Application of a Novel 3D-Printed Nasal Plug as a Conservative Treatment for Empty Nose Syndrome.

OBJECTIVE: Empty nose syndrome (ENS) is commonly treated by surgery, albeit with limited success. Herein, we introduce our experience of applying a newly developed "3D-printed nasal plug" as an alternative conservative treatment modality. METHODS: This retrospective study included 20 patients (14 males, 6 females; mean age 46.5 ± 13.5 years) with ENS who underwent the application of the 3D-printed nasal plug at Asan Medical Center between June 2022 and May 2023. Symptom improvement was assessed by Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) before and after applying the nasal plug. Clinical results, such as duration and frequency of plug use, discomfort, and level of satisfaction, were investigated. RESULTS: The mean follow-up duration was 40.3 ± 24.2 weeks. The average duration of nasal plug usage was 10.8 h per day and 5.3 days a week. The ENS6Q scores improved from 19.6 ± 4.6 to 6.8 ± 5.1 (mean reduction 12.8 ± 5.9) after 30 minutes of wearing. Symptom "nose feelings too open" was improved most by a score of 3.0 ± 1.5 (p < 0.001). Thirteen patients (65.0%) reported that the effectiveness of the plug, initially confirmed at the first wearing, was well maintained during the entire follow-up. Four patients (20.0%) wore the nasal plug uninterruptedly throughout the week, whereas nine patients (45.0%) wore it intermittently as needed. Frequently reported complaints with plug usage were 'displacement of the plug' and 'cosmetic concerns' about the visible hook portion. CONCLUSION: A 3D-designed nasal plug can be a useful conservative treatment option for ENS patients. LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.

Impact of long-term nasal airflow deprivation on sinonasal structures and chronic rhinosinusitis in total laryngectomy patients.

Objective: Total laryngectomy (TL) patients are good models in which to evaluate the effects of nasal airflow cessation on the sinonasal tract. Here, we evaluated changes in sinonasal structures and association with sinus opacification in the computed tomography (CT) images 3 years post-TL. Methods: Patients who underwent TL from 2005 to 2017 in a teaching academic center were reviewed retrospectively. Patients with a final follow-up CT taken less than 3 years after TL, tracheoesophageal puncture, inadequate CT image, or history of sinonasal surgery were excluded. The control group included patients who underwent a partial laryngectomy or hypopharyngectomy without requiring a tracheotomy for more than a month. Altogether, 45 TL patients and 38 controls were selected. The volume of all four paranasal sinuses, inferior turbinate soft tissue volume (ITSTV), maxillary sinus natural ostium (MSNO) mucosal width, and Lund-Mackay scores (LMS) were measured on preoperative and postoperative CT scans. Results: The mean duration between surgery and the final CT scan was 6.3 ± 2.4 and 5.5 ± 2.3 years for the TL and control groups, respectively. Neither group showed significant changes in the four paranasal sinuses' volume or MSNO mucosa width. The ITSTV decreased significantly, from 4.6 ± 1.3 to 2.8 ± 1.1 mL (p < .001), in the TL group, regardless of the presence of nasal septal deviation, showing ITSTV reduction on both concave and convex sides. By contrast, the control group showed no significant changes in ITSTV. Postoperative LMS changes in both groups were insignificant. The number of patients with LMS aggravation or alleviation was the same in both groups, regardless of preoperative sinus opacification. Conclusions: Paranasal sinus structures and sinus opacification are not affected significantly by nasal airflow cessation; however, the inferior turbinate mucosa is affected by long-term discontinuation of nasal airflow. Level of Evidence: 4 (case-control study).

Impact of nasal septal perforation on the airflow and air-conditioning characteristics of the nasal cavity.

