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1.
J Craniofac Surg ; 34(8): 2417-2421, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37682000

RESUMO

BACKGROUND: A crooked nose is an external nose deformity predominantly caused by congenital aplasia or acquired secondary to trauma or surgery, often accompanied by a deviated nasal septum. Patients with crooked nose have dual needs to improve both esthetic and functional problems. METHODS: The clinical and photographic information of 48 patients diagnosed with a crooked nose and nasal septum deviation treated from January 2018 to January 2022 was acquired. The morphology and functional effects were investigated by evaluating the general condition of the operation, measuring the esthetic indexes of the nose, and subjectively scoring. RESULTS: For both morphology and function, endoscopy-assisted one-stage correction showed positive results in this study. The external nose deviation distance postoperatively measured 1.28 (0.85, 1.97) mm, which significantly decreased from the preoperative value of 3.96 (3.31, 5.29) mm. The scores of doctors and irrelevant medical students on nose morphology increased significantly from 4.75±1.88 and 3.84±0.76 to 6.48±1.21 and 7.21±0.67, respectively. The rhinoplasty outcome evaluation score and the "nasal obstruction symptom evaluation "score of patients were both significantly improved ( t = -7.508 and t =6.310, respectively, P < 0.001). CONCLUSION: Endoscope-assisted one-stage correction of the crooked nose can restore nasal morphology, improve the symptoms of nasal obstruction, and achieve patient satisfaction. It is a minimally invasive, safe, effective, and fast recovery approach for patients who need to solve both esthetic and functional problems.


Assuntos
Obstrução Nasal , Deformidades Adquiridas Nasais , Rinoplastia , Humanos , Septo Nasal/cirurgia , Septo Nasal/anormalidades , Obstrução Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Deformidades Adquiridas Nasais/complicações , Estética Dentária , Nariz/cirurgia , Nariz/anormalidades , Rinoplastia/métodos , Resultado do Tratamento
2.
Facial Plast Surg ; 39(6): 595-602, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37532118

RESUMO

Nasal septal deviation is a frequent problem treated by otolaryngologists and facial plastic surgeons. Complete correction of the septal deformity is often essential both for straightening a crooked nose and for restoration of the nasal airway. While standard septoplasty techniques provide excellent outcomes in most patients, severe septal deformities may require treatment with more advanced maneuvers including adjacent grafting, caudal septal replacement, and even extracorporeal septoplasty. This article reviews a range of septoplasty techniques, with an emphasis on complex septal reconstruction and approaches that can be utilized to maintain keystone stability and establish a robust midline L-strut even in cases with challenging anatomy.


Assuntos
Implantes Dentários , Deformidades Adquiridas Nasais , Rinoplastia , Humanos , Septo Nasal/cirurgia , Septo Nasal/anormalidades , Rinoplastia/métodos , Deformidades Adquiridas Nasais/cirurgia , Compostos de Benzalcônio , Resultado do Tratamento
3.
J Craniofac Surg ; 34(7): 1971-1977, 2023 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-37322585

RESUMO

The purposes of this study were to analyze the effect of trans-sutural distraction osteogenesis (TSDO) on nasal bone, nasal septum, and nasal airway in the treatment of midfacial hypoplasia. A total of 29 growing patients with midfacial hypoplasia who underwent TSDO by a single surgeon were enrolled. The 3-dimensional measurement of nasal bone and nasal septum changes was performed using computed tomography (CT) images obtained preoperatively (T0) and postoperatively (T1). One patient was selected to establish 3-dimensional finite element models to simulate the characteristics of nasal airflow field before and after traction. After traction, the nasal bone moved forward significantly ( P <0.01). The septal deviation angle was lower than that before traction (14.43±4.70 versus 16.86 ±4.59 degrees) ( P <0.01). The length of the anterior and posterior margin of the vomer increased by 21.4% ( P <0.01) and 27.6% ( P <0.01), respectively, after TSDO. The length of the posterior margin of the perpendicular plate of ethmoid increased ( P <0.05). The length of the posterior inferior and the posterior superior margin of the nasal septum cartilage increased ( P <0.01) after traction. The cross-sectional area of nasal airway on the deviated side of nasal septum increased by 23.0% after traction ( P <0.05). The analysis of nasal airflow field showed that the pressure and velocity of nasal airflow and the nasal resistance decreased. In conclusion, TSDO can promote the growth of the midface, especially nasal septum, and increase the nasal space. Furthermore, TSDO is conductive to improve nasal septum deviation and decrease nasal airway resistance.


