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1.
J Laryngol Otol ; 134(3): 270-271, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32122421

RESUMO

BACKGROUND: Endoscopic frontal sinus surgery is frequently complicated by post-operative stenosis and obstruction of the frontal sinus outflow tract, resulting in recurrent disease. Frontal sinus stents may help prevent re-occlusion of the frontal neo-ostia. OBJECTIVE: This paper presents a simple and cost-effective approach to frontal sinus stenting using modified Silastic nasal splints. RESULTS AND CONCLUSION: The current technique provides an effective, reliable and inexpensive method for achieving post-operative frontal sinus outflow tract patency.


Assuntos
Endoscopia/instrumentação , Seio Frontal/cirurgia , Procedimentos Cirúrgicos Nasais/instrumentação , Doenças dos Seios Paranasais/cirurgia , Stents , Constrição Patológica/etiologia , Constrição Patológica/prevenção & controle , Endoscopia/métodos , Seio Frontal/patologia , Humanos , Obstrução Nasal/etiologia , Obstrução Nasal/prevenção & controle , Procedimentos Cirúrgicos Nasais/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Recidiva , Resultado do Tratamento
2.
J Laryngol Otol ; 134(3): 228-232, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32146914

RESUMO

OBJECTIVES: This prospective, epidemiological British Ophthalmological Surveillance Unit study into ophthalmic complications of functional endoscopic sinus surgery aimed to determine the minimum incidence, presenting features and management throughout the UK. METHODS: Cases of ophthalmic complications of functional endoscopic sinus surgery, between February 2016 and February 2018, were identified through the British Ophthalmological Surveillance Unit reporting card system. Reporting ophthalmic consultants were sent an initial questionnaire, followed by a second questionnaire at six months. RESULTS: Twenty-six cases of ophthalmic complications of functional endoscopic sinus surgery were reported. The majority (16 cases (62 per cent)) had limitations of ocular motility at presentation. The most common final diagnosis was rectus muscle (33 per cent) and nasolacrimal duct trauma (27 per cent). Using national data, this study reports a minimum incidence of ophthalmic complications of functional endoscopic sinus surgery in the UK of 0.2 per cent over two years. CONCLUSION: In terms of ophthalmic complications, functional endoscopic sinus surgery is shown to be safe. Ophthalmic complications are rare, but when they do occur, they commonly result in rectus muscle trauma, often requiring surgical intervention.


Assuntos
Endoscopia/efeitos adversos , Oftalmopatias/epidemiologia , Procedimentos Cirúrgicos Nasais/efeitos adversos , Vigilância da População/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia/métodos , Oftalmopatias/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Nasais/métodos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Reino Unido/epidemiologia
3.
Otolaryngol Head Neck Surg ; 162(1): 8-25, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31910122

