Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation.

INTRODUCTION: Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. OBJECTIVE: The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. METHODS: This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. RESULTS: Significantly higher left ventricular myocardial performance index (0.52 ±â€¯0.06 vs. 0.41 ±â€¯0.04, p <  0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p <  0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p <  0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p =  0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p =  0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p <  0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p  = 0.224). CONCLUSION: Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.

Spreader Graft for Severe Deviation of Nasal Septum with Obstruction of the Internal Nasal Valve: Clinical and Functional Results.

Difficulty in nasal ventilation is one of the most frequently occurring problems in otorhinolaryngology and its correct diagnosis is the key step to solve it. The dysfunctions in the valve area are a frequent cause of chronic nasal obstruction, though commonly ignored. The objective of the study is to analyze the clinical and functional outcomes in a group of patients with septal deviations and valve compromise treated with spreader graft with endonasal approach. Thirty-five patients with septal deviation with compromise of the internal nasal valve (INV; area II of Cottle), treated with spreader graft and a minimum follow-up of 12 months, were included for analysis. Patients were evaluated with video nasosinusal endoscopy, photography, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and rhinomanometry (RM). Postoperative complications were recorded. The results obtained in the pre- and postoperative NOSE scores showed significant differences (p = 0.001), as also in pre- and postoperative RM tests (p < 0.001). Two complications were reported in the 35 patients; thus the complication rate in our sample was 6%. The use of spreader grafts, with endonasal approach, as nasal septum's tutors improved perpendicular septal deviations with compromise of the INV (area II), reaching an effective functional improvement in the nasal airway, with low rate of complications.

Rinomodelação ou rinoplastia não-cirúrgica: uma abordagem segura e reprodutível / Rhinomodelation or non-surgical rhinoplasty: a safe and reproducible approach

Introdução: A rinoplastia é uma cirurgia que muitas vezes apresenta resultados imprevisíveis, mesmo em mãos de cirurgiões experientes. Neste sentido, a rinomodelação com preenchedores é um procedimento não-cirúrgico para corrigir pequenas alterações externas nasais em casos específicos. Métodos: Os autores descrevem a técnica de aplicação de preenchedores (ácido hialurônico ou hidroxiapatita de cálcio) para modelação nasal. Foram incluídos todos os pacientes submetidos ao preenchimento nasal, entre 2009 e 2012. Foi avaliado o edema da ponta nasal, a dor e o grau de satisfação dos pacientes com o resultado. Resultados: Foram incluídos 39 pacientes no estudo. Com relação aos desfechos analisados com ácido hialurônico: 52% apresentaram edema leve; 74% tiveram dor leve; 15% se mostraram muito satisfeitos e 74% satisfeitos com o resultado. Com relação aos pacientes submetidos à rinomodelação com hidroxiapatita de cálcio: 67% apresentaram edema moderado; 50% dor moderada; 17% dor intensa e 84% se mostraram satisfeitos com o resultado. Conclusão: A rinomodelação com preenchedores reabsorvíveis é um procedimento simples, com resultados estéticos aceitáveis, sendo necessário um profundo conhecimento anatômico para diminuir o risco de complicações.

Introduction: Rhinoplasty often leads to unpredictable results, even in the hands of experienced surgeons. However, in specific cases, rhinomodelation with fillers, a non-surgical procedure to correct minor nasal external changes, can be used. Methods: This study describes the application technique of fillers (hyaluronic acid or calcium hydroxyapatite) for nasal modeling. Patients undergoing nasal filling between 2009 and 2012 were included. Edema of the nasal tip, pain, and the degree of patient satisfaction with the outcome were assessed. Results: Thirty-nine patients were included in the study. Regarding the outcomes of rhinomodelation with hyaluronic acid, 52% patients presented with mild edema, 74% had mild pain, 15% were very satisfied, and 74% were satisfied with the result. For the outcomes of rhinomodelation with calcium hydroxyapatite, 67% patients presented with moderate edema, 50% had moderate pain; 17% had severe pain, and 84% were satisfied with the result. Conclusion: Rhinomodelation with resorbable fillers is a simple procedure with acceptable esthetic results. However, a deep anatomical knowledge is necessary to decrease the risk of complications.

