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1.
J Mol Diagn ; 23(1): 3-9, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33217552

RESUMO

Access to rapid and accurate detection of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is essential for controlling the current global pandemic of coronavirus disease 2019. In this study, the use of oral rinses (ORs) and posterior oropharyngeal saliva as an alternative to swab collection methods from symptomatic and asymptomatic health care workers for the detection of SARS-CoV-2 RNA by RT-PCR was evaluated. For saliva samples, the overall agreement with oropharyngeal swabs was 93% (Ƙ = 0.84), with a sensitivity of 96.7% (95% CI, 83.3%-99.8%). The agreement between saliva and nasopharyngeal swabs was 97.7% (Ƙ = 0.93), with a sensitivity of 94.1% (95% CI, 73.0%-99.7%). ORs were compared with nasopharyngeal swabs only, with an overall agreement of 85.7% (Ƙ = 0.65), and a sensitivity of 63% (95% CI, 46.6%-77.8%). The agreement between a laboratory-developed test based on the CDC RT-PCR and two commercial assays, the Xpert Xpress SARS-CoV-2 and the Cobas SARS-CoV-2, was also evaluated. The overall agreement was >90%. Finally, SARS-CoV-2 RNA in saliva samples was shown to be stable, with no changes in viral loads over 24 hours at both room temperature and 4°C. Although the dilution of SARS-CoV-2 in ORs precluded its acceptability as a sample type, posterior oropharyngeal saliva was an acceptable alternative sample type for SARS-CoV-2 RNA detection.


Assuntos
/métodos , RNA Viral/análise , Saliva/virologia , Humanos , Técnicas de Diagnóstico Molecular , Boca/virologia , Nariz/virologia , Orofaringe/virologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Carga Viral/métodos
2.
Am J Otolaryngol ; 42(1): 102777, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33125907

RESUMO

IMPORTANCE: Adequate sampling of the nasopharynx is crucial to performing accurate SARS-CoV-2 (COVID) testing. Formalized education of nasal anatomy may improve provider testing technique and reduce false-negative test results. OBJECTIVE: To assess the effect of nasal anatomy education on medical providers' comfort level and knowledge base in performing accurate SARS-CoV-2 (COVID) testing. STUDY DESIGN: Pre-post survey. SETTINGS: Tertiary care academic hospital. PARTICIPANTS: 17 nurses performing COVID testing were enrolled. INTERVENTION: An educational session on COVID nasopharyngeal testing technique and nasal anatomy was presented by an otolaryngologist. MAIN OUTCOMES AND MEASURES: A pre-session survey assessed providers' prior nasal testing training and COVID testing challenges. Provider comfort level with COVID testing was surveyed pre-and post-session. A 6-question nasal anatomy test was administered pre- and post-session. RESULTS: 16 out of 17 nurses performed fewer than 10 COVID tests prior to the educational session (94%). Reported challenges with COVID testing included patient discomfort (79.6%), inability to pass the test swab (23.5%) and nasal bleeding (11.8%). The number of providers comfortable with independently performing COVID testing increased from pre- to post-session (5 and 14, p = 0.013). The average number of correct responses to the 6-question nasal anatomy test increased following the session (3.2 ± 1.2 to 5.1 ± 1.1, p = 0.003). Specifically, the number of providers able to localize the nasopharynx increased from 8 providers pre-session to 14 providers post-session (p = 0.04). CONCLUSION: Early implementation of nasal anatomy and nasopharyngeal swab technique education can help improve provider comfort and knowledge in performing accurate COVID testing.


