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Purpose: To examine the stresses caused by different All-on-4 surgical techniques—conventional, a combination of monocortical and bicortical, bicortical, and nasal floor elevation—on the implant and the surrounding bone using 3D finite element analysis (FEA). Materials and Methods: A 3D bone model of the atrophic maxilla was created based on CT imaging of the fully edentulous adult patient. All implants used in the models were 4 mm in diameter, and the length was 13 mm in the anterior and 15 mm in the posterior. Implants were applied to four different atrophic maxillary models with the All-on-4 technique: anterior and posterior monocortical implants in the first model, anterior monocortical and posterior bicortical in the second model, anterior and posterior bicortical in the third model, and anterior and posterior bicortical with nasal floor elevation in the fourth model. Eight linear analyses were performed by applying force from both vertical and 45-degree oblique directions to the four models prepared in our study. Results: When the cortical and cancellous bone around the anterior implants was examined, it was observed that the oblique and vertical loading conditions and the stresses around the implant were similar in all models. When the posterior implants were examined, model 1 (ie, anterior and posterior monocortical implants) showed the greatest oblique compression, vertical compression, and vertical tension forces. According to the Von Mises stress (VMS) analysis results for anterior and posterior implants, higher values were observed in model 1 compared to models 3 and 4 under oblique and vertical forces. It was observed that bicortical placement of the implants reduced the stresses on the bone and implant-abutment system but had no significant effect on the stress on the bar. Conclusions: According to the results of our study, in the All-on-4 technique, bicortical placement of the implants reduced the stresses on the bone and implant when the anatomical limitations allowed. In addition, nasal floor elevation can be applied in the atrophic maxilla in appropriate indications. [ABSTRACT FROM AUTHOR]

Background: Paraffinoma is a rare and intriguing condition in medicine. In this disorder, an orbital lipogranulomatosis reaction is caused by the penetration of mineral oils (particularly paraffin) into the tissues surrounding the eye. Methods: In this report, we discuss six cases of paraffinoma affecting the eye socket following sinus surgery. For previous cases literature review, we obtained articles from searching in the PubMed, Scopus, Scholar Google and, Science of Web databases. Results: After the reporting of 6 paraffinoma cases and literature review, the data related to the disease were categorized into the categories of disease definition, differential diagnosis, clinical manifestation, radiological manifestation, and histopathological diagnosis and treatment methods. Conclusions: Paraffinoma is a rare and time-delayed diagnosis after various surgeries and therefore may challenge the physician to make the correct diagnosis at first. It is necessary for ophthalmologists to consider this diagnosis in cases of masses around the eyelid and orbit in patients with a history of sinus and nose surgery in other differential diagnoses. [ABSTRACT FROM AUTHOR]

The study examines the safety of performing simultaneous surgery for pituitary neoplasms and rhinosinusitis. Results show that there is no significant increase in nasal or intracranial complications when combining transsphenoidal surgery with endoscopic sinus surgery. The study suggests that simultaneous surgery for these conditions can be considered safe and feasible. Additionally, the research highlights the importance of preoperative antibiotic treatment and the lack of significant association between sinusitis severity and complication rates. [Extracted from the article]

ABSTRACT To explore the diagnostic and therapeutic strategies of chronic invasive fungal sinusitis involving the skull base or orbit based on the background of multidisciplinary team discussion and to provide a basis for clinical practice. The clinical data of five patients with chronic invasive fungal sinusitis involving the skull base or orbit admitted to the Department of Otorhinolaryngology, Head and Neck Surgery of Drum Tower Hospital affiliated with Nanjing University School of Medicine from July 2017 to February 2024, were retrospectively analysed. The diagnosis and treatment strategies were all formulated after the MDT discussion. Nasal endoscopic surgery dominated the treatment protocol. Surgery was completed while ensuring the integrity of the dura mater or orbital periosteum. During surgery, we remove the lesion as thoroughly as possible and open the sinuses to improve their drainage function. The efficacy of the surgery was comprehensively analysed in the postoperative period. None of the five patients had serious complications such as ocular motor or visual dysfunction, cerebrospinal fluid leakage or intracranial infection after surgery. Four of them were cured after comprehensive treatment and had no recurrence after 5–84 months of follow‐up; one case had a wider range of lesions, but the patient did not follow the recommended antifungal treatment after surgery and had a recurrence 5 months after surgery; after the recurrence, the patient underwent a second endoscopic surgery and actively cooperated with the antifungal treatment, there were no complications after the second surgery and there was no recurrence after 78 months of follow‐up. For patients with chronic invasive fungal sinusitis involving the skull base or orbits, the diagnosis and treatment plan are formulated through MDT discussion before surgery, and the lesions are resected with the assistance of image navigation and the plasma system to protect the natural barrier of the dura mater or orbital periosteum from being breached, so as to achieve the purpose of removing the lesions and clearing the sinus drainage, and then supplemented with antifungal treatment. In this way, we can achieve satisfactory therapeutic effects while reducing nose–brain and nose–eye complications and improving the prognosis. [ABSTRACT FROM AUTHOR]

Objective: This study functional endoscopic sinus surgery (FESS) is a surgical procedure requiring minimal bleeding to optimize the surgical field. This study aimed to evaluate the effectiveness of magnesium sulfate, lignocaine, and propofol in attenuating hemodynamic response. The primary objective of this study was to compare the efficacy of these agents in reducing hemodynamic response. The secondary objectives included assessing the quality of the surgical field, recovery time, and total neuromuscular dose. Methods: We randomly allocated 105 patients scheduled for FESS into three groups: lignocaine, propofol, and magnesium sulfate. Heart rate and mean arterial pressure were recorded every 5 min for the first 30 min, followed by measurements every 10 min at the end of the procedure. Moreover, recovery time, total neuromuscular blocking dose, and surgical field score were noted upon completion of the procedure. Statistical analysis was conducted using the number cruncher statistical systems version 9.0.8 software. Results: All three groups showed comparable hemodynamic response and surgical field scores. The recovery time was notably longer in the magnesium sulfate group [10.94 min (2.45)] than in the lignocaine [4.37 min (1.03)] [95% confidence interval (CI) -7.32, -5.83; P=0.000] and propofol groups [4.60 min (0.60)] (95% CI 5.60, 7.095; P=0.000). Moreover, the total neuromuscular blocking agent used was significantly lower in the magnesium sulfate group [5.89 mg (0.47)] than in the lignocaine [6.26 mg (0.56)] (95% CI 0.66, 0.03; P=0.035). Conclusion: Propofol, magnesium sulfate, and lignocaine exerted equal efficacy in attenuating hemodynamic responses during surgery and ensuring a satisfactory surgical field. However, magnesium sulfate led to significantly longer recovery times compared with propofol and lignocaine. In addition, magnesium sulfate required a significantly lower total dose of neuromuscular blocking agents than lignocaine. [ABSTRACT FROM AUTHOR]

Background: The nose is a common site for the development of skin cancers. Mohs micrographic surgery (MMS) is a highly curative treatment for skin cancer of the nose. Reconstruction of MMS defects on the nose, especially on the distal aspect, can be challenging given the proximity of multiple subunits and limited adjacent tissue reservoirs. Our goal was to describe our experience using a nasal tip rotation flap (NTRF) for MMS defects on the distal nose. Methods: A retrospective review of all MMS cases at multiple institutions between June 2018 and June 2022 was undertaken. Cases that used an NTRF to repair the MMS defect(s) were selected, and data were collected on patient demographics, tumor type, anatomical location of the tumor, preoperative and postoperative size, number of stages needed to clear the tumor, repair dimensions, and any postoperative complications. Results: A total of 66 cases that utilized an NTRF for reconstruction were included. The mean preoperative tumor size was 0.8 cm (range: 0.3–1.6 cm), and the mean defect size was 1.2 cm (range: 0.7–1.9 cm). The defects were most commonly on the nasal tip. There were no significant complications observed. Conclusions: The nasal tip rotation flap is a reliable reconstruction option for MMS defects of the distal nose. This flap can be used for defects that involve the nasal tip, soft triangle, and/or portions of the ala, including the alar rim. [ABSTRACT FROM AUTHOR]