RESUMO

OBJECTIVE: Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the United States. While the great majority of nosebleeds are limited in severity and duration, about 6% of people who experience nosebleeds will seek medical attention. For the purposes of this guideline, we define the target patient with a nosebleed as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient's quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nosebleeds. PURPOSE: The primary purpose of this multidisciplinary guideline is to identify quality improvement opportunities in the management of nosebleeds and to create clear and actionable recommendations to implement these opportunities in clinical practice. Specific goals of this guideline are to promote best practices, reduce unjustified variations in care of patients with nosebleeds, improve health outcomes, and minimize the potential harms of nosebleeds or interventions to treat nosebleeds. The target patient for the guideline is any individual aged ≥3 years with a nosebleed or history of nosebleed who needs medical treatment or seeks medical advice. The target audience of this guideline is clinicians who evaluate and treat patients with nosebleed. This includes primary care providers such as family medicine physicians, internists, pediatricians, physician assistants, and nurse practitioners. It also includes specialists such as emergency medicine providers, otolaryngologists, interventional radiologists/neuroradiologists and neurointerventionalists, hematologists, and cardiologists. The setting for this guideline includes any site of evaluation and treatment for a patient with nosebleed, including ambulatory medical sites, the emergency department, the inpatient hospital, and even remote outpatient encounters with phone calls and telemedicine. Outcomes to be considered for patients with nosebleed include control of acute bleeding, prevention of recurrent episodes of nasal bleeding, complications of treatment modalities, and accuracy of diagnostic measures. This guideline addresses the diagnosis, treatment, and prevention of nosebleed. It will focus on nosebleeds that commonly present to clinicians with phone calls, office visits, and emergency room encounters. This guideline discusses first-line treatments such as nasal compression, application of vasoconstrictors, nasal packing, and nasal cautery. It also addresses more complex epistaxis management, which includes the use of endoscopic arterial ligation and interventional radiology procedures. Management options for 2 special groups of patients, patients with hemorrhagic telangiectasia syndrome (HHT) and patients taking medications that inhibit coagulation and/or platelet function, are included in this guideline. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the working group. It is not intended to be a comprehensive, general guide for managing patients with nosebleed. In this context, the purpose is to define useful actions for clinicians, generalists, and specialists from a variety of disciplines to improve quality of care. Conversely, the statements in this guideline are not intended to limit or restrict care provided by clinicians based upon their experience and assessment of individual patients. ACTION STATEMENTS: The guideline development group made recommendations for the following key action statements: (1) At the time of initial contact, the clinician should distinguish the nosebleed patient who requires prompt management from the patient who does not. (2) The clinician should treat active bleeding for patients in need of prompt management with firm sustained compression to the lower third of the nose, with or without the assistance of the patient or caregiver, for 5 minutes or longer. (3a) For patients in whom bleeding precludes identification of a bleeding site despite nasal compression, the clinician should treat ongoing active bleeding with nasal packing. (3b) The clinician should use resorbable packing for patients with a suspected bleeding disorder or for patients who are using anticoagulation or antiplatelet medications. (4) The clinician should educate the patient who undergoes nasal packing about the type of packing placed, timing of and plan for removal of packing (if not resorbable), postprocedure care, and any signs or symptoms that would warrant prompt reassessment. (5) The clinician should document factors that increase the frequency or severity of bleeding for any patient with a nosebleed, including personal or family history of bleeding disorders, use of anticoagulant or antiplatelet medications, or intranasal drug use. (6) The clinician should perform anterior rhinoscopy to identify a source of bleeding after removal of any blood clot (if present) for patients with nosebleeds. (7a) The clinician should perform, or should refer to a clinician who can perform, nasal endoscopy to identify the site of bleeding and guide further management in patients with recurrent nasal bleeding, despite prior treatment with packing or cautery, or with recurrent unilateral nasal bleeding. (8) The clinician should treat patients with an identified site of bleeding with an appropriate intervention, which may include 1 or more of the following: topical vasoconstrictors, nasal cautery, and moisturizing or lubricating agents. (9) When nasal cautery is chosen for treatment, the clinician should anesthetize the bleeding site and restrict application of cautery only to the active or suspected site(s) of bleeding. (10) The clinician should evaluate, or refer to a clinician who can evaluate, candidacy for surgical arterial ligation or endovascular embolization for patients with persistent or recurrent bleeding not controlled by packing or nasal cauterization. (11) In the absence of life-threatening bleeding, the clinician should initiate first-line treatments prior to transfusion, reversal of anticoagulation, or withdrawal of anticoagulation/antiplatelet medications for patients using these medications. (12) The clinician should assess, or refer to a specialist who can assess, the presence of nasal telangiectasias and/or oral mucosal telangiectasias in patients who have a history of recurrent bilateral nosebleeds or a family history of recurrent nosebleeds to diagnose hereditary hemorrhagic telangiectasia syndrome (HHT). (13) The clinician should educate patients with nosebleeds and their caregivers about preventive measures for nosebleeds, home treatment for nosebleeds, and indications to seek additional medical care. (14) The clinician or designee should document the outcome of intervention within 30 days or document transition of care in patients who had a nosebleed treated with nonresorbable packing, surgery, or arterial ligation/embolization. The policy level for the following recommendation about examination of the nasal cavity and nasopharynx using nasal endoscopy was an option: (7b) The clinician may perform, or may refer to a clinician who can perform, nasal endoscopy to examine the nasal cavity and nasopharynx in patients with epistaxis that is difficult to control or when there is concern for unrecognized pathology contributing to epistaxis.


Assuntos
Epistaxe/epidemiologia , Epistaxe/terapia , Procedimentos Cirúrgicos Nasais/métodos , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Tratamento Conservador/métodos , Epistaxe/diagnóstico , Medicina Baseada em Evidências , Fidelidade a Diretrizes , Humanos , Incidência , Ligadura/métodos , Qualidade de Vida , Recidiva , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
4.
Ann Otol Rhinol Laryngol ; 129(1): 5-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31390881