East-West Flap After Mohs Micrographic Surgery. / Colgajo este-oeste después de la cirugía micrográfica de Mohs.

Repair of distal nasal defects resulting from Mohs micrographic surgery is a challenge, but surgeons can choose from a number of techniques. We present 3 cases in which an east-west flap was used to close the defect. The east-west flap is an easily conceived advancement flap that consists of a superior triangle used to cover the defect and an inferior triangle whose base is located along the advancement line. The flap results in an optimal cosmetic outcome and involves minimum movement of tissue (preserving the nasal architecture) and well-camouflaged suture lines.

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.

Disease-specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction / Qualidade de vida específica da doença após septoplastia e fratura bilateral de concha inferior em pacientes com obstrução nasal

Abstract Introduction: Septal deviations might cause nasal obstruction and negative impact on the quality of life of individuals. The efficacy of septoplasty for treatment of septal deviation and the predictors of satisfactory surgical outcomes remain controversial. Technical variability, heterogeneity of research samples and absence of a solid tool for clinical evaluation are the main hindrances to the establishment of reliable statistical data regarding the procedure. Objective: To evaluate the clinical improvements in the disease-specific quality-of-life between patients submitted to septoplasty with bilateral outfracture of the inferior turbinate under sedation and local anesthesia in a tertiary hospital and to assess possible clinical-epidemiological variables associated with functional outcome. Methods: Fifty-two patients consecutively submitted to septoplasty with bilateral outfracture of the inferior turbinate for treatment of nasal obstruction filled in forms regarding clinical and epidemiological information during enrollment and had their symptom objectively quantified using the Nose Obstruction Symptom Evaluation (NOSE) scale preoperatively and one and three months after the procedure. Statistical analysis aimed to determine overall and stratified surgical outcomes and to investigate correlations between the clinical-epidemiological variables with the scores obtained. Results: Statistically significant improvement in the preoperative NOSE questionnaire compared to the scores obtained three months after surgery was demonstrated (p < 0.001, T-Wilcoxon), with strong correlation between the preoperative score and the postoperative improvement during this period (r = −0.614, p < 0.001, Spearman). After one month, patients reached in average 87.15% of the result obtained at the study termination. Smokers and patients with rhinitis and/or pulmonary comorbidity showed increased average preoperative NOSE scores, although without statistical significance (p > 0.05). Gender, age, history of rhinitis and presence of pulmonary comorbidity did not influence significantly surgical outcomes (p > 0.05). Smokers presented greater reduction in NOSE scores during the study (p = 0.043, U-Mann-Whitney). Conclusion: Septoplasty with bilateral outfracture of the inferior turbinate has proven to significantly improve disease-specific quality-of-life and this favorable outcome seems to occur precociously.

