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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]

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]

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]

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

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]

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]

Objective: Although the role of brain-derived neurotrophic factor (BDNF) in allergic rhinitis and/or nasal polyps (NPs) development has been studied, the contribution of BDNF in non-allergic NPs has not been evaluated yet. This study was to investigate the possible role of BDNF in non-allergic NPs pathogenesis. Methods: The study was carried out at The Second Hospital of Shandong University from December 2020 to November 2021. The non-allergic NPs patients (n=26) and the control group (n=22) were included. Lund-Mackay CT scores, nasal endoscopy scores, and pulmonary function testing were evaluated before surgery. Tissue and serum levels of BDNF, eosinophil cationic protein (ECP), and cytokeratins 5 (CK5) were assessed between different groups. Result: The BDNF level in serum and tissue, CK5 count, and eosinophil infiltration in tissue were higher in non-allergic NPs. The eosinophils infiltration, ECP mRNA expression level, as well as BDNF mRNA level were increased in the BDNPigh subgroup compared with BDNFlow subgroup. Significantly negative correlations between BDNF count and the situation of airway obstruction were found in non-allergic NPs. Conclusion: BDNF may have both local and systemic effects in non-allergic NPs pathogenesis. BDNF may be a possible therapeutic target or an indicator for eosinophilic NPs management. [ABSTRACT FROM AUTHOR]

Empty nose syndrome (ENS) is a complex condition characterized by symptoms such as dyspnea, nasal discomfort, and emotional challenges. This study aimed to evaluate functional exercise capacity and perceived exertion in patients with ENS. Patients with ENS who presented with a range of severe symptoms were prospectively enrolled. Pulmonary function was evaluated using spirometry, and functional exercise capacity was measured via the 6 min walk test (6-MWT). Perceived exertion was quantified using the Borg scale, and cardiopulmonary function was evaluated by monitoring peripheral oxygen saturation (SpO2). These parameters were assessed before and after nasal reconstruction surgery. A total of 44 patients with ENS were enrolled and classified into mild-to-moderate (n = 20) and severe (n = 24) symptom groups. Spirometry results showed no significant differences before and after surgery in the entire cohort. Perceived exertion showed significant postoperative improvement (p = 0.006). The severe ENS symptom group experienced significant improvement in SpO2 (p = 0.013) and perceived exertion (p = 0.002) at the end of the 6-MWT after surgery. Surgical intervention significantly enhanced functional exercise capacity (p = 0.038) in patients with mild-to-moderate ENS symptoms. Surgical reconstruction positively affected perceived exertion and SpO2 at the end of the 6-MWT in patients with ENS. The severity of ENS symptoms, as assessed by SNOT-25 scores, influenced these outcomes. These findings underscore the potential benefits of surgical intervention for enhancing exercise tolerance and respiratory efficiency. [ABSTRACT FROM AUTHOR]

Functional septo(rhino)plasty incurs a 17–25% rate of revision for persistent symptoms. The main study objective was to assess functional results before and after surgical revision. The secondary objective was to describe the shortcomings or excesses of the prior surgeries, with a-posteriori comparison of efficacy for the surgical techniques requiring revision. A single-center retrospective study included functional salvage septo(rhino)plasties. Data comprised epidemiology, intraoperative anatomic abnormalities indicative of prior surgery, operative correction maneuvers, and pre- and post-intervention NOSE and RhinoQoL scores and satisfaction on VAS. Eighty-two patients were included. Anatomic abnormalities comprised deviated posterior septum (81.7%) and chondroethmoidal junction (58.5%), valve stenosis (54.9%), and obstructive boney spur or crest (46.3%). Prior surgeries comprised 33 submucosal resections, 29 septorhinoplasties, 14 Cottle septoplasties and 5 Killian procedures. Complete septoplasty was performed in 80% of cases, with associated maneuvers in 15%. All scores showed improvement taking the whole population together (P < 10−5), but on subgroup analysis improvement concerned only revision of septorhinoplasty (P < 10−4) and of submucosal resection (P < 10−3), while 17% of patients showed no change in scores. Functional nasoseptal salvage surgery enables most patients to recover respiratory comfort, with the exception of a few cases despite a perfectly straight nasal septum. [ABSTRACT FROM AUTHOR]

