Cost-effectiveness assessment in outpatient sinonasal surgery.

PubMed

Mortuaire, G; Theis, D; Fackeure, R; Chevalier, D; Gengler, I

2018-02-01

To assess the cost-effectiveness of outpatient sinonasal surgery in terms of clinical efficacy and control of expenses. A retrospective study was conducted from January 2014 to January 2016. Patients scheduled for outpatient sinonasal surgery were systematically included. Clinical data were extracted from surgical and anesthesiology computer files. The cost accounting methods applied in our institution were used to evaluate logistic and technical costs. The standardized hospital fees rating system based on hospital stay and severity in diagnosis-related groups (Groupes homogènes de séjours: GHS) was used to estimate institutional revenue. Over 2years, 927 outpatient surgical procedures were performed. The crossover rate to conventional hospital admission was 2.9%. In a day-1 telephone interview, 85% of patients were very satisfied with the procedure. All outpatient cases showed significantly lower costs than estimated for conventional management with overnight admission, while hospital revenue did not differ between the two. This study confirmed the efficacy of outpatient surgery in this indication. Lower costs could allow savings for the health system by readjusting the rating for the procedure. More precise assessment of cost-effectiveness will require more fine-grained studies based on micro costing at hospital level and assessment of impact on conventional surgical activity and post-discharge community care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

DigBody®: A new 3D modeling tool for nasal virtual surgery.

PubMed

Burgos, M A; Sanmiguel-Rojas, E; Singh, Narinder; Esteban-Ortega, F

2018-07-01

Recent studies have demonstrated that a significant number of surgical procedures for nasal airway obstruction (NAO) have a high rate of surgical failure. In part, this problem is due to the lack of reliable objective clinical parameters to aid surgeons during preoperative planning. Modeling tools that allow virtual surgery to be performed do exist, but all require direct manipulation of computed tomography (CT) or magnetic resonance imaging (MRI) data. Specialists in Rhinology have criticized these tools for their complex user interface, and have requested more intuitive, user-friendly and powerful software to make virtual surgery more accessible and realistic. In this paper we present a new virtual surgery software tool, DigBody ® . This new surgery module is integrated into the computational fluid dynamics (CFD) program MeComLand ® , which was developed exclusively to analyze nasal airflow. DigBody ® works directly with a 3D nasal model that mimics real surgery. Furthermore, this surgery module permits direct assessment of the operated cavity following virtual surgery by CFD simulation. The effectiveness of DigBody ® has been demonstrated by real surgery on two patients based on prior virtual operation results. Both subjects experienced excellent surgical outcomes with no residual nasal obstruction. This tool has great potential to aid surgeons in modeling potential surgical maneuvers, minimizing complications, and being confident that patients will receive optimal postoperative outcomes, validated by personalized CFD testing. Copyright © 2018 Elsevier Ltd. All rights reserved.

Is outpatient brain tumor surgery feasible in India?

PubMed

Turel, Mazda K; Bernstein, Mark

2016-01-01

The current trend in all fields of surgery is towards less invasive procedures with shorter hospital stays. The reasons for this change include convenience to patients, optimal resource utilization, and cost saving. Technological advances in neurosurgery, aided by improvements in anesthesia, have resulted in surgery that is faster, simpler, and safer with excellent perioperative recovery. As a result of improved outcomes, some centers are performing brain tumor surgery on an outpatient basis, wherein patients arrive at the hospital the morning of their procedure and leave the hospital the same evening, thus avoiding an overnight stay in the hospital. In addition to the medical benefits of the outpatient procedure, its impact on patient satisfaction is substantial. The economic benefits are extremely favorable for the patient, physician, as well as the hospital. In high volume centers, a day surgery program can exist alongside those for elective and emergency surgeries, providing another pathway for patient care. However, due to skepticism surrounding the medicolegal aspects, and how radical the concept at first sounds, these procedures have not gained widespread popularity. We provide an overview of outpatient brain tumor surgery in the western world, discussing the socioeconomic, medicolegal, and ethical issues related to its adaptability in a developing nation.

Outpatient versus Inpatient Primary Cleft Lip and Palate Surgery: Analysis of Early Complications.

PubMed

Kantar, Rami S; Cammarata, Michael J; Rifkin, William J; Plana, Natalie M; Diaz-Siso, J Rodrigo; Flores, Roberto L

2018-05-01

Fiscal constraints are driving shorter hospital lengths of stay. Outpatient primary cleft lip surgery has been shown to be safe, but outpatient primary cleft palate surgery remains controversial. This study evaluates outcomes following outpatient versus inpatient primary cleft lip and palate surgery. The American College of Surgeons National Surgical Quality Improvement Program Pediatric database was used to identify patients undergoing primary cleft lip and palate surgery between 2012 and 2015. Patient clinical factors and 30-day complications were compared for outpatient versus inpatient primary cleft lip and palate surgery. Univariate and multivariate analyses were performed. Three thousand one hundred forty-two patients were included in the primary cleft lip surgery group and 4191 in the primary cleft palate surgery group. Patients in the cleft lip surgery group with structural pulmonary abnormalities had a significantly longer hospital length of stay (β, 4.94; p = 0.001). Patients undergoing outpatient surgery had a significantly higher risk of superficial (OR, 1.99; p = 0.01) and deep wound dehiscence (OR, 2.22; p = 0.01), and were at a significantly lower risk of reoperation (OR, 0.36; p = 0.04) and readmission (OR, 0.52; p = 0.02). Outpatient primary cleft lip surgery is safe and has a complication profile similar to that of inpatient surgery. Outpatient primary cleft palate surgery is common practice in many U.S. hospitals and has a significantly higher rate of wound complications, and lower rates of reoperation and readmission. In properly selected patients, outpatient palatoplasty can be performed safely. Therapeutic, III.

Thoracoscopic Surgery for Pneumothorax Following Outpatient Drainage Therapy.

PubMed

Sano, Atsushi; Yotsumoto, Takuma

2017-10-20

We investigated the outcomes of surgery for pneumothorax following outpatient drainage therapy. We reviewed the records of 34 patients who underwent operations following outpatient drainage therapy with the Thoracic Vent at our hospital between December 2012 and September 2016. Indications for outpatient drainage therapy were pneumothorax without circulatory or respiratory failure and pleural effusion. Indications for surgical treatment were persistent air leakage and patient preference for surgery to prevent or reduce the incidence of recurrent pneumothorax. Intraoperatively, 9 of 34 cases showed loose adhesions around the Thoracic Vent, all of which were dissected bluntly. The preoperative drainage duration ranged from 5 to 13 days in patients with adhesions and from 3 to 19 days in those without adhesions, indicating no significant difference. The duration of preoperative drainage did not affect the incidence of adhesions. The operative duration ranged from 30 to 96 minutes in patients with adhesions and from 31 to 139 minutes in those without adhesions, also indicating no significant difference. Outpatient drainage therapy with the Thoracic Vent was useful for spontaneous pneumothorax patients who underwent surgery, and drainage for less than 3 weeks did not affect intraoperative or postoperative outcomes.

[Clinical analysis of nasal resistance and pulmonary function testing in patients with chronic nasal-sinusitis and nasal polyps].

PubMed

Liao, Hua; Shen, Ying; Wang, Pengjun

2015-05-01

To study the pulmonary function and nasal resistance characteristics of patients with chronic nose-sinusitis and nasal polyps (CRSwNP), to explore the evaluation role of nasal resistance in nasal ventilation function and the effect of endoscopic sinus surgery on pulmonary function in patients with CRSwNP. Fifty CRSwNP patients that met the study criteria were selected . The patients were performed endoscopic surgeries according to Messerklinger surgical procedures under general anesthesia. Extent of surgery was based on preoperative CT showing the range of the lesion of disease and endoscopic findings. Perioperative treatments contained intranasal corticosteroids, cephalosporin or penicillin antibiotics, nasal irrigation and other treatments. Main outcome measures included visual analog scale (VAS), endoscopic Lind-Kennedy scores, nasal resistence, pulmonary function in patientsone week before and after surgery, three months and six months after surgery. Pulmonary function includes forced expiratory volume in one second (FEV1), forced vital capacity FEV1/FVC and peak expiratory flow (PEF). The study found that there were significantly positive correlations among VAS score, Lund-Kennedy score and nasal resistance (P < 0.05) in CRSwNP patients, but there is a significantly negative correlation between VAS score, Lund-Kennedy score, nasal resistance and pulmonary function indexes of FEV1, FVC and PEF (P < 0.05). The VAS score, Lund-Kennedy score and nasal resistance values of CRSwNP patients were decreased significantly after comprehensive treatments with nasal endoscopic operation as the major one, the difference was statistically different (P < 0.05). And the pulmonary function indexs (FEV1, FVC, PEF) were significantly increased after surgery in CRSwNP patients. The nasal resistance can objectively and reliably reflect the degree of nasal congestion and the recovery of nasal function in CRSwNP patients after endoscopic sinus surgery. The detection method of nasal

Nasal changes after orthognathic surgery for patients with prognathism and Class III malocclusion: analysis using three-dimensional photogrammetry.

PubMed

Worasakwutiphong, Saran; Chuang, Ya-Fang; Chang, Hsin-Wen; Lin, Hsiu-Hsia; Lin, Pei-Ju; Lo, Lun-Jou

2015-02-01

Orthognathic surgery alters the position of maxilla and mandible, and consequently changes the nasal shape. The nasal change remains a concern to Asian patients. The aim of this study was to measure the nasal changes using a novel three-dimensional photographic imaging method. A total of 38 patients with Class III malocclusion and prognathism were enrolled. All patients underwent two-jaw surgery with the standard technique. A nasal alar cinching suture was included at the end of procedure. Facial landmarks and nasal morphology were defined and measured from pre- and postoperative three-dimensional photographic images. Intra-rater errors on landmark identification were controlled. Patient's reports of perceptual nasal changes were recorded. The average width of the alar base and subalare remained similar after surgery. Alar width was increased by 0.74 mm. Nasal height and length remained the same. Nasolabial angle increased significantly. The area of nostril show revealed a significant increase and was correlated with a decrease of columella inclination. Nasal tip projection decreased significantly, by 1.99 mm. Preoperative nasal morphology was different between patients with and without cleft lip/palate, but most nasal changes were concordant. In the self-perception, 37% of patients reported improved nasal appearance, 58% reported no change, and 5% were not satisfied with the nasal changes. After the surgery, characteristic nasal changes occurred with an increase of nasolabial angle and nostril show, but a preserved nasal width. The majority of patients did not perceive adverse nasal changes. Copyright © 2014. Published by Elsevier B.V.