Assuntos
/métodos , DNA Viral/análise , Educação em Enfermagem/métodos , Nariz/anatomia & histologia , Pandemias , /genética , /epidemiologia , Humanos , Reprodutibilidade dos Testes
3.
Diagn Microbiol Infect Dis ; 99(1): 115200, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32980807

RESUMO

The COVID-19 pandemic in the United States created a unique situation where multiple molecular SARS-CoV-2 diagnostic assays rapidly received Emergency Use Authorization by the FDA and were validated by laboratories and utilized clinically, all within a period of a few weeks. We compared the performance of four of these assays that were evaluated for use at our institution: Abbott RealTime m2000 SARS-CoV-2 Assay, DiaSorin Simplexa COVID-19 Direct, Cepheid Xpert Xpress SARS-CoV-2, and Abbott ID NOW COVID-19. Nasopharyngeal and nasal specimens were collected from 88 ED and hospital-admitted patients and tested by the four methods in parallel to compare performance. ID NOW performance stood out as significantly worse than the other 3 assays despite demonstrating comparable analytic sensitivity. Further study determined that the use of a nasal swab compared to a nylon flocked nasopharyngeal swab, as well as use in a population chronically vs. acutely positive for SARS-CoV-2, were substantial factors.


Assuntos
/métodos , /isolamento & purificação , /normas , Serviço Hospitalar de Emergência , Hospitais Universitários , Humanos , Pacientes Internados , Limite de Detecção , Nasofaringe/virologia , Nariz/virologia , Sensibilidade e Especificidade , Estados Unidos/epidemiologia
4.
Eur J Clin Microbiol Infect Dis ; 40(1): 193-195, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32666481

RESUMO

PURPOSE: PCR on a nasopharyngeal sample is the reference method for the detection of SARS-nCoV-2. However, combined throat/nasal sampling as a testing method has several advantages. We compared the combined throat/nasal sampling with nasopharyngeal sampling for detection of SARS-CoV-2 in healthcare workers suspected of COVID-19. METHODS: In 107 healthcare workers with symptoms of COVID-19, combined throat/nasal sampling and nasopharyngeal sampling was performed. Detection of SARS-CoV-2 was performed by RT-PCR targeting. RESULTS: A total of 80 healthcare workers (74.8%) tested negative with both sampling methods, and 25 healthcare workers (23.4%) tested positive with both sampling methods. There were two discrepant results with positive PCR in combined throat/nasal swabs and negative PCR in nasopharyngeal swabs (1.9%). The κ index for concordance between the 2 sampling methods was high (0.95). The median cycle threshold (Ct) value of PCR on nasopharyngeal samples was significantly lower than the Ct value of PCR on combined throat/nasal samples (19 (IQR 17-20) versus 21 (IQR 18-29) cycles, p value 0.01). CONCLUSION: Combined throat/nasal swabs yield a similar sensitivity to detect SARS-CoV-2 as nasopharyngeal swabs and are a good alternative sampling method, despite a lower Ct value for the nasopharyngeal samples.


Assuntos
/métodos , Nasofaringe/virologia , Nariz/virologia , Faringe/virologia , Manejo de Espécimes/métodos , Adulto , Pessoal de Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , RNA Viral/isolamento & purificação , Adulto Jovem
6.
Oral Maxillofac Surg Clin North Am ; 33(1): 125-129, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33246544

RESUMO

The overly shortened nose can often be the result of previous rhinoplasty. The causes can include weakening or missing cartilage for nasal tip support as well as contraction and scarring of the skin. The purpose of this article was to provide the authors' approach to this deformity.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Cartilagem/transplante , Humanos , Septo Nasal/cirurgia , Nariz/cirurgia , Deformidades Adquiridas Nasais/cirurgia
7.
Oral Maxillofac Surg Clin North Am ; 33(1): 131-141, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33246545

RESUMO

Cephalic positioning of lateral cruras literally means that the cartilage does not support the nasal rim. Cephalic positioning is a relatively common anatomic variant of lower lateral cartilages that shows an extremely vulnerable rhinoplasty patient. In these patients, any reductive technique, such as cephalic trimming without compensation, worsens the situation and may lead to esthetic failures and airway compromise. True cephalic malpositioning needs to be diagnosed from pseudomalpositions preoperatively. The presence of the pseudomalposition does not mean that it can be ignored. Either malposition or pseudomalposition is best diagnosed and considered in the treatment plan.


