Postoperative effects of bilateral sphenopalatine ganglion blockade in septorhinoplasty operations; double-blind randomized clinical trial.

OBJECTIVE: We aimed to investigate the effect of bilateral sphenopalatine ganglion blockade (SPGB) on the main postoperative complications in septorhinoplasty operations. METHODS: In this randomized, controlled, prospective study, 80 cases planned for Septorhinoplasty operations under general anesthesia were included in the study. The cases were divided into two groups; SPGB was performed with 2 mL of 0.25% bupivacaine bilaterally 15 min before the end of the operation in the SPGB group (Group S, n = 40). In the control group (Group C, n = 40), 2 mL of 0.9% NaCl solution was applied into both SPG areas. In the recovery unit after the operation; the pain and analgesic needs of the patients at 0, 2, 6 and 24 h were evaluated. RESULTS: There was no statistically significant difference between the groups in terms of hemodynamic parameters (ASA, MBP, HR) (p > 0.05) All VAS values were statistically lower in Group S than in Group C (p < 0.05). In Group S, the need for analgesic medication was found in 5 cases between 0-2 h, whereas in Group C, this rate was found in 17 cases, and it was statistically significant (p < 0.05). CONCLUSION: Bilateral SPGB application was determined to provide better analgesia in the early postoperative period compared to the control group, it was concluded that further studies are needed to say that there are significant effects on laryngospasm and nausea-vomiting. LEVEL OF EVIDENCE: 2, degree of recommendation B.

Postoperative effects of bilateral sphenopalatine ganglion blockade in septorhinoplasty operations; double-blind randomized clinical trial

Abstract Objective We aimed to investigate the effect of bilateral sphenopalatine ganglion blockade (SPGB) on the main postoperative complications in septorhinoplasty operations. Methods In this randomized, controlled, prospective study, 80 cases planned for Septorhinoplasty operations under general anesthesia were included in the study. The cases were divided into two groups; SPGB was performed with 2 mL of 0.25% bupivacaine bilaterally 15 min before the end of the operation in the SPGB group (Group S, n = 40). In the control group (Group C, n = 40), 2 mL of 0.9% NaCl solution was applied into both SPG areas. In the recovery unit after the operation; the pain and analgesic needs of the patients at 0, 2, 6 and 24 h were evaluated. Results There was no statistically significant difference between the groups in terms of hemodynamic parameters (ASA, MBP, HR) (p> 0.05) All VAS values were statistically lower in Group S than in Group C (p< 0.05). In Group S, the need for analgesic medication was found in 5 cases between 0-2 h, whereas in Group C, this rate was found in 17 cases, and it was statistically significant (p< 0.05). Conclusion Bilateral SPGB application was determined to provide better analgesia in the early postoperative period compared to the control group, it was concluded that further studies are needed to say that there are significant effects on laryngospasm and nausea-vomiting. Level of evidence: 2, degree of recommendation B.

Overall quality of life impact on candidates for septorhinoplasty according to the World Health Organization quality of life brief questionnaire (WHOQOL-Brief) / Impacto geral na qualidade de vida em candidatos à septorrinoplastia de acordo com o World Health Organization Quality of Life Brief Questionnaire (WHOQOL-Brief)

Abstract Introduction: Quality of life has been an increasingly reference measure in whole health impact of diseases and in septorhinoplasty evaluation as well. It is known that the decision for this elective surgical procedure requires the subjective perception of patients' complaints about their own health and life stage in association with the surgeon's aesthetic and functional perspective of each case. Objective: To define the quality of life of candidates for septorhinoplasty using the World Health Organization quality of life questionnaire, WHOQOL-Brief, and the prevalence of other independent variables for this population. Methods: A cross-sectional study using a sample of candidates for septorhinoplasty was performed. All patients responded to the WHOQOL-Brief during the pre-operative period. A normative population quality of life study was the reference for the sample size and means. Results: A total of 302 patients were included among the 322 eligible patients. Twenty patients did not complete the questionnaire correctly and were excluded from the study. The sample consisted of patients aged between 15 and 78 years (34.7±14 years): the most majority were Caucasian and female. Among this group, 88.1% declared symptoms of nasal obstruction and 77.4% complained of sleeping problems. It was seen that 10.9% patients chose the surgery primarily for aesthetic improvement; 37.1% chose it mainly because of functional symptoms and 52% chose it for both functional and aesthetic reasons. The physical health domain's mean was 62.2 ± 17), which is a higher mean compared to the references' standard one (Μ = 58.9± 10.5, p = 0.002). The social relationship domain mean was 70.8±18.1; that is a lower mean then general population's one (Μ = 76.2± 18.8, p < 0.001). The psychological and the environment domain means revealed no difference when comparing the sample to the norm (μ = 65.3 ±15.1 vs. μ = 65.9 ±10.8, p = 0.530 and μ = 60.3 ±13.1 vs. μ = 59.9 ± 14.9, p = 0.667). Conclusion: The WHOQOL-Brief questionnaire proved an accurate instrument to cross-check different populations in quality of life outcomes. The study provides good evidence of lower quality of life in social relations domain and high prevalence of nasal obstruction and sleeping symptoms in candidates for septorhinoplasty. This study contributes to recent literature with relevant data supporting a more integrative evaluation in this population in the preoperative period. The results may also encourage a multidisciplinary approach for chronic symptoms when associated with nasal obstruction, sleep disorders and aesthetic complaints.

