Vertical dorsal rhinotomy in pediatric nasal dermoid surgery.

INTRODUCTION AND OBJECTIVES: Nasal dermoids are uncommon midline congenital lesions in the nose, usually diagnosed in the first years of life. Imaging is mandatory to evaluate local and intracranial extension and treatment consists in surgical excision. This study aims to review the experience of the department in managing pediatric nasal dermoids using a dorsal rhinotomy surgical approach. MATERIAL AND METHODS: Retrospective case series of pediatric nasal dermoids treated at a tertiary university teaching hospital over a period of seven years. RESULTS: Nine children were treated during this period. Clinical presentation was a dermoid sinus-cyst in seven cases and a cystic lesion in two. Pre-operative imaging revealed extension of the lesion to the foramen cecum in three cases. Surgery was performed via vertical dorsal rhinotomy in all patients, and associated endoscopic surgery was used in three patients. Reconstruction with autologous material was performed in three cases. No complications or recurrences were registered during the follow-up. CONCLUSIONS: In the presented series, a vertical dorsal rhinotomy incision has provided good functional and aesthetic results. The possibility of nasal dermoid intracranial extension should be accessed with imaging but remains uncommon. In its absence, this approach may be useful and can be paired with other techniques, such as nasal endoscopy, to achieve the best outcomes.

Is Computed Tomography Necessary Before Septoplasty? Correlation With Physical Examination and Patient Complaints.

INTRODUCTION: Septoplasty is one of the most common surgeries performed by otorhinolaryngologists. The gold standard for the evaluation of septal deviation is anterior rhinoscopy and nasal endoscopy. Frequently, computed tomography (CT) is also performed, although the correlation between septal deviation on CT and physical examination is unclear. OBJECTIVES: To study the relationship between symptoms and physical and radiological evaluation in patients who underwent septoplasty. METHODS: A prospective study of patients with nasal obstruction and septal deviation who underwent septoplasty. Anterior rhinoscopy and nasal endoscopy were performed by the surgeon, and the CT was evaluated by a radiologist. The degree of obstruction was evaluated in three distinct septal locations. The Nasal Obstruction Symptom Evaluation (NOSE) score was used before the surgery and two months after the surgery. RESULTS: The study included 43 patients, of whom 60.5% were male, with an average age of 37.09 years (±12.56). The degree of septal deviation in the physical examination was significantly different from that observed in CT (p˂0.05). Cartilaginous or maxillary crest septal deviations >75% were more commonly recognized by physical examination, while osseous septum deviations of 25%-50% were more easily detected by CT. There was no difference between the degree of septal deviation and the preoperative NOSE. The median preoperative NOSE was 60, and the postoperative was 5, with significant improvement (p<0.05). CONCLUSION: CT doesn't appear to be useful in the evaluation of septal deviation since it is different from the findings of a physical examination and isn't associated with the NOSE score. Clinical decisions should be based on a physical examination and patient complaints.

Functional facial reconstruction in a patient with severe burn sequelae with a prelaminated parascapular free flap based on a three-dimensional model: A case report.

Significant evolution has been made concerning resuscitation and emergency management of severely burned patients, and nowadays most patients will survive and deal with burns sequelae. They constitute a reconstructive challenge, mainly because options and donor areas are frequently compromised, results are often limited, and other options should then be considered. A 27-year-old male patient with 55% total burn surface area, presented with severe facial disfigurement including ectropion, upper/lower lip retraction, and partial loss of the nose. In order to improve the patient's condition, autologous reconstruction was considered. The only unburned area in the body was the left dorsal region, and a three-stage reconstruction was planned using a paraescapular flap. In a first stage, an elective surgery was performed to identify and tag the recipient vessels in the neck. After 3 months, the prelamination process was initiated with the drawing of a facial model, and a nose and lips were opened inside the flap. This was based on a three-dimensional latex model as a print of the patient's face, which allowed us to calculate distances and estimate the length of the vascular pedicles. After 3 months, the flap (18 × 8 cm) was transferred and microvascular anastomoses were performed. No major complications were seen after surgeries, and after 28 months, an extremely important functional gain was obtained. Despite the number of surgeries required and less than optimal aesthetic results, this method may offer a satisfactory solution for complex acquired facial burn sequelae when other local or distant flap options are not available.

Tympanic Membrane Haematoma in a RivaroxabanTreated Patient: A Case Report.