Assuntos
Rinoplastia , Cartilagem , Estética Dentária , Humanos , Nariz/cirurgia , Planejamento de Assistência ao Paciente
8.
Oral Maxillofac Surg Clin North Am ; 33(1): 143-159, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33246546

RESUMO

Cleft lip and palate patients represent one of the most challenging groups of patients for septorhinoplasty, presenting as a complex surgical obstacle for even the most seasoned surgeons. These individuals have undergone several surgeries throughout their lives, resulting in a considerable amount of scar tissue, significant asymmetries and structural deficits. Key factors in successfully treating cleft lip and palate patients are the reconstruction of the absent/asymmetric cartilages and the replacement of bony structures. The use of autogenous rib cartilage allows the surgeon to create various grafts as well as fortify the soft tissue to resist persistent soft tissue deformities.


Assuntos
Fenda Labial , Fissura Palatina , Rinoplastia , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Nariz/cirurgia
9.
Oral Maxillofac Surg Clin North Am ; 33(1): 51-59, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33246547

RESUMO

Preservative dorsal hump surgery is an old approach that has revitalized recently. Preservation rhinoplasty aims to shape the existing structures instead of resection/reconstruction approaches. A thorough understanding of the applied anatomy of the nose is the backbone of preservative hump surgery. In preservative hump surgery keystone works as a joint, and by lowering this joint the hump is eliminated.


Assuntos
Septo Nasal , Rinoplastia , Humanos , Septo Nasal/cirurgia , Nariz
10.
Ann Otol Rhinol Laryngol ; 130(1): 60-66, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32627568

RESUMO

IMPORTANCE: Predicting nasal soft tissue envelope (STE) thickness is an important component of the preoperative evaluation for rhinoplasty that presently lacks validated tools. OBJECTIVE: Assess for patient facial features and factors that can help predict nasal STE thickness. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review and prospective assessment conducted at an academic tertiary referral center. This study included 190 adult patients and four expert raters. The patients had high-resolution maxillofacial CT scans and standardized facial photographs on file and did not have a history of nasal fracture, septal perforation, rhinoplasty, or other surgery or medical conditions altering nasal form. MAIN OUTCOMES AND MEASURES: Assess each face for features that could help predict nasal STE thickness: sebaceous quality of skin, visibility of nasal tip cartilages, presence of freckles, presence of telangiectasias, Fitzpatrick skin type, patient age, sex, and body mass index (BMI). Measure actual nasal STE thickness using high-resolution CT scans. Analyze which facial features and patient factors help predict nasal STE thickness. RESULTS: Pearson correlations were calculated between actual nasal STE thickness and patient facial features and factors. These showed that more sebaceous skin, telangiectasias, higher Fitzpatrick skin type, male sex, and higher BMI were associated with a thicker nasal STE. Increased visibility of nasal tip cartilages, freckles, lower Fitzpatrick skin type, female sex, and lower BMI were associated with a thinner nasal STE. CONCLUSIONS AND RELEVANCE: There are patient facial features and factors that can help surgeons predict nasal STE thickness before rhinoplasty. An accurate prediction of nasal STE thickness can improve preoperative planning for rhinoplasty, allowing implementation of pre-, intra-, and post-operative treatments to optimize the nasal STE, which may ultimately improve patient outcomes and satisfaction.


Assuntos
Nariz/anatomia & histologia , Rinoplastia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Técnica Delfos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz/diagnóstico por imagem , Fotografação , Exame Físico , Estudos Prospectivos , Estudos Retrospectivos , Fatores Sexuais , Fenômenos Fisiológicos da Pele , Telangiectasia , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
Oral Maxillofac Surg Clin North Am ; 33(1): 71-82, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33153886

RESUMO

Cosmetic rhinoplasty involves surgical manipulation of the nasal cartilages, nasal bones, lining mucosa and extracartilaginous soft. The nasal tip is a complex composite arrangement of tissues. These structures are responsible for creating individuality and asymmetries and for controlling nasal air entry and valving. Medical aesthetics involves filling relevant areas of the tip with hyaluronic acid to disguise grooves or soft defect contour defects. Standard tip surgery involves an open or closed approach. Manipulation of the flexible alar cartilage using intracartilaginous and interartilaginous sutures is preferable to resection, and alar base reduction is becoming more prevalent.


