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Objective: To evaluate and compare the costal cartilage lateral crural strut graft's (LCSG) ability to support a weak lateral crus in patients with external nasal valve dysfunction (EVD) undergoing primary versus revision functional rhinoplasty. Methods: This is a prospective cohort study of 26 patients (mean [SD]: 40.23 [6.75] years of age; 10 [38%] females) with clinically diagnosed EVD, who underwent primary versus revision functional rhinoplasty with the use of a costal cartilage LCSG (10 [38%] primary functional rhinoplasty patients and the 16 [62%] revision patients). Preoperative and 12-month postoperative subjective and objective functional measurements along with statistical analysis were performed. Results: While all baseline demographic and preoperative functional measurement scores were similar between the 2 groups, the primary cohort's preoperative scores were higher overall. Follow-up was a mean of 14.58 months. The primary group demonstrated a greater difference in score improvement postoperatively in all categories. All patients had significantly improved visual analog scale (VAS), Nasal Obstruction Symptom Evaluation Scale, 22-Item Sinonasal Outcome Test, and nasal peak inspiratory flow (NPIF) scores. When comparing the overall score outcome and surgical efficacy of the LCSG, both groups had near equal final score outcomes with the exception of VASL and NPIF. Conclusion: The LCSG is a viable and versatile option in the management of EVD for both primary and revision rhinoplasty patients. [ABSTRACT FROM AUTHOR]

Introduction: The anterior ethmoidal artery (AEA) demonstrates anatomic variability relative to its descent from the anterior skull base. Our study's objective was to assess for correlation of AEA descent and laterality, in addition to correlation of AEA descent and the presence of supraorbital ethmoid cells (SOEC) and concha bullosae (CB). Method: A retrospective study was performed at a tertiary rhinology center from January 2019 to January 2020. Noncontrast maxillofacial computed tomography scans were examined independently by 2 fellowship trained rhinologists. The vertical distance from both left and right AEAs to the ipsilateral skull base were compared and correlated with the presence of ipsilateral SOEC and CB. Results: Computed tomography scans from 50 subjects were included. Mean age was 50.68 years (40% females). The distance of AEA to the skull base was greater on the left when compared to the right (62% vs 48%) (P <.05). The left AEA had an average descent of 2.84 mm versus 1.78 mm on the right (P <.05). An SOEC was present in 56% of cases. Thirty-eight percent of subjects had both SOEC and AEA descent on the right, while 52% of subjects had both on the left. This reached a statistical significance on both sides (P <.05). Concha bullosa was present in 35% of cases, with both AEA descent and CB present in 16% on the right, and 32% on the left. Conclusion: The AEA displays variability in vertical descent from the skull base, with greater variability on the left. These findings implore vigilance with evaluation of preoperative imaging and during sinus surgery, especially in the presence of SOEC and CB. [ABSTRACT FROM AUTHOR]

Background: Delivery of topical pharmacotherapy to the paranasal sinuses remains integral to the management of chronic rhinosinusitis. The frontal sinus remains a difficult access site for irrigations, often limited by its position relative to the nostril and ethmoid sinus. In view of the previous demonstration of improved frontal sinus irrigation with Draf III vs Draf IIa, in this work we sought to evaluate topical access of Draf IIb relative to Draf IIa and Draf III modification of the frontal sinus outflow tract. Methods: Unfixed human cadaver heads were dissected using Draf IIa, Draf IIb, and Draf III frontal sinusotomies. Draf IIa, Draf IIb, and Draf III frontal sinusotomies were performed in progressive sequence on each cadaver head. Nasal irrigation fluid access to the frontal sinus was tested after each successive frontal sinus intervention. Irrigations were performed using Frankfort horizontal and vertex positioning. Blinded reviewers were then asked to evaluate nasal irrigation access based on an ordinal scale. Results: Eight cadaveric specimens (age, 78 ± 12.3 years; 62.5% female) were assessed. The greatest distribution scores were recorded by Draf III, then IIb, and then IIa (90.7% vs 81.3% vs 50.1%; p < 0.001). Similarly, the rate of lavage was greatest with Draf III (50% vs 12.5% vs 12.5%). Vertex positioning and increasing volume trended toward improved distribution but did not reach statistical significance. Conclusion: Adequate delivery of topical therapy to the paranasal sinuses by nasal irrigation remains critical in the postoperative state. Although increasing the dimensions of the frontal recess improves nasal irrigation delivery, the Draf III procedure provides the optimal delivery of pharmacotherapy in those with frontal sinus disease. [ABSTRACT FROM AUTHOR]

Objective: A growing body of evidence demonstrates that endonasal endoscopic dacryocystorhinostomy (eDCR) techniques provide comparable results to conventional external techniques. The purpose of this study was to evaluate long-term outcomes after powered endoscopic DCR without preservation of mucosal flaps for the management of acquired nasolacrimal duct obstruction performed by a single surgical team.Methods: A retrospective review was performed of patients with epiphora secondary to acquired nasolacrimal duct obstruction who underwent eDCR without mucosal flap preservation from May 2003 to April 2013 at a tertiary referral medical center. Main outcome measures were subjective improvement in epiphora and assessment of anatomic patency based on lacrimal irrigation and endoscopic evaluation.Results: Eighty patients (69 primary and 11 revision) totaling 103 procedures (87 primary, 16 revision) were available for analysis at a mean follow-up of 28.7 (range 6-114) months. At the most recent follow-up, 92 of 103 (89.3%) procedures had complete resolution of epiphora, and 10 of 103 procedures achieved mild intermittent epiphora. Complete resolution of epiphora was noted in 93.1% (81 of 87) of primary procedures and 68.8% (11 of 16) of revision procedures. Objective anatomic patency was confirmed in 98% (101 of 103). A revision procedure was required in 5.8% (6 of 103).Conclusion: Outcomes of powered eDCR without the preservation of mucosal flaps compare favorably to previously reported results in the literature. These long-term results suggest that mucosal flap preservation is not required to achieve successful outcomes with eDCR.Level Of Evidence: 4 Laryngoscope, 130:12-17, 2020. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The purpose of this study was to assess voice outcomes after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP).Study Design: Individual cohort study.Methods: A study was performed of patients with CRSwNP who underwent ESS from July 2015 to May 2016 at a tertiary referral medical center. The main outcome measures were subjective improvement in patient-reported outcomes, using the 22-item Sino-Nasal Outcome Test (SNOT-22) and 10-item Voice Handicap Index (VHI-10).Results: A total of 50 patients (age 47.9 years; 48% female), 66% revision and 34% primary, were available at a follow-up of 3 months. At the 3-month follow-up, both SNOT-22 and VHI-10 scores were improved from preoperative values (-41.8 and -14.7, respectively).Conclusions: Successful treatment of sinonasal disease can help to improve voice outcomes in patients with CRSwNP. There are inherent differences in the long-term outcomes of the results beyond 3 months based on practice patterns of ongoing medical management, but our results are interesting in that they show early improvement in voice outcomes.Level Of Evidence: 2b Laryngoscope, 129:299-302, 2019. [ABSTRACT FROM AUTHOR]