We investigated (1) how nasal septal perforations (NSPs) modify nasal airflow and air-conditioning characteristics and (2) how the modifications of nasal airflow are influenced by the size and location of the NSP. Computed tomography scans of 14 subjects with NSPs were used to generate nasal cavity models. Virtual repair of NSPs was conducted to examine the sole effect of NSPs on airflow. The computational fluid dynamics technique was used to assess geometric and airflow parameters around the NSPs and in the nasopharynx. The net crossover airflow rate, the increased wall shear stress (WSS) and the surface water-vapor flux on the posterior surface of the NSPs were not correlated with the size of the perforation. After the virtual closure of the NSPs, the levels in relative humidity (RH), air temperature (AT) and nasal resistance did not improve significantly both in the choanae and nasopharynx. A geometric parameter associated with turbinate volume, the surface area-to-volume ratio (SAVR), was shown to be an important factor in the determination of the RH and AT, even in the presence of NSPs. The levels of RH and AT in the choanae and nasopharynx were more influenced by SAVR than the size and location of the NSPs.

Changes in Nasal Tip Aesthetics Over Time Following Asian Tip Plasty.

OBJECTIVES: This study aimed to evaluate the sequential postoperative changes in tip aesthetics, by evaluating the aesthetic performance of the septal extension graft with or without tip grafting. METHODS: A total of 62 patients who underwent rhinoplasty with tip plasty were included. Using a three-dimensional scanner, we measured anthropometric aesthetic features of the nasal tip, including tip height, tip width, nasolabial angle, and columellar lobular angle. Preoperative and 1-month and 12-month postoperative anthropometric parameters were compared. The patients were grouped according to surgical techniques (i.e., septal extension only and septal extension plus tip grafting groups) and subtype of tip graft. RESULTS: The 1-month postoperative values of all four aesthetic features were significantly increased compared with the preoperative values. The tip height, tip width, and nasolabial angle at 12 months were significantly decreased compared with 1 month post-operation values, whereas the tip height and width were still greater than the preoperative values. No difference was found between 1 and 12 month values of columellar lobular angle. There were no differences in the degree of decrease in tip height, tip width, nasolabial angle, and columellar lobular angle between the septal extension graft only and septal extension graft plus tip graft groups. There were no differences in the tip graft by subtypes, single- and multi-layer tip grafts. CONCLUSIONS: Increased tip height, tip width, and widened nasolabial angle gained immediately after septal extension grafting surgery gradually decreased over the year regardless of addition of tip graft or tip grafting methods. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:678-683, 2024.

Facial Pain Triggered by Inferior Turbinate Partial Resection in a Patient with a Previous History of Inferior Meatal Antrostomy: A Case Report.

OBJECTIVES: Inferior meatal antrostomy (IMA) is regarded as a safe method, with minimal complications, for managing various lesions in the maxillary sinus. However, in patients with persisting IMA window, resection of the inferior turbinate may result in direct airflow into the antrum, irritating the antral mucosa. METHODS: Case report and review of literature. RESULTS/CASE: The present report describes a 29-year-old man who previously underwent unilateral IMA for the excision of a dentigerous cyst. The patient did not report any facial pain following the excision of the cyst. One year later, this patient underwent partial resection of the inferior turbinate for the resolution of nasal stuffiness by another surgeon. Soon after surgery, the patient developed severe facial and ocular pain on the side of the IMA, with the pain being especially aggravated upon inhalation. Endoscopy and computed tomography (CT) revealed a persisting IMA window. The patient's severe discomfort was thought to result from direct airflow into the maxillary sinus, as the resected turbinate may have altered normal nasal airflow. A unilateral inferior meatal augmentation procedure (IMAP) with an autologous ear cartilage implant was performed, resulting in complete relief of pain and discomfort. CONCLUSIONS: Although IMA alone is a relatively safe surgical procedure, care should be taken when performing inferior turbinoplasty in patients with persistent IMA opening.

Factors Affecting the Surgical Outcome in Nasal Septal Perforation Repair.