Assuntos
Osso Nasal , Osteogênese por Distração , Humanos , Osteogênese por Distração/métodos , Septo Nasal/diagnóstico por imagem , Septo Nasal/cirurgia , Septo Nasal/anormalidades , Face , Cartilagens Nasais
4.
J Craniofac Surg ; 34(4): 1235-1237, 2023 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-37143192

RESUMO

Congenital nasal anomalies are rare, with an estimated incidence of 1/20,000 to 40,000 live births. Hyperplasia and duplication anomalies are the most uncommon, comprising about 1% of reported cases. The authors present the case of a 6-year-old girl who presented to our institution with an isolated congenital bifid nasal septum. Parents reported a visibly abnormal nose since birth, and it had been continuously monitored by the parents and pediatrician. She demonstrated no history of difficulty breathing or other nasal concerns and was otherwise growing and developing normally. On physical examination, she was breathing comfortably through her bilateral nasal airways. Her nasal examination revealed a widened mid-vault with deep dorsal grooving and a bifid tip. Magnetic resonance imaging demonstrated an isolated bifid nasal septum without other facial malformation or intracranial extension. She underwent an open septorhinoplasty. Intraoperatively, the authors identified an anomalous dorsal nasal bone extension with a resultant bifidity in the body and caudal portions of the septum. Ostectomy and cartilaginous repositioning allowed for an autogenous reconstruction without the need for grafting. She subsequently recovered well without postoperative complications and continues to have improved nasal appearance with maintenance of function. A review of recent literatures revealed 2 other cases that are similar in presentation. The authors proposed that embryologically there might have been a change in expression of bone morphogenetic protein in the frontonasal area leading to caudal extension of the nasal bone. This in turn interferes with the fusion of nasal septum resulting in the bifid septum and dual dome morphology.


Assuntos
Doenças Nasais , Rinoplastia , Humanos , Criança , Feminino , Rinoplastia/métodos , Septo Nasal/diagnóstico por imagem , Septo Nasal/cirurgia , Septo Nasal/anormalidades , Osso Nasal/cirurgia , Doenças Nasais/cirurgia , Cartilagem/transplante
5.
J Craniofac Surg ; 34(7): 1938-1941, 2023 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-37194124

RESUMO

Septal cartilage deviations comprise the majority of deformities related to revision rhinoplasty operations. Therefore, the primary operation should be as eventless and durable as possible. Many techniques have been suggested, but most present with a monoplanar correction and fixation of the septum. This study aims to demonstrate a suture method that fixates and broadens the deviated septum. This method employs a single-stranded suture passing below the spinal periosteum, pulling the posterior and anterior portions of the septal base separately. It was utilized in 1578 patients, of which only 36 necessitated a revision of septoplasty in the past 11 years (2010-2021). With a revision rate of 2.29%, this method should be considered a preferable choice over many techniques described in the literature.


Assuntos
Septo Nasal , Rinoplastia , Humanos , Septo Nasal/cirurgia , Septo Nasal/anormalidades , Rinoplastia/métodos , Cartilagem/cirurgia , Reoperação , Técnicas de Sutura , Suturas , Resultado do Tratamento
6.
Plast Reconstr Surg ; 151(6): 1200-1204, 2023 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-36729736

RESUMO

SUMMARY: The deviated nose derives from underlying skeletal and soft-tissue deformities in the upper, middle, and/or lower third of the nose. Although deviation may stem from several intrinsic and extrinsic elements, the septum is most often the primary contributor. Attempts to straighten the nose without properly addressing the septum invariably result in a persistently deviated nose. The goal of this article is to review the 10 key steps for a reliable, methodical approach to correcting the deviated septum in primary rhinoplasty.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Humanos , Septo Nasal/cirurgia , Septo Nasal/anormalidades , Nariz/cirurgia , Nariz/anormalidades , Deformidades Adquiridas Nasais/etiologia , Deformidades Adquiridas Nasais/cirurgia
7.
Facial Plast Surg ; 39(4): 401-407, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36481968