RESUMO

OBJECTIVES: Intranasal septal splints are often used in nasal septal surgeries. Routine use of postoperative antibiotics is an accepted practice, although data regarding its efficacy in preventing postsurgical complications are limited. This study aimed to examine bacterial colonization on septal splints following prophylactic antibiotic therapy and the association with postoperative infections. METHODS: Fifty-five patients underwent septoplasty by a single surgeon between March 2015 and April 2016. All had intranasal septal splints and were given antibiotic prophylaxis for 7 days until removal of splints. Nasal cultures were taken before surgery, and septal splints were examined for bacterial colonization following their removal. RESULTS: Thirty-six patients (65%) had positive nasal culture prior to surgery. The most common isolates were Staphylococcus aureus (30%) and Enterobacteriaceae species (66%). All these patients had postoperative bacterial colonization on septal splints. In 15 patients with negative preoperative cultures, bacteria were isolated postoperatively. An increased resistance profile was documented postoperatively in 9 patients (16%), including two with multidrug resistance. In two of these patients preoperative wild-type strains acquired antibiotic resistance postoperatively. No adverse drug reactions to antibiotics were reported. CONCLUSIONS: Increased bacterial growth and emergence of resistant strains were observed on intranasal septal splints despite prophylactic antibiotic treatment. Nonetheless, this did not translate into clinical infection. Thus, considering antibiotics overuse and increasing bacterial resistance, further research is needed to determine the role of antibiotic prophylaxis in the setting of intranasal splints.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Cavidade Nasal/microbiologia , Septo Nasal/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Contenções/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Cefalexina/uso terapêutico , Técnicas de Cultura , Farmacorresistência Bacteriana , Farmacorresistência Bacteriana Múltipla , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação , Infecção da Ferida Cirúrgica/epidemiologia , Adulto Jovem
5.
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 422-426, Out.-Dez. 2019. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-1024327

RESUMO

Introduction: Chronic rhinosinusitis (CRS) is a highly prevalent pathology in our society. Due to the prevalence of this condition and to the persisting symptoms despite an appropriate medical treatment, surgical techniques are often required. Lately, minimal invasive techniques have been described, such as lacrimal diversion devices (LDDs). This technique offers a fast and convenient choice for delivery of sinus irrigation and topical medication. Objective: We aimed to describe our experience with LDDs and evaluate the safety and effectiveness of the procedure in patients with moderate to severe CRS without nasal polyposis (CRSsNP) and persistent symptomatology despite medical therapy. Methods: A total of 7 patients underwent bilateral lacrimal stents placement in the operating room. A retrospective observational study was conducted. The Sino-Nasal Outcome Test-20 (SNOT-20) survey was performed and the score obtained was compared before and 1 month after the procedure. Results: The LDDs were used for an average of 80 days. During the follow-up, only three patients had a mild complication with the device (granuloma in the punctum, obstruction, and early extrusion). The mean baseline SNOT-20 score dropped significantly ( p = 0.015) from 25.85 to 11.57 (mean: - 14.29) 1 month after the procedure. Conclusion: According to our experience and results, the use of LDD is a novel, feasible, and less invasive technique to treat refractory CRS. It reduces the risk of mucosal stripping, provides short-term outcomes, and the surgical procedure does not require advanced training in endoscopic sinus surgery. Moreover, it can be performed in-office under local anesthesia or sedation (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Sinusite/cirurgia , Stents , Rinite/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Aparelho Lacrimal/cirurgia
7.
Artigo em Chinês | MEDLINE | ID: mdl-31434375

RESUMO

Objective: To investigate the effect of nasal cavity ventilation expansion techniques in treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) with nasal obstruction. Methods: Thirty-two OSAHS patients with nasal obstruction hospitalized from January 2017 to January 2018 in Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital Affiliated to Anhui Medical University were selected, with 28 males and 4 females, aged 40.3±8.5 years old (x±s), and treated with individualized nasal cavity ventilation expansion techniques. Nasal acoustic reflex and resistance examination, polysomnography (PSG) monitoring were performed before and three months after operation. Nasal obstruction symptom evaluation (NOSE) and Quebec sleep questionnaire (QSQ) were completed as well. The nasal acoustic reflex, nasal resistance, NOSE, QSQ score, apnea hypopnea index (AHI) and lowest arterial oxygen saturation (LSaO(2)) before and after operation were compared and analyzed. SPSS 22.0 software was used for statistical analysis. Results: After the operation, the total nasal resistance and total score of NOSE scale of patients decreased significantly as well as the total score of QSQ scale increased significantly ((0.140±0.043) kPa·s/L vs (0.277±0.067) kPa·s/L, 9.84±4.11 vs 53.00±11.57, 5.67±0.43 vs 3.86±0.46, t value was 10.687, 18.035, -16.904, respectively, all P<0.05), and the scores of five dimensions increased in varying degrees. Among the indexes of PSG, there was no significant difference in AHI and LSaO(2) values before and after operation, but AHI decreased and LSaO(2) increased. Conclusion: Nasal cavity ventilation expansion techniques can effectively alleviate the symptoms of nasal obstruction in OSAHS patients and improve their sleep and quality of life.