Hypnosis closed loop TCI systems in outpatient surgery.

PubMed

Ramos-Luengo, A; Asensio-Merino, F

Determine the influence of general anaesthesia with closed-loop systems in the results of outpatient varicose vein surgery. Retrospective observational study including data from 270 outpatients between 2014 and 2015. The patients were divided into 2 groups according to the type of general anaesthesia used. The CL Group included patients who received propofol in closed-loop guided by BIS and remifentanil using TCI, and the C Group received non-closed-loop anaesthesia. Age, sex, surgical time, discharge time and failure of outpatient surgery were recorded. Quantitative data were checked for normal distribution by the method of Kolmogorov-Smirnov-Lilliefors. Differences between groups were analysed by a Student-t-test or Mann-Whitney-Wilcoxon test, depending on their distribution. Categorical data were analysed by a Chi-squared test. We used Kaplan-Meier estimator and the effect size (calculated by Cohen's d) to study the discharge time. Statistical analysis was performed using R 3.2.3 binary for Mac OS X 10.9. There were no significant differences in age, sex and surgical time and failure of outpatient surgery. Discharge time was different in both groups: 200 (100) vs. 180 (82.5) minutes, C Group and CL Group, respectively (data are median and interquartile rank); P=.005. The use of closed-loop devices for the hypnotic component of anaesthesia hastens discharge time. However, for this effect to be clinically significant, some improvements still need to be made in our outpatient surgery units. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

[Acute asthma attacks introduced by anesthesia before nasal endoscopic surgery].

PubMed

Lü, Xiaofei; Han, Demin; Zhou, Bing; Ding, Bin

2004-05-01

In order to pay our attention to the perioperative treatment before nasal endoscopic surgery. Three patients with asthma accompanied chronic sinusitis were analyzed systemically, who had undergone acute attacks of asthma introduced by anesthesia. Anesthetic drugs and instruments can lead to acute attacks of asthma, because sinusitis with asthma means allergic airway inflammation, broncho-hyperreactivity and lower compensatory pulmonary function. Then all of the 3 cases had missed the preoperative treatment. Anesthetic drugs and instruments can lead to acute attacks of asthma. The perioperative treatment before nasal endoscopic surgery is very important for the prevention of the occurrences of this severe complication. Except emergency, the operation should be can celled for avoiding the acute attack of asthma introduced by anesthesia.

Computed Intranasal Spray Penetration: Comparisons Before and After Nasal Surgery

PubMed Central

Frank, Dennis O.; Kimbell, Julia S.; Cannon, Daniel; Rhee, John S.

2012-01-01

Background Quantitative methods for comparing intranasal drug delivery efficiencies pre- and postoperatively have not been fully utilized. The objective of this study is to use computational fluid dynamics techniques to evaluate aqueous nasal spray penetration efficiencies before and after surgical correction of intranasal anatomic deformities. Methods Ten three-dimensional models of the nasal cavities were created from pre- and postoperative computed tomography scans in five subjects. Spray simulations were conducted using a particle size distribution ranging from 10–110μm, a spray speed of 3m/s, plume angle of 68°, and with steady state, resting inspiratory airflow present. Two different nozzle positions were compared. Statistical analysis was conducted using Student T-test for matched pairs. Results On the obstructed side, posterior particle deposition after surgery increased by 118% and was statistically significant (p-value=0.036), while anterior particle deposition decreased by 13% and was also statistically significant (p-value=0.020). The fraction of particles that by-passed the airways either pre- or post-operatively was less than 5%. Posterior particle deposition differences between obstructed and contralateral sides of the airways were 113% and 30% for pre- and post-surgery, respectively. Results showed that nozzle positions can influence spray delivery. Conclusions Simulations predicted that surgical correction of nasal anatomic deformities can improve spray penetration to areas where medications can have greater effect. Particle deposition patterns between both sides of the airways are more evenly distributed after surgery. These findings suggest that correcting anatomic deformities may improve intranasal medication delivery. For enhanced particle penetration, patients with nasal deformities may explore different nozzle positions. PMID:22927179

Effects of nasal septum perforation repair surgery on three-dimensional airflow: an evaluation using computational fluid dynamics.

PubMed

Nomura, Tsutomu; Ushio, Munetaka; Kondo, Kenji; Yamasoba, Tatsuya

2015-11-01

The purpose of this research is to determine the cause of nasal perforation symptoms and to predict post-operative function after nasal perforation repair surgery. A realistic three-dimensional (3D) model of the nose with a septal perforation was reconstructed using a computed tomography (CT) scan from a patient with nasal septal defect. The numerical simulation was carried out using ANSYS CFX V13.0. Pre- and post-operative models were compared by their velocity, pressure gradient (PG), wall shear (WS), shear strain rate (SSR) and turbulence kinetic energy in three plains. In the post-operative state, the crossflows had disappeared, and stream lines bound to the olfactory cleft area had appeared. After surgery, almost all of high-shear stress areas were disappeared comparing pre-operative model. In conclusion, the effects of surgery to correct nasal septal perforation were evaluated using a three-dimensional airflow evaluation. Following the surgery, crossflows disappeared, and WS, PG and SSR rate were decreased. A high WS.PG and SSR were suspected as causes of nasal perforation symptoms.

Impact of developing a multidisciplinary coded dataset standard on administrative data accuracy for septoplasty, septorhinoplasty and nasal trauma surgery.

PubMed

Nouraei, S A R; Hudovsky, A; Virk, J S; Saleh, H A

2017-04-01

This study aimed to develop a multidisciplinary coded dataset standard for nasal surgery and to assess its impact on data accuracy. An audit of 528 patients undergoing septal and/or inferior turbinate surgery, rhinoplasty and/or septorhinoplasty, and nasal fracture surgery was undertaken. A total of 200 septoplasties, 109 septorhinoplasties, 57 complex septorhinoplasties and 116 nasal fractures were analysed. There were 76 (14.4 per cent) changes to the primary diagnosis. Septorhinoplasties were the most commonly amended procedures. The overall audit-related income change for nasal surgery was £8.78 per patient. Use of a multidisciplinary coded dataset standard revealed that nasal diagnoses were under-coded; a significant proportion of patients received more precise diagnoses following the audit. There was also significant under-coding of both morbidities and revision surgery. The multidisciplinary coded dataset standard approach can improve the accuracy of both data capture and information flow, and, thus, ultimately create a more reliable dataset for use outcomes and health planning.

Peak nasal inspiratory flow correlates with quality of life in functional endoscopic sinus surgery.

PubMed

Whitcroft, K L; Andrews, P J; Randhawa, P S

2017-12-01

Whilst nasal function and airflow improve subjectively following functional endoscopic sinus surgery (FESS), a clinically useful and objective tool for quantifying such improvement is lacking. The peak nasal inspiratory flow (PNIF) metre offers convenient and objective measures of nasal patency. However, it has not yet been established whether changes in PNIF after surgery reflect changes in subjective disease burden. In this study we aimed to determine whether changes in PNIF correlate with commonly used subjective symptom and quality of life outcome measures following FESS for chronic rhinosinusitis (CRS). Prospective cohort. Royal National Throat Nose and Ear Hospital. Thirty-seven patients undergoing FESS for CRS, with or without polyps (21 male, mean age 48.8). PNIF, "SNOT-22", "NOSE" and "VAS" questionnaires were performed before and after surgery. In all patients, there was a strong negative correlation between change in PNIF and change in "SNOT-22" score following surgery (Pearson r=-.64, P<.0001). Strong negative correlations were also seen during subgroup analysis of patients with and without polyps (r=-.57, P=.006 and r=-.67, P=.005, respectively). Change in PNIF correlated significantly with change in "NOSE" score following surgery in all patients and those without polyps (r=-.54, P=.0005 and r=-.68, P=.003). There were no significant correlations between PNIF and VAS (nasal obstruction). Changes in PNIF after FESS appear to best reflect improvements in quality of life in CRS as measured using the "SNOT-22" questionnaire. © 2017 John Wiley & Sons Ltd.

[The effect of laryngoscopic surgery combined with nasal endoscopic system for the treatment of vocal cords benign lesions].

PubMed

Wang, Weian; Lu, Rong

2013-06-01

To investigate the effect of laryngoscopic surgery combined with nasal endoscopic system for the treatment of vocal cords benign lesions. Fifty-two patients admitted to our department with vocal cords benign lesions (including vocal polyps, vocal nodules, vocal cord cyst) underwent laryngoscopic surgery combined with nasal endoscopic system. All patients were treated successfully once and for all without any significant postoperative complication. The laryngoscopic surgery combined with nasal endoscopic system is a safe, minimally invasive and simple method for the treatment of benign lesions of vocal cords.

Ambulatory surgery center market share and rates of outpatient surgery in the elderly.

