results: The success rate of septal perforation closure was 78.3 %; being the most frequent etiologies antecedent of surgery and idiopathic. The most common complication was epistaxis in 26 % of patients, followed by pain in 21.7 % in the postoperative period, which improved in subsequent controls. Conclusion: the results with the technique of closure of septal perforation with bank grafting were satisfactory in this population.

A new classification for septal perforation and effects of treatment methods on quality of life / Nova classificação para perfuração septal e efeitos dos métodos de tratamento na qualidade de vida

Abstract Introduction: Septal perforation is a condition characterized by loss of cartilage and/or bony structures along with the mucoperichondrium and mucoperiosteum lining them. The etiology includes a history of nasal surgery or trauma, nose picking, bilateral septal cauterization, overuse of nasal sprays, cocaine abuse, vasculitis, and malignancies. Objective: Comparison of quality of life in patients with septal perforation after conservative or surgical treatment, and a new approach for the determination of the diameter of the perforation from a different point of view. Methods: The diameter of septal perforation, total vertical diameter of septum, and horizontal diameter of the perforation were measured in a total of 34 patients. Nineteen of the patients underwent surgical septal perforation repair, and 15 of them received septal button application. The patients were asked to complete the Glasgow Benefit Inventory quality of life questionnaire. Results: The septal perforation successfully healed in 18 of 19 patients who underwent surgical treatment. The quality of life scores were statistically significantly higher in the surgical treatment group when compared to the button group (p < 0.05). Conclusion: The septal perforation classification we propose would be beneficial for providing realistic dimensions, treatment methods, and surgical techniques.

Resumo Introdução: A perfuração septal é uma condição caracterizada pela perda de estruturas cartilaginosas e/ou ósseas, juntamente com o mucopericôndrio e o mucoperiósteo que as revestem. A etiologia inclui um histórico de cirurgia nasal ou trauma, cutucar o nariz, cauterização septal bilateral, uso excessivo de sprays nasais, abuso de cocaína, vasculite e neoplasias malignas. Objetivo: Comparar a qualidade de vida em pacientes com perfuração septal após tratamento conservador ou cirúrgico e uma nova abordagem para a determinação do diâmetro da perfuração sob um diferente ponto de vista. Método: O diâmetro da perfuração septal, o diâmetro vertical total do septo e o diâmetro horizontal da perfuração foram medidos em 34 pacientes; 19 foram submetidos ao reparo cirúrgico da perfuração septal e 15 receberam a aplicação do botão septal. Os pacientes foram solicitados a preencher o questionário de qualidade de vida Glasgow Benefit Inventory. Resultados: A perfuração septal cicatrizou com sucesso em 18 de 19 pacientes submetidos a tratamento cirúrgico. Os escores de qualidade de vida foram estatisticamente significativamente maiores no grupo de tratamento cirúrgico quando comparados aos do grupo que recebeu o botão septal (p < 0,05). Conclusão: A classificação de perfuração septal que fizemos seria benéfica para fornecer dimensões, métodos de tratamento e técnicas cirúrgicas realistas.

A new classification for septal perforation and effects of treatment methods on quality of life.

INTRODUCTION: Septal perforation is a condition characterized by loss of cartilage and/or bony structures along with the mucoperichondrium and mucoperiosteum lining them. The etiology includes a history of nasal surgery or trauma, nose picking, bilateral septal cauterization, overuse of nasal sprays, cocaine abuse, vasculitis, and malignancies. OBJECTIVE: Comparison of quality of life in patients with septal perforation after conservative or surgical treatment, and a new approach for the determination of the diameter of the perforation from a different point of view. METHODS: The diameter of septal perforation, total vertical diameter of septum, and horizontal diameter of the perforation were measured in a total of 34 patients. Nineteen of the patients underwent surgical septal perforation repair, and 15 of them received septal button application. The patients were asked to complete the Glasgow Benefit Inventory quality of life questionnaire. RESULTS: The septal perforation successfully healed in 18 of 19 patients who underwent surgical treatment. The quality of life scores were statistically significantly higher in the surgical treatment group when compared to the button group (p<0.05). CONCLUSION: The septal perforation classification we propose would be beneficial for providing realistic dimensions, treatment methods, and surgical techniques.