RESUMO

In order to correct severe septal deformities, complete septal reconstruction is often required to achieve the desired functional and aesthetic results. Several different techniques have been described. Systematic evaluation of the long-term results is crucial to assess and improve the quality of these surgical techniques. A custom-built dashboard (the rhinoplasty health care monitor [RHM]) was used for prospective and longitudinal outcome evaluation of the septal reconstruction. The RHM includes the Nasal Obstruction Symptom Evaluation (NOSE) scale for nasal obstruction and the Utrecht Questionnaire (UQ) for aesthetic outcome results. In total, 58 patients were included for septal reconstructive surgery. The mean preoperative NOSE scale scores decreased from 67.8 ± 19.1 to 12.2 ± 17.5, 1 year after surgery. Mean preoperative UQ scores went from 12.3 ± 6.4 to 6.2 ± 2.7. The beneficial functional and aesthetic effects of the techniques that we currently use to reconstruct the septum are efficient in terms of function and aesthetics.


Assuntos
Obstrução Nasal , Rinoplastia , Humanos , Resultado do Tratamento , Estudos Prospectivos , Obstrução Nasal/cirurgia , Obstrução Nasal/diagnóstico , Septo Nasal/cirurgia , Septo Nasal/anormalidades , Estética Dentária , Rinoplastia/métodos , Avaliação de Resultados em Cuidados de Saúde , Estética
8.
Facial Plast Surg Clin North Am ; 31(1): 107-117, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396281

RESUMO

Severe septal deviations are a constant challenge for rhinosurgeons. As the septum is the most important pillar of the nasal framework, septal deformities require correction to insure a straight nose. The septum should be on the midline without any tension to ensure a correct healing of the external nasal pyramid. In certain cases, the association of a correct septoplasty and dorsal preservation allows the treatment of the crooked nose and at the same time gives natural results with rapid postoperative recovery. The aim of this article was to underline the versatility of the dorsal preservation technique for the correction of severe septal deviation.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Humanos , Septo Nasal/cirurgia , Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/cirurgia , Rinoplastia/métodos , Cicatrização
9.
Ann Plast Surg ; 89(5): 487-491, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36279572

RESUMO

BACKGROUND: Anatomical deformities can greatly alter nasal function, which can be largely corrected during septoplasty and septorhinoplasty operations. In this study, we aimed to objectively measure the results of septoplasty surgeries of deviated noses with radiological analysis and compare the results with clinical evaluations. PATIENTS AND METHODS: Forty patients who were undergoing septorhinoplasty were included in the study. Patients were evaluated with preoperative and postoperative paranasal computed tomography scan measurements and satisfaction surveys. RESULTS: Preoperative and postoperative mean ± SD septal deviation angle measurements were 11.9 ± 5.3 degrees and 6.5 ± 3.1 degrees, respectively. Preoperative and postoperative mean ± SD septal deviation distance measurements were 7.3 ± 4 and 3 ± 1.3 mm, respectively. Preoperative and postoperative mean ± SD oblique conchal measurement on the deviated side was 17.3 ± 3.2 and 13.4 ± 2.8, respectively. Preoperative and postoperative mean ± SD patient satisfaction survey scores were 17 ± 1.9 and 4.5 ± 1.9 points, respectively. DISCUSSION: To obtain a nose with a greatly improved functional gains, especially in heavy deviated noses, is an important goal in septorhinoplasty surgery. It is essential to apply the technique that will benefit the patient. The most important success criterion seems to be the regression of the clinical complaints of the patients, which can be proven objectively with computed tomography scan measurements.