Utilizing endoscopes in surgery offers advantages and concerns, including potential nasal function impacts. Hyposmia following Transseptal Transsphenoidal hypophysectomy ranges from 0% to 2.2%. Debates persist about managing the M.T. in endoscopic sinus surgery due to its impact on nasal function. While preservation is recommended for sinonasal health, debates continue, as certain cases require resection. Our meta-analysis aims to compare turbinate resection and preservation effects on olfactory function. We searched five electronic databases to collect all relevant studies. Records were screened for eligibility. Data were extracted from the included studies independently. Our continuous outcomes were pooled as standardized mean difference with 95% CI. Statistical analyses was done by RevMan. Our meta-analysis included four studies involving 235 patients (81 males). Evaluating changes in olfaction scores, two one-month studies (82 patients) revealed no significant difference between preservation and resection groups (Std.MD = 0.05[−0.39, 0.50], p = 0.81). For three-month assessments (146 patients), SNOT tests indicated no significant difference (Std.MD = 0.21, 95% CI[−0.11, 0.54], p = 0.20). Two studies used other tests on 70 patients at three months, yielding no significant difference (Std.MD = 0.13, 95% CI [−0.35, 0.62], p = 0.59). Two six-month studies (72 patients) similarly found no significant difference (Std.MD = 0.09, 95% CI [−0.39, 0.56], p = 0.72). Our meta-analysis involving 235 patients examined olfaction score changes over various time frames in trans-nasal trans-sphenoidal pituitary surgeries. No significant differences were observed between turbinate preservation and resection groups at one month, three months, or six months post-surgery. [ABSTRACT FROM AUTHOR]

Objective: To determine frequency of correct placement of nasogastric/orogastric tube on POCUS in pediatric critical care unit patients. Study Design: Descriptive cross-sectional. Setting: High Dependency Unit and Pediatric Intensive Care Unit, Indus Hospital Health Network, Karachi, Pakistan. Period: November 2022 to April 2023. Methods: Patients of age 1 months to 15 years of age requiring NGT placement were enrolled into the study. Patients with nasal surgery, fracture of skull base/face, bleeding, coagulopathy, esophageal varices, stricture, upper gastrointestinal surgery were excluded from this study. NG tube was passed by principal investigator after evaluating correct size and length measurement. After passing the NG tube, gastric aspiration and gastric auscultation were also performed by principal investigator. Results: In this study we enrolled 147children with median age of patient was 3 (IQR=0.75-07) years. Majority of patient in our study were male (63.9%). Gastric aspiration and gastric auscultation was seen in all of the study patients. Based on POCUS, frequency of correct placement of nasogastric tube in children admitted in PICU was 83%. Sensitivity of POCUS against gastric aspiration and gastric auscultation was 82.5% with 100% positive predictive value (PPV). Specificity was unable compute as there was no negative finding in reference standard and hence there was also no false positive case. Conclusion: POCUS seems to be helpful and could help with the placement of NGT in paediatric clinical settings. Nevertheless, NGT envision in the stomach was difficult, and if the operator is not skilled or there is abdominal distention, it may go unnoticed. [ABSTRACT FROM AUTHOR]

Introduction Despite the high level of patient satisfaction with functional endoscopic sinus surgery (FESS) and the clinical improvement, polyp recurrence is observed in 23% to 87% of patients and requires reoperation. Objective To assess the prognostic value of polypoid changes of the middle turbinate (PCMT) in relapse of paranasal sinus polyps in patients with chronic rhinosinusitis with nasal polyp (CRSwNP) after FESS and the effect of partial middle turbinectomy (PMT) on the outcome of surgery. Methods We conducted a prospective clinical study on 60 patients with CRSwNP with and without PCMT. The patients were allocated into three groups: group I included twenty patients without PCMT; group II, twenty patients with PCMT; and group III included twenty patients with PCMT submitted to PMT. The patients were evaluated endoscopically according to the Lund-Kennedy endoscopic scoring system, radiologically according to the Lund-Mackay scoring system, and symptomatically through the 22-item Sinonasal Outcome Test (SNOT-22). Results The total postoperative Lund-Kennedy score differed significantly among the 3 groups (p < 0.001), with a group II presenting a significantly higher total score compared to groups I and III. The Preoperative SNOT-22 score differed significantly among the three groups (p = 0.013), with group II presenting a significantly higher score compared to group I. There was a significant association involving the 3 groups and relapse at 12 months (p = 0.029); relapse was higher in group II (50.0%) than in groups I (20%) and III (15.0%). Conclusion There was a significant association between PCMT and the relapse of nasal polyps. Also, nasal polyposis recurred at a lower rate in the group submitted to middle turbinate resection compared to the group in whom it was preserved. [ABSTRACT FROM AUTHOR]