Assuntos
Cavidade Nasal/cirurgia , Obstrução Nasal/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Apneia Obstrutiva do Sono/cirurgia , Adulto , Técnicas de Diagnóstico do Sistema Respiratório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico , Polissonografia , Qualidade de Vida , Reflexo Acústico , Apneia Obstrutiva do Sono/diagnóstico
8.
Eur Arch Otorhinolaryngol ; 276(10): 2819-2826, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31332548

RESUMO

BACKGROUND: The discomfort and complications have always been problems for nasal packing materials. This study provided a new nasal packing material called high expansion degradable cotton (HEDC). METHODS: Nasal endoscopic surgery was used to establish a dog model of nasal bleeding, and wound surfaces were filled with Merocel, Nasopore and HEDC, respectively. Intraoperative and postoperative bleeding of 24 h was calculated. We evaluate the absorbability score, adhesion score, infection sore and nasal mucosal epithelium in postoperative 3, 7, 14 and 28 days. HE staining and electron microscopy were used to evaluate the recovery of nasal mucosa. RESULTS: There was no significant difference in nasal bleeding between HEDC, Merocel and Nasopore. Nasal endoscopic examination revealed HEDC absorbability of score, adhesion score, infection score were significantly lower than Merocel and Nasopore. The epithelialization time of HEDC was significantly shorter than that of Merocel and Nasopore. HE staining showed that HEDC and Nasopore could significantly reduce scar hyperplasia on the wound surface. The results of electron microscopy suggested that HEDC could protect the edge cilia of the wound. CONCLUSION: HEDC could be used as new choice for hemostasis after nasal endoscopic surgery, which could reduce nasal epithelialization time, and protect wound edge cilia.


Assuntos
Epistaxe/terapia , Formaldeído/administração & dosagem , Procedimentos Cirúrgicos Nasais/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Álcool de Polivinil/administração & dosagem , Hemorragia Pós-Operatória/terapia , Animais , Cães , Técnicas Hemostáticas , Hemostáticos/administração & dosagem , Humanos , Modelos Animais , Procedimentos Cirúrgicos Nasais/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Aderências Teciduais , Resultado do Tratamento
9.
Acta Otolaryngol ; 139(9): 777-782, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31268404

RESUMO

Aims/objectives: To examine the effects of surgery for unilateral sinonasal lesions on sleep-disordered breathing (SDB). Material and methods: Oxygen desaturation index (3%ODI) as a marker of SDB and bilateral/unilateral nasal resistance were measured before and after surgery for 18 patients with unilateral sinonasal lesions. Various parameters were compared between those who achieved 60% or less decrease of 3%ODI and those who did not. Results: Bilateral nasal resistance as well as that of the surgical side five days after surgery was significantly lower than those of pre-operative value. Preoperative 3%ODI (times/hour) was 10.08 ± 7.32, which significantly decreased to 7.67 ± 5.79 five days after surgery. Even in unilateral patients, sinonasal surgery could reduce the bilateral nasal resistance, resulting in a decrease in 3%ODI. Age was younger and postoperative nasal resistance of the surgical side was significantly lower in the group who achieved 60% or less decrease in 3%ODI than those who did not. Conclusions and significance: SDB is influenced by even unilateral nasal obstruction. Surgery for unilateral lesion can improve the respiration during sleep as well as bilateral nasal resistance. Favorable outcome by surgery could be brought about in younger patients and those for whom sufficient improvement of nasal resistance was expected by surgery.


Assuntos
Obstrução Nasal/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Recuperação de Função Fisiológica/fisiologia , Síndromes da Apneia do Sono/etiologia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/complicações , Obstrução Nasal/diagnóstico , Polissonografia/métodos , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/diagnóstico , Resultado do Tratamento
10.
World Neurosurg ; 127: 695-709, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31266132

RESUMO

Pituitary tumors are a heterogeneous group of lesions (usually benign) and proper understanding of the anatomy, physiology, and pathology of the hypothalamic/pituitary region is essential to make an accurate diagnosis and define the essential treatment options (i.e., surgery, medical therapies, and radiotherapy, alone or in combination). Surgery is the primary treatment for acromegaly, Cushing disease, thyroid-stimulating hormone-secreting adenomas, resistant prolactinomas, and nonfunctioning pituitary adenomas causing mass effect. Medical and radiation therapy are reserved in cases in which surgery is not possible or does not provide a complete cure. In the last decades, tremendous innovations (i.e., targeted drugs and refined surgical tools and techniques) have expanded the treatment strategies for pituitary adenomas. We herein report the current indications for and depiction of the surgical techniques in pituitary surgery, review current medical treatments, and provide a glimpse of future possibilities.