Assuntos
Obstrução Nasal , Deformidades Adquiridas Nasais , Rinoplastia , Humanos , Satisfação do Paciente , Resultado do Tratamento , Deformidades Adquiridas Nasais/diagnóstico por imagem , Deformidades Adquiridas Nasais/cirurgia , Septo Nasal/diagnóstico por imagem , Septo Nasal/cirurgia , Septo Nasal/anormalidades , Rinoplastia/métodos , Obstrução Nasal/cirurgia
10.
Facial Plast Surg ; 38(4): 324-331, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35934315

RESUMO

Septoplasty is one of the most common procedures performed by facial plastic surgeons. Surgical decision-making surrounding septal deviation repair centers around the location of deviation and need for dorsal and/or caudal septal correction. Endonasal approaches are often adequate and external approaches are utilized for significant L-strut involvement. For severe deformities, extracorporeal septoplasty and anterior septal reconstruction can be utilized. We present an overview of septal deviation repair with technical nuances and advanced reconstruction techniques.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Humanos , Resultado do Tratamento , Septo Nasal/cirurgia , Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/cirurgia , Rinoplastia/métodos , Face/cirurgia
11.
J Craniofac Surg ; 33(5): e447-e449, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34690315

RESUMO

ABSTRACT: We aimed to evaluate whether the nasal septum deviation affects the development of sinonasal structures. Patients who had undergone paranasal sinus computed tomography (PNS-CT) imaging due to nasal obstruction were divided into 3 groups according to the septal deviation angle; group I: 0° to 9°, group II: 10° to 15°, and group III: >15°. The features of sinonasal structures were recorded when evaluating PNS-CT. There were totally 234 patients, 119 patients in group I, 68 in group II, and 47 in group III. On the opposite side of the deviation, keros 3 was significantly more in group III ( P < 0.001). Although the incidence of concha bullosa and agger nasi cell were not affected by the degree of deviation ( P > 0.05), the incidence of Haller and Onodi cells were significantly higher in group III ( P < 0.001). In addition, all cells were observed more in the opposite side of the deviation in each group ( P < 0.001). Maxillary sinus retention cysts and hypoplasia of maxillary and frontal sinuses, as an indicator of the low pneumatization of the sinuses, are seen more on the same side of nasal septum deviation, increasing with the degree of deviation increases ( P < 0.001). Nasal septum deviation affects the development of sinonasal structures by affecting the pneumatization. Preoperative PNS-CT evaluation is important in order to be aware of the situations that we may encounter during surgery and to provide adequate treatment.


Assuntos
Seio Frontal , Doenças Nasais , Humanos , Seio Maxilar , Septo Nasal/anormalidades , Septo Nasal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
12.
Laryngoscope ; 132(3): 509-517, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34125439

RESUMO

OBJECTIVES/HYPOTHESIS: About 260,000 septoplasties are performed annually in the US to address nasal septal deviation (NSD). Yet, we do not consistently understand what aspects of NSD result in symptoms. STUDY DESIGN: Blinded cohort study. METHODS: Two fellowship-trained surgeons blindly reviewed computerized tomography (CTs) of 10 confirmed NSD patients mixed with 36 healthy controls. All patients were correctly identified, however, 24/36 controls were falsely identified by both surgeons as patients (33.3% specificity), which were grouped as asymptomatic NSD (aNSD), while the remaining controls as non-NSD (healthy). Acoustic rhinometry, rhinomanometry, individual CT-based computational fluid dynamics and nasal sensory testing were applied to address the puzzling questions of why these aNSD had no symptoms and, more fundamentally, what caused symptoms in sNSD patients. RESULTS: aNSD reported no nasal symptoms - Nasal Obstruction Symptom Evaluation score (sNSD: 60.50 ± 13.00; aNSD: 5.20 ± 5.41; non-NSD: 6.66 ± 7.17, P < .05); 22-item Sino-Nasal Outcome Test score (sNSD: 32.60 ± 14.13; aNSD: 10.04 ± 10.10; non-NSD: 9.08 ± 12.42, P < .001). No significant differences in measured nasal resistance, minimum cross-sectional area (MCA), degree of septal deviation, and nasal airflow distributions were found between sNSD and aNSD groups. Only three variables differentiate sNSD versus aNSD: anterior averaged heat flux on deviated side, inferior turbinate peak heat flux on non-deviated side, and nasal cool sensitivity measured by menthol lateralization threshold, with no significant differences among these variables found between the two healthy groups (aNSD vs. non-NSD). These variables by themselves or combined can differentiate sNSD from controls with higher specificity than the physicians (ROC area under the curve = 0.84 with 70% sensitivity and 91.6% specificity). CONCLUSIONS: This study sheds light on the potential mechanisms of NSD symptomatology: distorted nasal cooling due to NSD exacerbated by poorer nasal mucosal sensitivity. It further supports our previous hypothesis that nasal obstruction complaints do not result directly from obstruction, rather from the capacity of our nose to subjectively sense airflow cooling. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:509-517, 2022.