Introduction Postoperative sore throat (POST) is a fairly common side effect of general anesthesia. The K-Y jelly is a well-known lubricant used in many medical procedures. Objective In this randomized study, we evaluated the use of throat packs soaked with K-Y jelly for POST outcomes in patients submitted to nasal surgery. Methods The present double-blinded, randomized, controlled study included 140 ASA I–II patients undergoing nasal surgery under general anesthesia. Patients received either or K-Y jelly or water-soaked X-ray detectable throat packs fully inserted into the mouth to occlude the oropharynx. Results Comparison between the studied groups regarding the severity of POST assessed by visual analog scale revealed significantly lower POST levels in the K-Y jelly group on recovery from anesthesia, and at 2, 4, and 6 hours postoperatively. Conclusions The use of K-Y jelly-soaked throat packs was associated with less severe POST after nasal surgery. [ABSTRACT FROM AUTHOR]

Background: Septoplasty is one of the most common operations in adults in order to improve qualitative and quantitative scores in nasal obstruction. Using Columellar strut graft in septoplasty is not a routine technique but helps not only to correct septal deviation but also provides a better breathing status. The aim of this study was to compare the outcome of routine septoplasty with septoplasty with Columellar strut graft in nasal breathing satisfaction. Methods: Forty patients with deviated nasal septum who scheduled for septoplasty, were randomly assigned into 2 equal groups. In first group routine septoplasty and in second group septoplasty with columellar strut graft were performed. Visual Analog Scale (VAS) was used to evaluate nasal breathing satisfaction, and Nasal Obstruction Symptom Evaluation (NOSE) score was used for the assessment of nasal obstruction. Results: According to VAS and NOSE score, nasal breathing satisfaction and nasal obstruction improved significantly in septoplasty with columellar strut graft group in comparison with the routine septoplasty group (P < .001). Conclusion: Using cartilaginous columellar strut graft in septoplasty is effective in improving nasal breathing satisfaction in patients after septoplasty. Therefore it should be recommended in septoplasties. [ABSTRACT FROM AUTHOR]

The nasal cavity constitutes the foremost portion of the respiratory system, composed of the anterior nasal aperture, nostrils, and choanae. It has an intricate anatomical structure since it has various functions, such as heat exchange, humidification, and filtration. Accordingly, clinical symptoms related to the nose, such as nasal congestion, snoring, and nasal septal deviation, are closely linked to the complex anatomical structure of the nasal cavity. Thus, the nasal cavity stands as a paramount structure in both forensic and clinical contexts. The majority of relevant studies have performed comparisons between sexes, with studies making comparisons according to the FI and NI only and examining relative percentages. Furthermore, the nasal cavity was measured in 2D, and not 3D, in most cases. In this study, we conducted a 3D modeling and anthropometric assessment of the nasal cavity using a 3D analysis software. Furthermore, we aimed to investigate whether the size of the nasal cavity differs according to sex, facial index (FI), and nasal index (NI). We retrospectively reviewed the cone-beam computed tomography (CBCT) data of 100 participants (50 males, 50 females) aged 20–29 years who visited the dental hospital of Dankook University (IRB approval no. DKUDH IRB 2020-01-007). Our findings showed that nasal cavity sizes generally differed according to sex, FI, and NI. These findings provide implications for performing patient-tailored surgeries in clinical practice and conducting further research on the nasal cavity. Therefore, we believe that our study makes a significant contribution to the literature. [ABSTRACT FROM AUTHOR]

