The Nasal Locator: An Innovative Instrument to Define the Exact Point of Osteotomy in Preservation or Structural Rhinoplasty.

One of the most common components of most dorsal preservation (DP) techniques is subdorsal septal excision. Whatever the instrument used for this procedure (piezoelectric, Rongeur, or long scissors), it is paramount to be able to determine the exact subdorsal point (SDoP) at which the osteotomy/ostectomy (or cartilage cut) has been reached. First, to avoid any unnecessary extension of the osteotomy that increases the risk of fracture spreading into the cribriform plate and a consequent cerebrospinal fluid leak; second, to be sure that the subdorsal cut is high enough and can be combined/unified with the planned radix osteotomy.In addition, transverse osteotomies are usually necessary in both preservation and structural rhinoplasties. Even though many surgeons are satisfied with their osteotomy lines, it sometimes proves difficult to be sure of their position, especially during a DP rhinoplasty when both the transverse lines have to go in the direction of the planned radix osteotomy.We have developed the Nasal Locator (NL) to precisely define various nasal points of interest, such as a subdorsal cut (cartilaginous or bony), or a transverse or medial osteotomy line. It ends in two tips. The lower tip is placed at the point we wish to determine (e.g., SDoP or a transverse osteotomy), while the upper tip is fixed a certain distance from it (in all three dimensions), showing its exact location.Our in-depth research of the literature and the market has not revealed any device similar in form and function to the NL.We have been using the NL for almost 2 years and are confident of its usefulness. It is easy to use, and practically no time is needed to become familiar with it. During surgery, it is needed for less than 30 seconds and is risk-free. It is fully sterilizable and can be used repeatedly.

Clicking larynx syndrome - a diagnostic and surgical challenge.

When swallowing, a clicking in the throat may uncommonly occur, causing great discomfort and pain. This unpleasant event may lead health professionals to attribute the symptoms to psychogenic aetiology. The case of a 49-year-old female is presented, who reported an audible bilateral clicking in the throat, associated with neck and throat pain when swallowing or turning her neck. From the ENT examination and palpation of the neck during patient swallowing, we located the source of the clicking on the left. However, during palpation from side to side, the patient suffered bilateral pain. Laryngeal computed tomography with a 3D reconstruction showed a short distance between the hyoid bone and the superior part of the thyroid cornua, accompanied by posterior-medially displaced bilateral superior cornua in the thyrohyoid region. The bilateral sensation of throat pain during swallowing or palpation, in combination with our desire to maintain laryngeal symmetry, led us to a two-sided exeresis of the superior thyroid cornua. This resulted in immediate and complete relief of the symptoms. Although it is an uncommon complaint, clicking larynx syndrome should be considered as a differential diagnosis.

Endoscopic sinus surgery outcomes in CRS: quality of life and correlations with NOSE scale in a prospective cohort study.

BACKGROUND: To evaluate the impact of endoscopic sinus surgery (ESS) on clinical outcomes, quality of life (QoL) and Nasal Obstruction and Symptom Evaluation (NOSE) scale in patients with CRSwNP and CRSsNP. An additional question that needs to be investigated is whether there is a correlation between patients at the age of relapse. METHODOLOGY/PRINCIPAL: A prospective cohort study of 150 subjects [96 males, 54 females, mean age: 51.99 ± (15.73)]. The SNOT-22 and NOSE questionnaires were used to measure the patients' QoL and their nasal blockage symptoms, respectively. Endoscopic and computerized tomography (CT) scores depicted the objective findings. RESULTS: Following ESS, the endoscopic scale showed a significant improvement in 83.85% of patients. QoL measured with SNOT-22 improved by 78.85% and with NOSE scale by 92.10%. Also, a statistically significant correlation was found between NOSE, SNOT-22 and the Lund-Kennedy scale. Recurrence was observed in 13 patients during follow-up. There was no statistically significant correlation between age, gender, smoking and recurrence tendency. Patients with baseline SNOT-22 and NOSE scores lower than 30 typically fail to obtain a clinically meaningful benefit. Patients with a rate greater than or equal to 40 achieved a minimal clinically important difference (MCID) of 83.9% and had an average symptom reduction (RI) rate of 60.3%. CONCLUSIONS: ESS is an important treatment option for symptomatic patients with CRSwNP and CRSsNP. Both objective and subjective measurements including QoL improved significantly, and the results stabilized at 12 to 18 months. The NOSE scale is a sensitive outcome measure in the CRS population, including subjects with and without nasal polyps. In our study, SNOT-22 and NOSE are excellent predictors of postoperative improvement.