PubMed

Hollenbeck, Brent K; Hollingsworth, John M; Dunn, Rodney L; Zaojun Ye; Birkmeyer, John D

2010-12-01

Relative to outpatient surgery in hospital settings, ambulatory surgery centers (ASCs) are more efficient and associated with a lower cost per case. However, these facilities may also spur higher overall procedure utilization and thus lead to greater overall health care costs. The authors used the State Ambulatory Surgery Database from the State of Florida to identify Medicare-aged patients undergoing 4 common ambulatory procedures in 2006, including knee arthroscopy, cystoscopy, cataract removal, and colonoscopy. Hospital service areas (HSAs) were characterized according to ASC market share, that is, the proportion of residents undergoing outpatient surgery in these facilities. The authors then examined relationships between ASC market share and rates of each procedure. Age-adjusted rates of ambulatory surgery ranged from 190.5 cases per 1000 to 320.8 cases per 1000 in HSAs with low and high ASC market shares, respectively (P < .01). For all 4 procedures, adjusted rates of procedures were significantly higher in HSAs with the highest ASC market share. The greatest difference, both in relative and absolute terms, was observed for patients undergoing cystoscopy. In areas of high ASC market share, the age-adjusted rate of cystoscopy was nearly 3-fold higher than in areas with low ASC market share (34.5 vs 11.9 per 1000 population; P < .01). The presence of an ASC is associated with higher utilization of common outpatient procedures in the elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear.

Does procedure profitability impact whether an outpatient surgery is performed at an ambulatory surgery center or hospital?

PubMed

Plotzke, Michael Robert; Courtemanche, Charles

2011-07-01

Ambulatory surgery centers (ASCs) are small (typically physician owned) healthcare facilities that specialize in performing outpatient surgeries and therefore compete against hospitals for patients. Physicians who own ASCs could treat their most profitable patients at their ASCs and less profitable patients at hospitals. This paper asks if the profitability of an outpatient surgery impacts where a physician performs the surgery. Using a sample of Medicare patients from the National Survey of Ambulatory Surgery, we find that higher profit surgeries do have a higher probability of being performed at an ASC compared to a hospital. After controlling for surgery type, a 10% increase in a surgery's profitability is associated with a 1.2 to 1.4 percentage point increase in the probability the surgery is performed at an ASC. Copyright © 2010 John Wiley & Sons, Ltd.

Outcomes of Surgeries Performed in Physician Offices Compared With Ambulatory Surgery Centers and Hospital Outpatient Departments in Florida

PubMed Central

Ohsfeldt, Robert L; Li, Pengxiang; Schneider, John E; Stojanovic, Ivana; Scheibling, Cara M

2017-01-01

Background: The proportion of outpatient surgeries performed in physician offices has been increasing over time, raising concern about the impact on outcomes. Objective: To use a private insurance claims database to compare 7-day and 30-day hospitalization rates following relatively complex outpatient surgical procedures across physician offices, freestanding ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPDs). Methods: A multivariable logistic regression model was used to compare the risk-adjusted probability of hospitalization among patients after any of the 88 study outpatient procedures at physician offices, ASCs, and HOPDs over 2008-2012 in Florida. Results: Risk-adjusted hospitalization rates were higher following procedures performed in physician offices compared with ASCs for all procedures grouped together, for most procedures grouped by type, and for many individual procedures. Conclusions: Hospitalizations following surgery were more likely for procedures performed in physician offices compared with ASCs, which highlights the need for ongoing research on the safety and efficacy of office-based surgery. PMID:28469457

Current aspects in reconstructive surgery for nasal cavity and paranasal sinus cancer

NASA Astrophysics Data System (ADS)

Shtin, V. I.; Novikov, V. A.; Gjunter, V. E.; Choinzonov, E. L.; Ryabova, A. I.; Sirkashev, V. A.; Surkova, P. V.; Vasilev, R. V.; Menkova, E. N.

2017-09-01

Tumors of the nasal cavity and paranasal sinuses present a challenge to treat them. A combination of surgery and radiation therapy can improve treatment outcomes in 49-56% [1, 2] of the patients with locally advanced nasal cavity and paranasal sinus cancer. The midface reconstruction poses a formidable challenge to the reconstructive surgeon due to the region's complex skeletal and soft-tissue anatomy. The rehabilitation program including the reconstruction of the resected orbital walls using the porous and mesh implants from titanium nickelid (TiNi) was developed at the Cancer Research institute jointly with the Research Institute of Medical Materials. The technique was proven effective, allowing the natural position of the eye and visual function to be preserved in 90% [1-3] of the patients. A long period of reparative processes and risk of developing inflammation in the implant area, as well as the need to decrease length of surgery, contributed to the development of a novel approach to repairing the midface bone structures using the implant based on the microporous wire and TiNi mesh. Eighteen patients with nasal cavity and paranasal sinus cancer were treated using the combined thin implants. The novel technique allowed the time of the implant installation to be reduced to 5-10 min. The structure of the implant contributed to prevention of inflammatory processes in 97% [1, 2] of cases. Thus, the natural position of the eyeball and visual function were preserved in 100% [1, 3, 4] of patients. The use of the TiNi implants in reconstructive surgery for patients with nasal cavity and paranasal sinus cancer led to reduced time of surgery and rehabilitation, increased level of social adaptation of patients and improved cosmetic and functional results.

Transient Exacerbation of Nasal Symptoms following Endoscopic Transsphenoidal Surgery for Pituitary Tumors: A Prospective Study.

PubMed

Davies, Benjamin M; Tirr, Erica; Wang, Yi Yuen; Gnanalingham, Kanna K

2017-06-01

Object  Endoscopic transsphenoidal surgery is the commonest approach to pituitary tumors. One disadvantage of this approach is the development of early postoperative nasal symptoms. Our aim was to clarify the peak onset of these symptoms and their temporal evolution. Methods  The General Nasal Patient Inventory (GNPI) was administered to 56 patients undergoing endoscopic transsphenoidal surgery for pituitary tumors preoperatively and at 1 day, 3 days, 2 weeks, 3 months, and 6 to 12 months postoperatively. Most patients underwent surgery for pituitary adenomas ( N  = 49; 88%) and through a uninostril approach ( N  = 55; 98%). Total GNPI (0-135) and scores for the 45 individual components were compared. Results  GNPI scores peaked at 1 to 3 days postoperatively, with rapid reduction to baseline by 2 weeks and below baseline by 6 to 12 months postsurgery ( p  < 0.01). Of the 45 individual symptoms on the GNPI scale, 19 (42%) worsened transiently after surgery ( p  < 0.05). Functioning tumors had a higher GNPI scores at postoperative day 1 and 3 than nonfunctioning tumors, although their temporal evolution was the same ( p  < 0.05). Conclusions  Nasal morbidity following endoscopic transsphenoidal pituitary surgery is common, but transient, more so in the functioning subgroup. Nasal symptoms improve below baseline by 6 to 12 months, without the need for specific long-term postoperative interventions in the vast majority of patients.

e-Consultation Improves Efficacy in Thoracic Surgery Outpatient Clinics.

PubMed

Novoa, Nuria M; Gómez, Maria Teresa; Rodríguez, María; Jiménez López, Marcelo F; Aranda, Jose L; Bollo de Miguel, Elena; Diez, Florentino; Hernández Hernández, Jesús; Varela, Gonzalo

2016-11-01

The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

Nasal and conjunctival screening prior to refractive surgery: an observational and cross-sectional study

PubMed Central

Kitazawa, Koji; Sotozono, Chie; Sakamoto, Masako; Sasaki, Miho; Hieda, Osamu; Yamasaki, Toshihide; Kinoshita, Shigeru

2016-01-01

Objectives To investigate bacterial flora of clinically healthy conjunctiva and nasal cavity among patients prior to refractive surgery, as well as the characteristics of patients with methicillin-resistant Staphylococcus aureus (MRSA) colonisation. Design Observational and cross-sectional study. Setting A single-centre study in Japan. Participants 120 consecutive patients pre-refractive surgery. Primary and secondary outcome measures methods Samples were obtained from the right conjunctival sac and the nasal cavity of 120 consecutive patients prior to refractive surgery and were then measured for the levels of the minimum inhibitory concentration (MIC) of antibiotics. Patients were interviewed regarding their occupation, family living situation and any personal history of atopic dermatitis, asthma, smoking or contact lens wear. Results Propionibacterium acnes (P. acnes) (32.5%) and Staphylococcus epidermidis (4.2%) were detected from the conjunctival sac. S. epidermidis was the most commonly isolated (68.3%) in the nasal cavity. Of the 30 patients (25.0%) with colonisation by S. aureus, 2 patients, both of whom were healthcare workers with atopic dermatitis, were found to be positive for MRSA in the nasal cavity. A history of contact lens wear, asthma or smoking, as well as patient gender and age, was not associated with MRSA colonisation. Conclusions There were only 2 patients who were colonised with MRSA, both of whom were healthcare workers with atopic dermatitis. P. acnes was predominantly found in the conjunctival sac. Further study is needed to investigate the involvement between nasal and conjunctival flora, and risk factors for infectious complications. PMID:27160843

Baby shampoo nasal irrigations for the symptomatic post-functional endoscopic sinus surgery patient.

PubMed

Chiu, Alexander G; Palmer, James N; Woodworth, Bradford A; Doghramji, Laurel; Cohen, Michael B; Prince, Anthony; Cohen, Noam A

2008-01-01

Symptoms of postnasal drainage and thickened mucus are commonly seen in patients with chronic rhinosinusitis (CRS) recalcitrant to sinus surgery and conventional medical therapies. Chemical surfactants can act as a mucolytic by reducing water surface tension and have the potential to serve as an antimicrobial agent. Baby shampoo is an inexpensive, commercially available solution containing multiple chemical surfactants. This is an in vitro study of its antimicrobial effects on Pseudomonas biofilms with translation to a clinical study for use as an adjuvant nasal wash in patients with CRS who remain symptomatic despite adequate sinus surgery and conventional medical therapies. In vitro testing was performed to determine the optimal concentration of baby shampoo that disrupted preformed bacterial biofilms and inhibited biofilm formation. This concentration was then used in a prospective study of symptomatic post-functional endoscopic sinus surgery (FESS) patients who irrigated twice a day for 4 weeks. Validated outcome forms and objective smell testing was performed before and after therapy. One percent baby shampoo in normal saline was the optimal concentration for inhibition of Pseudomonas biofilm formation. Baby shampoo had no effect on the eradication of preformed Pseudomonas biofilms. Eighteen patients with CRS with an average of 2.8 surgeries were studied after irrigating with 1% baby shampoo solution. Two patients discontinued use because of minor nasal and skin irritations; 46.6% of patients experienced an overall improvement in their subjective symptoms, and 60% of patients noted improvement in specific symptoms of thickened mucus and postnasal drainage. Baby shampoo nasal irrigation has promise as an inexpensive, tolerable adjuvant to conventional medical therapies for symptomatic patients after FESS. Its greatest benefit may be in improving symptoms of thickened nasal discharge and postnasal drainage.