BACKGROUND ENT surgeries necessitate endotracheal general anaesthesia for airway protection and prevention of aspiration. Sister rose position and head up with neck flexion are the 2 position commonly used for functional nasal endoscopic surgeries and tonsillectomy. Significant variation in endotracheal cuff pressure was noted in altered position. The increase in cuff pressure could after tracheal mucosal blood flow. This study focuses on changes in cuff pressure before and after positioning and stresses need for endotracheal cuff pressure monitoring. AIMS AND OBJECTIVES • To evaluate endotracheal cuff pressure before and after positioning in ENT surgery. • To compare the effect of extension and flexion of neck on endotracheal cuff pressure. • To correlate airway pressure and cuff pressure during altered position in ENT surgeries. • To offer recommendations on ET cuff pressure monitory. MATERIALS AND METHODS Patients who presented to pre anaesthetic clinic for tonsillectomy and endoscopic sinus surgery along with other surgeries. RESULT BMI and PAW have P value of 0.072 cuff pressure before and after positioning have P value of 0.249 Et CO2 and airway pressure were unaffected by rise in airway pressure. Both the postures for tonsillectomy and endoscopic sinus surgery showed rise in endotracheal cuff pressure. Significant increase was in head up and flexed position probably due to the effect of gravity on the endotracheal cuff. Significant association between BMI and airway pressure predict a raised airway pressure in an obese patient (P= 0.072). The following relation with cuff pressure were statistically significant namely with airway pressure (0.027) and cuff pressure before and after positioning (P=0.001) needing similar position for surgical access were included in the study. Airway pressure, cuff pressure before and after positioning along with patient demographic descriptive data were collected and analyzed. CONCLUSION Endotracheal cuff pressure increases due to altered position of head and neck and influenced by gravity and nitrous oxide. In this study, sister rose and head up neck flexed positions were studied. Both showed increased in cuff pressure more so in head up and neck flexed position. Periodic monitoring and correction of endotracheal cuff pressure to normal limits (20-30cm.H2O) is recommended. [ABSTRACT FROM AUTHOR]

Endoscopic endonasal surgical resection is an effective therapeutic approach for olfactory neuroblastoma (ONB). Unilateral excision of ONBs with limited extension has been reported with the purpose of preserving olfactory function. We aimed to review implications of surgical management, olfactory preservation feasibility, and survival outcomes in patients who underwent endoscopic unilateral resection of ONB. A systematic literature review was conducted using the search terms [("Olfactory neuroblastoma") OR ("Esthesioneuroblastoma")] AND [("Unilateral resection") OR ("Olfaction preservation")]. Studies reporting cases of unilateral ONB endoscopic resection with postoperative olfaction assessment were included. Concurrently, records of patients who met inclusion criteria at our institution were reviewed retrospectively. The survival and olfactory outcomes were analyzed in both cohorts. Thirty-three patients were identified in the published literature. Twenty-three (69.7%) reported postoperative olfaction preservation. Olfactory function after surgery did not show an association with Kadish stage (P = 0.128). No evidence of disease was observed at the latest follow-up in this group of patients. Nine patients who met inclusion criteria were identified at our institution. The extent of resection influenced the level of olfaction preservation when cribriform plate and nasal septum resection coexisted (P = 0.05). A single patient at our institution developed recurrence after being lost to follow-up for 22 months. Olfaction preservation can be achieved in patients who undergo endoscopic unilateral resection and adjuvant radiotherapy. The extent of resection should aim for negative margins, particularly in the midline. Larger studies are required to assess the risk of contralateral microscopic disease, and, hence, close follow-up is advised. [ABSTRACT FROM AUTHOR]

Background/Objectives: Uvulopalatopharyngoplasty (UPPP), palatal plus nasal surgery (PNS), and continuous positive airway pressure (CPAP) are widely implemented treatments for obstructive sleep apnea (OSA). This study aims to explore the long-term effects on objective sleep parameters and patient-reported outcomes (PROs) following different therapeutic interventions for OSA. Methods: Data from patients with moderate-to-severe OSA were retrospectively collected from a medical center and a regional hospital, spanning from December 2011 to August 2018. Objective evaluations included the Apnea–Hypopnea Index (AHI), minimum O2 saturation, and sleep efficiency. The PROs consisted of the Snore Outcomes Survey and Epworth Sleepiness Scale. Using mixed-effects models, we evaluated longitudinal changes in sleep parameters and PROs, accounting for repeated measures and variations within individuals over time. Results: Among 448 patients with moderate-to-severe OSA, follow-up data were collected for 42 patients undergoing UPPP surgery, 171 undergoing PNS, 127 using CPAP, and 108 in the non-treated group. The mean follow-up was 16.7 months (SD = 11.9, range: 1.6–77.3). Significant improvements were observed in AHI, minimum O2 saturation, and hypersomnia immediately following interventions with UPPP, PNS, and CPAP therapy (p < 0.05). Moreover, the analysis revealed no significant rate of change in these parameters over time, suggesting that the benefits of these treatments were sustained in the long term. Furthermore, all interventions exhibited a significant short-term effect on self-reported snoring when compared to the control group, with a p-value of less than 0.001. However, the magnitude of this improvement gradually decreased over time. The snore scores seemed to return to pre-treatment levels among the UPPP, PNS, and CPAP groups after averages of 46.4, 63.5, and 74.4 months, respectively (all p < 0.05). Conclusions: Surgical interventions and CPAP therapy showed potential long-term effectiveness in managing OSA. Snoring symptoms reappeared about 3.9–5.3 years after surgical treatments, which seemed earlier than the average of 6.2 years in patients receiving CPAP and should be considered in patient-participatory decision-making processes. [ABSTRACT FROM AUTHOR]

Secondary atrophic rhinitis (AR), a consequence of mucosal damage during nasal surgeries, significantly impairs patient quality of life. The lack of effective, lasting treatments underscores the need for alternative therapeutic strategies. A major impediment in advancing research is the scarcity of studies focused on secondary AR. Our study addresses this gap by developing an animal model that closely mirrors the histopathological changes observed in patients with secondary AR. These changes include squamous metaplasia, goblet cell hyperplasia, submucosal fibrosis, and glandular atrophy. Upon administering human nasal turbinate stem cells embedded in collagen type I hydrogel in these models, we observed ciliary regeneration. This finding suggests the potential therapeutic benefit of this approach. Our animal models not only emulate the clinical manifestations of secondary AR but also serve as valuable tools for evaluating the efficacy of cell‐based biotechnological interventions. [ABSTRACT FROM AUTHOR]

Background: Bioresorbable nasal packing is associated with a decreased incidence of adhesions and bleeding postoperatively after endoscopic sinus surgery (ESS). However, discomfort during postoperative debridement is still a major area of concern for patients. Our objective was to compare the efficacy of a peptide hydrogel to that of a chitosan‐based polymer in reducing pain during debridement after ESS. Methods: A prospective, multicenter, randomized, blinded trial was conducted in adults undergoing bilateral total ethmoidectomy for chronic rhinosinusitis. Participants served as their own controls with each subject receiving the hydrogel in a randomized ethmoid cavity and chitosan‐based polymer in the contralateral ethmoid cavity. Participants were evaluated at 1, 4, and 12 weeks postoperatively. Pain during debridement as well as endoscopic evaluation of mucosal healing and hemostasis were measured. Results: Thirty patients who underwent ESS were included in this trial. During the week 1 postoperative debridement, patients reported significantly less pain on the hydrogel‐treated side compared to the chitosan‐based polymer‐treated side. There were no significant differences in bleeding severity, Lund–Kennedy scores, debridement time, or need for further intervention between the two groups. Conclusion: This study demonstrated the efficacy of a peptide hydrogel in minimizing pain during postoperative debridement. [ABSTRACT FROM AUTHOR]

This study aimed to comprehend the influence of surgery on the lateral nasal wall, primarily focusing on the inferior turbinates, and its impact on olfactory function. A systematic review was carried out utilizing electronic databases like PubMed, Cochrane (including various registers and databases), and Web of Science. No restrictions were imposed on publication year or language. The PRISMA criteria guided study selection, and predefined inclusion and exclusion criteria were employed. Risk of bias assessment for randomized controlled trials (RCTs) utilized the "Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)," while Hawker et al. scale evaluated the quality of non-RCT studies. The review encompassed nine studies after rigorous selection and bias assessment. All studies unanimously demonstrated improved olfactory function following surgery on the inferior turbinate. Different surgical techniques and olfactory assessment methods were employed across studies. Evaluation encompassed pre- and post-surgery olfactory measurements. Most studies employed the Visual Analogue Scale (VAS) and commercial smell test kits (like Sniffin' Stick Test). The Nasal Obstruction Symptom Evaluation (NOSE) scale was used in two studies, and the butanol threshold test in one. Olfactory improvement was measured through enhanced patient numbers or nasal cavities, often expressed via VAS scores. One study utilized both patient count and VAS scores. A few studies also employed NOSE scale and olfactory threshold measurements. All studies consistently concluded that olfactory function post-surgery was superior to preoperative measures. The collective evidence strongly suggests that surgery on inferior turbinates has a positive impact on olfactory function, as indicated by the studies reviewed. Nonetheless, for a comprehensive understanding of surgical efficacy, future research should incorporate randomized controlled trials featuring control groups. This would facilitate the establishment of optimal surgical techniques for specific indications and the formulation of practical guidelines. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the subjective effect of office-based blue laser therapy for inferior turbinate hypertrophy in patients with nasal obstruction. Methods: Patients with nasal obstruction who underwent office-based blue laser for the inferior turbinate hypertrophy between October 2022 and December 2023 were included in the study. The two outcome measures used to gauge the improvement in nasal obstruction and success of surgery were the Nasal Obstruction Symptom Evaluation (NOSE) scale and the Visual Analogue Scale (VAS). Patient's level of comfort during the procedure was also rated using a 10-point VAS scale. Results: A total of 14 patients were included in this study. The mean age of the study group was 41.47 ± 18.52 and the F/M ratio was 4.67. All patients reported significant improvement in nasal breathing. The mean NOSE score decreased significantly from 13.07 ± 3.89 pre-operatively to 2.64 ± 2.43 post-operatively (p = 0.002). Similarly, the mean VAS score decreased from 7.43 ± 0.85 to 2.0 ± 1.57 (p = 0.002) following surgery. The procedure was well-tolerated by all participants and the mean total score ranged from 6 to 9 with an average of 7.59 ± 1.34. Conclusion: Office-based blue laser therapy for inferior turbinate hypertrophy may be an effective treatment modality for nasal obstruction from the patient's perspective. Although the procedures were tolerated well with no complications noted, these results should be cautiously interpreted until studies using objective measures are conducted. [ABSTRACT FROM AUTHOR]