Assuntos
Adenoma/terapia , Neoplasias Hipofisárias/terapia , Adenoma Hipofisário Secretor de ACT/patologia , Adenoma Hipofisário Secretor de ACT/terapia , Adenoma/patologia , Antagonistas Adrenérgicos/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Quimioterapia Combinada , Previsões , Adenoma Hipofisário Secretor de Hormônio do Crescimento/patologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/terapia , Humanos , Procedimentos Cirúrgicos Nasais/métodos , Neuroendoscopia/métodos , Neuroendoscopia/tendências , Hipófise/cirurgia , Neoplasias Hipofisárias/patologia , Cuidados Pós-Operatórios , Prolactinoma/patologia , Prolactinoma/terapia , Radiocirurgia/métodos , Receptores de Glucocorticoides/antagonistas & inibidores , Inibidores da Síntese de Esteroides/uso terapêutico
11.
Eur Arch Otorhinolaryngol ; 276(8): 2115-2123, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31187241

RESUMO

INTRODUCTION: Septal perforation (SP) is a rather uncommondisorder and the most frequent aetiology of SP is nasal surgery, but they can also be secondary to drug abuse, inhaled substances, trauma, neoplasms, or inflammatory systemic diseases. DISCUSSION: Despite some asymptomatic presentations, the majority of SPs cause intermittent epistaxis, nasal obstruction, crusting, dryness, purulent discharge, and/or nasal whistling. Patients who have SP and mild symptoms usually require medical treatment such as nasal irrigations and ointments. Septal buttons may also be used in these patients. No gold standard technique has been recognized for the surgical management of SPs. The literature describes many methods of closure of SP. Many endoscopic techniques are available for septal repair, and the choice depends on the osteo-cartilaginous support, characteristics of the perforation (size, location) and the experience of the surgeon. CONCLUSION: This article provides a meticulous review focusing on the endoscopic approaches to repair SP. Furthermore; educational drawings and tips and tricks are also discussed.


Assuntos
Perfuração do Septo Nasal/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Humanos
13.
Lancet ; 394(10195): 314-321, 2019 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-31227374

RESUMO

BACKGROUND: Septoplasty (surgical correction of the deviated nasal septum) is the most frequently performed ear, nose, and throat operation in adults, but no randomised controlled trials or non-randomised comparative studies on the effectiveness of septoplasty have been published. Consequently, health-care providers, health insurance companies, and policy makers are concerned about the effectiveness of the procedure. We aimed to assess the effectiveness of septoplasty for nasal obstruction in adults with a deviated septum. METHODS: We did this open, multicentre, pragmatic, randomised controlled trial in 16 secondary and two tertiary referral hospitals in the Netherlands. Adults (aged ≥18 years) with nasal obstruction, a deviated septum, and an indication to have septoplasty done were randomly allocated (1:1) to receive either septoplasty with or without concurrent turbinate surgery or non-surgical management. Patients were stratified by sex, age (<35 years or ≥35 years), and deviation severity (mild, moderate, or severe). The primary outcome was health-related quality of life, measured with the validated Glasgow Health Status Inventory at 12 months. Analyses were done on an intention-to-treat basis. The trial is registered with the Netherlands Trial Register, number NTR3868. FINDINGS: Between Sept 2, 2013, and Dec 12, 2016, we randomly assigned 203 participants to receive either septoplasty with or without concurrent turbinate surgery (n=102) or non-surgical management (n=101). 189 participants were analysed at 12 months. At 12 months, mean score on the Glasgow Health Status Inventory of patients assigned to septoplasty was 72·2 (SD 12·2) and for those assigned to non-surgical management was 63·9 (SD 14·5, mean difference 8·3 [95% CI 4·5-12·1], favouring septoplasty). Septal abscess occurred in one surgical patient and septal perforation in two surgical patients. No side-effects of nasal medication were reported. INTERPRETATION: Septoplasty is more effective than non-surgical management for nasal obstruction in adults with a deviated septum. This effect was sustained up to 24 months of follow-up. FUNDING: The Netherlands Organisation for Health Research and Development (ZonMw).


Assuntos
Corticosteroides/uso terapêutico , Obstrução Nasal/terapia , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/terapia , Conchas Nasais/cirurgia , Conduta Expectante/métodos , Adulto , Idoso , Feminino , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Nasais/métodos , Países Baixos , Qualidade de Vida , Resultado do Tratamento , Conchas Nasais/patologia , Adulto Jovem
14.
Eur Arch Otorhinolaryngol ; 276(9): 2475-2482, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31227870