The primary function of nasal packs is to modulate the bleeding, prevent adhesions and obstruction, with least discomfort to the subjects without risking secondary infection. However, both packing and removal of the pack is an unpleasant experience, with the latter being extremely painful. Therefore the need of the hour is a dressing which prioritizes subject comfort without compromising other desired nasal pack properties. Twenty subjects were enrolled in this interventional, open label study. The subjects had 10 hospital visits, starting from baseline (Visit 1) to postoperative day 28 (Visit 10), at regular intervals. The proportion of the population with postoperative pain alleviation and bleeding control failure (within 10 min) were the main objectives. Within 10 min of VELNEZ administration, all 20 participants got their bleeding under control. With VELNEZ, the painful nasal pack removal method was totally avoided because it was biodegradable. No moderate/severe pain, infection and adhesions were reported in any of the subjects, but few subjects reported moderate obstruction until Visit 3 (Discharge Day). In the present study, for participants undergoing nasal surgery, VELNEZ proved to be a secure and reliable nasal pack. Trial Registration: CTRI/2021/09/036437, prospectively registered. [ABSTRACT FROM AUTHOR]

Maxillary palatal defects due to tumor resection require immediate reconstruction to prevent morphological/functional disorders. Reconstruction options ranges from obturator placement to free flap. We adopted a surgical maxillary exposure using nasolabial groove incision in contrast to classical Weber Ferguson incision. This has the added advantage of simultaneous reconstruction of the resultant defect using nasolabial flap, with a good cosmetic and functional outcomes. We hereby present our experience in ten cases with palatal defects post maxillectomy for carcinoma of the upper gingivobuccal sulcus and upper alveolus reconstructed with this technique. This is a case series of ten patients (7 males and 3 females) who underwent partial maxillectomy using nasolabial groove incision with simultaneous reconstruction of palatal defect with nasolabial flap from January 2019 to June 2021 in our department. The primary disease was squamous cell carcinoma (SCC) in all ten patients with clinically N0 and M0. No necrosis, infection, or severe scar contracture in grafts was found in any patient. The wound stabilized, ingestion was started, and rehabilitation was performed with appropriate denture within 10 days after surgery in these patients. The postoperative oronasal communication (5×5 mm in size) in the posterior midline end was found in two cases, seen 1 month after surgery. All patients have good extra oral cosmetic outcomes. No radiation therapy was given in any case. This is a feasible surgical option utilizing nasolabial groove incision for partial maxillectomy along with simultaneous reconstruction of the resultant defect using nasolabial flap. It is a simple surgical procedure with reduced operative time with good cosmesis. [ABSTRACT FROM AUTHOR]

Introduction and objective: Nowadays, treatment proposals for patients with recurrent sinonasal polyposis are based on the use of local intranasal corticosteroid therapy based on topical inhalers, cycles of systemic corticosteroids and endoscopic nasal surgery. Biological therapy is gaining more and more prominence in the treatment of this pathology. The objective of this work is based on determining which biological treatment of those administered today for this disease is more effective in managing symptoms and in its evolution. Method: Retrospective study of 21 patients with chronic rhinosinusitis with sinonasal polyposis and asthma under treatment with biological therapy at the University Hospital of Fuenlabrada. Using a Wilcoxon signed-rank study, we will analyze the efficacy of the different biological treatments administered. Results: A statistical significance with p = <0, 001 was evidenced in terms of the improvement of the symptoms suffered by the study patients (with the exception of smell) as well as an improvement in the Nasal Polyp Score of 3 points. The Wilconxon test result was statistical significance with p = <0, 001. Discussion: The data obtained in this study agree with those obtained in studies on biological therapy in CRSwNP. Remarkable reductions in the disease burden of CRSwNP have been documented objectively and subjectively. This is consistent with the fact that our patients required fewer reinterventions throughout the procedure. Conclusions: In our study, the efficacy of biological therapy has been corroborated in practically all the data analyzed. However, it has not been possible to demonstrate the relevance of one type of therapy over another. [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic nasal and sinus surgery is a surgical procedure frequently performed by otolaryngologists. Postoperative bleeding is detrimental to both healthcare providers and patients. We investigated the epidemiology of postoperative bleeding during endoscopic nasal and sinus surgery and explored possible bleeding triggers. Methods: We evaluated the patients who underwent endoscopic nasal and sinus surgery. Data regarding the age, sex, presence of hypertension, and abnormal coagulability, including oral anticoagulants, diagnoses, operative procedures, intraoperative use of drills and blood loss, and postoperative antimicrobial administration of eligible patients, were extracted from medical records and retrospectively reviewed. Results: One hundred and eighty-six patients underwent endoscopic nasal or sinus surgery during the study period, and postoperative bleeding occurred in 9 patients (4.8%). Posterior nasal neurotomy (PNN) was the procedure most likely to cause postoperative bleeding (4 surgeries, 13.3%). Postoperative antimicrobial administration significantly reduced the incidence of postoperative bleeding (p = 0.04). Conclusions: Postoperative bleeding requiring intervention occurs in 4.8% of cases, and PNN is associated with a high risk of postoperative bleeding. Wound infection is a potential cause of postoperative bleeding, and antimicrobial administration should be considered in addition to local treatment. [ABSTRACT FROM AUTHOR]