Background: Bleeding during nose surgery is very important, because it can cause a problem in the surgeon's field of view and lead to an increase in the probability of surgical complications. The aim of this study was to compare the local effects of tranexamic acid and phenylephrine on bleeding in rhinoplasty. Methods: The present study is a double-blind clinical trial in which 98 patients who were candidates for rhinoplasty Shiraz were randomly divided into 49 groups of phenylephrine and tranexamic acid. In the first group, 1 cc of phenylephrine and in the second group, 1 cc of tranexamic acid was used locally and then the variables in the two groups were compared. The current study was approved by the Iranian Clinical Trial Registration Center with code IRCT20201205049602N1. Results: The average blood pressure and heart rate in the phenylephrine group first increased and then decreased, but in the tranexamic acid group decreased from the beginning to 30 minutes. Based on the results of the test, there was a difference between the two groups in terms of the amount of bleeding, and a statistically significant relationship was observed. The average bleeding volume was lower in the phenylephrine group (p<0.0001). Conclusion: Results of this study showed that the amount of bleeding in the phenylephrine group was lower than that of tranexamic acid. It is recommended to use phenylephrine in rhinoplasty surgery to reduce bleeding and improve the surgeon's vision. [ABSTRACT FROM AUTHOR]

Background and Objectives: Empty nose syndrome (ENS) is a debilitating condition that often results from traumatic or iatrogenic causes, such as nasal surgery. There are various conservative and surgical treatments for ENS, but their effectiveness remains uncertain. Therefore, the development of animal models that accurately mimic human ENS is essential for advancing effective treatment strategies. Materials and Methods: To investigate ENS development, turbinoplasty was performed in the nasal cavity of swine, entailing partial removal of the ventral turbinate using turbinectomy scissors followed by electrocauterization. After 56 days, samples were obtained for histological and morphological analyses. Results: A significant reduction in the volume of the ventral turbinate in the ENS model led to an expansion of the nasal cavity. Histological analysis revealed mucosal epithelial changes similar to those observed in ENS patients, including squamous cell metaplasia, goblet cell metaplasia, submucosal fibrosis, and glandular atrophy. Biomarkers related to these histopathological features were identified, and signals potentially contributing to squamous cell metaplasia were elucidated. Conclusions: The swine ENS model is anticipated to be instrumental in unraveling the pathogenesis of ENS and may also be useful for evaluating the effectiveness of various treatments for ENS. [ABSTRACT FROM AUTHOR]

Objective: Nasal septoplasty is one of the most performed procedures within ENT. Nasal obstruction secondary to a deviated nasal septum is the primary indication for functional septoplasty. Since the coronavirus disease 2019 pandemic, waiting lists have increased and are now long. This study assessed patients on the waiting list for septoplasty and/or inferior turbinate reduction surgery using the Nasal Obstruction Symptom Evaluation instrument. Method: Patients on our waiting list for septoplasty and/or inferior turbinate reduction surgery were reviewed using a validated patient-reported outcome measure tool to assess symptom severity. Results: Eighty-six out of a total of 88 patients (98 per cent) had Nasal Obstruction Symptom Evaluation scores of 30 or more. In addition, 78 (89 per cent) and 50 (57 per cent) patients were classified as having 'severe' or 'extreme' nasal obstruction, respectively. Two patients scored less than 30 and were classified as having non-significant nasal obstruction. Conclusion: The Nasal Obstruction Symptom Evaluation instrument is a quick and easy way to validate septoplasty waiting lists. In this study, two patients were identified who no longer required surgery. [ABSTRACT FROM AUTHOR]

Restoring the integrity of the external nose presents a complex surgical challenge due to its three-dimensional structure and subunit divisions. The most frequent causes of nasal defects include basal or squamous cell carcinoma, animal bites and trauma. The reconstruction approach varies depending on factors such as the defect's size, the affected subunit of the nose, the condition and quality of the surrounding tissues and the surgeon's expertise. Commonly employed surgical techniques for nasal reconstruction include the forehead flap, nasolabial flap, Rieger flap, bilobed flap, and free autologous skin graft. We present a clinical case of a patient with a full-thickness nasal alar defect who underwent three-layer reconstruction with a combination of an inverted skin flap- for the internal lining, a conchal graft to substitute the missing alar cartilage and a forehead flap for external coverage. One of the challenges of nasal reconstruction surgery is to restore a full-thickness defect, especially the internal nasal lining. We offer a different perspective on this problem, showcasing considerable advantages, as there are limited literature data on this method. [ABSTRACT FROM AUTHOR]

Ewing-like sarcomas (ELS) are round cell mesenchymal neoplasms that are highly aggressive to bone and/or soft tissue. However, they rarely occur in the nose, with no reported such cases in the medical literature to date. Here, we reported the case of a two-year-old Chinese boy who presented with a mass in the left nasal cavity. Surprisingly, the final histopathological diagnosis of the nasal mass was determined to be a subtype of ELS, BCOR -rearranged sarcoma. Therefore, we retrospectively analyzed the clinical data of this case and reviewed the relevant literature on ELS and BCOR -rearranged sarcoma. The purpose of this article is to provide new insights into the clinical characteristics of children with BCOR -rearranged Ewing-like sarcoma and to improve the understanding of this disease. [ABSTRACT FROM AUTHOR]

This study is a randomized controlled interventional study aimed to determine the effect of preoperative brochure‐assisted education on surgical fear and anxiety in patients scheduled for septorhinoplasty surgery. The study was conducted between May 2022 and February 2023 in the Otorhinolaryngology services and clinics of a training and research hospital in the southern region of Turkey. The study included 61 patients, with 29 in the education group and 32 in the control group. All patients received routine nursing care before surgery, with the education group receiving additional education through an informative brochure. The data were collected using the "Personal Information Form", "Surgical Fear Questionnaire", and "Surgical Anxiety Questionnaire". There was no significant difference in the mean scores of surgical fear between the groups on the morning of the surgery (p > 0.05). However, a significant difference was found in the mean scores of surgical anxiety between the groups (p < 0.05). In conclusion, patients in the education group who received preoperative brochure‐assisted education had lower anxiety compared with the control group. [ABSTRACT FROM AUTHOR]

As a common nasal deformity in clinical practice, the retraction of the nasal margin seriously affects the aesthetic appearance of the patient's nose. Despite the rapid development of nasal plastic surgery in recent years, the treatment of nasal alar retraction remains a challenge in plastic surgery. A comprehensive summary and analysis of the definition, pathogenesis, and treatment plans of nasal alar retraction by scholars at home and abroad in recent years is conducted to further enhance clinical physicians' understanding of nasal alar retraction. [ABSTRACT FROM AUTHOR]