OBJECTIVE: Nasal septal perforation (NSP) repair is challenging surgery considered in patients with symptomatic NSP intractable to conservative treatments. This study aimed to assess the success rate and identify factors affecting the surgical outcome of NSP by analyzing consecutive series of NSP repairs by a single surgeon. METHODS: We enrolled 84 patients diagnosed with NSP and who underwent surgical repair of NSP by a single surgeon (Y.J.J.) between November 2007 and July 2022. Medical records were retrospectively reviewed regarding variables involving preoperative symptoms, rhinologic history, etiology, surgical techniques, and the outcome of surgery. In addition, features of NSP were objectively evaluated using computed tomography scans. RESULTS: The overall success rate of NSP repair was 64.3% (54 of 84). Nasal obstruction (79.8%), crusting (34.5%), and epistaxis (27.4%) were frequent preoperative symptoms. Iatrogenic injury from previous nasal surgery (70.2%) was the most common cause. The average size of NSP on preoperative CT was 9.53 ± 6.68 mm. Patients with incomplete NSP closure had significantly larger perforations (12.21 ± 7.92 mm) than those with successful closure (8.04 ± 5.41 mm) preoperatively (P = .005). Patients with smoking history (OR = 2.971, 95% CI 1.170-7.548, P = .020) and NSP repair with combined rhinoplasty (OR = 3.811, 95% CI 1.401-10.370, P = .007) were more likely to experience incomplete closure. Patients whose perforations were reinforced with interposition graft were more likely to result in successful repair (OR = 6.752, 95% CI 2.496-18.262, P < .001). The bilaterality of mucosal flap coverage, surgical approach, types of mucosal flap and interposition graft, perforation shape, mucosal thickness around perforation, and distance from the nasal floor were not significantly related to the surgical outcome. CONCLUSIONS: Significant factors affecting the outcome of NSP repair were patient's smoking status, combined rhinoplasty, application of interposition graft, and perforation size.

Aesthetic Outcomes of Rhinoplasty Performed in the Early Posttrauma Period after Nasal Bone Fracture.

The optimal timing of rhinoplasty for patients with nasal bone fractures remains controversial. We investigated whether the timing of rhinoplasty after nasal trauma affects the aesthetic outcome of the procedure. A total of 41 adult patients with nasal bone fractures who underwent rhinoplasty between 2006 and 2021 were enrolled in this study. A visual analog scale (VAS) was used to indicate the assessor's satisfaction with the surgical outcome after a comparison of the pre- and postoperative facial photographs of each patient. Of the 41 patients, 28 underwent rhinoplasty within 14 days after nasal trauma (early rhinoplasty group), whereas 13 underwent rhinoplasty more than 14 days after nasal trauma (late rhinoplasty group). The rate of receiving spreader and shield graft was higher in the late rhinoplasty group (p = 0.043 and 0.018, respectively). Patients with type IV or V nasal bone fracture and patients with preoperative saddle noses had higher VAS scores than those with types I to III fractures and those without preoperative saddle nose (p = 0.003 and 0.020, respectively). There was no significant difference in overall aesthetic outcome between the early and late rhinoplasty groups. Both groups achieved significantly better radix height, dorsal height, and tip projection after rhinoplasty. The aesthetic outcome of rhinoplasty performed in the early posttrauma period is comparable with that of rhinoplasty performed more than 2 weeks after nasal bone fracture. Rhinoplasty can be considered a safe surgical treatment option for nasal bone fracture, even in the early posttrauma period. LEVEL OF EVIDENCE: : 4.

Revision Rhinoplasty Using Glued Diced Costal Cartilage Shaped With Mold for Management of Complicated Silicone Rhinoplasty.