Purpose: Posterior epistaxis is a common emergency in ENT practice varying in severity and treatment. Many management guidelines have been proposed, all of which are a product of retrospective analyses due to the nature of this pathology, as large-scale double-blind studies are impossible—even unethical—to conduct. The purpose of this review is to perform a thorough analysis and comparison of every treatment plan available and establish guidelines for the best possible outcome in accordance to every parameter studied. Given the extensive heterogeneity of information and the multitude of studies on this topic, along with the comparison of various treatment options, we opted for a literature review as our research approach. Methods: A review of the literature was performed using PubMed Database and search terms included "posterior epistaxis", "treatment", "management", "guidelines", "algorithm" "nasal packing", "posterior packing", "surgery", "SPA ligation", "embolization", "risk factors" or a combination of the above. Results: Initial patients' assessment invariably results in most cases in posterior packing. There seems to be a superiority in recent literature of early surgery over nasal packing as a definitive treatment. Embolization is usually used after surgery failure, except for specific occasions. Conclusion: Despite the vast heterogeneity of information, there seems to be a need for re-evaluation of the well-established treatment plans according to more recent studies. [ABSTRACT FROM AUTHOR]

Key Points: Empty nose syndrome (ENS) is characterized by a patent nasal airway and a sense of nasal obstruction.ENS and psychological symptoms improved after surgery and remained stable for up to three years.Identifying residual disease is necessary for enhancing therapeutic outcomes in ENS patients. [ABSTRACT FROM AUTHOR]

Background: Septal surgery is one of the most commonly performed procedures in Otolaryngology. Following septal surgery, nasal packing is administered to prevent potential postoperative complications, including septal hematoma, hemorrhage, and synechiae formation. Nasal packing is commonly done using either ribbon gauze or non-absorbable materials like Merocele (Medtronic Xomed Inc., Jacksonville, FL, USA). Aims and Objectives: The objective of the study is to compare the post-operative outcomes of ribbon gauze packing and merocele packing. Materials and Methods: The study was a prospective observation study, conducted in Burdwan Medical College and Hospital from August 2023 to October 2023. The study population was 40 with equal distribution between the two groups. Patients older than 18 years undergoing only septal surgery are included in the study. All the surgeries are performed by the same surgeon, both packs are removed after 48 h and followed up with diagnostic nasal endoscopy (DNE) after 1 month. Statistical analysis was done using SPSS version 22.0 (IBM Inc., US). Results: The total number of patients in our cohort was 40, out of which 20 were given ribbon gauze packs (Group A) and the rest were given merocele packs (Group B). The mean visual analog scale score for nasal pain (4.25±1.77), headache (4.30±1.63), dysphagia (2.50±1.15), sleep disturbance (3.15±1.09) in Group B was significantly lower than in Group A (6.65±1.63, 5.40±1.70, 4.00±1.84, and 5.40±2.35 respectively, p all<0.05). The mean of the postnasal drip score was lower in Group B, though that did not reach statistical significance (2.75±1.070 vs. 3.25±1.650, p=0.264). There were no significant differences between the two groups with respect to the age of the patients, gender distribution, or the presence of synechiae, granulation tissue, or signs of infection on DNE. Conclusion: Although both the merocele and ribbon gauze packs can be suggested for use after septal operations, the merocele pack has the benefit of producing much less morbidity. Merocele cost is a major constraint at present so we should try to develop a similar nasal pack with less cost to benefit the maximum population. [ABSTRACT FROM AUTHOR]