Dans cet article, nous présentons notre expérience universitaire à propos de la reconstruction des pertes de substances (PDS) de la pointe nasale et des ailes narinaires par lambeau frontal paramédian plicaturé décrite par F.J. Ménick (LFPP). Nous revenons sur les artifices techniques de la technique chirurgicale et sur les résultats esthétiques au niveau des sites donneurs. Nous comparons notre technique chirurgicale avec celles de la littérature. Une étude rétrospective monocentrique était menée sur les patients opérés par LFPP pour des reconstructions chirurgicales du dorsum du nez et de la pointe nasale entre janvier 2017 et décembre 2022. Dans chaque cas était recherché par analyse des dossiers la typologie de la PDS à reconstruire, le type de reconstruction et le résultat esthétique de la reconstruction. Une enquête de satisfaction sur le résultat esthétique et fonctionnel avait été envoyée au patient ayant bénéficié d'une reconstruction par LFPP à 6 mois postopératoire. Sur les 17 cas de reconstruction par LFPP, aucun cas de nécrose, même partielle, n'était noté. La taille de la perte de substance moyenne était de 3,5 ± 0,6 cm [2,5–5]. Le nombre de SUE à reconstruire était de 2,6 ± 0,9 [1–4]. Les étiologies des PDS étaient essentiellement liées à des tumeurs cutanées dont 58 % de carcinome basocellulaire (n = 10), 24 % de carcinome épidermoïde (n = 4), 6 % de carcinome adénoïde kystique (n = 1) et 12 % de mélanome (n = 2). Les patients étaient globalement très satisfaits tant d'un point de vue fonctionnel avec un résultat, suite à notre questionnaire, de 89 % (8,94 ± 1,98 [2–10]), qu'esthétique avec un résultat de 87 % (8,76 ± 1,75 [3–10]) Parmi les différentes techniques de reconstructions de la pyramide nasale incluant les lambeaux frontaux paramédian en 2 temps combinés avec un lambeau local de recouvrement de la muqueuse interne, la technique de reconstruction par lambeau frontal paramédian plicature en 3 temps décrite par F.J. Ménick est la technique de choix dans les reconstructions nasales complexes avec des PDS transfixiantes étendues à plusieurs SUE. Il s'agit d'une technique fiable avec d'excellent résultat esthétique et fonctionnel avec une morbidité faible du site donneur. In this article, we present our academic experience with the reconstruction of the dorsum and nasal tip by folded paramedian forehead flap described by F.J. Ménick (LFPP). We take a closer look at the technical aspects of this surgical technique and the aesthetic results at the donor sites. We compare our surgical technique with those reported in the literature. A monocentric retrospective study was carried out on patients operated on by LFPP for surgical reconstructions of the nasal dorsum and nasal tip between January 2017 and December 2022. In each case, we analysed the typology of the type of substance loss for reconstruction, the type of reconstruction and the aesthetic result of reconstruction. A satisfaction survey on the aesthetic and functional results was sent to patients who had undergone LFPP reconstruction at 6 months post-op. There was no necrosis, even partial in any of the 17 cases of LFPP reconstruction. The average size of the substance loss was 3.5 ± 0.6 cm [2.5–5]. The number of aesthetic subunit (SUE) to be reconstructed was 2.6 ± 0.9 [1–4]. The etiologies of substance loss were mainly related to skin tumors, including 58% basal cell carcinoma basal cell carcinoma (n = 10), 24% squamous cell carcinoma (n = 4), 6% adenoid cystic carcinoma adenoid cystic carcinoma (n = 1) and 12% melanoma (n = 2). The patients were very satisfied overall, both from a functional point of view with a questionnaire result of 89% (8.94 ± 1.98 [2–10]), aesthetic, with a result of 87% (8.76 ± 1.75 [3–10]). Among the various techniques for reconstructing the nasal pyramid, including paramedian 2-stage paramedian forehead flaps combined with a local flap of the internal lining, the technique of reconstruction described by J.F. Menick using a 3-stage paramedian folded flap is the most reliable option for complex nasal reconstructions with low donor-site morbidity. [ABSTRACT FROM AUTHOR]

Introduction: The nasal region plays a pivotal role in both facial esthetics and functionality. The use of volumizing fillers has emerged as a potential means to enhance nasal appearance. Preliminary findings from cadaveric studies have highlighted potential risks associated with deeper needle injection, leading to cartilage damage and lateral migration of filler material. Understanding the subcutaneous tissue depth is crucial to prevent such complications and ensure safe filler placement guided by anatomical knowledge. Methods: This study aimed to employ ultrasonographic assessment to precisely measure the depth of soft tissue in the nasal area. Fifty‐two participants without prior nasal surgery or filler injections underwent detailed ultrasonographic evaluation, focusing on seven key anatomical points: Glabellar, Sellion, Rhinion, between Rhinion and Pronasal, Pronasal, between Pronasal and Subnasal, and Subnasal. Results: The ultrasonographic observation revealed varying depths of subcutaneous tissue across these points: Glabellar (4.11 ± 0.79), Sellion (5.21 ± 0.97), Rhinion (2.02 ± 0.74), Rhinion to Pronasal midpoint (6.45 ± 3.1), Pronasal (9.5 ± 2.2), between Pronasal and Subnasal (8.8 ± 0.8), and Subnasal (8.5 ± 0.5). Discussion: The discussion underscores the significance of understanding subcutaneous tissue depth in guiding needle length and approach angles during filler injections. This knowledge aids in achieving effective filling while ensuring safe placement within the subcutaneous tissue. [ABSTRACT FROM AUTHOR]

Purpose: Middle turbinate (MT) surgery is extremely common during endoscopic sinus surgery procedures, though no agreement exists on which techniques provide the best outcomes. This PRISMA-compliant systematic review aims to assess which MT surgery technique yields the least postoperative adverse effects and the best objective and subjective outcomes. Methods: A comprehensive search criteria was conducted in multiple databases up to July 3, 2023, to identify studies reporting surgical treatments of the MT. After screening and quality assessment, 14 articles were included for analysis. Data on patients demographics, surgical approaches, postoperative treatment and follow-up, objective and subjective outcomes were extracted and reviewed. Results: Out of 173 unique papers identified, 14 articles met the inclusion criteria, predominantly randomized controlled trials (n = 9). Antero-inferior middle turbinectomy was the predominant surgical approach. Most studies evaluated results with postoperative endoscopy, a superior outcome was documented in the intervention group (ten out of eleven cases). In four out five studies using the SNOT-22, the treatment group was associated with a statistically significant improvement. Olfactory questionnaires highlighted superior olfactory outcome in two out of three studies. The UPSIT score revealed no significant difference between groups. Objective olfactory assessments favored treatment groups in both studies utilizing olfactometry. Conclusions: It seems that a partial MT surgical approach consistently yields subjective and objective improvements compared to conservative measures, also suggesting a positive impact on smell function. Despite it appears that better outcomes with fewer complications are consistently achieved with partial techniques, it remains challenging identifying which partial technique surpasses the others, due to significant heterogeneity among the studies. [ABSTRACT FROM AUTHOR]

Objectives: To describe and assess the vertical sectioning technique for mid vault dissection in patients undergoing primary and secondary rhinoplasty. Methods: A retrospective review of 208 patients undergoing primary or revision rhinoplasty utilizing the vertical sectioning technique. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to patients pre- and post-operatively. A detailed description of the technique is presented. Results: Mean follow up was 8.59 ± 7.30 months. Spreader grafts were used in 185 patients (89%), upper lateral cartilage autospreader flaps were utilized in 16 patients (7.7%), and both spreader grafts and autospreader flaps were used in 7 patients (3.4%). Ten primary rhinoplasty patients (4.8%) and 3 revision rhinoplasty patients (4.5%) complained of functional nasal obstruction post-operatively. At time of last follow-up, there was a significant improvement in mean NOSE scores for patients receiving spreader grafts (71.2 ± 21.4-21.5 ± 2.8, P <.001), autospreader flaps (69.2 ± 25.9-17.2 ± 21.5, P <.001), and both (57.9 ± 35.0-26.1 ± 20.2, P =.03). Conclusion: The vertical sectioning technique respects the anatomic, functional, and esthetic relationship of the middle vault, while maximizing cartilage preservation. [ABSTRACT FROM AUTHOR]

Septoplasty is one of the most frequently performed surgical procedures in otorhinolaryngology to overcome nasal obstruction. Following septal surgery, nasal packs are commonly inserted by surgeons to support and appose septal flaps the types of which depend on the preference and experience of the surgeon. Background We conducted a study to compare the Merocel sponge with that of a newly developed septal clip with the splint in patients who underwent septoplasty or submucosal resection to find out which one is better. A total of 50 patients were included in the study over a period of 3 years. Patients were divided into 2 groups of 25 each where group M is for patients receiving Merocel after surgery and group C is for patients receiving septal clips with splints. Aim The aim of this study was to assess and compare the effects of a Merocel pack on nasal functions with that of the septal clip and their eventual complications and outcome in the post-operative period. Results The main observations that were found in both groups in the immediate postoperative period were (1) pain (2) nasal obstruction (3) sleep disturbance (4) headache (5) epiphora (6) dryness of mouth and (7) postnasal drip. Pain was mild to moderate in the case of group M (MPS was 2.4) and moderate to severe degree in the case of group C (MPS was 5.7). Nasal obstruction was more common in Merocel group patients. Sleep disturbance, headache, epiphora, post-nasal drip, and dryness of mouth were also more in the Merocel group. After pack removal in both groups, the nasal examination was done to see crusts, vestibulitis, and septal ulcers. All these findings were more in the septal clip with the splint group. Conclusions It was observed that Merocel nasal packing causes significant morbidity and discomfort in the immediate post-operative period as compared to septal clips. It is also expensive. The new septal clips with splints can be used as an effective alternative to Merocel for approximation of flaps after septal surgery. [ABSTRACT FROM AUTHOR]