Resumo Introdução: A qualidade de vida tem sido cada vez mais uma medida de referência no impacto total das doenças na saúde e também na avaliação da septorrinoplastia. Sabe-se que a decisão por esse procedimento médico eletivo requer a percepção subjetiva da queixa do paciente sobre sua própria saúde e estágio de vida em associação com a perspectiva estética e funcional do cirurgião de cada caso. Objetivo: Definir a qualidade de vida de pacientes candidatos à septorrinoplastia por meio do questionário de qualidade de vida da OMS, WHOQOL-Brief e a prevalência de outras variáveis independentes para essa população. Método: Foi feito um estudo transversal com uma amostra de candidatos à septorrinoplastia. Todos os pacientes responderam ao WHOQOL-Brief no momento pré-operatório. Um estudo normativo de qualidade de vida populacional foi a referência para o tamanho e as médias da amostra. Resultados: Foram incluídos 302 pacientes entre os 322 elegíveis. Vinte pacientes não preencheram o questionário corretamente e foram excluídos do estudo. A amostra foi composta por pacientes entre 15 e 78 anos (34,7 ± 14 anos) e a maioria era branca e do sexo feminino. Entre todos, 88,1% declararam sintomas de obstrução nasal e 77,4% declararam ter sintomas durante o sono. Observou-se que 10,9% dos pacientes optaram pela cirurgia principalmente para melhoria estética; 37,1% optaram principalmente devido a sintomas funcionais e 52% optaram por queixa funcional e estética. A média do domínio saúde física foi de 62,2 ± 17, uma média mais alta em comparação com o padrão de referências (μ = 58,9 ± 10,5, p = 0,002). A média do domínio do relacionamento social foi de 70,8 ±18,1, uma média inferior à da população geral (μ = 76,2 ± 18,8, p < 0,001). As médias dos domínios psicológico e meio ambiente não diferiram na comparação da amostra com o normativo (μ = 65,3 ±15,1 vs. μ = 65,9 ± 10,8, p = 0,530 e μ = 60,3 ±13,1 vs. μ = 59,9 ± 14,9, p = 0,667). Conclusão: O questionário WHOQOL-Brief demonstrou servir como um instrumento preciso para cruzar diferentes populações nos desfechos de qualidade de vida. O estudo fornece boas evidências de menor qualidade de vida no domínio relações sociais e alta prevalência de obstrução nasal e sintomas durante o sono em candidatos à septorrinoplastia. Este estudo contribui para a literatura recente com dados relevantes que subsidiam uma avaliação mais integrativa nessa população no momento pré-operatório. Os resultados também podem incentivar uma abordagem multidisciplinar para os sintomas crônicos quando associados, como ocorre na obstrução nasal, distúrbios do sono e queixas estéticas.

Overall quality of life impact on candidates for septorhinoplasty according to the World Health Organization quality of life brief questionnaire (WHOQOL-Brief).