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Introduction: In secondary cleft lip and nasal deformity (CLND) correction, structural grafts are commonly used to control the nasal tip and restore the symmetry of the ala. However, the septal cartilage in Asians often weak and small. Biocompatible absorbable materials are alternatives to autologous grafts. This study assessed the surgical outcomes and complications of poly lactic-co-glycolic acid (PLGA) plate grafts in secondary CLND correction. Methods: This study was retrospectively analyzed for patients who underwent secondary rhinoplasty for unilateral CLND correction between March 2015 and November 2020. Using open rhinoplasty, the PLGA plate was grafted as a columellar strut. Clinical photographs taken at the initial (T0) and follow-up visits (T1: short-term, T2: long-term) were analyzed and anthropometric parameters, such as nostril height and width, dome height, and tip height, were measured. Results: Twenty-four patients were included in this study. The mean T1 and T2 periods were 1.0 ± 0.4 and 15.5 ± 3.1 months, respectively. The nostril height ratio increased from 0.78 ± 0.12 at T0 to 0.88 ± 0.08 at T1 and 0.86 ± 0.09 at T2 (p < 0.001; Relapse ratio −2.6 ± 6.7%). The tip height ratio increased from 0.60 ± 0.07 (T0) to 0.66 ± 0.05 (T2) (Relapse ratio −3.7 ± 3.0%). Conclusions: The PLGA plate graft provided stable nasal tip projection and alar symmetry without major complications. It can be a good option for patients lacking available septal and concha cartilages or apprehensive of additional scarring. [ABSTRACT FROM AUTHOR]

Background: This retrospective, single-center study aimed to identify factors affecting the success rate of endonasal dacryocystorhinostomy (DCR). Methods: A total of 891 eyes that underwent endonasal DCR were reviewed. Univariate and multivariate association analyses were performed to assess the impact of various factors on anatomical and functional success rates. Anatomical success was defined as patent lacrimal irrigation and well-formed osteotomy in nasopharyngoscopy, while functional success was defined as a Munk score of 0-1 after silicone tube removal. Results: Early removal of the silicone tube and use of absorbable nasal packing material were significantly associated with lower anatomical and functional success rates in univariate and multivariate analyses. Anatomical success rates were 59.56% with early removal of the silicone tube and 70.29% with absorbable nasal packing material. Similarly, functional success rates were 49.33% with early removal of the silicone tube and 62.10% with absorbable nasal packing material. The odds ratios of the anatomical success rate for early removal of silicone tube and using absorbable nasal packing material were 0.377 and 0.567, respectively (P < .001, P=.002). In addition, the odds ratio of the functional success rate was .257 and .523, respectively (P < .001, P=.001). Conclusion: Early removal of silicone tubes and absorbable packing material were identified as factors that negatively impact the functional and anatomical success rates of endonasal DCR. [ABSTRACT FROM AUTHOR]

Empty nose syndrome (ENS) is a rare complication following nasal surgery, particularly surgery of the turbinates, with limited effectiveness of its treatments. A synthesis without meta-analysis (SWiM) was carried out to assess treatments and their reported effectiveness. In August 2022, a literature search was conducted on PubMed, Google Scholar, Cochrane Database, Science Direct, and Embase. Article selection, eligibility assessment, and risk of bias evaluation of each article were performed independently by each author and then compared. A synthesis without meta-analysis was then conducted on the selected studies. Forty-three articles were selected from 445 potential references, encompassing 586 patients. The quality of publications on ENS was generally poor or critical. Reported treatments for ENS, attributed to a combination of endonasal aerodynamic changes, impaired intranasal trigeminal function, and psychological factors, primarily consisted of intranasal topical instillations, lower meatus filling, stem cell therapy, and psychological/psychiatric management. However, all reported case series were subject to significant biases. As it was not feasible to address the question, “How effective are the treatments for ENS?” this synthesis aimed to answer, “Is there evidence of effectiveness of ENS treatments?” Possible treatments encompassed medical, surgical, psychological, and respiratory interventions. Nevertheless, the available data with limited bias were insufficient to provide precise recommendations for their indications. Future research employing robust methodological approaches is essential to assess treatment effectiveness. [ABSTRACT FROM AUTHOR]