Assuntos
Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/complicações , Estudos de Casos e Controles , Humanos , Septo Nasal/diagnóstico por imagem , Septo Nasal/fisiopatologia , Deformidades Adquiridas Nasais/patologia , Deformidades Adquiridas Nasais/fisiopatologia , Transtornos do Olfato/etiologia , Rinomanometria , Rinometria Acústica , Tomografia Computadorizada por Raios X
13.
Auris Nasus Larynx ; 49(1): 67-76, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33966932

RESUMO

OBJECTIVE: Several methods have been reported to correct caudal deviation of the nasal septum, including open septorhinoplasty (OSR) and septoplasty with Killian incision (KI). In general, OSR is applied instead of KI for caudal deviation. However, there is little objective evidence own on the effects of OSR and KI for caudal deviation. In this study, we compared surgical outcomes between OSR and KI by quantifying nasal septum deviation using two simple and objective parameters on routine paranasal sinus CT scans. METHODS: We retrospectively analyzed 18 patients who underwent OSR and 11 patients who underwent septoplasty with KI between April 2006 and October 2019. Caudal deviation was defined on the basis of the "Anterior-posterior Position of the most deviated point of the nasal septum (AP)," which was measured on computerized tomography. The deformation rate (DR) of the nasal septum was also calculated. Nasal airway resistance and visual analogue scale (VAS) score for nasal obstruction were examined. RESULTS: The AP was significantly correlated with the VAS score (r=-0.58, p=0.017). The DR in patients with caudal septal deviation was significantly decreased by OSR (0.14±0.06 to 0.03±0.03, p=0.004), but not by KI (0.09±0.08 to 0.04±0.03, p=0.25). OSR also improved nasal airway resistance (1.10±0.44 to 0.42±0.15, p=0.02), and the VAS score (79.11±14.74 to 5.78±7.89, p=0.004). CONCLUSION: Nasal obstruction is more severe in patients with the caudal deviation. OSR corrects caudal deviation of the nasal septum more effectively than does KI. The AP could be useful for the evaluation of the deviation of the nasal septum and help in selecting the appropriate septoplastic technique.


Assuntos
Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/etiologia , Septo Nasal/anormalidades , Septo Nasal/patologia , Deformidades Adquiridas Nasais/complicações , Estudos Retrospectivos , Rinoplastia/métodos
14.
Eur Arch Otorhinolaryngol ; 279(4): 1943-1950, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34291346

RESUMO

PURPOSE: To investigate the long-term safety and efficacy of a 3D-printed bioresorbable polycaprolactone (PCL) nasal implant for nasal septal deformity reconstruction. METHODS: Fourteen patients who had undergone nasal septum reconstruction surgery using 3D-printed PCL nasal septal implants were enrolled. The primary outcome was the change in total Nasal Obstruction Symptom Evaluation (NOSE) scale scores between postoperative 3 months and current status (3.59 ± 0.51 years). The secondary outcomes were changes in the minimum cross-sectional area (MCA) and volume of both nasal cavities based on acoustic rhinometry, the cross-sectional area of the ostiomeatal unit, and the nasal septum angle of the paranasal sinus (PNS) in computed tomography (CT) images, and a visual analog scale (VAS) of the patients' subjective satisfaction. RESULTS: The results showed no significant changes in the MCAs (Cohen's d:0.09; p = 0.711) or nasal volume (Cohen's d:0.26; p = 0.356), the area of the ostiomeatal unit (Cohen's d:0.49; p = 0.064), septum angles (Cohen's d:0.18; p = 0.831), the NOSE scale (Cohen's d:0.14; p = 0.621), or patients' subjective satisfaction (Cohen's d:0.52; p = 0.076) during the follow-up period. CONCLUSIONS: This homogeneous composite microporous PCL nasal septal implant demonstrated long-term clinical efficacy and safety in human tissues that required maintenance of mechanical strength. Therefore, the indications for this implant could extend to various other craniofacial reconstructions in the future.


