Powered Micro-saw Versus Conventional Osteotome for Septorhinoplasty: A Prospective, Double-Blind, Comparative Study.

BACKGROUND: Various powered instruments are used to perform osteotomy. A consensus on the best method has not been established due to discrepancies in previous studies. This study aimed to compare the conventional osteotome and a powered micro-saw during septorhinoplasty. METHODS: The single-center, prospective cohort study included 60 patients that were grouped into two groups of 30 each. Group 1 underwent open septorhinoplasty using a conventional osteotome, and group 2 underwent open septorhinoplasty using a powered micro-saw. Postoperative edema, ecchymosis, pain, and nasal blockage were compared between groups. Preoperative and postoperative (6 months) functional and aesthetic outcomes were compared based on FACE-Q, SNOT-22, and T-NOSE scores. RESULTS: There were not any differences in age, gender, follow-up duration, the Brinkman index, or level of education between groups. Postoperative pain scores were significantly lower in group 2 on d 1 and d 3 postsurgery. Nasal blockage scores were significantly higher in group 1 on d 3 and d 7 postsurgery. Edema and ecchymosis scores were similar in both groups at all time points. Preoperative and postoperative (6 months) functional and aesthetic outcomes were also similar in both groups. CONCLUSION: Osteotomy using a powered micro-saw is an effective technique that results in less postoperative pain and nasal blockage than when using conventional osteotome. Early postoperative period edema and ecchymosis scores and long-term functional and aesthetic outcomes are similar when using a powered micro-saw and a conventional osteotome. Osteotomy using a powered micro-saw can be considered an alternative to using a conventional osteotome. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Traumatic Facial and Vestibulocochlear Nerve Injury in The Internal Acoustic Canal in The Absence of A Temporal Bone Fracture.

We present a rare case of traumatic facial and vestibulocochlear nerve injury in the internal acoustic canal in the absence of a temporal bone fracture. A 2.5-year-old female presented with sudden-onset left-sided facial paralysis and ipsilateral total hearing loss after being hit by a falling television. High-resolution computed tomography revealed an occipital fracture line that spared the temporal bone and otic capsule. Diagnostic auditory brainstem response testing showed that wave V at 90-db normal hearing level was absent in the left ear. Needle electromyography revealed severe axonal injury. Facial paralysis regressed to House-Brackmann grade IV 9 months after the trauma, and no surgical intervention was scheduled. Traumatic facial and vestibulocochlear nerve injury can occur in the absence of a temporal bone fracture. Thus, careful evaluation of the internal acoustic canal is mandatory if concurrent 7th and 8th cranial nerve paralyses exist with no visible fracture line.

The Association Between Modiolar Base Anomalies and Intraoperative Cerebrospinal Fluid Leakage in Patients With Incomplete Partition Type-II Anomaly: A Classification System and Presentation of 73 Cases.

OBJECTIVE: Modiolus and modiolar base abnormalities in patients with incomplete partition-II anomaly (IP-II) increase the risk of intraoperative cerebrospinal fluid (CSF) leakage. This study aimed to classify modiolar abnormalities and define objective radiological measures for preoperatively evaluating intraoperative CSF leakage risk. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: The study included 73 patients with IP-II that underwent cochlear implant surgery between 2002 and 2017. INTERVENTION: Analysis of preoperative temporal bone computed tomography (CT) scans and surgical records. MAIN OUTCOME MEASURES: Preoperative CT modiolar anomalies and intraoperative CSF leakage status. RESULTS: Among the 73 patients (41 men and 32 women), mean age at cochlear implant surgery was 11.4 (range, 0-42) years. Preoperative CT-based modiolar base anomaly classification was as follows: grade 1 (complete modiolus, n = 1), grade 2 (thin plate of bone in the modiolar base + partial modiolus, n = 14); grade 3 (thin plate of bone in the modiolar base, n = 53); grade 4 (total modiolar base defect, n = 5). The gusher rate was 8%. All patients with grade 4 anomaly had an intraoperative gusher. Patients with grade 3 anomaly accounted for 86% of oozing cases. Oozing, pulsation, and no CSF leakage rates were similar in those with grade 2 anomaly. CONCLUSIONS: The modiolus and modiolar base must be carefully evaluated in patients with IP-II. Gushers primarily occur in IP-II patients with grade 4 anomaly. A thin plate of bone in the modiolar base most commonly prevents gushers.

The serum leptin level in non-obese patients with obstructive sleep apnea.

OBJECTIVE: This study aimed to determine the association between the severity of obstructive sleep apnea (OSA) and the serum leptin level in non-obese OSA patients. METHODS: This prospective case-control study included non-obese OSA patients that presented with sleep-related disturbances and underwent polysomnography (PSG) between April 2015 and June 2016. The serum leptin level was measured and its relationship to PSG parameters was investigated. RESULTS: The study included 73 OSA patients (20 female and 53 male) with a mean age of 41.1±11.5 years and mean body-mass index (BMI) of 26.4±2.7kgm-2. The serum leptin level in 44 patients with moderate/severe OSA (AHI ≥15) was 3.4±2.6ngmL-1, versus 4.5±3.8ngmL-1 in 29 patients with snoring/mild OSA (AHI <15) (P=0.20). There were not any correlations between any of the PSG parameters and the serum leptin level, but there was a significant correlation between the leptin level and BMI (r=0.345, P<0.01). CONCLUSION: The serum leptin level does not differ significantly between non-obese OSA patients with moderate/severe and snoring/mild OSA. Obesity is the primary factor associated with the serum leptin level.

Effects of Expansion Sphincter Pharyngoplasty on the Apnea-Hypopnea Index and Heart Rate Variability.

PURPOSE: Heart rate variability (HRV) is a noninvasive and sensitive method used to evaluate autonomic function of the heart based on specific polysomnographic parameters. This study aimed to determine the effect of expansion sphincter pharyngoplasty (ESP) on HRV and the apnea-hypopnea index (AHI) in patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS: This retrospective cohort study included patients who presented to the Department of Otorhinolaryngology, Hacettepe University Hospital (Ankara, Turkey), were diagnosed with OSA, and underwent ESP. Patient medical records, including demographic data, polysomnographic findings, and HRV parameters, were reviewed. The predictor variable was the effect of ESP on the AHI and the primary outcome variables were HRV parameters. Descriptive and bivariate statistics were computed using χ2 test, t test, and Mann-Whitney U test. RESULTS: The mean age of the 28 patients (20 men and 8 women) was 43 ± 9.9 years. Surgical success (AHI, <20; 50% decrease in the AHI) was achieved in 16 patients (57.1%). The AHI decreased in 22 patients (78.6%) but increased in 6 patients (21.4%) after ESP. The ratio of low-frequency power (LF) to high-frequency power (HF) decreased significantly in the patients with successful surgery and in those whose AHI decreased after surgery (P = .02 and P = .001, respectively). For the change in the LF/HF ratio, 19 patients had a decrease in sympathetic activity, whereas 9 had an increase in sympathetic activity, after ESP. A decrease in sympathetic activity after ESP was significantly associated with surgical success and a decrease in the AHI (P = .033 and P = .001, respectively). CONCLUSION: ESP is an effective surgical option for the treatment of OSA and lowers the AHI. Successful ESP plays a role in decreasing sympathetic activity of the heart, which might be associated with a decrease in the risk of cardiovascular disease.