Resumo Introdução: Os desvios septais podem causar obstrução nasal e impacto negativo na qualidade de vida dos indivíduos. A eficácia da septoplastia para o tratamento do desvio septal e os preditores de resultados cirúrgicos satisfatórios continuam controversos. A variabilidade técnica, a heterogeneidade das amostras de estudo e a ausência de uma ferramenta sólida para avaliação clínica são os principais obstáculos ao estabelecimento de dados estatísticos confiáveis sobre o procedimento. Objetivo: Avaliar a melhora clínica na qualidade de vida específica da doença entre pacientes submetidos a septoplastia e fratura bilateral da concha inferior sob sedação e anestesia local em um hospital terciário e possíveis variáveis clínico-epidemiológicas associadas ao desfecho funcional. Método: Cinquenta e dois pacientes consecutivamente submetidos a septoplastia e fratura bilateral da concha inferior para o tratamento da obstrução nasal preencheram formulários com informações clínicas e epidemiológicas durante a inclusão no estudo e tiveram seus sintomas quantificados objetivamente utilizando a escala de Avaliação de Sintomas de Obstrução Nasal (Nose Obstruction Symptom Evaluation - NOSE) no pré-operatório e um e três meses após o procedimento. A análise estatística objetivou determinar resultados cirúrgicos globais e estratificados e investigar correlações entre as variáveis clínico-epidemiológicas e os escores obtidos. Resultados: Foi demonstrada uma melhora estatisticamente significativa nos escores obtidos no questionário NOSE três meses após a cirurgia (p < 0,001, T-Wilcoxon), quando comparado com os escores obtidos no pré-operatório, com uma forte correlação entre o escore pré-operatório e a melhora pós-operatória durante esse período (r = -0,614, p < 0,001, Spearman). Após um mês, os pacientes atingiram em média 87,15% do resultado obtido ao término do estudo. Fumantes e pacientes com rinite e/ou comorbidade pulmonar apresentaram valores médios pré-operatórios do escore NOSE aumentados, embora sem significância estatística (p > 0,05). Sexo, idade, história de rinite e presença de comorbidade pulmonar não influenciaram significativamente os resultados cirúrgicos (p > 0,05). Os fumantes apresentaram maior redução nos escores de NOSE (p = 0,043, U-Mann-Whitney). Conclusão: A septoplastia e a fratura bilateral da concha inferior demonstraram melhorar significativamente a qualidade de vida específica da doença e este resultado favorável parece ocorrer de forma precoce.

Avaliação da modificação da técnica de reconstrução das cartilagens alares de Max Pereira no protocolo de reconstrução nasal total do Hospital de Clínicas de Porto Alegre / Evaluation of Max Pereira alar reconstruction technique modification in the total nasal reconstruction protocol of the Hospital of Clinics of Porto Alegre

Introdução: A reconstrução nasal é a mais antiga das cirurgias plásticas. A anatomia nasal é complexa e necessita de uma associação de técnicas para a restauração da função e estética nasal adequada. Pereira et al. descreveram uma técnica que possibilita a reconstrução nasal total da cartilagem alar, com o uso de um enxerto da cartilagem auricular, com mínima deformidade auricular secundária à retirada do enxerto. O objetivo deste trabalho é apresentar uma modificação da técnica acima descrita, que possibilita reconstruir mais uma região anatômica do nariz, sem aumentar a morbidade, realizada por Collares et al., e a sua inserção no protocolo de reconstrução nasal total do Hospital de Clínicas de Porto Alegre. Métodos: Foi realizado um estudo retrospectivo. Avaliou-se a inserção da modificação da técnica em 10 pacientes que realizaram reconstrução nasal total. Resultados: Após a análise dos 10 casos, utilizando a modificação da técnica inserida no protocolo de reconstrução nasal total do Hospital de Clínicas de Porto Alegre, encontramos uma melhoria da forma do nariz, a válvula nasal interna com preservação da função e sem sequelas secundárias à retirada do enxerto auricular. Conclusão: Nesta série de casos, a modificação da técnica de Max Pereira resultou em tratamento estético funcional adequado quando implementada no protocolo de reconstrução nasal total do Hospital de Clínicas de Porto Alegre, sem aumentar a morbidade na área doadora.

Introduction: Nasal reconstruction is the oldest plastic surgery technique. The nasal anatomy is complex and requires an association of techniques for the restoration of function and adequate nasal esthetics. Pereira et al. described a technique that allows total nasal reconstruction of the alar cartilage through the use of an auricular cartilage graft, with minimal deformity secondary to the donor site. The objective of the present study is to present a modification, by Collares et al., of the technique described above, which allows the reconstruction of another anatomical region of the nose without increasing morbidity, and its insertion into the total nasal reconstruction protocol of Hospital de Clínicas of Porto Alegre. Methods: A retrospective study was conducted. We evaluated technique modification in 10 patients who underwent total nasal reconstructions. Results: After examining the 10 patients who were treated with the modified total nasal reconstruction protocol at the Hospital de Clínicas of Porto Alegre, we observed an improvement in the nose shape and internal nasal valve with preservation of function, without sequelae secondary to auricular graft removal. Conclusion: In this case series, the modification of the Max Pereira technique resulted in adequate aestheticfunctional treatment when implemented in the total nasal reconstruction protocol of the Hospital de Clínicas of Porto Alegre, without increasing the morbidity in the donor area.