Assuntos
Obstrução Nasal , Rinoplastia , Humanos , Obstrução Nasal/cirurgia , Septo Nasal/anormalidades , Septo Nasal/diagnóstico por imagem , Septo Nasal/cirurgia , Impressão Tridimensional , Rinometria Acústica , Rinoplastia/métodos , Resultado do Tratamento
15.
Plast Reconstr Surg ; 148(6): 983e-991e, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34847124

RESUMO

BACKGROUND: Late correction of cleft lip nose deformity continues to be a challenge because of the weakness of cartilages and the collapsing forces of tight contracted soft tissues. The authors describe the new technique of costal cartilage spring graft for columella and lower lateral cartilage as a block to achieve symmetric, aesthetically more durable, and acceptable results for the late correction of cleft lip nose deformity. METHODS: Late cleft lip nose repair with simultaneous rhinoplasty was performed in 92 patients with unilateral cleft lip nose deformity. For correction of cleft lip nose deformity, a strut graft 2 to 3 mm in width, 0.5 to 1 mm in thickness, and 5 to 7 cm in length was prepared from costal cartilage (autograft or allograft). The strut graft was curved and bowed with fingers to simulate the medial and lateral crura of the alar cartilage. A crescent-shaped skin excision from the alar rim and a vertical incision in the columella were made. The intercrural and alar areas were dissected to create sufficient space for the insertion of a bow-shaped spring cartilage graft. After insertion of the cartilage graft, the alar rim was closed with continuous 6-0 Monocryl and the columella was closed with 5-0 Vicryl. RESULTS: Correction of depressed alar cartilage and webbing, lengthening the columella using spring costal cartilage, and symmetric nostrils were achieved in all cases. The mean follow-up period was 5 years (range, 2 to 15 years). CONCLUSION: These procedures, septoplasty, and simultaneous rhinoplasty provided long-term satisfactory results in the late correction of cleft lip nose deformity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Fenda Labial/complicações , Cartilagem Costal/transplante , Septo Nasal/anormalidades , Rinoplastia/métodos , Adolescente , Adulto , Estética , Feminino , Seguimentos , Humanos , Masculino , Septo Nasal/cirurgia , Fatores de Tempo , Tempo para o Tratamento , Transplante Autólogo/métodos , Transplante Homólogo/métodos , Resultado do Tratamento , Adulto Jovem
16.
PLoS One ; 16(11): e0259468, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34735521

RESUMO

BACKGROUND & AIMS: Nasal obstruction caused by nasal septal deviation is very bothersome and, therefore, can affect the patient's emotional state. However, little is known about the effect of nasal septal deviation (NSD) on the neuropsychiatric aspects of patients. Therefore, this study aims to verify the higher incidence of anxiety, depression, and migraine in patients diagnosed with NSD compared to general populations using big data. METHODS: This retrospective cohort study collected subjects from the Korean National Health Insurance Service (NHIS) database. Adjustments were made to minimize the confounding of variables for age, sex, residence type, income levels, hypertension, diabetes, dyslipidemia, rhinitis, and chronic rhinosinusitis between the two groups. The primary endpoint of this study was newly diagnosed anxiety, depression, and migraine between January 2009 and December 2018. Kaplan-Meier survival curves, logarithmic rank test, and Cox proportional regression test were used for statistical analysis. RESULTS: Among a total of 135,769 subjects in the NHIS database, 48,495 patients with NSD (NSD group) and 54,475 control subjects (control group) were selected. Patients with NSD had an increased risk of anxiety, depression, and migraine compared to the control group. In the NSD group, the adjusted hazard ratios (HR) were 1.236 (95% CI, 1.198-1.276) for anxiety, 1.289 (95% CI, 1.238-1.343) for depression, and 1.251 (95% CI, 1.214-1.290) for migraine. CONCLUSION: NSD is associated with a higher incidence of anxiety, depression, and migraine. Therefore, it is suggested that physicians carefully consider psychoneurological distress and employ therapeutic strategies to minimize these conditions.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Obstrução Nasal/psicologia , Septo Nasal/anormalidades , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/genética , República da Coreia/epidemiologia , Estudos Retrospectivos
17.
J Plast Reconstr Aesthet Surg ; 74(10): 2744-2750, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34266802