Background: Remimazolam is an ultrashort-acting benzodiazepine. Few studies have evaluated the effects of remimazolam-based total intravenous anesthesia (TIVA) on emergence agitation (EA). This study aimed to compare the incidence and severity of EA between TIVA using remimazolam and desflurane. Methods: This prospective randomized controlled study enrolled 76 patients who underwent nasal surgery under general anesthesia. Patients were randomized into two groups of 38 each: desflurane-nitrous oxide (N2O) (DN) and remimazolam-remifentanil (RR) groups. The same protocol was used for each group from induction to emergence, except for the use of different anesthetics during maintenance of anesthesia according to the assigned group: desflurane and nitrous oxide for the DN group and remimazolam and remifentanil for the RR group. The incidence of EA as the primary outcome was evaluated using three scales: Ricker Sedation-Agitation Scale, Richmond Agitation-Sedation Scale, and Aono's four-point agitation scale. Additionally, hemodynamic changes during emergence and postoperative sense of suffocation were compared. Results: The incidence of EA was significantly lower in the RR group than in the DN group in all three types of EA assessment scales (all P < 0.001). During emergence, the change in heart rate differed between the two groups (P = 0.002). The sense of suffocation was lower in the RR group than in the DN group (P = 0.027). Conclusions: RR reduced the incidence and severity of EA in patients undergoing nasal surgery under general anesthesia. In addition, RR was favorable for managing hemodynamics and postoperative sense of suffocation. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of platelet-rich plasma (PRP) on the healing of nasal mucosa after surgery of the nose. Methods: This prospective, randomized, Comparative Analytic study was conducted on 40 patients. Patients were randomly allocated into two groups: Group A, subjected to PRP, and Group B, who were not subjected to PRP after nasal surgery. The outcome of both Techniques was analyzed and compared. Results: Significant differences were found in dryness, encrustations, and postoperative healing days in the PRP group. However, no significant differences between the two groups were observed in primary bleeding, secondary bleeding, nasal synechiae, pain, healing time, return to physical activity, and patient satisfaction. Conclusion: Our study detects the potential hopeful effect of PRP on postoperative wound healing of nasal mucosa, dryness, and nasal crustations. According to these results, the application of PRP post-nasal surgery can be considered an effective method for maintaining post-nasal surgery Mucosa. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis(CRS) is a condition characterized by inflammation of the lining of nose and sinuses lasting for 12 weeks or more. CRS with nasal polyp nasal polyp(CRSwNP) is seen in 0.5–4% of the population and is present in about 20% of patients with CRS. Functional endoscopic sinus surgery aids in restoring the ventilation and drainage of paranasal sinuses. Postoperatively, various solutions are used to irrigate the sinus cavity for pharmaceutical and mechanical lavage. Hence, it is imperative to compare different solutions to choose the best to give a favorable outcome. A total of 24 postoperative CRSwNP patients were randomly divided into two groups. Group A received routine post-FESS medication as per the institute guidelines. Group B received budesonide nasal irrigation in addition to regular care. Both groups were evaluated endoscopically at 1, 4, and 12 weeks after the surgery. Pre and postoperative quality of life were compared. Endoscopic Lund–Kennedy scoring (objective measurement) and Sino-Nasal Outcome Test 22 score were used to compare the two groups. The mean preoperative Sino Nasal Outcomes Test 22 score(SNOT-22) was 46.58 ± 6.18 in group A and 50.5 ± 5.7 in group B. It was reduced to 15.00 ± 2.00 and 9.75 ± 1.95 postoperatively in both groups respectively at the end of 3 months. Postoperatively, the mean endoscopic score was 2.36 ± 0.80 in group A and 1.18 ± 0.40 in group B at the end of 3 months. In conclusion, saline plus budesonide nasal irrigation is a better option when compared to saline only irrigation in terms of efficacy and therapeutic effect in patients undergoing FESS for CRSwNP, hence, it should be advocated in regular clinical practice. [ABSTRACT FROM AUTHOR]

Nasal surgeries (e.g.: rhinoplasties, septoplasties) and sinus surgeries (e.g.: Functional Endoscopic Sinus Surgeries) are common procedures in Otorhinolaryngology. Tranexamic acid (TXA), an antifibrinolytic drug, has been increasingly utilized to reduce hemorrhage recently. While close in proximity anatomically, the bleeding nature of sinus and nasal surgeries may differ. We present the first meta-analysis that has reviewed both nasal and sinus surgery collectively and compares the two. Pubmed, Embase, Cochrane Library and WoS were searched until April 2023. Outcomes of interest include Boezart Scoring, clotting time, postoperative complications and surgical field quality. 27 Studies were assessed, of which 25 studies were evaluated quantitatively. Of the 27 studies, 15 studies involved Sinus surgery while 12 involved Nasal surgery. The use of tranexamic acid was notably beneficial in the evaluation of blood loss, reduction of operating time, surgical field quality and surgeon satisfaction. TXA has proven to be efficacious in both nasal and sinus surgeries to varying degrees. TXA has more effects in sinus surgeries compared to nasal surgeries in objective markers such as reducing blood loss and operating time, but the converse occurs for subjective markers such as surgeon satisfaction scores. [ABSTRACT FROM AUTHOR]

Purpose: Nasal valve insufficiency is known to have a negative impact on both nasal patency and quality of life. The titanium butterfly implant is a surgical treatment proven to have a positive effect on these aspects up to 6 months postoperative. This study aimed to determine the long-term effects of the titanium butterfly implant on nasal obstruction symptoms and quality of life in adult patients with nasal valve insufficiency up to 5 years after procedure. Methods: A prospective single cohort study was performed including 29 patients that underwent the titanium butterfly implant in one tertiary medical center. Data was obtained before and at least 5 years after surgery using three questionnaires: the Nasal Obstruction and Septoplasty Effectiveness questionnaire, the Sino-Nasal Outcome Test 22 and the Glasgow Benefit Inventory questionnaire. Results: A significant decrease in total NOSE score was seen compared to baseline measurements. The SNOT-22 scores also showed a significant decrease, whereas the GBI scores showed no significant changes at the late follow-up. Conclusion: Seven years after placement the titanium butterfly implant still has a statistically significant improvement on otorhinologic-related quality of life compared to preoperative measurements. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the effects of nasal septum deviation and inferior turbinate hypertrophy on nasal obstruction by utilizing the Nose Obstruction Symptom Evaluation (NOSE) values and paranasal sinus computed tomography (PSCT) findings for correct preoperative evaluation. Methods: Ninety-six patients (57 males and 39 females) aged between 18 and 54 years (mean age, 30.3 ± 9.7 years) participated in this study. Among them, 56 patients underwent septoplasty combined with inferior turbinate outfracture, while 40 patients underwent septoplasty alone. Preoperative nasal examinations were performed on all patients. The direction, location, nasal septum deviation classification, and inferior turbinate hypertrophy size classification were carefully evaluated and compared with the NOSE survey results. PSCT of 56 patients were evaluated and classified by calculating the coronal location of septum deviation, the axial location of septum deviation, the coronal angle of septum deviation, and the axial angle of septum deviation. Results: A positive correlation was found between the coronal location of the septal deviation and the preoperative NOSE 2, and the NOSE total, and the difference of postoperative and preoperative NOSE (p = 0.032, p = 0.007, p = 0.021, respectively). There was a statistically significant relationship between the coronal location of the septal deviation classification and the NOSE preoperative total values (p = 0.26). A negative statistically significant correlation was found between inferior turbinate hypertrophy and preoperative NOSE 5 values (p = 0.029). Conclusion: We conclude that the combination of PSCT and the NOSE scale is helpful in determining the severity of nasal obstruction prior to surgery. Specifically, we found that nasal septum deviations located in the anterior and coronal planes have a greater impact on nasal obstruction compared to deviations in the axial plane. Inferior turbinate fracture does not provide more benefit than septoplasty alone in treating patients' nasal obstruction. These findings emphasize the importance of a comprehensive approach in addressing nasal obstruction for optimal patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Emergence agitation is a transient confusional state of a child associated with consciousness from general anaesthesia, commonly occurs in the postoperative setting which delays their recovery and exposes them to traumas. The main objective of the current study was to investigate the magnitude of emergence agitation, its interventions and associated factors among paediatric surgical patients at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods: Hospital based cross-sectional study with prospective follow-up framework was conducted on a paediatric surgical patients aged 2-14 years who underwent surgery under general anaesthesia between June 1 - October 30 2022. Stratified sampling method followed by simple random sampling technique was employed to reach study participants. Magnitude of emergence agitation and its interventions done at post-anaesthetic care units were recorded. Data analysis was carried out using a descriptive statistics method and the results were summarized using tables and diagrams. Bivariate analysis was done to identify causal relationship and multivariable analysis to assess the confounding effects of factors associated with emergence agitation. A p-value of less than 0.05 was considered statistically significant factor. Results: A total of 150 participants were included in the current study, where 107 (71.3%) were male and 97 (64.7%) were preschool aged. About 81 (54%) of care givers were female and majority of them have completed primary school. The mean (standard deviation) age of the participants was 6.4 (3.57) years. Around 42.7% of them developed emergence agitation with an average duration of 8.39 ± 4.45 minutes. Factors such as propofol administration at the end of procedure (OR of 0.104 with 95% CI [0.035, 0305]), Ear, nose, throat surgery and oral maxillofacial surgery (OR of 2.341 with 95% CI [1.051, 5.211]) and arrival of patient to recovery awake (OR of 0.456 95% CI [0.209, 0.994]) showed statistically significant association with emergence agitation. Conclusion: Almost half of the study participants experienced emergence agitation which is high magnitude. Ear, nose, throat surgery and oral maxillofacial surgeries were predictive factors of emergence agitation while propofol administration at the end of procedure and arrival of patient to recovery awake significantly decreased risk of emergence agitation. Therefore, anaesthesia personnel should have essential skills and knowledge to effectively care for children perioperatively including to minimize and treat emergence agitation. [ABSTRACT FROM AUTHOR]