BACKGROUND: Complicated silicone nose is a common clinical problem. Selection of replacement material for revision dorsal augmentation is a challenging task. OBJECTIVES: The authors presented their experience in the use of molded glued diced cartilage graft (GDCG) for revision rhinoplasty in patients who had complicated silicone augmentation. METHODS: The authors performed a retrospective review of the medical records of 28 patients who underwent silicone implant removal and revision dorsal augmentation with costal cartilage at a tertiary center between February 1, 2018, and February 28, 2022. Patient demographics, surgical technique, anthropometric measurements, and complication data were retrieved and analyzed. Aesthetic outcome scoring and anthropometric measurements were performed. RESULTS: Twenty-eight patients (9 males and 19 females) who underwent revision rhinoplasty with augmentation were reviewed. The principal indication for revision was cosmetic dissatisfaction. Mean postoperative follow-up duration was 18.3 months. All patients had revision dorsal augmentation with molded GDCG. Other key surgical techniques include the use of caudal septal extension and extended spreader and tip grafts. The majority of the patients were judged to have good or excellent outcomes (91.1%). There were significant percentage increases in dorsal height, radix height, nasal length, and nasal tip projection (2.78%, 2.26%, 7.53%, and 2.40%, respectively; P < .05) and reduction of nasal axis deviation of 1.15° (P < .05) postoperatively. Two patients had postoperative complications, including infection and cosmetic dissatisfaction. CONCLUSIONS: Revision rhinoplasty following unsuccessful silicone augmentation is commonly encountered in the Asian population. Molded GDCG for revision dorsal augmentation is a reliable option that delivers good to excellent aesthetic outcomes with acceptable complication rates.

Preoperative Prediction of Sinonasal Inverted Papilloma-associated Squamous Cell Carcinoma (IP-SCC).

INTRODUCTION: Sinonasal inverted papillomas (IP) can undergo transformation into IP-squamous cell carcinomas (IP-SCC). More aggressive treatment plan should be established when IP-SCC is suspected. Nevertheless, inaccuracy of the preoperative punch biopsy results to detect IP-SCC from IP raises the need for an additional strategy. The present study aimed to investigate significant clinicoradiological remarks associated with IP-SCC than IP. MATERIAL AND METHODS: Postoperative surgical specimens obtained from patients with confirmed IP or IP-SCC at a single tertiary medical center from 1997 to 2018 were retrospectively evaluated. Patients' demographic and clinical characteristics, preoperative in-office punch biopsy results, and preoperative computed tomography (CT) or magnetic resonance images were reviewed. Univariate and multivariate analyses were performed to assess the odds ratio (OR) associated with IP-SCC. The area under the curve (AUC) in the receiver Operating Characteristic (ROC) curve was calculated in the prediction model to discriminate IP-SCC from IP. RESULTS: The study included 44 IP-SCC and 301 patients with IP. The diagnostic sensitivity of in-office punch biopsy to detect IP-SCC was 70.7%. Multivariate analysis showed that factors significantly associated with IP-SCC included tobacco smoking >10PY (adjusted-OR [aOR]: 4.1), epistaxis (aOR: 3.4), facial pain (aOR: 4.2), bony destruction (aOR: 37.6), bony remodeling (aOR: 36.3), and invasion of adjacent structures (aOR: 31.6) (all p < 0.05). Combining all significantly related clinicoradiological features, the ability to discriminate IP-SCC from IP reached an AUC of 0.974. CONCLUSION: IP patients with a history of tobacco smoking, facial pain, epistaxis, and bony destruction, remodeling, or invasion of an adjacent structure on preoperative images may be at higher risk for IP-SCC. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:2502-2510, 2023.

Factors Affecting the Complication Rate of Septoplasty: Analysis of 1,506 Consecutive Cases of Single Surgeon.