Disease-specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction.

INTRODUCTION: Septal deviations might cause nasal obstruction and negative impact on the quality of life of individuals. The efficacy of septoplasty for treatment of septal deviation and the predictors of satisfactory surgical outcomes remain controversial. Technical variability, heterogeneity of research samples and absence of a solid tool for clinical evaluation are the main hindrances to the establishment of reliable statistical data regarding the procedure. OBJECTIVE: To evaluate the clinical improvements in the disease-specific quality-of-life between patients submitted to septoplasty with bilateral outfracture of the inferior turbinate under sedation and local anesthesia in a tertiary hospital and to assess possible clinical-epidemiological variables associated with functional outcome. METHODS: Fifty-two patients consecutively submitted to septoplasty with bilateral outfracture of the inferior turbinate for treatment of nasal obstruction filled in forms regarding clinical and epidemiological information during enrollment and had their symptom objectively quantified using the Nose Obstruction Symptom Evaluation (NOSE) scale preoperatively and one and three months after the procedure. Statistical analysis aimed to determine overall and stratified surgical outcomes and to investigate correlations between the clinical-epidemiological variables with the scores obtained. RESULTS: Statistically significant improvement in the preoperative NOSE questionnaire compared to the scores obtained three months after surgery was demonstrated (p<0.001, T-Wilcoxon), with strong correlation between the preoperative score and the postoperative improvement during this period (r=-0.614, p<0.001, Spearman). After one month, patients reached in average 87.15% of the result obtained at the study termination. Smokers and patients with rhinitis and/or pulmonary comorbidity showed increased average preoperative NOSE scores, although without statistical significance (p>0.05). Gender, age, history of rhinitis and presence of pulmonary comorbidity did not influence significantly surgical outcomes (p>0.05). Smokers presented greater reduction in NOSE scores during the study (p=0.043, U-Mann-Whitney). CONCLUSION: Septoplasty with bilateral outfracture of the inferior turbinate has proven to significantly improve disease-specific quality-of-life and this favorable outcome seems to occur precociously.

Usefulness of the subunit principle in nasal reconstruction.

The subunit principle in nasal reconstruction proposed the concept of reconstructing the specific topographic subunits that were identified as dorsum, tip, columella, the paired alae, sidewalls, and soft triangles. In patients with more than 50% of subunit loss, removing the remaining portion of the subunit and reconstructing the entire subunit may yield better results. The placement of incisions along the borders of the subunits minimizes scar lines. Furthermore, as trapdoor contraction occurs, the entire restored subunit bulges in a way that mimics the normal contour of a nasal tip, dorsum or ala. Two cases of nasal reconstruction that followed this important principle are described.

Correção do dorso nasal baixo ou em sela com enxerto composto de cartilagem conchal fragmentada fixa ao pericôndrio envolvidos à fáscia da mastóide / Correction of low or saddle nasal dorsum with a composite graft of fragmented conchal cartilage fixed to the perichondrium wrapped in mastoid fascia