Palate ulcer, uvular destruction and nasal septal perforation caused by Sporothrix brasiliensis in an HIV-infected patient.

Sporotrichosis is a human and animal disease caused by dimorphic pathogenic species of the genus Sporothrix. We report a dramatic presentation of Sporothrix brasiliensis infection, with destruction of the nasal septum, soft palate, and uvula of an HIV-infected woman. She was successfully treated with amphotericin B deoxycholate followed by itraconazole. Sporotrichosis remains a neglected opportunistic infection in patients with AIDS and awareness of this potentially fatal infection is of utmost importance.

Resultados y consideraciones técnicas en la rinoplastia y cierre de perforación septal combinados / Results and technical considerations in combined rhinoplastyand septal perforation repair / Resultados e considerações técnicas na rinoplastia e fechamento de perfuração septal combinados

Introducción: la combinación de dos técnicas como la rinoplastia y el cierre de perforación septal representa un desafío quirúrgico. El objetivo de este trabajo es presentar los resultados a largo plazo y las dificultades en las técnicas quirúrgicas utilizadas al realizar ambos procedimientos en simultáneo. Métodos: Se realizó un estudio descriptivo retrospectivo que incluyó un total de 6 pacientes sometidos a rinoplastia y cierre de perforación septal combinados. Se evaluaron antecedentes personales, motivos estéticos, síntomas, tamaño de la perforación septal, técnica quirúrgica, injertos utilizados y sitio donante. Se analizaron las complicaciones y los resultados subjetivos y objetivos obtenidos. Resultados: La edad promedio de los pacientes fue de 37,5 años. Los motivos de consulta estéticos más frecuentes fueron presencia de giba osteocartilaginosa y combinación de punta nasal ancha e hiporrotada. El síntoma funcional más frecuente fue la obstrucción nasal. En todos los casos se realizó cirugía por abordaje abierto. Se llevó a cabo el cierre de la perforación septal mediante la técnica de colgajo bipediculado con interposición de cartílago envuelto en fascia temporal. El cierre completo de la perforación se logró en 5 pacientes. En todos los casos se logró mejoría sintomática y se cumplió el objetivo estético propuesto. Conclusiones: Realizar una rinoplastia con cierre de perforación septal combinado mediante un correcto plan preoperatorio es un procedimiento viable, desafiante y eficaz en cirujanos entrenados. El abordaje abierto facilita el cierre de la perforación septal sin afectar el resultado estético.

Introduction: the combination of two surgical techniques such as rhinoplasty and septal perforation repair, present a surgical challenge. The objective of this study is to show long-term results and difficulties in the surgical techniques used when performing both procedures simultaneously. Methods: A retrospective descriptive study which included six (6) patients who underwent combined rhinoplasty and repair of septal perforation. Personal history, aesthetic motives, symptoms, size of the septal perforation, surgical techniques, grafts used and donor site we evaluated. The complications and subjective and objective results obtained were analyzed. Results: A total of 6 patients were included with an average age of 37.5 years. The most frequent motives for aesthetic consultation were the presence of a dorsal hump and the combination of a wide nasal tip with reduced tip rotation. The most frequent functional motive was nasal obstruction. An external approach was used in all the cases. The septal repair was performed with bipedicled advancement mucosal flaps and concurrent interposed composite graft formed with cartilage and temporal fascia. Complete repair was achieved in five (5) patients. Symptom improvement and aesthetic goals were reached in all the patients. Conclusions: Combined rhinoplasty and septal perforation repair is a viable, challenging and effective procedure when done by trained surgeons with a correct surgical plan. The external approach facilitates the septal perforation repair and this repair dose not affect the aesthetic outcome.