Based on the analysis of a single surgeon's consecutive cases, we present the incidence of septoplasty complications and factors that contribute to the increased risk of complications. We retrospectively reviewed the medical records from 1,506 patients diagnosed with deviated nasal septum who underwent septoplasty by a single surgeon from January 2003 until May 2020. The incidence of different complications was investigated. Predisposing factors for specific complications were examined with univariate analysis. The average age of patients was 35 (11-76) years. Out of 1,506 patients, 1,252 were male, and 254 were female. The most frequent complication was insufficient correction (78 cases, 5.2%), and revision septoplasty was performed in 21 cases. We also reported 59 (3.9%), 55 (3.7%), 33 (2.2%), 20 (1.3%), and 18 (1.2%) cases of olfactory dysfunction, hematoma, synechia, abscess, and septal mucosal defect, respectively. Additionally, there were nine (0.6%), six (0.4%), five (0.3%), four (0.3%), and four (0.3%) cases of septal perforation, postoperative bleeding, saddle nose, chondritis, empty nose syndrome, respectively. The proportion of insufficient correction was higher in revision cases than in primary cases. Hematoma formation, abscess formation, and septal mucosal defect occurred more frequently in the bilateral flap elevation group. Olfactory dysfunction was significantly more frequent when the bony batten was inserted, while hematoma, abscess formation, and septal mucosal defect were more frequent when the cartilage batten was used. Septoplasty was associated with the risk of several complications, while complication rates were influenced by choice of surgical techniques and approaches.

The Relationship Between Lateral Nasal Wall Collapse and Nasal Obstruction.

OBJECTIVES: In clinical practice, lateral nasal wall collapse during forced inspiration is widely regarded as a sign of nasal obstruction or criterion indicating nasal valve surgery. This study aims to evaluate the relationship between the degree of lateral nasal wall collapse and subjective nasal obstruction. In addition, factors related to lateral nasal wall collapse were also investigated. METHODS: In this study, lateral nasal wall collapse is determined by the degree of lateral nasal wall triangle (LNWT) area reduction on frontal view during forced inspiration compared to quiet inspiration. LNWT area ratio of the patient and control groups was compared. The relationship between the lateral nasal wall collapse and clinical factors including symptom scores, nasal valve angles, skin thickness were evaluated. RESULTS: The average LNWT area ratio of the patient (n = 24) and control groups (n = 27) was 0.96 and 0.83 respectively (P = .001). Symptom score (NOSE and VAS) is not related to the degree of lateral nasal wall collapse. Moreover, nasal valve angle and skin thickness were also not related to the degree of lateral nasal wall collapse. In 14 of the 19 patients, the more obstructed side corresponded to the side of narrower nasal valve angle, and 5 were not. CONCLUSION: Lateral nasal wall collapse is not related to a patients' nasal obstruction.

Impact of the Location of Nasal Septal Deviation on the Nasal Airflow and Air Conditioning Characteristics.

The location of nasal septal deviation (NSD) directly impacts nasal physiology. The objective is to examine, using computational fluid dynamics (CFD), the difference in the airflow and air conditioning characteristics according to the location of NSD. Twenty patients with septal deviation were divided into two: 10 caudal septal deviation (CSD) and 10 posterior septal deviation (PSD). Physiological variables were compared and numerical models for nasal cavity were created with CT scans. Cases with CSD had distinctive features including restricted airflow partition, larger nasal resistance, and decreased surface heat flux in the more obstructed side (MOS), and lower humidity and air temperature in the lesser obstructed side (LOS). Physiological differences were observed according to the location of septal deviation, CSD cases exhibit significantly more asymmetric airflow characteristics and air conditioning capacity between LOS and MOS.

Management of Chronic Nasal Pain Developing After Rhinoseptoplasty or Nasal Trauma.

Background: Management of patients who experience refractory chronic nasal pain (CNP) of no apparent cause can be unclear. Objectives: To measure pain outcomes in managing patients with CNP after rhinoseptoplasty or nasal trauma. Methods: We retrospectively reviewed patients with CNP after rhinoseptoplasty or trauma, treated with a gabapentinoid drug, local nerve block with lidocaine plus dexamethasone, or both. Results: The study included 28 patients, 12 men and 16 women, of mean age 39.1 years (range 22-66), experiencing CNP after rhinoseptoplasty (n = 22) and nasal bone fracture (n = 6). Pain was distributed at the nasal dorsum (53%), periorbital area (15%), septum (13%), nasal tip (13%), and cheek (6%). The most common types of pain pattern, onset time, and duration were pressing and stabbing pain (41%), immediately developed (43%), and lasting 3-6 months (39%), respectively. After treatment, pain was relieved completely in 12 (43%) patients and mild to moderate in 7 (25%), but 9 (32%) showed no response. Conclusions: Postoperative or traumatic CNP can be a complex manifestation with several atypical characteristics. The combination of a gabapentinoid drug and local nerve block with lidocaine plus dexamethasone improved CNP in 68% of patients.