Introdução: A rinoplastia de aumento em muitos casos torna-se mais difícil que a rinoplastia de redução. Enxertos dorsais sólidos realizados com cartilagem costal têm sido muito utilizados para aumento dorsal, porém estão associados com altos índices de revisão, por isso, muitos autores passaram a utilizar cartilagem em cubos envoltos por fáscia. A fáscia da mastoide, conectada ao pericôndrio da cartilagem conchal auricular, pode formar um enxerto composto para o aumento do dorso nasal, sendo também uma opção de tratamento. O objetivo é demonstrar a possibilidade do uso de cartilagem da concha auricular fragmentada fixa ao seu pericôndrio, e envoltos na fáscia da mastoide, formando um enxerto composto para aumento do dorso nasal. Métodos: Tratase de um estudo retrospectivo de 9 pacientes operados entre 2012 e 2016 no Hospital de Base da Faculdade de Medicina de São José do Rio Preto, em que foi realizado aumento do dorso nasal com cartilagem conchal fragmentada fixa ao seu pericôndrio e envolto à fáscia da mastoide. Resultados: Os pacientes foram acompanhados de 6 a 48 meses. Foram questionados quanto à satisfação do procedimento nasal e sensibilidade auricular, com avaliação positiva dos pacientes e cirurgiões. Conclusão: A cartilagem conchal parece ser uma alternativa de grande valia para procedimentos de aumento de dorso nasal. Esta cartilagem envolta com fáscia da mastoide parece ser uma alternativa vantajosa em comparação ao uso de outras fáscias, com baixa morbidade e taxa de complicações, podendo ser uma grande opção para tratamento do nariz em sela.

Introduction: In many cases, augmentation rhinoplasty is more difficult than reduction rhinoplasty. Solid dorsal grafts performed with costal cartilage have been widely used for dorsal augmentation; however, they are associated with high rates of revision. Thus, many authors began to use cartilage cut into cubes wrapped in fascia. The mastoid fascia, connected to the perichondrium of the auricular conchal cartilage can form a composite graft to augment the nasal dorsum, which is also a treatment option. The objective is to demonstrate the possibility of using fragmented auricular conchal cartilage fixed to its perichondrium and wrapped in mastoid fascia to form a composite graft for augmentation of the nasal dorsum. Methods: This is a retrospective study of 9 patients who underwent operation between 2012 and 2016 at the Base Hospital of the Faculty of Medicine of São José do Rio Preto, in which the nasal dorsum was augmented with fragmented conchal cartilage fixed to its perichondrium and wrapped in the mastoid fascia. Results: The patients were followed up for up 6 to 48 months. They were questioned about their satisfaction with the nasal procedure and hearing sensitivity, and provided a positive evaluation of the surgeons. Conclusion: The conchal cartilage seems a highly valuable alternative graft for nasal dorsum augmentation procedures. The technique of using cartilage wrapped in mastoid fascia seems to be an advantageous alternative when compared with those using cartilage wrapped in other fasciae: it has low morbidity and complications rates and can be a great option for saddle nose treatment.

A straight choice: avoiding septal re-deviation using titanium plates. A 16 year retrospective patient follow-up evaluation.

BACKGROUND: To propose a new surgical technique for fixing the nasal septum to the midline, for long term prevention of nasal obstruction, in secondary and select cases of primary septoplasty. METHODOLOGY: Retrospective study, within hospital medical center. PATIENTS: Two hundred and twenty two patients who underwent septoplasty. Data collection occurred consecutively between March 1st of 2000 and May 1st 2016. Twenty six percent females and seventy four percent males. MAIN OUTCOME MEASURES: Patterns of septal deformity, materials used for titanium plates, surgical results, symptom improvement, and surgical complications were investigated. RESULTS: A total of 222 patients were included in this study. 163 patients (73%) had no previous nasal surgery. Fifty nine patients (27%) presented with a previous nasal surgery. Sixteen year follow up included more than 90% of patients and resulted in an overall 2.7% revision rate. CONCLUSIONS: The use of titanium plate for septoplasty has shown to be simple, safe, and easy to learn technique in both secondary and select cases of primary septoplasty. Most importantly the results indicate a long term prevention of the.

Difficult septal deviation cases: open or closed technique? / Difficult septal deviation cases: open or closed technique?