Staphylococcus aureus nasal decolonization in joint replacement surgery reduces infection.

PubMed

Hacek, Donna M; Robb, William J; Paule, Suzanne M; Kudrna, James C; Stamos, Van Paul; Peterson, Lance R

2008-06-01

Surgical site infections (SSIs) with Staphylococcus aureus are a recognized adverse event of hip and knee replacements. We evaluated the impact of a program to detect S. aureus nasal carriers before surgery with preoperative decolonization (using mupirocin twice daily for 5 days prior to surgery) of carriers. Nasal swab samples were obtained from patients prior to surgery from 8/1/2003 through 2/28/2005. Samples were tested using real-time PCR technology to detect S. aureus. The group that developed S. aureus SSI was compared to a combined concurrent and historical control for one year following the operation. S. aureus caused 71% of SSIs in the combined control groups. Of the 1495 surgical candidates evaluated, 912 (61.0%) were screened for S. aureus; 223 of those screened (24.5%) were positive and then decolonized with mupirocin. Among the 223 positive and decolonized patients, three (1.3%) developed a SSI. Among the 689 screen-negative patients, four (0.6%) developed SSIs for an overall rate of 0.77%. Among the 583 control patients who were not screened or decolonized, 10 (1.7%) developed S. aureus SSIs. SSIs from other organisms were 0.44% and 0.69%, respectively. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

[Evolution and viability of an outpatient surgery center for cataract surgery on a large scale in a university hospital].

PubMed

Kara-Junior, Newton; Espíndola, Rodrigo França de

2010-01-01

To analyze the number of surgeries performed in outpatient surgical center at a university hospital and to assess its financial viability during and after the interruption of the Cataract National Campaign in 2006. Retrospective analytical study between 2005 and 2009 at the Clinical Hospital of the University of São Paulo (HC-FMUSP) which evaluated the economic viability of the outpatient surgical center, the number of cataract surgeries performed and the number of surgeons present daily in that unit. It would be necessary to perform at least 400 procedures monthly to ensure the financial viability of the outpatient surgical center. This number was lower than the expected in the years of 2008 and 2009 (average of 370.6 and 390.1 surgeries respectively). The number of cataract fellows decreased from 13 in 2005 to 3 in 2009. The main factor for the reduction in the number of cataract surgeries performed in the outpatient surgical center after 2006 was the difficulty of access of the population to the hospital due to restrictions on the development of screening projects. The increased use of the operating rooms by other clinics and the decrease in the admission of new surgeons, made the outpatient surgical center appropriate and viable for the new political-economic reality.

[Innovating to support the development of outpatient surgery].

PubMed

Dubois, Ronan

Le Confluent private hospital in Nantes has opened a unit devoted to outpatient surgery. Its architecture, organisation, facilities and services have all been designed to treat patients in as short a timeframe as possible. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Appraisal of transverse nasal groove: a study.

PubMed

Sathyanarayana, Belagola D; Basavaraj, Halevoor B; Nischal, Kuchangi C; Swaroop, Mukunda R; Umashankar, Puttagangu N; Agrawal, Dhruv P; Swamy, Suchetha S; Okram, Sarda

2012-01-01

Transverse nasal groove is a condition of cosmetic concern which awaits due recognition and has been widely described as a shallow groove that extends transversely over the dorsum of nose. However, we observed variations in the clinical presentations of this entity, hitherto undescribed in literature. We conducted a clinicoepidemiological study of transverse nasal lesions in patients attending our outpatient department. We conducted a prospective observational study. We screened all patients attending our out-patient department for presence of transverse nasal lesions, signs of any dermatosis and associated other skin conditions. One hundred patients were recruited in the study. Females (80%) predominated over males. Most patients were of 15-45 years age group (70%). Majority of the transverse nasal lesions were classical transverse nasal groove (39%) and others included transverse nasal line (28%), strip (28%), ridge (4%) and loop (1%). Seborrhoeic diathesis was the most common condition associated with transverse nasal lesion. Occurrence of transverse nasal line, strip, ridge and loop, in addition to classical transverse nasal groove implies that latter is actually a subset of transverse nasal lesions. Common association of this entity with seborrheic dermatitis, seborrhea and dandruff raises a possibility of whether transverse nasal lesion is a manifestation of seborrheic diathesis.

The Effect of Dexpanthenol-Vitamin A (Nazalnem) on Silastic Splints After Nasal Septal Surgery.

PubMed

Yildirim, Güven; Kumral, Tolgar Lütfi; Altindağ, Cem; Özdemir, Erdi; Uyar, Yavuz

2017-11-01

To investigate the effect of dexpanthenol-vitamin A (Nazalnem) ointment applied to the surface of silastic splints with an airway immediately after nasal septal surgery on postoperative complaints and nasal mucosa function. The study enrolled 60 patients undergoing nasal septoplasty surgery. Group 1 (n = 30) received silastic splints with ointment containing dexpanthenol-vitamin A (Nazalnem), and Group 2 (n = 30), the control group, received silastic splints with vaseline. Of these patients, 2 patients from the Group 1 and 9 from the Group 2 were excluded.A thin layer of ointment was applied to the flat side of a silastic splint with an airway. The splints were removed on the second postoperative day. Patients were evaluated preoperatively and 1 and 2 weeks postoperatively using a visual analog scale and the Sino-Nasal Outcome test (SNOT-22). Mucociliary clearance (MCC) tests were performed at the same times. Visual analog scale for nasal crusting, nasal congestion, and foul odor was better in Group 1 than in Group 2 both at 1 week and at 2 weeks postoperatively (P < 0.05).The SNOT scores were significantly lower in Group 1 than in Group 2 at 1 week (P < 0.01), but did not differ at 2 weeks postoperatively (P > 0.05).Postoperatively, the MCC were insignificant between the groups and within the groups at 1 and 2 weeks (P > 0.05). Although Dexpanthenol-Vitamin A ointment had no direct effect on wound healing, it had significant effects on crusting, obstruction, and foul smell. However, silastic splints with dexpanthenol did not improve the MCC of the nose.

Rethink outpatient surgery strategy? Study finds hospitals lose money on 56 procedures.

PubMed

1998-01-01

A new study reveals hospitals are losing an average of $268 on each Medicare patient who has outpatient surgery. Losses depend on procedures, ownership structure, and how often the particular type of surgery is performed.

Burden incurred by patients and their caregivers after outpatient surgery: a prospective observational study.

PubMed

Manohar, Asha; Cheung, Kristin; Wu, Christopher L; Stierer, Tracey S

2014-05-01

The burden of patients and their caregivers after outpatient surgery has not been fully examined. The number of outpatient surgeries has dramatically increased in the last several years, particularly in the orthopaedic sector. Patients undergoing outpatient orthopaedic procedures may be expected to have more postdischarge pain than those undergoing nonorthopaedic outpatient procedures. In light of this, assessment of patient and caregiver expectations and actual burden after discharge is of importance. We assessed the impact of outpatient surgery on recovery of patients and their caregivers in the postoperative period by determining (1) expected versus actual time to resume daily activities, including work; (2) expected versus actual recovery at 7 and 30 days postoperatively; and (3) the number of caregivers that felt emotional or physical disturbances from caring for outpatients. Forty-four adult patients undergoing outpatient surgical procedures and their primary caregivers were enrolled in this prospective survey study, of which 30% were orthopaedic patients. Surveys assessing postoperative recovery were given to patients at six time points, on Postoperative Days 0 to 3, 7, and 30. Surveys assessing the burden of informal caregiving were given to each patient's primary caregiver at four time points, on Postoperative Days 1 to 3 and 7. The enrollment rate was 79% (44 enrolled of 56 approached) and the survey response rate was 100% for patients and 93% (41 of 44) for caregivers. We found that 16 of 44 patients (36%) needed more time than originally anticipated to resume their daily activities and three of 29 patients (10%) needed more time off from work than originally anticipated. Patients were approximately 66% and 88% fully recovered 7 and 30 days after surgery, respectively. The primary caregivers noted disturbances in emotional (nine of 43, 21%) and physical (17 of 43, 40%) aspects of their daily lives while providing care for patients. Our surveyed

Effect of physician ownership of specialty hospitals and ambulatory surgery centers on frequency of use of outpatient orthopedic surgery.

PubMed

Mitchell, Jean M

2010-08-01

Physician-owned specialty hospitals and ambulatory surgery centers have become commonplace in many markets throughout the United States. Little is known about whether the financial incentives linked to ownership affect frequency of outpatient surgery. To evaluate if financial incentives linked to physician ownership influence frequency of outpatient orthopedic surgical procedures. We analyzed 5 years of claims data from a large private insurer in Idaho to compare frequency by orthopedic surgeon owners and nonowners of surgical procedures that could be performed in either ambulatory surgery centers or hospital outpatient surgery departments. Frequency of use, calculated as number of patients treated with the specific diagnoses who received the surgical procedure of interest divided by the number of patients with such diagnoses treated by each physician. Age- and sex-adjusted odds ratios indicate that the likelihood of having carpal tunnel repair was 54% to 129% higher for patients of surgeon owners compared with surgeon nonowners. For rotator cuff repair, the adjusted odds ratios of having surgery were 33% to 100% higher for patients treated by physician owners. The age- and sex-adjusted probability of arthroscopic surgery was 27% to 78% higher for patients of surgeon owners compared with surgeon nonowners. The consistent finding of higher use rates by physician owners across time clearly suggests that financial incentives linked to ownership of either specialty hospitals or ambulatory surgery centers influence physicians' practice patterns.