Features of Odontogenic Sinusitis Associated With Dental Implants.

OBJECTIVES: With the increase in dental implants for tooth loss, odontogenic sinusitis following maxillary dental implants is frequently encountered in otorhinolaryngology practice. The authors aimed to reveal the association between implant extrusion into maxillary sinus, along with implant-related complications in patients diagnosed with implant-related odontogenic sinusitis (IR-ODS). STUDY DESIGN: Case-control study. METHODS: This study enrolled 60 patients who received functional endoscopic sinus surgery due to IR-ODS. The preoperative sinus computed tomography was retrospectively reviewed. Among the 120 maxillary sinuses of the 60 patients, 68 sides were diagnosed with IR-ODS sides, whereas 27 sides showed no clinical or radiological evidence of this condition after the implant insertion and were defined as the control sides. Statistical analysis between these two groups was conducted, in addition to odds ratio (OR) calculations for associations with IR-ODS. RESULTS: The mean age of the IR-ODS subjects was 59.5 ± 19.1, with a male to female ratio of 32/28 (53.3%/46.7%). Implants extruding by more than 4 mm into the maxillary sinus, peri-implantitis, bone graft disruption-extrusion were associated with a significantly higher incidence in the IR-ODS (p = 0.035, p = 0.003, p = 0.011, respectively). The IR-ODS sides showed an adjusted-OR (95% confidence interval) of 27.4 (2.7-276.5) for extrusion length >4 mm, 11.8 (3.0-46.5) for peri-implantitis, and 34.1 (3.3-347.8) for bone graft disruption (p = 0.005, p < 0.001, and p = 0.003, respectively). CONCLUSION: Maxillary dental implants extruding more than 4 mm into the maxillary sinus, peri-implantitis, and disrupted-extruded bone grafts show significant association with IR-ODS. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:237-243, 2023.

Changes in inflammatory biomarkers in the nasal mucosal secretion after septoplasty.

Deviated nasal septum (DNS) is suggested to be associated with nonspecific inflammation of the nasal mucosa. The authors hypothesized septoplasty may reduce nasal mucosal inflammation, therefore the authors aimed to measure various inflammatory biomarkers in the nasal secretion following septoplasty. Prospectively, 17 patients undergoing elective septoplasty were included. Symptomatic changes after septoplasty were evaluated with Sino-nasal Outcome Test (SNOT-22) and Nasal obstruction symptom evaluation (NOSE) scores. Using acoustic rhinometry, changes of the nasal airway volume were measured. Nasal secretion was collected within 2 weeks and 3 months before and after septoplasty, respectively. The inflammatory biomarker high-mobility group box 1 (HMGB1) and vasoactive intestinal peptide (VIP), and inflammatory cytokines including tumor necrosis factor α (TNF α), interferon γ (IFN-γ), interleukin-4 (IL-4), eotaxin-1, and regulated upon activation, normal T cell expressed and presumably secreted (RANTES) were quantified in the nasal secretion by enzyme-linked immunosorbent assays or multiplex bead array assays. The patients' mean age was 30.5 ± 6.8 (ranging from 19 to 43), consisting of 15 male and 2 female patients. The median SNOT-22 and NOSE scores changed from 54 to 14 and 78 to 15, respectively, both showing a significant decrease. In acoustic rhinometry, nasal cavity volume of convex side significantly increased after septoplasty, whereas significant discrepancy of nasal airway volume between concave and convex sides became insignificant. No significant difference was noted both before and after septoplasty between the concave and convex sides in all seven biomarkers. The HMGB1, RANTES, IL-4, and TNF-α concentrations following septoplasty showed significant decrease in 34 nasal cavities of 17 patients (all p < 0.05). However, when the 17 concave and 17 convex sides were analyzed separately, the significant reduction in four biomarkers were only significant in the concave sides (all p < 0.05), but not significantly reduced in convex sides. Septoplasty may have benefited not only in normalizing the nasal airflow and symptom improvement, but also in nonspecific inflammation attenuation in the nasal airway.