Introdução: a combinação de dois técnicas cirúrgicas como a Rinoplastia e o fechamento de perfuração septal representa um desafio cirúrgico. O objetivo deste trabalho é apresentar os resultados a longo prazo e as dificuldades nas técnicas cirúrgicas utilizadas ao realizar ambos procedimentos em simultâneo. Métodos: Realizouse um estudo descritivo retrospectivo que incluiu (6) seis pacientes sometidos a rinoplastia e fechamento de perfuração septal combinados. Avaliaram-se antecedentes pessoais, motivos estéticos, sintomas, tamanho da perfuração septal, técnica cirúrgica, enxertos utilizados e sitio doador. Analisaram-se as complicações e os resultados subjetivos e objetivos obtidos. Resultados: Incluíram-se um total de 6 pacientes com uma idade média de 37,5 anos. Os motivos de consulta estéticos mais frequentes foram presença de giba osteocartilaginosa e combinação de ponta nasal larga e hiporrotada. O motivo funcional mais frequente foi a obstrução nasal. Em todos os casos realizou-se uma cirurgia por abordagem aberta. Levou- se a cabo o fechamento da perfuração septal mediante a técnica de retalho bipediculado com interposição de cartilagem envolta em fáscia temporal. O fechamento completo da perfuração logrouse em 5 pacientes. Em todos os pacientes logrou-se melhoria sintomática e cumpriu-se o objetivo estético proposto. Conclusões: Realizar uma rinoplastia com fechamento de perfuração septal combinados é um procedimento viável, desafiante e eficaz em cirurgiões treinados com um correto plano pré-operatório. A abordagem aberta facilita o fechamento da perfuração septal, enquanto as reparações do mesmo não afetam o resultado estético.

Assessment of mucosal changes associated with nasal splint in a rabbit model / Avaliação sobre alterações na mucosa, associadas ao uso de splints nasais, utilizando coelhos como cobaias

INTRODUCTION: There is no consensus on duration of the nasal splint after nasal septum surgeries. The pressure of nasal splint on the mucosa may cause tissue necrosis and nasal septum perforation. OBJECTIVES: To investigate the histopathological changes of the nasal mucosa caused by nasal splints in a rabbit model. METHODS: No splint was used in group A. Bilateral silicone nasal splints were placed for five, ten, and 15 days in groups B, C, and D, respectively. Biopsy of the nasal mucosa was performed after removal of splint. Histopathologic evaluations were performed. The severity and depth of the inflammation were scored. RESULTS: Group A had a normal histological appearance. Comparison of the results of groups B, C, and D with group A demonstrated statistically significant differences with regards to the severity of histopathological findings. There was no statistically significant difference between groups B and C. There were statistically significant differences between the groups B and D, and also between groups C and D. CONCLUSIONS: Longer duration of nasal splint had a higher risk for septal perforation. Therefore, removal of the splint as soon as possible may be helpful for preventing potential perforations. .

INTRODUÇÃO: Não existe consenso acerca do tempo de permanência de splints nasais no pós-operatório de cirurgias no septo. A pressão causada pelos mesmos na mucosa nasal pode causar necrose e perfurações septais. OBJETIVOS: Investigar mudanças histopatológicas da mucosa nasal causadas por splints nasais em coelhos. MÉTODO: Nenhum splint foi utilizado no grupo A. Splints de silicone foram utilizados por 5, 10 e 15 dias nos grupos B, C e D, respectivamente. Biópsia da mucosa nasal foi realizada após a remoção dos mesmos. Avaliações histopatológicas foram realizadas, e a gravidade e a profundidade do processo inflamatório foram medidas. RESULTADOS: Grupo A apresentou uma aparência histológica normal. Comparações de resultados entre os grupos B, C e D com o grupo A demonstraram diferenças estatísticas relevantes na gravidade histopatológica. Não houve diferenças estatísticas relevantes entre os grupos B e D, assim como entre os grupos C e D. CONCLUSÃO: De acordo com os resultados, quanto maior a duração no uso de splints nasais maior o risco de perfuração septal. Portanto, a remoção de splints nasais deve ser realizada assim que possível, prevenindo potenciais perfurações. .

Assessment of mucosal changes associated with nasal splint in a rabbit model.