Nasal packing and stenting

PubMed Central

Weber, Rainer K.

2011-01-01

Nasal packs are indispensable in ENT practice. This study reviews current indications, effectiveness and risks of nasal packs and stents. In endoscopic surgery, nasal packs should always have smooth surfaces to minimize mucosal damage, improve wound healing and increase patient comfort. Functional endoscopic endonasal sinus surgery allows the use of modern nasal packs, since pressure is no longer required. So called hemostatic/resorbable materials are a first step in this direction. However, they may lead to adhesions and foreign body reactions in mucosal membranes. Simple occlusion is an effective method for creating a moist milieu for improved wound healing and avoiding dryness. Stenting of the frontal sinus is recommended if surgery fails to produce a wide, physiologically shaped drainage path that is sufficiently covered by intact tissue. PMID:22073095

The efficacy of mobile application use on recall of surgical risks in nasal bone fracture reduction surgery

PubMed Central

Kim, Choong Hyeon; Cheon, Ji Seon; Choi, Woo Young; Son, Kyung Min

2018-01-01

Background The number of surgical risks recalled by a patient after surgery can be used as a parameter for assessing how well the patient has understood the informed consent process. No study has investigated the usefulness of a self-developed mobile application in the traditional informed consent process in patients with a nasal bone fracture. This study aimed to investigate whether delivery of information, such as surgical risks, through a mobile application is more effective than delivery of information through only verbal means and a paper. Methods This prospective, randomized study included 60 patients with a nasal bone fracture. The experimental group (n=30) received preoperative explanation with the traditional informed consent process in addition to a mobile application, while the control group (n=30) received preoperative explanation with only the traditional informed consent process. Four weeks after surgery, the number of recalled surgical risks was compared for analysis. The following six surgical risks were explained: pain, bleeding, nasal deformity, numbness, nasal obstruction, and nasal cartilage necrosis. Results The mean number of recalled surgical risks among all patients was 1.58±0.56. The most frequently recalled surgical risk was nasal deformity in both groups. The mean number of recalled surgical risks was 1.72±0.52 in the experimental group and 1.49±0.57 in the control group. There was a significant association between mobile application use and the mean number of recalled surgical risks (p=0.047). Age, sex, and the level of education were not significantly associated with the mean number of recalled surgical risks. Conclusion This study found that a mobile application could contribute to the efficient delivery of information during the informed consent process. With further improvement, it could be used in other plastic surgeries and other surgeries, and such an application can potentially be used for explaining risks as well as

The efficacy of mobile application use on recall of surgical risks in nasal bone fracture reduction surgery.

PubMed

Kim, Choong Hyeon; Cheon, Ji Seon; Choi, Woo Young; Son, Kyung Min

2018-03-01

The number of surgical risks recalled by a patient after surgery can be used as a parameter for assessing how well the patient has understood the informed consent process. No study has investigated the usefulness of a self-developed mobile application in the traditional informed consent process in patients with a nasal bone fracture. This study aimed to investigate whether delivery of information, such as surgical risks, through a mobile application is more effective than delivery of information through only verbal means and a paper. This prospective, randomized study included 60 patients with a nasal bone fracture. The experimental group (n=30) received preoperative explanation with the traditional informed consent process in addition to a mobile application, while the control group (n=30) received preoperative explanation with only the traditional informed consent process. Four weeks after surgery, the number of recalled surgical risks was compared for analysis. The following six surgical risks were explained: pain, bleeding, nasal deformity, numbness, nasal obstruction, and nasal cartilage necrosis. The mean number of recalled surgical risks among all patients was 1.58±0.56. The most frequently recalled surgical risk was nasal deformity in both groups. The mean number of recalled surgical risks was 1.72±0.52 in the experimental group and 1.49±0.57 in the control group. There was a significant association between mobile application use and the mean number of recalled surgical risks ( p =0.047). Age, sex, and the level of education were not significantly associated with the mean number of recalled surgical risks. This study found that a mobile application could contribute to the efficient delivery of information during the informed consent process. With further improvement, it could be used in other plastic surgeries and other surgeries, and such an application can potentially be used for explaining risks as well as delivering other types of information.

Beclomethasone Nasal Spray

MedlinePlus

... the lining of the nose) after nasal polyp removal surgery. Beclomethasone nasal spray should not be used ... room temperature and away from excess heat and moisture (not in the bathroom).Unneeded medications should be ...

A modified intranasal endoscopic excision for nasal vestibular cyst in China.

PubMed

Huang, Zizhen; Li, Jingjia; Yang, Qintai; Li, Peng; Ye, Jin; Liu, Xian; Zhang, Gehua

2015-03-01

This study aimed to improve the surgical removal procedure for nasal vestibular cysts. Twenty-three patients with nasal vestibular cysts underwent surgical removal of the cyst via a transoral sublabial approach and another 30 patients via a modified intranasal endoscopic excision method. The 30 patients were treated with local anesthesia and the roof of the cyst, which was firmly attached to the mucous membrane of the anterior floor of the nasal cavity, was removed transnasally with microdebrider. Bleeding of the opening was stopped by electric coagulation without nasal packing. Among the 30 consecutive patients who underwent the modified surgical procedure, all patients were successfully treated. The mean duration of surgery was 5.7 ± 2.6 min. The mean estimated blood loss was 3.5 ± 2.1 ml. All patients were outpatients. The mean hospital stay was 1 h. The mean total cost was 140. The visual analog scale scores of postoperative pain, pressure and nasal obstruction were 1, 0 and 1, respectively. The incidence rate of postoperative lip swelling or numbness was 0 %. Postoperative endoscopic findings revealed that the cyst was replaced by an air-containing sinus with a persistent opening at the anterolateral nasal floor. There was no recurrence during a mean follow-up of 18 months. The modified intranasal endoscopic excision is a simple, less invasive, low-cost and effective surgical procedure for the treatment of nasal vestibular cysts. It might change the pattern of treatment for nasal vestibular cysts in China.

Treatment of hyperplastic inferior nasal turbinates by means of a Ho:YAG laser

NASA Astrophysics Data System (ADS)

Sroka, Ronald; Leunig, Andreas; Janda, P.; Rosler, P.; Grevers, G.; Baumgartner, Reinhold

1999-06-01

Although the successful use of the Ho:YAG laser in nasal turbinate surgery had been reported no clinical study had been performed to assess the clinical outcome in longterm. By means of a pulsed Ho:YAG laser emitting at λ=2080nm (1J/pulse, 3-8 Hz) 57 patients suffering from nasal obstruction due to allergic rhinitis and vasomotoric rhinitis were treated under local anesthesia. The study was conducted by standardized questionnaire, photo documentation, allergy test, mucocilliar test, rhinomanometry, radiology and histology. Within 2 weeks after laser treatment a significant improvement of nasal airflow correlating to the extent of the ablated turbinate tissue could be determined. This effect lasted up until 1 year post treatment resulting in an improved quality of life in more than 80 percent of the patients. Side effects like nasal dryness and pain were rare (<4%), no immediate complications were observed. The total treatment time takes 3-8 min and nasal packing was not necessary after the laser procedure. In conclusion Ho:YAG laser treatment can be performed as an outpatient procedure under local anesthesia with excellent ablation of soft tissue in a short treatment time with promising results.

76 FR 72003 - Calendar Year 2011 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-21

... Cosmetic Surgery Services Furnished by Department of Defense Medical Treatment Facilities; Certain Rates... of the full cost of all services provided. The outpatient medical, dental, and cosmetic surgery... recovery from tortiously liable third persons for the cost of outpatient medical, dental, and cosmetic...

Clinical efficacy of a spray containing hyaluronic Acid and dexpanthenol after surgery in the nasal cavity (septoplasty, simple ethmoid sinus surgery, and turbinate surgery).

PubMed

Gouteva, Ina; Shah-Hosseini, Kija; Meiser, Peter

2014-01-01

Background. This prospective, controlled, parallel-group observational study investigated the efficacy of a spray containing hyaluronic acid and dexpanthenol to optimise regular treatment after nasal cavity surgery in 49 patients with chronic rhinosinusitis. Methods. The control group received standard therapy. Mucosal regeneration was determined using rhinoscopy sum score (RSS). Pre- and postoperative nasal patency was tested using anterior rhinomanometry. The participants were questioned about their symptoms. Results. Regarding all RSS parameters (dryness, dried nasal mucus, fibrin deposition, and obstruction), mucosal regeneration achieved good final results in both groups, tending to a better improvement through the spray application, without statistically significant differences during the whole assessment period, the mean values being 7.04, 5.00, 3.66, and 3.00 (intervention group) and 7.09, 5.14, 4.36, and 3.33 (control group). No statistically significant benefit was identified for nasal breathing, foreign body sensation, and average rhinomanometric volume flow, which improved by 12.31% (control group) and 11.24% (nasal spray group). Conclusion. The investigational product may have additional benefit on postoperative mucosal regeneration compared to standard cleaning procedures alone. However, no statistically significant advantage could be observed in this observational study. Double-blind, controlled studies with larger populations will be necessary to evaluate the efficacy of this treatment modality.