Abstract Introduction: The aim of this study is to compare the functional aspects of open technique (OTS) and endonasal septoplasty (ENS) in "difficult septal deviation cases". Methods: 60 patients with severe nasal obstruction from S-shaped deformities, multiple deformities, high deviations etc. were included in the study. The OTS was used in 30 patients and the ENS was performed in 30 patients. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered preoperatively and at first month following surgery. Patients were also evaluated for pain postoperatively with Visual Analog Scale (VAS). Results: The mean NOSE score was decreased 62.5-11.0 in the OTS group and 61.3-21.33 in the ENS group. Improvement of the symptoms following the two surgical techniques is similar and no statistically significant difference was found between both techniques. Also there was no statistically significant difference in postoperative pain between the OTS and ENS groups evaluated by VAS. Conclusion: ENS is as successful as the OTS in management difficult septal deviation cases. In patients with severe septal deformities type of the surgical technique should be selected according to the surgeon's experience and the patient's preference.

Resumo Introdução: O objetivo deste estudo é comparar os aspectos funcionais da septoplastia entre a técnica aberta (STA) e a endonasal (SEN) em "casos difíceis de desvio de septo nasal". Método: Foram incluídos 60 pacientes com obstrução nasal devido a deformidades em forma de S, múltiplas deformidades, desvios altos, etc. A STA foi usada em 30 pacientes e a SEN em 30. A escala de avaliação do sintoma de obstrução nasal (NOSE) foi administrada no pré-operatório e no primeiro mês após a cirurgia. Os pacientes também foram avaliados com Escala Visual Analógica (EVA) para dor no pós-operatório. Resultados: O escore médio de NOSE foi reduzido de 62,5-11,0 no grupo da STA e de 61,3-21,33 no grupo da SEN. Houve melhora dos sintomas com as duas técnicas cirúrgicas e não foi encontrada diferença estatisticamente significativa entre elas. Também não houve diferença estatisticamente significativa nos graus de dor no pós-operatório que tenha sido avaliada pela EVA entre o grupo de STA e o de SEN. Conclusão: De acordo com nossos dados, a SEN é tão bem-sucedida quanto a STA no tratamento de casos difíceis de desvio de septo nasal. Em pacientes com deformidades septais graves, o tipo de técnica cirúrgica deve ser escolhido de acordo com a experiência do cirurgião e a preferência do paciente.

Difficult septal deviation cases: open or closed technique?

INTRODUCTION: The aim of this study is to compare the functional aspects of open technique (OTS) and endonasal septoplasty (ENS) in "difficult septal deviation cases". METHODS: 60 patients with severe nasal obstruction from S-shaped deformities, multiple deformities, high deviations etc. were included in the study. The OTS was used in 30 patients and the ENS was performed in 30 patients. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered preoperatively and at first month following surgery. Patients were also evaluated for pain postoperatively with Visual Analog Scale (VAS). RESULTS: The mean NOSE score was decreased 62.5-11.0 in the OTS group and 61.3-21.33 in the ENS group. Improvement of the symptoms following the two surgical techniques is similar and no statistically significant difference was found between both techniques. Also there was no statistically significant difference in postoperative pain between the OTS and ENS groups evaluated by VAS. CONCLUSION: ENS is as successful as the OTS in management difficult septal deviation cases. In patients with severe septal deformities type of the surgical technique should be selected according to the surgeon's experience and the patient's preference.

Usefulness of the subunit principle in nasal reconstruction

Abstract The subunit principle in nasal reconstruction proposed the concept of reconstructing the specific topographic subunits that were identified as dorsum, tip, columella, the paired alae, sidewalls, and soft triangles. In patients with more than 50% of subunit loss, removing the remaining portion of the subunit and reconstructing the entire subunit may yield better results. The placement of incisions along the borders of the subunits minimizes scar lines. Furthermore, as trapdoor contraction occurs, the entire restored subunit bulges in a way that mimics the normal contour of a nasal tip, dorsum or ala. Two cases of nasal reconstruction that followed this important principle are described.