INTRODUCTION: There is no consensus on duration of the nasal splint after nasal septum surgeries. The pressure of nasal splint on the mucosa may cause tissue necrosis and nasal septum perforation. OBJECTIVES: To investigate the histopathological changes of the nasal mucosa caused by nasal splints in a rabbit model. METHODS: No splint was used in group A. Bilateral silicone nasal splints were placed for five, ten, and 15 days in groups B, C, and D, respectively. Biopsy of the nasal mucosa was performed after removal of splint. Histopathologic evaluations were performed. The severity and depth of the inflammation were scored. RESULTS: Group A had a normal histological appearance. Comparison of the results of groups B, C, and D with group A demonstrated statistically significant differences with regards to the severity of histopathological findings. There was no statistically significant difference between groups B and C. There were statistically significant differences between the groups B and D, and also between groups C and D. CONCLUSIONS: Longer duration of nasal splint had a higher risk for septal perforation. Therefore, removal of the splint as soon as possible may be helpful for preventing potential perforations.

Clinical and pathologic characteristics of intranasal abuse of combined opioid-acetaminophen medications.

BACKGROUND: The nonmedical abuse of prescription opioids via intranasal administration is a growing problem. The objective of this study is to investigate of the typical presentation of intranasal opioid-acetaminophen abuse and outline optimal therapy. METHODS: This study was a retrospective chart review. Patients with intranasal pathology from inhalation of combined opioid-acetaminophen medications (COAMs) from 3 academic otolaryngology practices in western Pennsylvania from January 2012 to October 2012 were included in the review. RESULTS: Seven adults ranging in age from 23 to 46 years were identified with nasal complaints from the intranasal inhalation of COAMs. All patients presented with nasal pain and were found to have fibrinous necrotic nasal mucosa involving the posterior nasal cavity and nasopharynx. Of the 7 patients, 6 (85.7%) presented with a septal perforation. Pathology and culture revealed fungus in 85.7% of the patients; however, no invasive fungal disease was noted in any of the specimens. Patients did not improve with either systemic or topical antifungal therapy. Polarizable material characteristic of talc used as a tablet binder was present in the histopathology of 4 of 7 (57.1%) patients. Patients who abstained from intranasal drug use along with serial debridement demonstrated the greatest improvement. CONCLUSION: Intranasal COAM abuse causes nasal pain, tissue necrosis with potential septal and palatal perforation, and noninvasive fungal colonization. Antifungal therapy was of no benefit in the current series of patients. Current therapy should focus on recognition of the etiology of patients' pathology and encourage abstinence from intranasal use of these drugs along with serial debridements.

Leishmaniasis de la mucosa nasal en paciente de 66 años, con 40 años de vivir fuera de área endémica: reporte de caso / Nasal mucosa Leishmaniasis in a 66 years old patient, with 40 years of living outside of endemic area: case report

La Leishmaniasis es una enfermedad parasitaria que en su infección a mucosas presenta lesiones ulceradas extensas, y que en su compromiso nasal afecta principalmente el septum. Es una enfermedad de predilección por zonas climáticas por debajo de los 1..750 metros, en clima cálido y húmedo, conzonas endémicas en nuestro país. Reportamos en nuestro servicio, el caso de una paciente de 66 años, con historia de aproximadamente 15 años de obstrucción nasal y perforación septal. Diagnóstico de rinitis alérgica con pobre respuesta al manejo médico. Con antecedente de habitar por 16 años zonaendémica para Leishmania con lesión en miembro inferior derecho por picadura de “pito”. Biopsia de borde de perforación septal positiva para la enfermedad.

Leishmaniasis is a parasitic illness that in its infection to mucosa presents extensive ulcerated lesions and that in its nasal commitment it affects mainly the septum. It is an illness of predilection for climatic areas below the 1.750 meters, in warm and humid climate, with endemic areas in our country. We report in our service, the case of a 66 year old patient, with approximately 15 years of history of nasal obstruction and septal perforation. Diagnosis of rhinitis allergic with poor response to the medical management. With antecedent of inhabiting for 16 years in endemic area for Leishmania with lesion in the right leg for sting of “I whistle”. Biopsy of the edge of septal perforation was positive for theillness.