Clinical Efficacy of a Spray Containing Hyaluronic Acid and Dexpanthenol after Surgery in the Nasal Cavity (Septoplasty, Simple Ethmoid Sinus Surgery, and Turbinate Surgery)

PubMed Central

2014-01-01

Background. This prospective, controlled, parallel-group observational study investigated the efficacy of a spray containing hyaluronic acid and dexpanthenol to optimise regular treatment after nasal cavity surgery in 49 patients with chronic rhinosinusitis. Methods. The control group received standard therapy. Mucosal regeneration was determined using rhinoscopy sum score (RSS). Pre- and postoperative nasal patency was tested using anterior rhinomanometry. The participants were questioned about their symptoms. Results. Regarding all RSS parameters (dryness, dried nasal mucus, fibrin deposition, and obstruction), mucosal regeneration achieved good final results in both groups, tending to a better improvement through the spray application, without statistically significant differences during the whole assessment period, the mean values being 7.04, 5.00, 3.66, and 3.00 (intervention group) and 7.09, 5.14, 4.36, and 3.33 (control group). No statistically significant benefit was identified for nasal breathing, foreign body sensation, and average rhinomanometric volume flow, which improved by 12.31% (control group) and 11.24% (nasal spray group). Conclusion. The investigational product may have additional benefit on postoperative mucosal regeneration compared to standard cleaning procedures alone. However, no statistically significant advantage could be observed in this observational study. Double-blind, controlled studies with larger populations will be necessary to evaluate the efficacy of this treatment modality. PMID:25104962

[Clinical analysis of nasal mucosa contact headache].

PubMed

Gu, Qingjia; Wen, Bei; Li, Jingxian; Fan, Jiangang; He, Gang

2013-07-01

To investigate the efficacy of nasal mucosa contact point headache with the treatment of endoscopic sinus surgery. Clinical data of 75 cases with nasal mucosa contact point headache treated in our department from Jan 2008 to Nov 2011 were retrospectively analyzed. These patients were performed with endoscopic sinus surgery. All patients were followed up for more than six months. They all achieved significant efficacy and no complications occurred. Nasal mucosa contact point headache and primary headache had different clinical features and different treatment. Misdiagnosis were easily made if not being carefully analyzed. Three lines tension relaxing septorhinoplasty combined with nasal bone fracture correction can achieve satisfactory curative effect and can effectively prevent the occurrence of complications. Therefore, it is necessary to strengthen the awareness of this disease. Nasal structure abnormality is the main reason of nasal mucosa contact point headache. The implementation of individualized nasal endoscopic sinus surgery can achieve satisfactory curative effect.

Does rhinoplasty improve nasal breathing?

PubMed

Xavier, Rui

2010-08-01

Rhinoplasty is a surgical procedure that aims to improve nasal aesthetics and nasal breathing. The aesthetic improvement of the nose is usually judged subjectively by the patient and the surgeon, but the degree of improvement of nasal obstruction is difficult to assess by clinical examination only. The measurement of peak nasal inspiratory flow (PNIF) is a reliable tool that has been shown to correlate with other objective methods of assessing nasal breathing and with patients' symptoms of nasal obstruction. Twenty-three consecutive patients undergoing rhinoplasty have been evaluated by measurement of PNIF before and after surgery. All but three patients had an increase in PNIF after surgery. The mean preoperative PNIF was 86.5 L/min and the mean postoperative PNIF was 123.0 L/min ( P < 0.001). Not surprisingly, the greatest improvement in PNIF was achieved when bilateral spreader grafts were used. This study suggests that rhinoplasty does improve nasal breathing. (c) Thieme Medical Publishers

Simulating the nasal cycle with computational fluid dynamics

PubMed Central

Patel, Ruchin G.; Garcia, Guilherme J. M.; Frank-Ito, Dennis O.; Kimbell, Julia S.; Rhee, John S.

2015-01-01

Objectives (1) Develop a method to account for the confounding effect of the nasal cycle when comparing pre- and post-surgery objective measures of nasal patency. (2) Illustrate this method by reporting objective measures derived from computational fluid dynamics (CFD) models spanning the full range of mucosal engorgement associated with the nasal cycle in two subjects. Study Design Retrospective Setting Academic tertiary medical center. Subjects and Methods A cohort of 24 nasal airway obstruction patients was reviewed to select the two patients with the greatest reciprocal change in mucosal engorgement between pre- and post-surgery computed tomography (CT) scans. Three-dimensional anatomic models were created based on the pre- and post-operative CT scans. Nasal cycling models were also created by gradually changing the thickness of the inferior turbinate, middle turbinate, and septal swell body. CFD was used to simulate airflow and to calculate nasal resistance and average heat flux. Results Before accounting for the nasal cycle, Patient A appeared to have a paradoxical worsening nasal obstruction in the right cavity postoperatively. After accounting for the nasal cycle, Patient A had small improvements in objective measures postoperatively. The magnitude of the surgical effect also differed in Patient B after accounting for the nasal cycle. Conclusion By simulating the nasal cycle and comparing models in similar congestive states, surgical changes in nasal patency can be distinguished from physiological changes associated with the nasal cycle. This ability can lead to more precise comparisons of pre and post-surgery objective measures and potentially more accurate virtual surgery planning. PMID:25450411

Should Breast Cancer Surgery Be Done in an Outpatient Setting?: Health Economics From the Perspective of Service Providers.

PubMed

Formago, Margaret; Schrauder, Michael G; Rauh, Claudia; Hack, Carolin C; Jud, Sebastian M; Hildebrandt, Thomas; Schulz-Wendtland, Rüdiger; Frentz, S; Graubert, S; Beckmann, Matthias W; Lux, Michael P

2017-08-01

The care of patients with breast cancer is extremely complex and requires interdisciplinary care in certified facilities. These specialized facilities provide numerous services without being correspondingly remunerated. The question whether breast cancer surgery should be performed in an outpatient setting to reduce costs is increasingly being debated. This study compares inpatient surgical treatment with a model of the same surgery performed on an outpatient basis to examine the potential financial impact. A theoretical model was developed and the DRG fees for surgical interventions to treat primary breast cancer were calculated. A theoretical 1-day DRG was then calculated to permit comparisons with outpatient procedures. The costs of outpatient surgery were calculated based on the remuneration rates of the AOP (Outpatient Surgery) Contract and the EBM (Uniform Assessment Scale) and compared to the costs of the 1-day DRG. The DRG fee for both breast-conserving surgery and mastectomy is higher than the fee paid in the context of the EBM system, although the same procedures were carried out in both systems. If a hospital were to carry out breast-conserving surgery as an outpatient procedure, the fee would be € 1313.81; depending on the type of surgery, the hospital would therefore only receive between 39.20% and 52.82% of the DRG fee. This was the case even for a 1-day treatment. Compared to the real DRG fees the difference would be even more striking. Carrying out breast cancer surgery as an outpatient procedure would result in a significant shortfall of revenues. Additional services from certified centers, such as the interdisciplinary planning of treatment, psycho-oncological and social-medical care with the involvement of relatives, detailed documentation, etc., which are currently provided without surcharge or adequate remuneration, could no longer be maintained. The quality of processes and excellent results which have been achieved and ultimately the care

Effect of liposomes, vitamins A and E nasal spray in reducing the healing time after septoplasty with concurrent turbinate surgery in adolescents.

PubMed

Ricciardiello, Filippo; Cantone, Elena; Abate, Teresa; DI Lullo, Antonella M; Oliva, Flavia; Iengo, Maurizio; DE Bernardo, Giuseppe

2017-02-01

This study evaluates endoscopic and quality of life (QoL) outcomes in two groups, composed by both allergic (A) and non-allergic (N-A) adolescents undergoing septoplasty with concurrent turbinate surgery by radiofrequency treated after surgery with nasal spray containing liposomes and vitamins A and E. This double-blind randomized study was carried out on 40 patients (22 males, 18 females, mean age 15.5±1.0 years) undergoing septoplasty and volumetric tissue reduction of inferior turbinates by radiofrequency for post-traumatic deformities and severe nasal obstruction. We enrolled 20 subjects with positive skin prick tests and 20 with negative skin prick tests (SPT) to aeroallergens. All subjects underwent the Visual Analogue Scale (VAS) questionnaire and the nasal endoscopy score by Lund and Kennedy (LK) at baseline before surgery (T0) and 15 days (T15) and 21 days (T21) after treatment. After surgery, the nose was not packed and the day after surgery all subjects were randomized into two groups, experimental arm group I (GI) and control arm group II (GII) and given the treatment, nasal spray containing liposomes composed of phospholipids, fatty acids, and vitamin A and E for group I and saline solution (sodium chloride 0.9%) for group II. After therapy, the VAS and LK scores were better (P<0.05) in the investigational than in the control arm in both sub-groups (A and N-A). Our findings suggested that liposomal, vitamins A and E nasal spray improves the QoL in the early postoperative period, both in A and N-A sub-groups.

High-Flow Nasal Oxygen vs Noninvasive Positive Airway Pressure in Hypoxemic Patients After Cardiothoracic Surgery: A Randomized Clinical Trial.

PubMed

Stéphan, François; Barrucand, Benoit; Petit, Pascal; Rézaiguia-Delclaux, Saida; Médard, Anne; Delannoy, Bertrand; Cosserant, Bernard; Flicoteaux, Guillaume; Imbert, Audrey; Pilorge, Catherine; Bérard, Laurence

2015-06-16

Noninvasive ventilation delivered as bilevel positive airway pressure (BiPAP) is often used to avoid reintubation and improve outcomes of patients with hypoxemia after cardiothoracic surgery. High-flow nasal oxygen therapy is increasingly used to improve oxygenation because of its ease of implementation, tolerance, and clinical effectiveness. To determine whether high-flow nasal oxygen therapy was not inferior to BiPAP for preventing or resolving acute respiratory failure after cardiothoracic surgery. Multicenter, randomized, noninferiority trial (BiPOP Study) conducted between June 15, 2011, and January 15, 2014, at 6 French intensive care units. A total of 830 patients who had undergone cardiothoracic surgery, of which coronary artery bypass, valvular repair, and pulmonary thromboendarterectomy were the most common, were included when they developed acute respiratory failure (failure of a spontaneous breathing trial or successful breathing trial but failed extubation) or were deemed at risk for respiratory failure after extubation due to preexisting risk factors. Patients were randomly assigned to receive high-flow nasal oxygen therapy delivered continuously through a nasal cannula (flow, 50 L/min; fraction of inspired oxygen [FiO2], 50%) (n = 414) or BiPAP delivered with a full-face mask for at least 4 hours per day (pressure support level, 8 cm H2O; positive end-expiratory pressure, 4 cm H2O; FiO2, 50%) (n = 416). The primary outcome was treatment failure, defined as reintubation, switch to the other study treatment, or premature treatment discontinuation (patient request or adverse effects, including gastric distention). Noninferiority of high-flow nasal oxygen therapy would be demonstrated if the lower boundary of the 95% CI were less than 9%. Secondary outcomes included mortality during intensive care unit stay, changes in respiratory variables, and respiratory complications. High-flow nasal oxygen therapy was not inferior to BiPAP: the treatment

Spillover effects of state mandated benefit laws: the case of outpatient breast cancer surgery.