Assuntos
Rinoplastia , Estética Dentária , Humanos , Cartilagens Nasais/cirurgia , Nariz/cirurgia
12.
Oral Maxillofac Surg Clin North Am ; 33(1): 31-37, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33153887

RESUMO

Dorsal hump modification is a commonly performed procedure in most rhinoplasties. Specifically, hump reductions play a significant role in aesthetic rhinoplasty when the surgeon and patient wish to have a "smaller" and less projected nasal complex. There are several techniques available in order to perform a hump reduction. The purpose of this article is to review some of the surgical options available for dorsal hump reduction and management of the dorsum following this procedure.


Assuntos
Estética Dentária , Rinoplastia , Humanos , Nariz
13.
Oral Maxillofac Surg Clin North Am ; 33(1): 111-117, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33153890

RESUMO

Nasal tip deformities after primary rhinoplasty may occur, including the formation of bossae, a pinched nasal tip, and nasal tip ischemia. Because of the central location in the midface, even minimal nasal tip deformities (small bossa) may be noticed and upsetting to the patient. This is in addition to more severe nasal tip deformities, including nasal tip ischemia, that are easily visible to any viewer. Prevention, early recognition, and, depending on the case, intervention are critical in minimizing these complications. If complications do occur, regular communication with the patient and follow-up are crucial.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Humanos , Nariz/cirurgia , Deformidades Adquiridas Nasais/etiologia , Deformidades Adquiridas Nasais/cirurgia
14.
Oral Maxillofac Surg Clin North Am ; 33(1): 7-21, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33153891

RESUMO

By performing a preservation rhinoplasty, the surgeon can achieve natural and stable results by intraoperative replacement of resection with preservation and excision with manipulation of ligaments, cartilages, soft tissues, and the osseocartilaginous dorsum. In this article, the authors explain step by step the dorsal preservation rhinoplasty with low septal strip and a combination of nasal bones osteoplasty and osteotomies, the tip preservation rhinoplasty based on nose tip polygons, and the authors' technique for modify the nasal tip projection and rotation with a posterior strut or anterior septal strip.


Assuntos
Implantes Dentários , Rinoplastia , Estética Dentária , Humanos , Cartilagens Nasais/cirurgia , Septo Nasal/cirurgia , Nariz/cirurgia , Resultado do Tratamento
15.
Oral Maxillofac Surg Clin North Am ; 33(1): 39-50, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33160864

RESUMO

Dorsal augmentation is commonly indicated in many primary and secondary aesthetic nose surgeries. Throughout the history, various synthetic and autogenous materials have been used for dorsal augmentation. In this article, we give an overview of basic concepts of cartilage grafting, review new concepts of dorsal augmentation, and discuss some emerging engineering modalities.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Cartilagem/transplante , Humanos , Nariz/cirurgia , Deformidades Adquiridas Nasais/cirurgia
17.
Med Hypotheses ; 144: 110261, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33254560

RESUMO

The contribution of various modes of transmission of SARS-CoV-2 has been the subject of recent intensive debate. The predominant route of the viral transmission is via exhaled droplets of different sizes which can be inhaled by nearby exposed individuals or deposited on peoples and surfaces. Touching contaminated surfaces followed by hand to facial transfer has been identified as a potential infection route. As humans involuntarily touch their faces over 20 times per hour a hand washing with soap and water is recommended to avoid hands to face transmission. To date however, there is no clear explanation how the viruses arrive form the face into the nose and the lung. Our hypothesis is that during the physiological nasal air inspiration the virion particles attached on the face close to the nose are resuspended in the air and then are inhaled into the nose. Our preliminary fluid dynamics simulations confirm our hypothesis. Further experimental and computational studies are warranted.