INTRODUCTION: Quality of life has been an increasingly reference measure in whole health impact of diseases and in septorhinoplasty evaluation as well. It is known that the decision for this elective surgical procedure requires the subjective perception of patients' complaints about their own health and life stage in association with the surgeon's aesthetic and functional perspective of each case. OBJECTIVE: To define the quality of life of candidates for septorhinoplasty using the World Health Organization quality of life questionnaire, WHOQOL-Brief, and the prevalence of other independent variables for this population. METHODS: A cross-sectional study using a sample of candidates for septorhinoplasty was performed. All patients responded to the WHOQOL-Brief during the pre-operative period. A normative population quality of life study was the reference for the sample size and means. RESULTS: A total of 302 patients were included among the 322 eligible patients. Twenty patients did not complete the questionnaire correctly and were excluded from the study. The sample consisted of patients aged between 15 and 78 years (34.7 ±â€¯14 years): the most majority were Caucasian and female. Among this group, 88.1% declared symptoms of nasal obstruction and 77.4% complained of sleeping problems. It was seen that 10.9% patients chose the surgery primarily for aesthetic improvement; 37.1% chose it mainly because of functional symptoms and 52% chose it for both functional and aesthetic reasons. The physical health domain's mean was 62.2 ±â€¯17), which is a higher mean compared to the references' standard one (µâ€¯= 58.9 ±â€¯10.5, p = 0.002). The social relationship domain mean was 70.8 ±â€¯18.1; that is a lower mean then general population's one (µâ€¯= 76.2 ±â€¯18.8, p < 0.001). The psychological and the environment domain means revealed no difference when comparing the sample to the norm (µâ€¯= 65.3 ±â€¯15.1 vs. µâ€¯= 65.9 ±â€¯10.8, p = 0.530 and µâ€¯= 60.3 ±â€¯13.1 vs. µâ€¯= 59.9 ±â€¯14.9, p = 0.667). CONCLUSION: The WHOQOL-Brief questionnaire proved an accurate instrument to cross-check different populations in quality of life outcomes. The study provides good evidence of lower quality of life in social relations domain and high prevalence of nasal obstruction and sleeping symptoms in candidates for septorhinoplasty. This study contributes to recent literature with relevant data supporting a more integrative evaluation in this population in the preoperative period. The results may also encourage a multidisciplinary approach for chronic symptoms when associated with nasal obstruction, sleep disorders and aesthetic complaints.

Different techniques for caudal extension graft placement in rhinoplasty.

INTRODUCTION: The caudal extension graft is usually a cartilage graft that overlaps the caudal margin of the nasal septum. A combination of the caudal extension graft and the tongue-in-groove technique is used to stabilize the nasal base, set tip projection, and refine the alar-columellar relationship. OBJECTIVES: In this study we present some new modifications to the placement of caudal extension grafts in rhinoplasty. METHODS: This study is a retrospective review of a prospectively collected database of 965 patients who underwent septorhinoplasty from June 2011 to July 2015. Of these, 457 patients required a caudal extension graft and were included in the study. Minimum follow-up was 13.2 months with a mean follow-up time of 17.4 months. RESULTS: In most cases, comparison of photographs before and after surgery were satisfactory and showed improved contour. Minor deformity was detected in 41 patients and 11 patients needed revision surgery. CONCLUSION: With these modifications the surgeon can employ the caudal extension graft even in angulated caudal septal deviations. A variety of methods have been proposed for correction of caudal nasal deviation.

Effects of septorhinoplasty on smell perception.

PURPOSE: To assess whether significant changes in smell perception occur after septorhinoplasty, and evaluate whether septum deviation, allergic rhinitis, and surgical technique affect postoperative smell perception. METHODS: Thirty-four patients (> 18 years old) awaiting septorhinoplasty were included, while those with previous severe hyposmia or anosmia were excluded. The participants self-assessed their smell perception using a 100-mm visual analogue scale (VAS), where 0 mm indicated the inability to smell and 100 mm indicated normal smell perception. The University of Pennsylvania Smell Identification Test (UPSIT) was applied before the procedure, and 4 and 12 weeks after surgery. RESULTS: The UPSIT score showed no significant changes at 4 (p = 0.59; 95% CI - 0.35 to + 2) or 12 weeks (p = 0.16; 95% CI - 1.13 to + 0.66). A comparison of the VAS scores before and 4 weeks after surgery (p = 0.62; 95% CI - 0.63 to + 0.39) yielded similar results. However, the average VAS scores improved 12 weeks after surgery (p = 0.007; 95% CI + 0.22 to + 1.30). Olfactory function, measured using the UPSIT, was not influenced by open or closed surgical techniques (p ≥ 0.10), the presence or absence of rhinitis (p ≥ 0.15), or obstructive septum deviation (p ≥ 0.38). Twelve weeks after surgery, self-evaluated smell perception was better in patients who underwent a closed procedure rather than an open procedure (p = 0.006; 95% CI: -1.39 to -0.37). CONCLUSION: A validated test demonstrates that septorhinoplasty does not compromise smell perception 4 and 12 weeks after surgery. However, it might improve smell perception by the self-report observation.