Rinofima: opção cirúrgica como tratamento / Rhinophyma: a surgical treatment option

Introdução: Rinofima é uma inflamação crônica dos tecidos do nariz, caracterizada por hipertrofia e hiperplasia progressivas das glândulas sebáceas e do tecido conjuntivo. Determina um aspecto de elefantíase nasal, secundária à congestão dos vasos da derme. Sua etiologia está associada, na maioria dos casos, ao uso abusivo de álcool. É considerada por alguns autores como sendo um estágio avançado de acne rosácea. O artigo tem como objetivo relatar um caso de rinofima, tratado cirurgicamente no Serviço de Cirurgia Plástica do Hospital Universitário da Universidade Federal de Santa Catarina com decorticação e eletrocoagulação. Método: Foi realizado revisão de prontuário e registro fotográfico de um caso de rinofima. Resultados: Paciente foi submetido a tratamento cirúrgico com evolução favorável. Conclusão: Existem diversos tratamentos para rinofima, sendo que a decorticação e a eletrocoagulação constituem uma excelente opção terapêutica.

Introduction: Rhinophyma is a condition involving chronic inflammation of the nose and is characterized by progressive hypertrophy and hyperplasia of sebaceous glands and connective tissue. Rhinophyma leads to an appearance of nasal elephantiasis, which is caused by the congestion of dermis vessels. Its etiology is mostly associated with alcohol abuse. Rhinophyma is considered by some researchers to be an advanced stage of acne rosacea. Here, we report a case of rhinophyma that was surgically treated with decortication and electrocoagulation at the Plastic Surgery Service of the University Hospital of the Federal University of Santa Catarina. Methods: A review of medical and photographic records of a case of rhinophyma was conducted. Results: The patient was underwent surgical treatment with favorable outcomes. Conclusion: There are several treatments for rhinophyma, with decortication and electrocoagulation being an excellent therapeutic option.

Two-level septocolumellar suture technique for correction of septal caudal dislocation / Técnica de sutura septocolumelar em dois níveis para correção de desvio septal caudal

ABSTRACT INTRODUCTION: Caudal septal dislocation is a respiratory and cosmetic problem. The correction of caudal septal dislocation is a challenging issue. Although different modalities have been described for the treatment, it is still controversial. OBJECTIVES: This study aims to describe a two-level suture technique which can be used to correct and stabilize the septum in the columellar pocket. METHODS: The caudal septum was fixed to the nasal spine with suturing, and an anterior columellar pocket was formed. Two septocolumellar sutures including superior and inferior were performed to correct the dislocated caudal septum and to increase the stability of caudal septum in the columellar pocket. RESULTS: Anterior rhinoscopy showed no recurrent deviation or dislocation in our patients. CONCLUSION: Our suture technique is an effective and easy-to-use method to correct the caudal septal dislocation. It can also be used to increase the stability of corrected septum by other techniques. A two-level suture technique increases the success of correction and reduces the risk of postoperative septal caudal luxation, stabilizing the superior portion of the caudal septum, in particular. Therefore, it would reduce the rate of redo surgeries.

Resumo Introdução: O desvio septal caudal é um problema respiratório e estético, e a sua correção é tarefa desafiadora. Embora tenham sido descritas diferentes modalidades para o tratamento, esse é ainda um tópico controverso. Objetivos: O presente estudo objetivou descrever uma técnica de sutura em dois níveis, que pode ser empregada na correção e estabilização do septo na bolsa columelar. Método: O septo caudal foi fixado à espinha nasal com suturas, após a realização de uma bolsa columelar anterior. Duas suturas septocolumelares, superior e inferior, foram aplicadas para a correção do desvio septal caudal e, também, para maior estabilidade do septo caudal na bolsa columelar. Resultados: Rinoscopia anterior não resultou em recorrência do desvio ou luxação em nossos pacientes. Conclusão: Nossa técnica de sutura é um método efetivo e de fácil uso para a correção do desvio septal caudal. A técnica também pode ser utilizada para aumentar a estabilidade de septos corrigidos por outras técnicas. A técnica de sutura em dois níveis aumenta o sucesso da correção e diminui o risco de luxação septal caudal, estabilizando, em particular, a parte superior do septo caudal. Portanto, nossa técnica diminui o percentual de reoperações.

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.

Two-level septocolumellar suture technique for correction of septal caudal dislocation.

