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Background: Simulation is a rapidly developing field in modern undergraduate skills education and postgraduate surgical training. Aim: We aim to evaluate simulation training as a tool for higher surgical training in functional endoscopic sinus surgery (FESS) using the Kirkpatrick evaluation model. Methods: This was a prospective cohort study in which a qualitative survey and multiple-choice questionnaire were distributed to otolaryngology trainees pre- and post-FESS training course using simulation models. Participants' reactions and interpretations of the models were assessed. Pre- and post-simulation knowledge and subjective skills were assessed. Results: A total of 21 trainees completed the course. Trainees reported simulation models to be accurate representations of human anatomy 95% and easy to use 90%. There was an improvement in anatomical 54 to 62% (Z = 76, p0.03) and procedural 65 to 72% (Z = 87, p0.03) knowledge overall. Conclusion: Simulation training is an effective method of postgraduate education. This has been particularly useful following reduced operative exposure in the COVID-19 era. [ABSTRACT FROM AUTHOR]

Objective: To develop a hierarchical task listing of steps required to perform successful Functional Endoscopic Sinus Surgery (FESS). To complete a technical and human factor analysis of tasks resulting in the identification of errors, frequency of occurrence, severity, and reduction through remediation. Methods: A triangulation of methods was used in order to derive the steps required to complete a FESS: 1) a literature review was carried out of published descriptions of FESS techniques; 2) observations of three FESS; 3) interviews with surgeons on FESS techniques. Data sets were combined to develop a task analysis of a correct approach to conducting FESS. A review by 12 surgeons, and observation of 25 FESS resulted in refinement of the task analysis. With input from five consultant surgeons and one consultant anesthetist, a Systematic Human Error Reduction and Prediction Approach (SHERPA) was used to identify the risks and mitigating steps in FESS. Results: Ten tasks and 49 subtasks required for a correct approach to completing FESS were identified based on literature review and expert consensus. A risk score for each subtask was calculated from a suitable risk matrix. Risk reduction methods at each subtask were detailed. High‐scoring subtasks were evaluated and varying strategies examined to reduce the likelihood and mitigate the impact of error. The study demonstrates the usefulness of the HTA and SHERPA approach in standardization and optimization of clinical practice in order to improve patient safety. Conclusion: Hierarchical Task Analysis and SHERPA are valuable tools to deconstruct expert performance and to highlight potential errors in FESS. The HTA and SHERPA approach to surgical procedures are useful learning and assessment tools for novice surgeons. The information derived offers the opportunity to improve surgical training and enhance patient safety by identifying high‐risk steps in the procedure, and how risk can be mitigated. Level of Evidence: 2c Outcomes Research [ABSTRACT FROM AUTHOR]

Nasal tip projection refers to the anteroposterior extent to which the nasal tip is separated from the facial surface at the level of the alar-facial groove. Although its relevance in rhinoplasty is obvious, it is important to understand that changes to the projection of the nasal tip affect nasal tip rotation, dorsal height, and nasofacial aesthetic harmony. The following article discusses the subjective and objective assessment of nasal tip projection, the relevant anatomy, and tools to plan ways of modifying aspects of tip projection. Several different techniques will then be described in detail, along with relevant clinical illustrations. [ABSTRACT FROM AUTHOR]

Objective: To review the outcomes of rhinoplasty in patients who underwent full-length dorsal reconstruction. Design: Retrospective review. Setting: Private-practice facial plastic surgery clinic. Patients: Thirty-seven patients in a consecutive series of 1273 rhinoplasty cases. Interventions: In all patients, a single high-density porous polyethylene implant was used to span the full length of the nasal bridge as part of their rhinoplasty reconstruction. Main Outcome Measures: Retrospective review of medical charts and preoperative and postoperative photographs to identify any complications, including infection, extrusion, movement, or displacement, and examination of the aesthetic outcome. A telephone survey was performed to assess patient satisfaction regarding the appearance and sensation of the nose. Results: In all cases, the full-length dorsal implant provided a smooth bridge contour without leaving an inverted V deformity or focal irregularities. There were no cases of infection or extrusion. In 2 cases, revision surgery was required to enhance cosmetic outcome. Conclusions: The high rate of patient acceptance, safety, and success of full-length dorsal reconstruction in providing a natural frontal contour challenges the minimal indications for using this type of reconstruction as opposed to using smaller grafts. As with all alloplasts, longterm follow-up is required. [ABSTRACT FROM AUTHOR]

Juvenile angiofibromas are vascular tumors found almost exclusively in the adolescent male. Although benign, their clinical course can be aggressive and can result in major morbidity and mortality. Endoscopic transnasal resection of juvenile angiofibromas, confined to the nose, paranasal sinuses, pterygopalatine fossa, and medial infratemporal fossa, has been a significant advance in their management, eliminating or reducing the need for extensive soft tissue and bony dissection of traditional surgical approaches. We discuss a case of a juvenile angiofibroma resected transnasally using the XPS microdebrider (Medtonic Xomed, Jacksonville, Florida) and outline the role of this instrument in this surgery. [ABSTRACT FROM AUTHOR]

Focuses on a case of a 77-year-old woman with a 5-year history of chronic cough diagnosed as Tracheobronchomalacia. Treatment given to the women; Result of the bronchoscopy done on the patient; Overview of chronic cough.