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis/métodos , Face , Desinfecção das Mãos , Mãos , Aerossóis , Simulação por Computador , Humanos , Hidrodinâmica , Modelos Teóricos , Nariz , Resistência ao Cisalhamento , Carga Viral , Vírion
18.
Facial Plast Surg ; 36(5): 539-553, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33368078

RESUMO

The Asian nose has its unique morphology and forms a significant proportion of noses treated by the rhinoplasty surgeon not only in Asia but also in other countries where the Asian diaspora resides. The anatomical features and dimensions of the Asian nose differ from noses of persons of African, Caucasian, Indian, and Middle Eastern origins, poses its own challenges, and warrants a unique set of techniques for its aesthetic improvement. In this article, we present an overview of the approach to the lengthening of the Asian nose, drawing from our own experience with managing the Asian nose and referencing the published literature on the subject.


Assuntos
Estética Dentária , Rinoplastia , Grupo com Ancestrais do Continente Asiático , Grupo com Ancestrais do Continente Europeu , Humanos , Nariz/cirurgia
19.
Ned Tijdschr Tandheelkd ; 127(12): 683-689, 2020 Dec.
Artigo em Holandês | MEDLINE | ID: mdl-33367295

RESUMO

Variation in the assessment of facial aesthetics through time was investigated with the help of measurements of actresses from 1875 to 2020 most widely considered to be beautiful. Measurements were carried out on reasonably standardised profile and frontal photographs. During the length of the period studied, the following trends in changing attitudes to facial beauty were recognised: a steady increase in the redness and prominence of lips, a decrease in eye height and an increase in eye width, and with it, a decrease in the height/width ratio or the eyes. In addition, the chin-neck angle and the nasolabial angle became sharper. This trend was especially evident after 1950. Both the group of actresses from 1875 to 1900 and a group of British female students from 2005 showed a relatively flatter lip profile, a more prominent chin and a larger nasolabial angle. After 2000 a mild preference developed for somewhat more redness of the upper and lower lips both frontally and from the side, somewhat more prominent lips, sharper nasolabial and chin-neck angles and a narrower eye height.


Assuntos
Beleza , Face , Cefalometria , Queixo , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Lábio , Nariz
20.
Facial Plast Surg ; 36(5): 499-504, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33368074

RESUMO

Osteotomies in rhinoplasty are performed to correct deformities in nasal contour. The size of osteotome used is dictated by the thickness of the bony nasal pyramid along the osteotomy route. The aim of this study is to determine whether nasal bony dimensions differ between different ethnic groups in Singapore. Randomly selected patients' computed tomography (CT) scans of the face performed between the years 2010 to 2013 in our institution (Khoo Teck Puat Hospital) were evaluated. The setting was a tertiary government hospital. CT images of 309 patients (233 Chinese [147 males, 86 females], 32 Malays [16 males, 16 females], and 44 Indians [33 males, 11 females]) were evaluated. Anthropomorphic measurements of the nasal bone along the track of the lateral, medial, and intermediate osteotomies, as well as the nasal bone length and pyriform aperture width were measured on the CT images by two independent observers. Statistical analysis was performed using Student's t-test and two-way analysis of variance (ANOVA) test. There was no significant difference between the nasal pyramid bone thickness between different ethnicities along the osteotomy tracks (p > 0.05; degrees of freedom [df] = 2). However, there was a significant difference between males and females of the same ethnicity at the low level of the lateral osteotomy (p = 0.003) and the midlevel (p = 0.002) and high-level (p = 0.004) of the intermediate osteotomy. There was a statistically significant difference in nasal pyramid length (p < 0.05, df = 2) and pyriform aperture width (p < 0.05, df = 2) among the races and between the genders (p < 0.05). The mean difference in nasal pyramid length of 2.54 mm and pyriform aperture width of 1.89 mm was particularly significant between the Chinese and the Indians. Gender and ethnic differences in nasal bony dimensions should be considered in surgical planning for rhinoplasty.


Assuntos
Grupos Étnicos , Rinoplastia , Feminino , Humanos , Masculino , Osso Nasal/diagnóstico por imagem , Osso Nasal/cirurgia , Nariz/diagnóstico por imagem , Nariz/cirurgia , Tomografia Computadorizada por Raios X
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