INTRODUCTION: Caudal septal dislocation is a respiratory and cosmetic problem. The correction of caudal septal dislocation is a challenging issue. Although different modalities have been described for the treatment, it is still controversial. OBJECTIVES: This study aims to describe a two-level suture technique which can be used to correct and stabilize the septum in the columellar pocket. METHODS: The caudal septum was fixed to the nasal spine with suturing, and an anterior columellar pocket was formed. Two septocolumellar sutures including superior and inferior were performed to correct the dislocated caudal septum and to increase the stability of caudal septum in the columellar pocket. RESULTS: Anterior rhinoscopy showed no recurrent deviation or dislocation in our patients. CONCLUSION: Our suture technique is an effective and easy-to-use method to correct the caudal septal dislocation. It can also be used to increase the stability of corrected septum by other techniques. A two-level suture technique increases the success of correction and reduces the risk of postoperative septal caudal luxation, stabilizing the superior portion of the caudal septum, in particular. Therefore, it would reduce the rate of redo surgeries.

Reconstrução nasal: análise de série de casos / Nasal reconstruction: an analysis of a series of cases

INTRODUÇÃO: A reconstrução nasal é desafiadora devido à posição central e proeminente do nariz na face. Pequenos defeitos nessa região tornam-se óbvios. Análise retrospectiva das 146 cirurgias de reconstrução nasal nos Serviços Integrados de Cirurgia Plástica do Hospital Ipiranga - SICPHI, avaliando a incidência dos defeitos nasais, assim como as principais técnicas cirúrgicas realizadas de acordo com cada região nasal. MÉTODOS: Estudo descritivo retrospectivo pela revisão de 109 prontuários e arquivos fotográficos, dos pacientes atendidos nos Serviços Integrados de Cirurgia Plástica do Hospital Ipiranga, em São Paulo, SP, no período compreendido entre janeiro de 2011 a junho de 2014. RESULTADOS: Foram realizadas 146 cirurgias. A faixa etária média foi de 67 anos. Em relação ao tipo de tumores malignos encontrados, 104 (73%) eram carcinoma basocelular e três (2%) carcinoma espinocelular. As 36 (25%) lesões restantes eram de características benignas. As regiões nasais mais acometidas foram: asa nasal, 55 (38%); dorso, 36 (25%); ponta, 26 (18%); lateral, 12 (8%); não especificada, sete (5%); comprometimento total do nariz, cinco (3%); e columela, dois (1%). Observou-se a preferência ao fechamento primário dos defeitos. No caso de impossibilidade do mesmo, realizaram-se retalhos locais, concordando com a literatura. CONCLUSÃO: As subunidades estéticas nasais podem ser reconstruídas por uma variabilidade de técnicas cirúrgicas. O cirurgião deve buscar um adequado resultado estético e funcional.

INTRODUCTION: Nasal reconstruction is challenging because of the central position and role of the nose in the face. Minor defects in this region become obvious. A retrospective analysis of 146 nasal reconstruction surgeries in the Integrated Plastic Surgery Services of the Ipiranga Hospital (SICP-HI) was performed, evaluating the incidence of nasal defects, as well as the main surgical techniques performed in accordance with each nasal region. METHODS: A retrospective descriptive study through a review of 109 medical records and photograph archives of patients treated in SICP-HI, São Paulo, SP, from January 2011 to June 2014. RESULTS: A total of 146 surgeries were performed. The mean patient age was 67 years. Regarding the type of malignant tumors found, 104 (73%) were basal cell carcinoma and 3 (2%) were squamous cell carcinoma. The remaining 36 (25%) lesions were benign. The most affected nasal regions were as follows: nasal wing, 55 (38%); the dorsum, 36 (25%); tip, 26 (18%); sidewalls, 12 (8%); unspecified, 7 (5%); total involvement of the nose, 5 (3%); and the columella, 2 (1%). There was a preference for primary closure of the defect. However, if this was infeasible, local flaps were used, in agreement with the literature. CONCLUSION: The nasal aesthetic subunits can be reconstructed using a variety of surgical techniques. The surgeon should seek an appropriate aesthetic and functional outcome.