Outcomes of external septorhinoplasty in a Turkish male population / Resultados de rinosseptoplastia externa em uma população turca do sexo masculino

Abstract Introduction The first and one of the most important steps in facial plastic surgery is accurate preoperative facial analysis and recording of data that may help the surgeon to check the outcomes of his/her techniques, promoting a surgeon's professional development. Objective To evaluate the esthetic outcomes of external septorhinoplasty relevant to ethnic facial harmony and to investigate the relationship of the columellar incision scar with the type of skin and columellar incision type in a Turkish population. Methods In total, 28 consecutive adult male patients with a mean age of 32.14 ± 10.66 years (range: 18-61 years) were included the study. Primary outcomes were preoperative and postoperative photogrammetric facial analyses of the patients including measurement of nasofrontal angle, nasolabial angle and nasal projection ratios (Gode) assessed according to the data derived from the Rhinobase program. Results were compared to facial proportions of the Turkish population. Columellar incision scar scores related to the Fitzpatrick skin type classification of the patients and columellar incision types used for the external approach were secondary outcomes of the study. Results Mean preoperative and postoperative nasofrontal angles were 148.04° ± 8.18° and 144.50° ± 7.15°, respectively, while mean preoperative and postoperative nasolabial angles were 87.59° ± 14.01° and 98.50° ± 9.71°, respectively. Mean preoperative and postoperative nasal tip projection ratios were 0.56 ± 0.05 and 0.60 ± 0.06, respectively. The differences between pre- and postoperative measurements were all significantly different and were in accordance with Turkish nasal harmony. Columellar inverted "V" incisions were performed in 15 (53.6%) patients while "V" incisions were used in 13 (46.4%) patients. Fitzpatrick skin Type 4 was seen in 46.42% of the patients, Fitzpatrick Type 3 in 46.42% and Fitzpatrick Type 2 in 7.14% of the patients. No significant difference was seen between columellar scar scores according to skin type and columellar incision type used for external septorhinoplasty. Conclusions This study demonstrated that outcomes for nasofrontal angle, nasolabial angle and nasal tip projection ratios analyzed using the Rhinobase program in patients who underwent external septorhinoplasty were similar to reference values for the Turkish population.

Resumo Introdução O primeiro e um dos mais importantes passos na cirurgia plástica facial é a análise pré-operatória facial precisa e o registro de dados que podem ajudar o cirurgião a verificar os resultados de suas técnicas, promovendo seu desenvolvimento profissional. Objetivo Avaliar os resultados estéticos da rinosseptoplastia externa relevantes para a harmonia étnica facial e investigar a associação da cicatriz de incisão columelar com o tipo de pele e o tipo de incisão columelar em uma população turca. Método No total, 28 pacientes adultos consecutivos com média de idade de 32,14 ± 10,66 anos (intervalo: 18-61 anos) foram incluídos no estudo. Os desfechos primários foram as análises faciais fotogramétricas pré-operatórias e pós-operatórias dos pacientes, incluindo a medida do ângulo nasofrontal, ângulo nasolabial e razões da projeção nasal (Gode), avaliados de acordo com os dados derivados do programa Rhinobase. Os resultados foram comparados às proporções faciais da população turca. Os escores de cicatriz de incisão columelar relacionados com a classificação de Fitzpatrick do tipo de pele dos pacientes e os tipos de incisão columelar usados para a abordagem externa foram os desfechos secundários do estudo. Resultados Os ângulos nasofrontais pré- e pós-operatórios médios foram 148,04 ± 8,18° e 144,50 ± 7,15°, respectivamente, enquanto os ângulos nasolabiais pré- e pós-operatórios médios foram 87,59 ± 14,01° e 98,50 ± 9,71°, respectivamente. As razões médias da projeção nasal pré- e pós-operatória foram de 0,56 ± 0,05 e 0,60 ± 0,06, respectivamente. As diferenças entre as medidas pré- e pós-operatórias foram todas significativamente diferentes e estavam de acordo com a harmonia nasal turca. A incisão columelar em "V" invertido foi utilizada em 15 (53,6%) pacientes e a incisão em "V" foi utilizada em 13 (46,4%) pacientes. Pele Fitzpatrick tipo 4 foi observada em 46,42% dos pacientes, Fitzpatrick tipo 3 em 46,42% e Fitzpatrick tipo 2 em 7,14% dos pacientes. Não foi observada diferença significativa entre os escores de cicatriz columelar de acordo com o tipo de pele e o tipo de incisão columelar utilizados na rinosseptoplastia externa. Conclusões Este estudo demonstrou que os desfechos para ângulo nasofrontal, ângulo nasolabial e razões de projeção nasal analisados pelo programa Rhinobase em pacientes submetidos à rinosseptoplastia externa foram semelhantes aos valores de referência para a população turca.