RESUMO

BACKGROUND: Even a small amount of bleeding during nose surgery can impair the surgeon's vision, prolong the duration of operation, and affect surgery quality; therefore, various techniques have been proposed to control the bleeding. The aim of this study was to compare the efficacy of the local use of tranexamic acid (TXA) in the dry field of surgery. METHOD: This randomized, double-blinded, controlled trial was conducted in the operation room of Imam Reza Hospital, Tehran, Iran, from January 10, 2016 to February 8, 2017. Sixty patients with age range from 20 to 60 years and the American Society of Anesthesiologists physical status classes I candidates who require septoplasty enrolled. Patients were randomized through white and black cards to receive either syringes. Thirty patients in the intervention group received lidocaine + adrenaline + TXA and 30 patients in the control group received lidocaine + adrenaline. Bleeding volume accumulated in the suction chamber, the nasopharyngeal pack, and hemodynamic variations were measured. Surgeon's satisfaction scores and suitability of operation field were obtained from the surgeon by using the Likert scale and Boezaart grading scale, respectively. RESULTS: The intervention group had a higher score of surgeon satisfaction [4.1 vs 3.16 in the control group (P = 0.001)] and fewer hemodynamic variations. The mean bleeding volume in the intervention was 187.23 ± 54.61 mL and in the control group was 341.22 ± 49.17 mL (P = 0.001). The mean Boezaart score (suitability of operation field) in the intervention group was 1.8 (score range: 1-3) and in the control group was 2.53 (score range: 2-4) and it was statistically significant (P = 0.001). CONCLUSION: The local use of TXA + lidocaine + adrenaline is associated with reduced bleeding, greater surgeon satisfaction, reduced need for Karpol injection, and better hemodynamic stability.


Assuntos
Antifibrinolíticos/administração & dosagem , Septo Nasal/cirurgia , Qualidade da Assistência à Saúde , Rinoplastia/normas , Ácido Tranexâmico/administração & dosagem , Administração Tópica , Pressão Arterial/efeitos dos fármacos , Atitude do Pessoal de Saúde , Perda Sanguínea Cirúrgica/prevenção & controle , Volume Sanguíneo , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/cirurgia , Duração da Cirurgia
18.
Plast Reconstr Surg ; 148(1): 133-143, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34076624

RESUMO

BACKGROUND: Secondary cleft rhinoplasty presents some of the most challenging cases of both cosmetic and functional nasal deformities. Understanding the anatomy and growth abnormality seen with the cleft nasal deformity helps to tailor surgical management. This article seeks to expand on the application of current concepts in secondary rhinoplasty for unilateral cleft lip nasal deformity. METHODS: The authors review nasal analysis in the cleft rhinoplasty patient and provide the surgical management for each aspect in the secondary cleft rhinoplasty. RESULTS: The secondary rhinoplasty was divided into seven areas: piriform hypoplasia, septal reconstruction, dorsal reshaping, tip reshaping, tip projection, alar reshaping, and alar repositioning. Surgical management for each is provided. CONCLUSION: Secondary cleft rhinoplasty requires an understanding of the structural dysmorphology, and the use of cosmetic, functional, and secondary rhinoplasty techniques for its successful management.