RESUMO

PURPOSE: To study the surgical and oncological outcomes of endoscopic endonasal transpterygoid nasopharyngectomy (EETN) in salvaging locally recurrent nasopharyngeal carcinoma (NPC). METHOD: This was a retrospective clinical record review study carried out at a tertiary centre from June 2013 until May 2017. A total of 55 locally recurrent NPC patients (rT1-rT4) underwent EETN performed by single skull base surgeon with curative intention with postoperative adjuvant chemotherapy but without postoperative radiotherapy. RESULTS: There were 44 (80.0%) males and 11 (20.0%) females, with mean age of 52.5 years. The mean operating time was 180 min (range 150-280 min). 85% (47/55) of patients achieved en bloc tumour resection. 93% (51/55) of patients obtained negative microscopic margin based on postoperative histopathological evaluation. Intraoperatively, one (1.8%) patient had internal carotid artery injury which was successfully stented and had recovered fully without neurological deficit. There were no major postoperative complications reported. During a mean follow-up period of 18-month (range 12-48 months) postsurgery, five patients (9.1%) had residual or recurrence at the primary site. All five patients underwent re-surgery. One patient at rT3 passed away 6 months after re-surgery due to distant metastasis complicated with septicaemia. The 1-year local disease-free rate was 93% and the 1-year overall survival rate was 98%. CONCLUSIONS: EETN is emerging treatment options for locally recurrent NPC, with relatively low morbidity and encouraging short-term outcome. Long-term outcome is yet to be determined with longer follow-up and bigger cohort study. However, a successful surgical outcome required a very experienced team and highly specialised equipment.


Assuntos
Carcinoma Nasofaríngeo/cirurgia , Neoplasias Nasofaríngeas/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Faringectomia/métodos , Quimioterapia Adjuvante , Feminino , Seguimentos , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Nasais/métodos , Carcinoma Nasofaríngeo/tratamento farmacológico , Carcinoma Nasofaríngeo/mortalidade , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/mortalidade , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Terapia de Salvação , Taxa de Sobrevida
15.
Rev. cuba. estomatol ; 56(2): e2021, abr.-jun. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1093221

RESUMO

RESUMEN Introducción: Los pacientes con lesiones cutáneas presentan cambios en su apariencia personal, no solo por la lesión propiamente dicha, sino también por los tratamientos quirúrgicos a que deben someterse. En la región facial estas lesiones son claramente evidentes y poseen mayor importancia estética. Objetivo: Caracterizar un caso de reconstrucción nasal alar tridimensional por exéresis de carcinoma basocelular en paciente geriátrico. Caso clínico: Paciente masculino de 81 años de edad con antecedentes patológicos personales de hipertensión arterial, que refiere presentar lesión nasal de 5 meses de evolución con crecimiento progresivo. Al examen físico facial se detecta alteración del contorno del ala nasal derecha por una lesión con impresión diagnóstica de carcinoma basocelular. Luego del chequeo preoperatorio se decide la exéresis tridimensional de esta, y reconstrucción mediante injerto cartilaginoso de concha auricular y colgajo pediculado nasogeniano. A las cuatro semanas se programa el segundo acto quirúrgico para la desconexión del colgajo pediculado. Conclusiones: El colgajo pediculado de la región nasogeniana combinado con injerto cartilaginoso autólogo constituye una excelente opción terapéutica que permite la reconstrucción nasal tridimensional, en la cual se obtienen buenos efectos estéticos y funcionales, combinados con una alta satisfacción del paciente por los resultados(AU)


ABSTRACT Introduction: Patients with skin lesions have changes in their personal appearance, not only because of the injury itself, but also because of the surgical treatments they must undergo. In the facial region these lesions are clearly evident and have greater aesthetic importance. Objective: Characterize a case of three-dimensional alar nasal reconstruction by exeresis of basal cell carcinoma in a geriatric patient. Clinical case: An 81-year-old male patient with a personal history of hypertension reports the presence of a nasal lesion of 5-month evolution with progressive growth. At facial physical examination an alteration is detected of the contour of the right nasal wing due to a lesion with a diagnostic impression of basal cell carcinoma. After the preoperative check-up, it is decided to perform three-dimensional exeresis and reconstruction by cartilaginous graft of the auricular concha and nasogenian pedicled flap. At four weeks, the second surgical act is scheduled for disconnection of the pedicled flap. Conclusions: The nasogenian pedicled flap combined with an autologous cartilage graft constituted an excellent therapeutic option that allowed three-dimensional nasal reconstruction, obtaining good aesthetic and functional effects, as well as high patient satisfaction with the results obtained(AU)


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Retalhos Cirúrgicos/efeitos adversos , Carcinoma Basocelular/cirurgia , Procedimentos Cirúrgicos Nasais/métodos
16.
Eur Arch Otorhinolaryngol ; 276(8): 2223-2228, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31037387