Outcomes of external septorhinoplasty in a Turkish male population.

INTRODUCTION: The first and one of the most important steps in facial plastic surgery is accurate preoperative facial analysis and recording of data that may help the surgeon to check the outcomes of his/her techniques, promoting a surgeon's professional development. OBJECTIVE: To evaluate the esthetic outcomes of external septorhinoplasty relevant to ethnic facial harmony and to investigate the relationship of the columellar incision scar with the type of skin and columellar incision type in a Turkish population. METHODS: In total, 28 consecutive adult male patients with a mean age of 32.14±10.66 years (range: 18-61 years) were included the study. Primary outcomes were preoperative and postoperative photogrammetric facial analyses of the patients including measurement of nasofrontal angle, nasolabial angle and nasal projection ratios (Gode) assessed according to the data derived from the Rhinobase program. Results were compared to facial proportions of the Turkish population. Columellar incision scar scores related to the Fitzpatrick skin type classification of the patients and columellar incision types used for the external approach were secondary outcomes of the study. RESULTS: Mean preoperative and postoperative nasofrontal angles were 148.04°±8.18° and 144.50°±7.15°, respectively, while mean preoperative and postoperative nasolabial angles were 87.59°±14.01° and 98.50°±9.71°, respectively. Mean preoperative and postoperative nasal tip projection ratios were 0.56±0.05 and 0.60±0.06, respectively. The differences between pre- and postoperative measurements were all significantly different and were in accordance with Turkish nasal harmony. Columellar inverted "V" incisions were performed in 15 (53.6%) patients while "V" incisions were used in 13 (46.4%) patients. Fitzpatrick skin Type 4 was seen in 46.42% of the patients, Fitzpatrick Type 3 in 46.42% and Fitzpatrick Type 2 in 7.14% of the patients. No significant difference was seen between columellar scar scores according to skin type and columellar incision type used for external septorhinoplasty. CONCLUSIONS: This study demonstrated that outcomes for nasofrontal angle, nasolabial angle and nasal tip projection ratios analyzed using the Rhinobase program in patients who underwent external septorhinoplasty were similar to reference values for the Turkish population.

The accuracy of different methods for diagnosing septal deviation in patients undergoing septorhinoplasty: A prospective study.

OBJECTIVE: This study aimed to determine the diagnostic accuracy of different diagnostic tests in predicting nasal septum deformities during preoperative planning for septorhinoplasty. METHODS: Consecutive patients who underwent septorhinoplasty between June 2011 and August 2012 were included (n = 30) and underwent a protocol of diagnostic tests, including nasal speculoscopy, craniofacial computed tomography (CT), three-dimensional (3D) reconstruction of the nasal septum by CT and nasal endoscopy. A modified Guyuron classification of septal deformities was used for classifying the septal deviations. Direct surgical assessment of the nasal septum during open septorhinoplasty was the reference standard with which each of the diagnostic tests was compared. Sensitivity, specificity and predictive values of each test were calculated. RESULTS: The preoperative diagnosis was nasal bone fracture in 11 patients, nasal septal fracture in 15 and post-traumatic nasal deformity in four. For type A deviations (localised), craniofacial CT showed the highest performance with a sensitivity of 100%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 99%. For type B septal deformations (C shape), nasal endoscopy (sensitivity, 100%; specificity, 87.5%; PPV, 87.7%; and NPV, 100%) showed the highest performance. For type C deformities (S shape), nasal endoscopy (sensitivity, 70%; specificity, 100%; PPV, 100%; and NPV, 87%) showed the highest performance. The accuracy for nasal endoscopy was 27/30 (90%), 26/30 (87%) for craniofacial CT, 22/30 (73%) for 3D reconstruction and 10/28 (36%) for speculoscopy. CONCLUSIONS: Nasal endoscopy and craniofacial CT were more accurate and precise than nasal speculoscopy and 3D reconstruction for preoperative evaluation of the nasal septum, thus enabling more appropriate surgical planning for septorhinoplasty.