Introduction: Congenital nasal pyriform aperture stenosis (CNPAS) is a rare condition that results in neonatal respiratory difficulty. The purpose of this systematic review was to compare surgical outcomes of drilling versus dilation techniques in the treatment of CNPAS. Methods: Pubmed, Embase, and Cochrane Clinical Trials databases were searched for terms "congenital nasal pyriform aperture stenosis" or "pyriform aperture stenosis" from 2010 to 2021. Twenty-five studies were included that evaluated pediatric patients treated surgically for CNPAS with available outcomes data including complications, revisions, and length of stay. Results: A total of 51 patients with CNPAS were pooled from included studies. The median age was 29 days, 56.9% were female, and 54.9% were born full-term. The median pyriform aperture width before surgery was 5.00 mm (IQR = 4.10, 6.45). Forty (78.4%) patients underwent sublabial drilling, while 6 had a dilation procedure performed with hegar cervical dilators, 2 had a balloon dilation, and 3 were dilated with either an acrylic device, endotracheal tube, or bougie. There were no post-operative complications for 76.5% of patients, while a second surgery was required in 9 (17.6%) patients. The median length of stay was 11 days (IQR = 4, 26). No statistically significant difference was observed between sublabial drilling and surgical dilation techniques with respect to complications, need for revision surgery, or length of stay. Conclusion: Current literature is insufficient to determine if drilling or dilation is more effective in the treatment of CNPAS. [ABSTRACT FROM AUTHOR]

Purpose: To compare the functional and esthetic outcomes of dorsal preservation rhinoplasty (DPR) and conventional dorsal hump reduction (DHR) in primary rhinoplasty using patient-reported outcome measures (PROMs) and cone beam computed tomography (CBCT). Methods: In our randomized prospective double-blinded clinical trial, 50 patients had dorsal nasal hump surgery between October 2021 and November 2022 in our tertiary referral center. All surgeries were done by the same surgeon. Patients were randomly assigned to two groups: Group (A): 25 patients had DPR, and group (B): 25 patients underwent DHR. Pre-operative and post-operative evaluations were conducted using standardized cosmesis and health nasal outcomes survey (SCHNOS), surgeons' rhinoplasty evaluation questionnaire (SREQ), and the CBCT. Results: Following an average of 7.22 ± 2.07 months, patients in both groups reported significantly higher levels of satisfaction, as measured by the SCHNOS score (p < 0.001) and the average of three SREQ scores (p < 0.001). These results align with the radiological analysis, which denoted an overall improvement in the average of both sides' internal nasal valve angle and cross-sectional area after surgery with (p = 0.001) and (p = 0.085), respectively, for the DPR group and with (p = 0.281) and (p = 0.014), respectively, for the DHR group. There was no statistically significant difference in outcomes between both groups (p > 0.05). Conclusion: Dorsal preservation is a viable alternative to conventional dorsal hump reduction in primary rhinoplasty. There was no difference in the functional and esthetic outcomes between both techniques, which were verified by radiological investigation. [ABSTRACT FROM AUTHOR]

Objective: To explore whether the different phases of the nasal cycle have a significant effect on nasal temperature, the nasal mucosal clearance rate, and levels of nasal nitric oxide (nNO) and to investigate the correlation between these nasal conditions. Methods: The study participants were divided into 2 groups: the control group and the rhinitis group. The participants' nasal temperature, cilia clearance rate, and nNO levels were measured during different phases of the nasal cycle (the congestion phase and decongestion phase) in the control group and before and after undergoing inferior turbinate ablation in the rhinitis group. Results: The temperature of the nasal cavity in the control group was significantly higher in the congestion phase than in the decongestion phase (P =.0025), while in the rhinitis group, the temperature of the nasal cavity decreased significantly after inferior turbinate ablation (P =.001). In the control group, the nasal mucosa clearance time was significantly shorter in the congestion phase than in the decongestion phase (P =.001), and in the rhinitis group, the clearance time of the nasal mucosa was significantly shortened after the operation (P =.0025). In the control group, the levels of nNO were significantly higher in the congestion phase than in the decongestion phase (P =.025), while in the rhinitis group, nNO levels decreased significantly after the operation (P =.005). Conclusion: The function of the nasal cavity changes in different phases of the nasal cycle. Therefore, when evaluating the impact of various factors on nasal function, factors associated with the nasal cycle should also be considered. Inferior turbinate plasma ablation can improve the ciliary function of the nasal mucosa, reduce the temperature of the nasal cavity, and reduce nNO levels. [ABSTRACT FROM AUTHOR]

Lesions situated within the orbit pose significant challenges in management due to the confined space they occupy and their proximity to critical anatomical structures. The objective of our study is to assess the feasibility of the ipsilateral endoscopic endonasal approach for orbital cavernous hemangiomas and to comprehend the surgical anatomy of the orbital apex and inferomedial orbital structures. Thirteen patients (8 women, 5 men), with ages ranging from 25 to 54 years (mean 35.2 ± 8.3 years), with orbital cavernous hemangioma who underwent surgery via the ipsilateral mononostril endoscopic endonasal approach between August 2018 and August 2023 were retrospectively evaluated. Demographic characteristics, clinical data, radiographic images, and clinical outcomes of the patients were collected from digital medical records. The left orbit was more commonly affected (9 left, 4 right). The average postoperative follow-up duration was 22.2 months (range: 6–50 months). Among the 13 cases of orbital cavernous hemangioma, 1 (7.7%) was located in the extraconal compartment, and 12 (92.3%) were situated in the intraconal compartment. Complete surgical resection of the tumor was successfully achieved in all patients. Our study highlights the potential advantages of employing a purely ipsilateral mononostril endoscopic endonasal approach for orbital surgery, particularly for accessing the orbital apex and managing medial and inferomedial orbital lesions. This technique holds promise for reducing morbidity and enhancing outcomes, especially when combined with careful patient selection, preoperative planning, and advanced endoscopic skills. [ABSTRACT FROM AUTHOR]