Assuntos
Fenda Labial/cirurgia , Cartilagens Nasais/anormalidades , Septo Nasal/anormalidades , Reoperação/métodos , Rinoplastia/métodos , Fenda Labial/complicações , Estética , Humanos , Cartilagens Nasais/crescimento & desenvolvimento , Cartilagens Nasais/cirurgia , Septo Nasal/crescimento & desenvolvimento , Septo Nasal/cirurgia , Resultado do Tratamento
19.
Plast Reconstr Surg ; 148(1): 66-70, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34181604

RESUMO

BACKGROUND: The primary element of a crooked nose is a midline deviation of the nasal pyramid. To date, no surgical strategies have been described as compatible with the philosophy of dorsal preservation. The dorsal preservation technique differs from the Joseph structured rhinoplasty because it preserves both the keystone area and the continuity of the cartilaginous vault. The authors focused on the versatility of the dorsal preservation technique even for the deviated nose, introducing the "Pisa Tower concept." METHODS: From January of 2015 to June of 2019, 280 patients diagnosed as having a crooked nose underwent primary septorhinoplasty with dorsal preservation through an asymmetric bony wedge resection and lowering of the bony pyramid onto the frontal process of the maxilla (the let-down osteotomy), in accordance with the Pisa Tower concept. Inclusion criteria were a preoperative computed tomography examination, nasal axis deviation, a complete photographic examination preoperatively, and at least a 1-year follow-up. RESULTS: The mean nasal axis deviation was 7.62 degrees preoperatively and 1.15 degrees postoperatively (p < 0.05). Of the 84 patients, 47 (55.95 percent) were very satisfied, 33 (39.28 percent) were satisfied, and four (4.76 percent) were unsatisfied with surgical results and required revision surgery. CONCLUSIONS: The authors' opinion is that the association of "swinging door" septoplasty with the Pisa Tower concept can be a valid alterative to other techniques when working with the structured rhinoplasty philosophy in patients with a crooked nose. Although this is only a preliminary study, the decreased use of spreaders graft and less aggressive reconstructive methods look very promising. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/cirurgia , Satisfação do Paciente , Rinoplastia/métodos , Adolescente , Adulto , Estética , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Septo Nasal/lesões , Septo Nasal/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Rinoplastia/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
20.
Auris Nasus Larynx ; 48(5): 914-921, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33685756

RESUMO

OBJECTIVE: Many authors have investigated the most appropriate surgical approach to the deviated septum in childhood, considering the obligate mouth-breathing habit a possible cause of malocclusion and disharmonious development of the facial skeleton in growing kids. Nevertheless, controversies still remain about the long-term functional/esthetic results of such procedures, mainly due to the duration of the follow-up and possible confounding factors. METHODS: 111 Caucasian children (age range: 6-13 years) were submitted to a personal "Quick" septoplasty surgical technique between 2005 and 2010. Preoperative otorhinolaryngological examination using flexible nasal endoscopy, anterior active rhinomanometry (AAR), Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire, and dentofacial evaluation (including cephalometry) were performed. Postoperative AAR, NOSE questionnaire and cephalometric assessment were carried out in all patients at the age of 18 years. Informed consent was obtained from children's parents as appropriate. RESULTS: No surgical complication was recorded. Among our patients, a significant (p <0.001) improvement of nasal breathing resistances at AAR and NOSE questionnaire scores was found after surgery. A significant improvement in cephalometric/dental parameters (gonial angle values, anterior facial height, prevalence of class I occlusion, maxillary intermolar width, and cross-bite frequency) was noticed after the follow-up with respect to preoperative conditions. CONCLUSION: The "Quick" septoplasty technique described is a practical and conservative procedure with a low complication rate that offers long-term favourable results for the correction of nasal septum deviations in children. Nasal-breathing restoration may favor a physiological and harmonious development of craniofacial and dental structures in offspring.


Assuntos
Ossos Faciais/crescimento & desenvolvimento , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Rinoplastia/métodos , Adolescente , Cefalometria , Criança , Feminino , Humanos , Masculino , Má Oclusão/epidemiologia , Respiração Bucal/fisiopatologia , Obstrução Nasal/fisiopatologia , Septo Nasal/anormalidades , Estudos Prospectivos , Mecânica Respiratória/fisiologia , Rinomanometria
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