New generation oral anticoagulants - rivaroxaban, apixaban and edoxaban - represent an important medical achievement. Their therapeutic effectiveness and ease of use make them essential in the management of thromboembolic conditions. However, as warfarin, they have known haemorrhagic risks. This paper reports the case of a 50-year-old female who presented with ear pain and spontaneous blood discharge in her right ear, after a two-week treatment with rivaroxaban. The physical examination revealed a spontaneous tympanic haematoma in the inferior quadrants, adjacent to the umbus. She denied any manipulation of the ear canal. Our goal is to alert for a presumable side effect of this drug in clinical practise.

A nova geração de anti-coagulantes orais ­ rivaroxabano, apixabano e edoxabano ­ constitui um avanço significativo na medicina. Estes fármacos têm, atualmente, um papel fundamental no tratamento de doenças tromboembólicas, pela sua facilidade de administração. No entanto, tal como a varfarina, têm efeitos adversos, nomeadamente aqueles relacionados com o risco hemorrágico. Neste artigo, apresentamos o caso de uma doente de 50 anos de idade, do género feminino, que se apresentou no serviço de urgência com otalgia e otorragia espontânea à direita, após duas semanas de tratamento com rivaroxabano em dose profilática. No exame objetivo, destacava-se a presença de hematoma nos quadrantes inferiores do tímpano, adjacente ao umbus. Não havia história de manipulação do ouvido. O nosso objetivo é alertar para um provável efeito adverso deste fármaco, na prática clínica.

Risk factors for the occurrence of epistaxis: Prospective study.

OBJECTIVE: Analyse and compare the characteristics of patients with epistaxis admitted to the otolaryngology emergency department with those provided by a control group. Establish a model to identify epistaxis predictive factors. METHODS: Prospective analysis of 283 consecutive adults, admitted to the otolaryngology emergency department of a tertiary referral centre between 25 January and 25 February 2014. Comparison of gender, age, co-morbidities, usual medication, history of epistaxis or nasal trauma, presence of septal deviation and blood pressure value on admission, between the elements that were admitted to the emergency due to epistaxis (group 1) and a group composed of patients with other symptoms (group 2). Intergroup variations were analyzed using t student and chi-square tests. Multivariate logistic regression and a receiver operating characteristic curve were used to establish a predictive model and test its suitability. RESULTS: Male gender (OR=2.57, 95% CI 1.1-6.0, p=0.029), older age (OR=1.03, 95% CI 1.0-1.1, p=0.002), existence of peripheral vascular disease (OR=13.47, 95% CI 1.9-95.3, p=0.009), cardiovascular disease (OR=3.91, 95% CI 1.6-9.7, p=0.003) and previous history of epistaxis (OR=5.53, 95% CI 2.5-12.1, p<0.001) were predictors of epistaxis when adjusted for the presence of elevated blood pressure, history of hypertension, cerebrovascular disease and chronic use of anticoagulants or antiplatelet drugs. The model revealed a good applicability (area under the curve of 0.852). CONCLUSIONS: The only predictive factors of admission to the emergency department due to epistaxis were male gender, older age, peripheral vascular disease, cardiovascular disease and history of epistaxis.

Audiometric Outcome Comparison between Titanium Prosthesis and Molded Autologous Material.

OBJECTIVE: To evaluate and compare the audiometric outcomes of ossicular reconstruction with titanium prosthesis and autologous material. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Audiometric results of consecutive patients who performed ossiculoplasty with titanium prosthesis (n = 43) or autologous material (n = 48), from October 2008 to December 2011, were reviewed retrospectively and compared. The association between air-bone gain and age, ossiculoplasty material (autologous or titanium), preoperative diagnosis (chronic otitis media without cholesteatoma, cholesteatoma, or conductive hearing loss with intact tympanic membrane), and type of surgery (tympanoplasty, canal wall-down mastoidectomy, or canal wall-up mastoidectomy) was explored using regression analysis. RESULTS: Preoperative audiometric evaluation did not show differences between titanium and autologous groups in air-bone gap and pure-tone average. A postoperative decrease of 11.0 dB in air-bone gap and 12.4 dB in pure-tone average was observed in titanium ossiculoplasty compared with a reduction of 4.0 dB in air-bone gap and 5.1 dB in pure-tone average when autologous reconstruction was used. Mann-Whitney test revealed superior results in the titanium group compared with autologous reconstruction patients in air-bone gap (P = .02) and pure-tone average (P = .02). However, no statistically significant associations were observed after multivariate linear regression analysis of air-bone gap gain when adjusted for age, ossiculoplasty material, type of surgery, and preoperative diagnosis. One titanium prosthesis extrusion occurred during follow-up (2%). CONCLUSION: Audiometric results achieved by titanium prosthesis are promising, but significant differences compared with autologous ossiculoplasty were not present.