Sweet taste receptor agonists attenuate macrophage IL-1ß expression and eosinophilic inflammation linked to autophagy deficiency in myeloid cells.

BACKGROUND: Eosinophilic inflammation is a hallmark of refractory chronic rhinosinusitis (CRS) and considered a major therapeutic target. Autophagy deficiency in myeloid cells plays a causal role in eosinophilic CRS (ECRS) via macrophage IL-1ß overproduction, thereby suggesting autophagy regulation as a potential therapeutic modality. Trehalose is a disaccharide sugar with known pro-autophagy activity and effective in alleviating diverse inflammatory diseases. We sought to investigate the therapeutic potential of autophagy-enhancing agent, trehalose, or related sugar compounds, and the underlying mechanism focusing on macrophage IL-1ß production in ECRS pathogenesis. METHODS: We investigated the therapeutic effects of trehalose and saccharin on macrophage IL-1ß production and eosinophilia in the mouse model of ECRS with myeloid cell-specific autophagy-related gene 7 (Atg7) deletion. The mechanisms underlying their anti-inflammatory effects were assessed using specific inhibitor, genetic knockdown or knockout, and overexpression of cognate receptors. RESULTS: Unexpectedly, trehalose significantly attenuated eosinophilia and disease pathogenesis in ECRS mice caused by autophagy deficiency in myeloid cells. This autophagy-independent effect was associated with reduced macrophage IL-1ß expression. Various sugars recapitulated the anti-inflammatory effect of trehalose, and saccharin was particularly effective amongst other sugars. The mechanistic study revealed an involvement of sweet taste receptor (STR), especially T1R3, in alleviating macrophage IL-1ß production and eosinophilia in CRS, which was supported by genetic depletion of T1R3 or overexpression of T1R2/T1R3 in macrophages and treatment with the T1R3 antagonist gurmarin. CONCLUSION: Our results revealed a previously unappreciated anti-inflammatory effect of STR agonists, particularly trehalose and saccharin, and may provide an alternative strategy to autophagy modulation in the ECRS treatment.

Dorsal Augmentation Using a Glued Diced Cartilage Graft Fashioned with a Newly Developed Mold in Asian Rhinoplasty.

BACKGROUND: In dorsal augmentation, costal cartilage can be used in a number of different ways: monobloc, fascia wrapped, or glued diced cartilage grafting (GDCG). The authors developed a mold to make the use of GDCG more convenient. This report describes their experience with GDCG using a novel mold for dorsal augmentation. METHODS: The study involved 80 patients who underwent dorsal augmentation with the molded GDCG. Facial photographs and medical records were reviewed to assess patient satisfaction and postoperative complications. For the 23 patients who had three-dimensional scanned imaging, dorsal widths and dorsal heights at the radix and rhinion levels were measured to investigate changes in the implants over time. Resorption of the graft was assessed comparing the 3-month postoperative photograph with the latest photograph taken at the last follow-up (at least 1 year after the surgery). Serial changes of the dorsum were assessed with three-dimensional scanned images. RESULTS: A total of 66 patients (82.5 percent) were satisfied with their surgical outcomes. Complications were encountered in 19 patients (23.8 percent) and eight revision procedures (10 percent) were performed. One patient underwent revision surgery because of resorption of the GDCG. Analysis using a three-dimensional scanning device showed a significant increment of the dorsal height ( p < 0.05) without dorsal widening when comparing preoperative with 1-year postoperative follow-up data. There were no significant reductions in dorsal height between postoperative 3 months and 1 year. CONCLUSION: The use of a novel mold for shaping glued diced cartilage appears to be a useful technique for dorsal augmentation in rhinoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

A Novel Approach on Deep Learning-Based Decision Support System Applying Multiple Output LSTM-Autoencoder: Focusing on Identifying Variations by PHSMs' Effect over COVID-19 Pandemic.