RESUMO

BACKGROUND: The aim of this study was to identify predictors of outcome after septoplasty in 888 patients from the Swedish National Septoplasty Register. METHODOLOGY: This is an observational register study analysing data from patients undergoing septoplasty in Sweden between 2015 and 2016. The patients reported severity of nasal obstruction (mild, moderate, severe) pre- and again 12 months postoperatively (none, mild, moderate, severe), unplanned visits within 30 days after surgery. The examining doctor reported co-morbidities such as allergic rhinitis and snoring. The primary end-point was one level improvement of the nasal obstruction 12 months after surgery. RESULTS: Nasal obstruction had improved in 63% 12 months after surgery. Twelve months after surgery, 81% with severe nasal obstruction and 31% with mild nasal obstruction before surgery had improved. Only 56% reported that the results of the surgery were as they had expected. Higher patient age at surgery, no unplanned visits within 1 month of surgery and activity limitation before surgery were associated with improvements in nasal breathing in the logistic regression model. CONCLUSION: Septoplasty should be offered to patients with severe nasal obstruction and surgery should be avoided in mild nasal obstruction confirmed by both an improvement in nasal obstruction and patient expectations in this study.


Assuntos
Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Procedimentos Cirúrgicos Nasais , Complicações Pós-Operatórias , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Nasais/efeitos adversos , Procedimentos Cirúrgicos Nasais/métodos , Seleção de Pacientes , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Suécia/epidemiologia , Resultado do Tratamento
17.
Eur Arch Otorhinolaryngol ; 276(8): 2251-2257, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076882

RESUMO

PURPOSE: Nasal packing is frequently used after septoplasty and some complications caused by nasal packing are unavoidable. A nasal septal retainer has recently been developed. We evaluated the safety and clinical efficacy of the retainer in septoplasty, and the subjective symptoms of patients with the retainer were compared with Merocel nasal packing. METHODS: A prospective, randomized, controlled study was performed in patients who had undergone septoplasty. In total, 39 patients were randomized to receive Merocel (n = 17) or the retainer (n = 22) after septoplasty. The deviation of nasal septum and nasal mucosa was evaluated by endoscopy. The clinical efficacy and subjective symptoms were compared using the visual analog scale. RESULTS: During the packing/retaining period, the mean scores of headache, nasal obstruction, epiphora, and facial pressure in the retainer group were significantly lower than in the Merocel group (P < 0.05); the mean scores of nasal pain, nasal itching, rhinorrhea, dysphagia, and sleep disturbance in the retainer group were lower than in the Merocel group, but the difference did not reach statistical significance. On the removal of Merocel/retainer, nasal pain was significantly lower in patients with the retainer (P < 0.05). In the retainer group, the incidence of grade 1 bleeding was 45.5%, and grade 0 bleeding was 54.5%. In the Merocel group, the incidence of grade 2 bleeding was 23.5%, grade 1 was 47.1%, and grade 0 was 29.4%. CONCLUSIONS: The nasal septal retainer is suitable for use after septoplasty with more beneficial effects than nasal packing.


Assuntos
Formaldeído/uso terapêutico , Obstrução Nasal , Septo Nasal/cirurgia , Procedimentos Cirúrgicos Nasais , Álcool de Polivinil/uso terapêutico , Hemorragia Pós-Operatória , Adulto , Endoscopia/métodos , Feminino , Hemostáticos/uso terapêutico , Humanos , Masculino , Cavidade Nasal/diagnóstico por imagem , Obstrução Nasal/diagnóstico , Obstrução Nasal/etiologia , Obstrução Nasal/prevenção & controle , Procedimentos Cirúrgicos Nasais/efeitos adversos , Procedimentos Cirúrgicos Nasais/métodos , Curativos Oclusivos/efeitos adversos , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/prevenção & controle , Resultado do Tratamento
18.
Plast Surg Nurs ; 39(2): 48-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136558

RESUMO

Nasal trauma is a common complication of nasal continuous positive airway pressure (NCPAP) and may range from erythema, edema, and skin breakdown to columellar necrosis. Although rare, columellar necrosis can be a devastating complication following NCPAP, and surgical repair remains challenging due to contour and color-match difficulties, tenuous vascularity, and limited available adjacent skin. In addition, because operative site protection is critical to a successful repair, many surgeons opt to delay surgical intervention from infancy until a later age so that the patient does not inadvertently injure and compromise the graft during the early postoperative period. Here, we present a case of composite nasal reconstruction in an infant following columellar necrosis secondary to NCPAP, along with the design and implementation of a simple, inexpensive, and protective nasal splint that allows for early repair at the time of infancy.