Background: Nasal obstruction, triggered by allergic rhinitis, often does not resolve with allergen-specific immunotherapy (AIT) alone, thus inferior turbinate reduction surgery (ITR) may be required. This study aims to investigate the impact of combined treatment on nasal obstruction, as evidence is currently limited. Methodology/Principal: A retrospective cohort study of perennial allergic rhinitis patients experiencing nasal obstruction and undergoing ≥12 months AIT was conducted. Two groups were derived, those undergoing AIT—with or without an ITR. Patient reported nasal obstruction (evaluated with questionnaires) and nasal airway function (Nasal Peak Inspiratory Flow [NPIF] and Nasal Airflow Resistance [NAR]) were monitored. The change from baseline to 12 months post-treatment in each group were compared. Results: A total of 118 patients (33.71 ± 14.43 years, 41.5% female) were recruited, 72% had AIT and 28% AIT&ITR. At baseline, the AIT&ITR group had a higher level of nasal obstruction (>moderate%; 63.6% vs 52.9%, P =.048). Post treatment, AIT&ITR group reported greater reduction in nasal obstruction (>1 category change: 75.8% vs 48.2%, P =.002). Similarly, the AIT&ITR group had greater improvement in nasal function by NPIF (−13.9 ± 110.3 L/minute vs −3.4 ± 78.1 L/minute, P =.049) and NAR (−0.120 ± 0.342 Pa/cm³/second vs −0.093 ± 0.224 Pa/cm³/second, P =.050). Conclusions: Allergic rhinitis patients, with moderate to severe nasal obstruction, who undergo combined AIT&ITR have greater relief of nasal obstruction and improved airflow analysis compared to AIT alone. [ABSTRACT FROM AUTHOR]

Choanal atresia is an uncommon condition with an incidence of 1:5,000–8,000 live births, affecting females more frequently and often associated with other malformations. This case report presents a 42-year-old female patient who was born with bilateral choanal atresia and intervened surgically for the first time at birth. However, the formed orifice was reobstructed a few months afterward, necessitating reoperation in adulthood. The purpose of this case report is to describe bilateral choanal atresia in detail, including its clinical presentation, epidemiology, diagnosis, pathogenesis, and therapeutic approach. It aims to enhance understanding of this rare but significant condition. [ABSTRACT FROM AUTHOR]

Impairment of nasal breathing is a highly prevalent and bothersome symptom that affects daily functioning and/or sleep quality. Those surgeons dealing with patients seeking rhinoplasty need to carefully analyze the preoperative nasal breathing capacity and predict the positive or even negative impact of rhino(septo)plasty on nasal breathing. Given the lack of correlation between the subjective feeling of suboptimal nasal breathing and the objective measurements of nasal flow and nasal resistance, a critical and mainly clinical evaluation of all anatomical, mucosal, and sensory mechanisms involved in nasal obstruction is mandatory. Indeed, thermo-, mechano-, and chemosensory receptors on the nasal mucosa, airflow, and respiratory dynamics might all contribute to the overall perception of nasal breathing capacity. In this review, we provide an overview of the factors determining suboptimal nasal breathing including different diagnostic and experimental tests that can be performed to evaluate nasal flow and nasal resistance and current limitations in our understanding of the problem of nasal breathing in an individual patient. An algorithm for the preoperative or diagnostic workup for nasal obstruction is included that might be useful as a guide for clinicians dealing with patients seeking nose surgery. [ABSTRACT FROM AUTHOR]

Corrective septal surgery for children with nasal obstruction has historically been avoided due to concern about the impact on the growing nose, with disruption of midfacial growth. However, there is a paucity of data evaluating complication and revision rates post-nasal septal surgery in the pediatric population. In addition, there is evidence to suggest that failure to treat nasal obstruction in children may itself result in facial deformity and/or developmental delay. The aim of this systematic review is to evaluate the efficacy and safety of septal surgery in pediatric patients with nasal obstruction. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. MEDLINE, Embase, and the Cochrane Library were searched. Original studies in pediatric patients (<18 years of age) with nasal obstruction were eligible for inclusion. Patients with cleft lip or palate as their primary diagnosis were excluded. Our primary outcomes were patient-reported outcome measures (PROMs), postsurgical complications, and revision rates. Secondary outcomes included surgical technique, anatomical considerations, and anthropometric measurements. Eighteen studies were included (1,080 patients). Patients underwent septoplasty, septorhinoplasty, rhinoplasty, or a combination of procedures for nasal obstruction. Obstruction was commonly reported secondary to trauma, nasal septal deviation, or congenital deformity. The mean age of the patients was 13.04 years with an average follow-up of 41.8 months. In all, 5.6% patients required revision surgery and there was an overall complication rate of 7.8%. Septal surgery for nasal obstruction in children has low revision and complication rates. However, a pediatric-specific outcome measure is yet to be determined. Larger prospective studies with long-term follow-up periods are needed to determine the optimal timing of nasal surgery for nasal obstruction in the pediatric population. [ABSTRACT FROM AUTHOR]

Nasal obstruction is one of the main symptoms of different nasal pathologies. Many physiological and pathological conditions can produce nasal airflow impairment causing nasal obstruction and affecting patients' quality of life. There are different methods for the measurement of nasal obstruction, but in clinical practice the most common used are acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow. This review describes the fundamentals of acoustic rhinometry, its normal values, the different physiological and pathological conditions that can modify nasal patency, and the utility of this instrument for the measurement of nasal obstruction in clinical practice. Acoustic rhinometry is a simple test, so it is suitable for measurements in the pediatric population, i.e., for evaluating adenoid hypertrophy. Acoustic rhinometry normal values are available, unilaterally and bilaterally for pediatric and adult populations. Acoustic rhinometry has been demonstrated to be reproducible and even superior to rhinomanometry when measuring nasal modifications during challenges. It is possible to use acoustic rhinometry before and after nasal surgery. Measuring nasal cavities volume and cross-sectional area, acoustic rhinometry is particularly indicated in rhinosurgery, especially for the evaluation of spreader grafts. Brief considerations about the correlation between nasal symptoms, in particular the subjective sensation of nasal obstruction, and the acoustic rhinometry results as well as the correlation of acoustic rhinometry with other methods for the measurement of nasal obstruction are also reported. Objective and subjective evaluation of nasal obstruction gives different information that together optimizes the diagnosis and the treatment of rhinologic patients. Acoustic rhinometry alone or in combination of other instruments for the measurement of nasal obstruction or patency should be used regularly in every outpatient clinic that treats patients with nasal obstruction as there is an increasing need of evidence-based therapies. [ABSTRACT FROM AUTHOR]

Measuring nasal obstruction should be mandatory before every nasal surgery to determine the necessary surgical steps and to separate mucosal congestion from skeletal deformity. Rhinomanometry is considered the "golden standard" for measuring nasal airway resistance. An extension of the diagnostic power was achieved by the introduction of the four-phase rhinomanometry (4PR), which provides additional information about the influence of the elasticity of the nasal wall. Also, a high correlation to the subjective sensing of obstruction could be achieved by the introduction of logarithmic parameters. The parameters of 4PR could be classified by evaluating 36,500 measurements. The International Standardization Committee on the Objective Assessment of the Upper Airway (ISCOANA) determined it as the new standard. Adding a visual analog scale (VAS) to every measurement is a documentation of the feeling of obstruction at the moment of measurement. Practical hints for 4PR are given. The determination of obstruction for both nasal sides or the calculation of the total nasal resistance should be followed by a second analysis of the detailed obstruction anatomy. In the future, pressure losses or temperature gradients can be determined by computational fluid dynamics (CFD). A reliable way to simulate the success of single surgical steps with a high didactical meaning is the three-dimensional (3D) print of sliced nose models and to measure the effect of stepwise mechanical corrections. [ABSTRACT FROM AUTHOR]

Background:Intractable rhinitis either due to allergic rhinitis or vasomotor rhinitis could affect patient lifestyle and quality of lifesurgical therapy is recommended if symptoms are not adequately controlled by medications. This study aims to examine the outcomes of posterior nasal neurectomy and surface coblation in order to alleviate the symptoms of intractable rhinorrhea. Patients and methods: This prospective non-randomized clinical study included 18 patients above age of 12 who have intractable rhinorrhea, not respond to medical treatment and admitted to ORL-HNS department, Zagazig University. Included patients were classified into two groups; the posterior nasal nerve(PNN) was excised endoscopically in the first group, while surface coblation was used to ablatethe posterior nasal nerve region in the second group. Results: There was significant improvement in rhinorrhea, sneezing, nasal obstruction, itching, smell and gustatory rhinorrhea after treatment in both group. Repeated measures of rhinorrhea, sneezing, nasal obstruction and itchingwere lower in the (PNN) section group compared to the surface coblation group but there was no statistically significant difference between both groups regarding repeated assessment for smell and gustatory rhinorrhea. Conclusion:Intractable rhinitis symptoms, especially rhinorrhea, sneezing and nasal obstruction, can be significantly relieved by either endoscopic resection of the posterior nasal nerve or endoscopic ablation of the posterior nasal nerve area using surface coblation. Although symptoms of both groups improved, the post-operative results of PNN section were better than surface coblation but the technique of surface coblation is simpler, safer and time saver. [ABSTRACT FROM AUTHOR]