PubMed

Bian, John; Lipscomb, Joseph; Mello, Michelle M

This paper examines the "spillover effects" of state laws that mandate inpatient coverage for breast cancer surgery. It looks at outpatient utilization of two types of breast cancer surgery among Medicare fee-for-service patients, who are exempt from state regulation. Using data from the Surveillance, Epidemiology and End Results cancer registries and Medicare claims, we performed difference-in-differences analyses of patients in nine states from 1993 to 2002. The analyses show that state laws had a significant impact on only the likelihood of outpatient mastectomy, which was reduced by five percentage points. Such a spillover effect may diminish the expected impact of federal coverage laws for inpatient breast cancer surgery, which have been proposed to achieve similar ends.

[Endoscopic treatment of small osteoma of nasal sinuses manifested as nasal and facial pain].

PubMed

Li, Yu; Zheng, Tianqi; Li, Zhong; Deng, Hongyuan; Guo, Chaoxian

2015-12-01

To discuss the clinical features, diagnosis and endoscopic surgical intervention for small steoma of nasal sinuses causing nasal and facial pain. A retrospective review was performed on 21 patients with nasal and facial pain caused by small osteoma of nasal sinuses, and nasal endoscopic surgery was included in the treatment of all cases. The nasal and facial pain of all the patients was relieved. Except for one ase exhibiting periorbital bruise after operation, the other patients showed no postoperative complications. Nasal and facial pain caused by small osteoma of nasal sinuses was clinically rare, mostly due to the neuropathic pain of nose and face caused by local compression resulting from the expansion of osteoma. Early diagnosis and operative treatment can significantly relieve nasal and facial pain.

Virtual Surgery for the Nasal Airway: A Preliminary Report on Decision Support and Technology Acceptance.

PubMed

Vanhille, Derek L; Garcia, Guilherme J M; Asan, Onur; Borojeni, Azadeh A T; Frank-Ito, Dennis O; Kimbell, Julia S; Pawar, Sachin S; Rhee, John S

2018-01-01

Nasal airway obstruction (NAO) is a common problem that affects patient quality of life. Surgical success for NAO correction is variable. Virtual surgery planning via computational fluid dynamics (CFD) has the potential to improve the success rates of NAO surgery. To elicit surgeon feedback of a virtual surgery planning tool for NAO and to determine if this tool affects surgeon decision making. For this cross-sectional study, 60-minute face-to-face interviews with board-certified otolaryngologists were conducted at a single academic otolaryngology department from September 16, 2016, through October 7, 2016. Virtual surgery methods were introduced, and surgeons were able to interact with the virtual surgery planning tool interface. Surgeons were provided with a patient case of NAO, and open feedback of the platform was obtained, with emphasis on surgical decision making. Likert scale responses and qualitative feedback were collected for the virtual surgery planning tool and its influence on surgeon decision making. Our 9 study participants were all male, board-certified otolaryngologists with a mean (range) 15 (4-28) number of years in practice and a mean (range) number of nasal surgeries per month at 2.2 (0.0-6.0). When examined on a scale of 1 (not at all) to 5 (completely), surgeon mean (SD) score was 3.4 (0.5) for how realistic the virtual models were compared with actual surgery. On the same scale, when asked how much the virtual surgery planning tool changed surgeon decision making, mean (SD) score was 2.6 (1.6). On a scale of 1 (strongly disagree) to 7 (strongly agree), surgeon scores for perceived usefulness of the technology and attitude toward using it were 5.1 (1.1) and 5.7 (0.9), respectively. Our study shows positive surgeon experience with a virtual surgery planning tool for NAO based on CFD simulations. Surgeons felt that future applications and areas of study of the virtual surgery planning tool include its potential role for patient counseling

Obesity is associated with increased health care charges in patients undergoing outpatient plastic surgery.

PubMed

Sieffert, Michelle R; Fox, Justin P; Abbott, Lindsay E; Johnson, R Michael

2015-05-01

Obesity is associated with greater rates of surgical complications. To address these complications after outpatient plastic surgery, obese patients may seek care in the emergency department and potentially require admission to the hospital, which could result in greater health care charges. The purpose of this study was to determine the relationship of obesity, postdischarge hospital-based acute care, and hospital charges within 30 days of outpatient plastic surgery. From state ambulatory surgery center databases in four states, all discharges for adult patients who underwent liposuction, abdominoplasty, breast reduction, and blepharoplasty were identified. Patients were grouped by the presence or absence of obesity. Multivariable regression models were used to compare the frequency of hospital-based acute care, serious adverse events, and hospital charges within 30 days between groups while controlling for confounding variables. The final sample included 47,741 discharges, with 2052 of these discharges (4.3 percent) being obese. Obese patients more frequently had a hospital-based acute care encounter [7.3 percent versus 3.9 percent; adjusted OR, 1.35 (95% CI,1.13 to 1.61)] or serious adverse event [3.2 percent versus 0.9 percent; adjusted OR, 1.73 (95% CI, 1.30 to 2.29)] within 30 days of surgery. Obese patients had adjusted hospital charges that were, on average, $3917, $7412, and $7059 greater (p < 0.01) than those of nonobese patients after liposuction, abdominoplasty, and breast reduction, respectively. Obese patients who undergo common outpatient plastic surgery procedures incur substantially greater health care charges, in part attributable to more frequent adverse events and hospital-based health care within 30 days of surgery. Risk, II.

An Employee Questionnaire for Assessing Patient Safety in Outpatient Surgery

DTIC Science & Technology

2005-01-01

461 An Employee Questionnaire for Assessing Patient Safety in Outpatient Surgery Pascale Carayon, Carla J. Alvarado, Ann Schoofs Hundt, Scott...Springman, Amanda Borgsdorf, Peter L.T. Hoonakker Abstract This paper provides information on the reliability and validity of an employee ...intervention on both employees and patients. In this paper, we describe the SEIPS employee questionnaire, which surveys various elements of the work system

Management of Intractable Nasal Hyperreactivity by Selective Resection of Posterior Nasal Nerve Branches

PubMed Central

Takahara, Daisuke; Hamamoto, Takao; Ishino, Takashi; Hirakawa, Katsuhiro

2017-01-01

The posterior nasal nerves emerge from the sphenopalatine foramen and contain sensory and autonomic nerve components. Posterior nasal neurectomy is an effective method to remove pathological neural networks surrounding the inferior turbinate that cause unregulated nasal hypersensitivity with excess secretion in patients with severe allergic rhinitis (AR). We describe the sophisticated endoscopic surgical procedure that allows feasible access to the confined area and selective resection of the nerve branches with the preservation of the sphenopalatine artery (SPA). We retrospectively analyzed the cases of 23 symptomatic severe AR patients who failed to respond to standard medical treatment and underwent surgery. There have been no major complications after surgery including nasal bleeding or transient numbness of the upper teeth. The mean total nasal symptom scores (TNSS) were decreased by 70.2% at 12 months after the procedure. Our comparison of the clinical effectiveness based on the number of severed nerve branches revealed that the improvement of the TNSS was significantly higher in patients with >2 branches. We conclude that this minimally invasive technique that preserves the SPA is clinically useful and decreases the rate of postoperative complications. This trial is registered with UMIN000029025. PMID:29379524

Management of Intractable Nasal Hyperreactivity by Selective Resection of Posterior Nasal Nerve Branches.

PubMed

Takahara, Daisuke; Takeno, Sachio; Hamamoto, Takao; Ishino, Takashi; Hirakawa, Katsuhiro

2017-01-01

The posterior nasal nerves emerge from the sphenopalatine foramen and contain sensory and autonomic nerve components. Posterior nasal neurectomy is an effective method to remove pathological neural networks surrounding the inferior turbinate that cause unregulated nasal hypersensitivity with excess secretion in patients with severe allergic rhinitis (AR). We describe the sophisticated endoscopic surgical procedure that allows feasible access to the confined area and selective resection of the nerve branches with the preservation of the sphenopalatine artery (SPA). We retrospectively analyzed the cases of 23 symptomatic severe AR patients who failed to respond to standard medical treatment and underwent surgery. There have been no major complications after surgery including nasal bleeding or transient numbness of the upper teeth. The mean total nasal symptom scores (TNSS) were decreased by 70.2% at 12 months after the procedure. Our comparison of the clinical effectiveness based on the number of severed nerve branches revealed that the improvement of the TNSS was significantly higher in patients with >2 branches. We conclude that this minimally invasive technique that preserves the SPA is clinically useful and decreases the rate of postoperative complications. This trial is registered with UMIN000029025.

Unused Opioid Pills After Outpatient Shoulder Surgeries Given Current Perioperative Prescribing Habits.