Following the outbreak of the COVID-19 pandemic, the continued emergence of major variant viruses has caused enormous damage worldwide by generating social and economic ripple effects, and the importance of PHSMs (Public Health and Social Measures) is being highlighted to cope with this severe situation. Accordingly, there has also been an increase in research related to a decision support system based on simulation approaches used as a basis for PHSMs. However, previous studies showed limitations impeding utilization as a decision support system for policy establishment and implementation, such as the failure to reflect changes in the effectiveness of PHSMs and the restriction to short-term forecasts. Therefore, this study proposes an LSTM-Autoencoder-based decision support system for establishing and implementing PHSMs. To overcome the limitations of existing studies, the proposed decision support system used a methodology for predicting the number of daily confirmed cases over multiple periods based on multiple output strategies and a methodology for rapidly identifying varies in policy effects based on anomaly detection. It was confirmed that the proposed decision support system demonstrated excellent performance compared to models used for time series analysis such as statistical models and deep learning models. In addition, we endeavored to increase the usability of the proposed decision support system by suggesting a transfer learning-based methodology that can efficiently reflect variations in policy effects. Finally, the decision support system proposed in this study provides a methodology that provides multi-period forecasts, identifying variations in policy effects, and efficiently reflects the effects of variation policies. It was intended to provide reasonable and realistic information for the establishment and implementation of PHSMs and, through this, to yield information expected to be highly useful, which had not been provided in the decision support systems presented in previous studies.

Incidence and Predisposing Factors of Postoperative Infection after Rhinoplasty: A Single Surgeon's 16-Year Experience with 2630 Cases in an East Asian Population.

BACKGROUND: This study evaluated the incidence and clinical characteristics of postoperative infection following rhinoplasty. METHODS: This article is a retrospective review of 2630 East Asian rhinoplasty cases performed by a single surgeon (Y.J.J.), from July of 2003 to June of 2018. There were 1595 male patients (69.9 percent) and 687 female patients (30.1 percent), and the median age was 31 years. The incidence of infection was compared between primary and revision cases and analyzed according to the materials used. The authors evaluated the organisms cultured and the timeframe of infection development and intervention. RESULTS: There were 2134 primary and 496 revision cases. Materials included autologous costal cartilage (413 cases), conchal cartilage (572 cases), homologous fascia lata (829 cases), homologous costal cartilage (102 cases), Gore-Tex (373 cases), and silicone (32 cases). The authors identified 22 cases (0.84 percent) of postoperative infection, 18 of which were revision. Revision surgery had a 19-fold greater infection rate than primary surgery (3.63 percent versus 0.19 percent). Women were 3.6 times as likely to develop an infection ( p = 0.002). The infection rate using autologous costal cartilage was 3.39 percent, and that for simultaneous correction of a septal perforation was 8.57 percent. In 11 cases (50 percent), infection developed within 1 month after surgery (12 ± 7 days). Methicillin-resistant Staphylococcus aureus was cultured in eight cases. Infection manifested at the nasal tip in 45 percent and the caudal septum/columella in 32 percent of cases. Twenty cases (90.9 percent) underwent surgical débridement. CONCLUSION: Revision rhinoplasty in women, requiring the use of costal cartilage or simultaneous correction of septal perforation, showed a higher risk of postrhinoplasty infection, which usually manifested at the nasal tip and caudal septum/columella and needed to be managed by surgical débridement. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.