Our aim is to investigate the effects of the submucoperichondrial application of Platelet Rich Plasma (PRP) on nasal mucosal healing after septoplasty surgery. This prospective randomized observational study was conducted between July 2019 and February 2021, with 40 patients aged 18–60 years who underwent closed the only septoplasty operation for similar septal deviations. Patient divided into two group; 21 patients were placed in PRP group to which PRP was applied on all mucosal surface and submucoperichondrial area of septum and 19 patients were placed in control group to which saline solution was applied on same regions. Nasal obstruction score, mucociliary clearance time, presence of nasal crusting, and bleeding time were evaluated on 5th, 10th, 15th day after surgery and compared between groups. Intranasal crusting on day 10 was found to be lower in the PRP group (n :13 68.4 %) than control group (n :7 33.3 %) with a statistically significant difference (p = 0.028). The nasal obstruction score on day 10 and 15 were found to be lower in the PRP group (3,33 ± 2,75, 2,07 ± 2,20) (than the control group (5,44 ± 2,26, 3,37 ± 1,92) with a statistically significant difference (p = 0,003, p = 0,009). The mucociliary clearance rate was found to be higher and the bleeding time was found to be lower in the PRP group, but a statistically significant difference was not observed. Application of submucoperichondrial PRP could have beneficial effects on nasal mucosal repair, nasal crusting, and congestion after septoplasty surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Nasal surgeries, addressing anatomical variations for form and function, require careful anesthesia administration, including dexmedetomidine and remifentanil. This meta-analysis evaluates their safety and efficacy variations in nasal surgeries, emphasizing patient comfort and optimal outcomes. Methods Four electronic databases (PubMed, Scopus, Web of Science, and CINAHL Complete) were searched for records in English. Studies that measure the effect of dexmedetomidine versus remifentanil on patients underwent nasal surgery were included. The Cochrane Collaboration’s tool was used to assess the quality of the included studies. A random-effect model was preferred and statistical analysis was performed by Stata software version 17. Results Out of an initial pool of 63 articles, five studies were selected for this analysis. All of these chosen studies were Randomized Controlled Trials (RCTs). The meta-analysis involved a total of 302 participants, with 152 in the remifentanil group and 150 in the dexmedetomidine group. The analysis aimed to compare the effects of Dexmedetomidine and Remifentanil on heart rate (HR) and mean arterial pressure (MAP) during surgery. Both groups exhibited similar MAP and HR, with the exception of a slightly lower HR in the remifentanil group at the 15th minute of surgery (Standardized Mean Difference: -0.24 [-0.83, 0.34]). Furthermore, when evaluating the impact of these medications on post-surgery outcomes, including pain levels, the use of pain relief medications, patient-surgeon satisfaction, agitation scores, and recovery time, no significant differences were observed between the two medications in any of these aspects. Conclusion In summary, the study compared Dexmedetomidine and Remifentanil in nasal surgeries anesthesia. No significant differences were found in heart rate, blood pressure, satisfaction, pain, agitation, or recovery time. The study had limitations, and future research should establish standardized protocols and consider various surgical factors.

Abstract Background Post-anesthetic emergence agitation is common after general anesthesia and may cause adverse consequences, such as injury as well as respiratory and circulatory complications. Emergence agitation after general anesthesia occurs more frequently in nasal surgery than in other surgical procedures. This study aimed to assess the occurrence of emergence agitation in patients undergoing nasal surgery who were extubated under deep anesthesia or when fully awake. Methods A total of 202 patients (18–60 years, American Society of Anesthesiologists classification: I–II) undergoing nasal surgery under general anesthesia were randomized 1:1 into two groups: a deep extubation group (group D) and an awake extubation group (group A). The primary outcome was the incidence of emergence agitation. The secondary outcomes included number of emergence agitations, sedation score, vital signs, and incidence of adverse events. Results The incidence of emergence agitation was lower in group D than in group A (34.7% vs. 72.8%; p

Inferior turbinate reduction procedures have been performed for decades. After significant evolution, turbinoplasty and other mucosal-sparing techniques have become the main method to successfully reduce turbinate hypertrophy. The debate of which technique produces the most effective and durable outcomes is ongoing. During this critical era of widespread communicable diseases, including but not limited to COVID-19, HIV, and hepatitis, additional attention is necessary to balance outcomes with a degree of generation of airborne particles when selecting a technique. This review article aims to identify the optimal method for inferior turbinate reduction that weighs both outcomes and aerosol production. The MEDLINE database was searched to discover relevant publications through August 2022. Key search terms included inferior turbinate hypertrophy, turbinate reduction surgery, turbinoplasty methods, surgical management of turbinate hypertrophy, surgical aerosol generation, COVID-19 surgery, surgery smoke plume, SARS-CoV-2 transmission during surgery, and nasal procedures COVID-19 aerosols. Surgical management of the inferior turbinates includes radiofrequency ablation (RFA), microdebrider-assisted turbinoplasty (MAIT), electrocautery, laser, and ultrasound. Piezo-assisted turbinoplasty and a turbinate-specific coblation wand are new additions to the literature. All techniques appear to improve patient symptoms of nasal obstruction. MAIT and RFA are comparable, although MAIT demonstrated better long-term outcomes in some studies and appears to generate fewer airborne particles. Studies evaluating the production of aerosols due to RFA are lacking. Ultrasound outcomes are also excellent and generate no aerosols, but the technique has not been compared against the microdebrider. Electrocautery can result in increased pain and crusting for patients and causes the highest amount of aerosols. Deficiencies of current studies, including a lack of comparison of aerosol generation, duration of follow-up, omission of outfracture, and inadequate randomized controlled trials among existing and new techniques, have limited the identification of the best inferior turbinate reduction method. Given the durability of MAIT and its minimal aerosol production, it can be reinforced as the most sensible technique until further evidence is available.

Background: Nasal surgeries, addressing anatomical variations for form and function, require careful anesthesia administration, including dexmedetomidine and remifentanil. This meta-analysis evaluates their safety and efficacy variations in nasal surgeries, emphasizing patient comfort and optimal outcomes. Methods: Four electronic databases (PubMed, Scopus, Web of Science, and CINAHL Complete) were searched for records in English. Studies that measure the effect of dexmedetomidine versus remifentanil on patients underwent nasal surgery were included. The Cochrane Collaboration's tool was used to assess the quality of the included studies. A random-effect model was preferred and statistical analysis was performed by Stata software version 17. Results: Out of an initial pool of 63 articles, five studies were selected for this analysis. All of these chosen studies were Randomized Controlled Trials (RCTs). The meta-analysis involved a total of 302 participants, with 152 in the remifentanil group and 150 in the dexmedetomidine group. The analysis aimed to compare the effects of Dexmedetomidine and Remifentanil on heart rate (HR) and mean arterial pressure (MAP) during surgery. Both groups exhibited similar MAP and HR, with the exception of a slightly lower HR in the remifentanil group at the 15th minute of surgery (Standardized Mean Difference: -0.24 [-0.83, 0.34]). Furthermore, when evaluating the impact of these medications on post-surgery outcomes, including pain levels, the use of pain relief medications, patient-surgeon satisfaction, agitation scores, and recovery time, no significant differences were observed between the two medications in any of these aspects. Conclusion: In summary, the study compared Dexmedetomidine and Remifentanil in nasal surgeries anesthesia. No significant differences were found in heart rate, blood pressure, satisfaction, pain, agitation, or recovery time. The study had limitations, and future research should establish standardized protocols and consider various surgical factors. [ABSTRACT FROM AUTHOR]

Background: Post-anesthetic emergence agitation is common after general anesthesia and may cause adverse consequences, such as injury as well as respiratory and circulatory complications. Emergence agitation after general anesthesia occurs more frequently in nasal surgery than in other surgical procedures. This study aimed to assess the occurrence of emergence agitation in patients undergoing nasal surgery who were extubated under deep anesthesia or when fully awake. Methods: A total of 202 patients (18–60 years, American Society of Anesthesiologists classification: I–II) undergoing nasal surgery under general anesthesia were randomized 1:1 into two groups: a deep extubation group (group D) and an awake extubation group (group A). The primary outcome was the incidence of emergence agitation. The secondary outcomes included number of emergence agitations, sedation score, vital signs, and incidence of adverse events. Results: The incidence of emergence agitation was lower in group D than in group A (34.7% vs. 72.8%; p < 0.001). Compared to group A, patients in group D had lower Richmond Agitation-Sedation Scale scores, higher Ramsay sedation scores, fewer agitation episodes, and lower mean arterial pressure when extubated and 30 min after surgery, whereas these indicators did not differ 90 min after surgery. There was no difference in the incidence of adverse events between the two groups. Conclusions: Extubation under deep anesthesia can significantly reduce emergence agitation after nasal surgery under general anesthesia without increasing the incidence of adverse events. Trial registration: Registered in Clinicaltrials.gov (NCT04844333) on 14/04/2021. [ABSTRACT FROM AUTHOR]