Assuntos
Procedimentos Cirúrgicos Nasais/métodos , Contenções/tendências , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Desenho de Equipamento , Feminino , Humanos , Lactente , Procedimentos Cirúrgicos Nasais/normas , Resultado do Tratamento
19.
Trials ; 20(1): 246, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036048

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) is a common source of ill health; 11% of UK adults reported CRS symptoms in a worldwide population study. Guidelines are conflicting regarding whether antibiotics should be included in primary medical management, reflecting the lack of evidence in systematic reviews. Insufficient evidence to inform the role of surgery contributes to a fivefold variation in UK intervention rates. The objective of this trial is to establish the comparative effectiveness of endoscopic sinus surgery (ESS) or a prolonged course of antibiotics (clarithromycin) in adult patients with CRS in terms of symptomatic improvement and costs to the National Health Service compared with standard medical care (intranasal medication) at 6 months. METHODS/DESIGN: A three-arm parallel-group trial will be conducted with patients who remain symptomatic after receiving appropriate medical therapy (either in primary or secondary care). They will be randomised to receive: (1) intranasal medication plus ESS, (2) intranasal medication plus clarithromycin (250 mg) or (3) intranasal medication plus a placebo. Intranasal medication (current standard medical care) is defined as a spray or drops of intranasal corticosteroids and saline irrigations. The primary outcome measure is the SNOT-22 questionnaire, which assesses disease-specific health-related quality of life. The study sample size is 600. Principal analyses will be according to the randomised groups irrespective of compliance. The trial will be conducted in at least 16 secondary or tertiary care centres with an internal pilot at six sites for 6 months. DISCUSSION: The potential cardiovascular side effects of macrolide antibiotics have been recently highlighted. The effectiveness of antibiotics will be established through this trial, which may help to reduce unnecessary usage and potential morbidity. If ESS is shown to be clinically effective and cost-effective, the trial may encourage earlier intervention. In contrast, if it is shown to be ineffective, then there should be a significant reduction in surgery rates. The trial results will feed into the other components of the MACRO research programme to establish best practice for the management of adults with CRS and design the ideal patient pathway across primary and secondary care. TRIAL REGISTRATION: ISRCTN36962030 . Registered on 17 October 2018.


Assuntos
Antibacterianos/administração & dosagem , Claritromicina/administração & dosagem , Endoscopia , Pólipos Nasais/terapia , Procedimentos Cirúrgicos Nasais/métodos , Rinite/terapia , Sinusite/terapia , Administração Oral , Antibacterianos/efeitos adversos , Doença Crônica , Claritromicina/efeitos adversos , Pesquisa Comparativa da Efetividade , Esquema de Medicação , Endoscopia/efeitos adversos , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Pólipos Nasais/diagnóstico , Procedimentos Cirúrgicos Nasais/efeitos adversos , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como Assunto , Rinite/diagnóstico , Sinusite/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Reino Unido
20.
Am J Otolaryngol ; 40(4): 530-535, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31036416

RESUMO

INTRODUCTION: Epistaxis is a common condition with an estimated $100 million in health care costs annually. A significant portion of this stems from Emergency Department (ED) management and hospital transfers. Currently there is no data in the literature clearly depicting the differences in treatment of epistaxis between Emergency Medicine (EM) physicians and Otolaryngologists. Clinical care pathways (CCP) are a way to standardize care and increase efficiency. Our goal was to evaluate the variability in epistaxis management between EM and Otolaryngology physicians in order to determine the potential impact of a system wide clinical care pathway. MATERIALS AND METHODS: A retrospective case study was conducted of all patients transferred between emergency departments for epistaxis over an 18-month period. Exclusion criteria comprised patients under 18 years old, recent sinonasal surgery, bleeding disorders, and recent facial trauma. RESULTS: 73 patients met inclusion criteria. EM physicians used nasal cautery in 8%, absorbable packing in 1% and non-absorbable packing in 92% (with 33% being bilateral). In comparison, Otolaryngologists used nasal cautery in 37%, absorbable packing in 34%, and non-absorbable packing in 23%. Eighty percent of patients treated by an Otolaryngology physician required less invasive intervention than previously performed by EM physicians prior to transfer. CONCLUSIONS: Epistaxis management varied significantly between Emergency Medicine and Otolaryngology physicians. Numerous patients were treated immediately with non-absorbable packing. On post-transfer Otolaryngology evaluation, many of these patients required less invasive interventions. This study highlights the variability of epistaxis treatment within our hospital system and warrants the need for a standardized care pathway.


Assuntos
Procedimentos Clínicos , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Epistaxe/terapia , Otolaringologia , Transferência de Pacientes , Melhoria de Qualidade , Cauterização , Procedimentos Clínicos/normas , Feminino , Departamentos Hospitalares , Humanos , Masculino , Procedimentos Cirúrgicos Nasais/métodos , Procedimentos Cirúrgicos Nasais/estatística & dados numéricos , Segurança do Paciente , Estudos Retrospectivos , Tampões Cirúrgicos
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