PubMed

Kumar, Kanupriya; Gulotta, Lawrence V; Dines, Joshua S; Allen, Answorth A; Cheng, Jennifer; Fields, Kara G; YaDeau, Jacques T; Wu, Christopher L

2017-03-01

In the past 16 years, the number of prescription opioids sold in the United States, as well as deaths from prescription opioids, has nearly quadrupled. However, the overall amount of pain reported by patients has not changed significantly. Specific information about opioid prescriptions in the perioperative period is lacking. Of the studies that have been published, investigators have shown that the majority of patients have unused postoperative opioid pills. Moreover, patients appear to lack information about disposal of unused opioid pills. To compare the number of pills prescribed versus the numbers left unused after outpatient shoulder surgeries at an orthopaedic surgery institution. Case series; Level of evidence, 4. In this prospective, observational study, 100 patients (age >18 years) undergoing outpatient shoulder surgery (rotator cuff repair, labral repair, stabilization/Bankart repair, debridement) were enrolled. Follow-ups were conducted via surveys on postoperative days (PODs) 7, 14, 28, and 90. The primary outcome was the number of unused pills from the originally prescribed medication. For all procedure types, the median (Q1, Q3) number of prescribed pills was 60 (40, 80). On POD 90, patients reported a median (Q1, Q3) of 13 (0, 32) unused pills; patients who underwent rotator cuff repairs had the lowest number of pills remaining (median [Q1, Q3], 0 [0, 16]), whereas patients who had stabilization/Bankart repairs had the highest number of unused pills (median [Q1, Q3], 37 [29, 50]). Patient satisfaction with pain management ranged from an average of 70% to 90%. Only 25 patients received instructions or education about opioid disposal. Most outpatient shoulder surgery patients who underwent certain operations were prescribed more opioid analgesics than they consumed. Patient education regarding the disposal of opioids was lacking.

Added Healthcare Charges Conferred by Smoking in Outpatient Plastic Surgery.

PubMed

Sieffert, Michelle R; Johnson, R Michael; Fox, Justin P

2018-01-31

A history of smoking confers additional risk of complications following plastic surgical procedures, which may require hospital-based care to address. To determine if patients with a smoking history experience higher rates of complications leading to higher hospital-based care utilization, and therefore greater healthcare charges, after common outpatient plastic surgeries. Using ambulatory surgery data from California, Florida, Nebraska, and New York, we identified adult patients who underwent common facial, breast, or abdominal contouring procedures from January 2009 to November 2013. Our primary outcomes were hospital-based, acute care (hospital admissions and emergency department visits), serious adverse events, and cumulative healthcare charges within 30 days of discharge. Multivariable regression models were used to compare outcomes between patients with and without a smoking history. The final sample included 214,761 patients, of which 10,426 (4.9%) had a smoking history. Compared to patients without, those with a smoking history were more likely to have a hospital-based, acute care encounter (3.4% vs 7.1%; AOR = 1.36 [1.25-1.48]) or serious adverse event (0.9% vs 2.2%; AOR = 1.38 [1.18-1.60]) within 30 days. On average, these events added $1826 per patient with a smoking history. These findings were consistent when stratified by specific procedure and controlled for patient factors. Patients undergoing common outpatient plastic surgery procedures who have a history of smoking are at risk for more frequent complications, and incur higher healthcare charges than patients who are nonsmokers. © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Electrocauterization and no packing may be comparable with nasal packing for postoperative hemorrhage after endoscopic sinus surgery.

PubMed

Kim, Dong-Kyu; Rhee, Chae Seo; Kim, Jeong-Whun

2016-05-01

Nasal packing is commonly performed after functional endoscopic sinus surgery (FESS). However, nasal packing is associated with higher cost (owing to the cost of packing materials), patient discomfort, delayed wound healing, and concern about toxic shock syndrome. Some surgeons have been performing FESS without packing, but there are few studies that show its safety. The purpose of this study was to evaluate the safety of electrocauterization and no packing. A total of 490 patients who underwent bilateral FESS for chronic rhinosinusitis were included in this retrospective study, 242 in the nasal packing group and 248 in the electrocauterization and no-packing group. Electrocauterization was performed by using a suction coagulator. Rates of immediate (first 24 hours after surgery) and delayed postoperative bleeding were compared. Patient characteristics, including concomitant disease and medication history, and Lund-Mackay computed tomography score were also assessed Results: There were no significant differences in age; sex; Lund-Mackay score; use of anticoagulant drugs; or prevalence of hypertension, diabetes, or asthma between the two groups. In the electrocauterization and no-packing group, there were fewer patients with allergic rhinitis and more smokers. Primary bleeding did not occur in the nasal packing group, but 11 patients (4.4%) had delayed bleeding. Primary bleeding occurred in four patients (1.7%) in the electrocauterization and no-packing group, and five patients (2.1%) had delayed bleeding. There were no significant differences in primary (p = 0.058) and secondary bleeding (p = 0.142) between the two groups. All bleeding was minor and easily controlled. Multivariate logistic regression analysis ruled out significant correlation between no packing and postoperative bleeding. This study provided evidence that, in terms of postoperative hemorrhage, the safety of the electrocauterization and no-packing technique after FESS was comparable with that of

Safety analysis of long-term budesonide nasal irrigations in patients with chronic rhinosinusitis post endoscopic sinus surgery.

PubMed

Soudry, Ethan; Wang, Jane; Vaezeafshar, Reza; Katznelson, Laurence; Hwang, Peter H

2016-06-01

Although the safety of topical nasal steroids is well established for nasal spray forms, data regarding the safety of steroid irrigations is limited. We studied the effect of long-term budesonide nasal irrigations (>6 months) on hypothalamic-pituitary-adrenal axis (HPAA) function and intraocular pressure (IOP) in patients post-endoscopic sinus surgery. This was retrospective case series. Adrenal function was assessed by using the high-dose cosyntropin stimulation test. A total of 48 patients were assessed, with a mean duration of budesonide irrigations of 22 months. Stimulated cortisol levels were abnormally low in 11 patients (23%). None reported to have symptoms of adrenal suppression. Three of 4 patients who repeated the study being off budesonide for at least 1 month returned to near normal levels. Logistic regression analysis revealed that concomitant use of both nasal steroid sprays and pulmonary steroid inhalers was significantly associated with HPAA suppression (p = 0.024). Patients with low stimulated cortisol levels were able to continue budesonide irrigations under the supervision of an endocrinologist without frank clinical manifestations of adrenal insufficiency. IOP was within normal limits in all patients. Long-term use of budesonide nasal irrigations is generally safe, but asymptomatic HPAA suppression may occur in selected patients. Concomitant use of both nasal steroid sprays and pulmonary steroid inhalers while using daily budesonide nasal irrigations is associated with an increased risk. Rhinologists should be alerted to the potential risks of long-term use of budesonide nasal irrigations, and monitoring for HPAA suppression may be warranted in patients receiving long-term budesonide irrigation therapy. © 2016 ARS-AAOA, LLC.

Complications of Nasal Bone Fractures.

PubMed

Hwang, Kun; Yeom, Seung Han; Hwang, Suk Hyun

2017-05-01

The aim of this study was to perform a systematic review of the treatment of nasal bone fractures. The search terms ("nasal bone fracture" AND complication) and ("nasal bone fracture" AND [anosmia OR olfaction OR olfactory nerve OR smell]) and (anosmia AND ["nasal preparation" OR "nasal antiseptics"]) were used to search PubMed and SCOPUS. Of the 500 titles, 40 full papers were reviewed. One paper was excluded, and 3 mined papers were added. Ultimately, 12 papers were analyzed. The overall deformity rate was 10.4% ± 4.8%. No significant differences were found between patients who underwent closed reduction (14.7% ± 7.3%) and those who underwent open reduction (9.4% ± 4.4%), between those who underwent local anesthesia (5.8% ± 4.5%), and those who underwent general anesthesia (8.8% ± 3.8%), or between those who received timely treatment (5.7%) and those whose treatment was delayed (9.0%). Septal deviation occurred in 10.0% of patients as a sequela of nasal bone fracture. The nasal obstruction rate was 10.5% ± 5.3%. Fewer patients of nasal obstruction occurred in the open reduction patients (6.9% ± 4.4%) than in the closed reduction patients (15.2%). One patient of epiphora and 1 patient of diplopia were reportedAmong the 77 patients with nasal bone fractures, 29 (37.7% ± 11.3%) complained of olfactory disturbances. No significant associations were found between the type of fracture and the presence of olfactory disturbances. It is recommended for providers to explain to patients that approximately one-tenth of nasal bone fractures exhibit deformity, septal deviation, or nasal obstruction after surgery. Surgeons should take considerable care to avoid the olfactory mucosa during reduction surgery.

A new modified speculum guided single nostril technique for endoscopic transnasal transsphenoidal surgery: an analysis of nasal complications.

PubMed

Waran, Vicknes; Tang, Ing Ping; Karuppiah, Ravindran; Abd Kadir, Khairul Azmi; Chandran, Hari; Muthusamy, Kalai Arasu; Prepageran, Narayanan

2013-12-01

Abstract The endoscopic transnasal, transsphenoidal surgical technique for pituitary tumour excision has generally been regarded as a less invasive technique, ranging from single nostril to dual nostril techniques. We propose a single nostril technique using a modified nasal speculum as a preferred technique. We initially reviewed 25 patients who underwent pituitary tumour excision, via endoscopic transnasal transsphenoidal surgery, using this new modified speculum-guided single nostril technique. The results show shorter operation time with reduced intra- and post-operative nasal soft tissue injuries and complications.

76 FR 15349 - Fiscal Year 2010 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-21

... OFFICE OF MANAGEMENT AND BUDGET Fiscal Year 2010 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by Department of Defense Medical Treatment Facilities; Certain Rates Regarding... recovery from tortiously liable third persons for the cost of outpatient medical, dental and cosmetic...

Staphylococcus aureus nasal carriage among outpatients attending primary health care centers: a comparative study of two cities in Saudi Arabia and Egypt.

PubMed

Abou Shady, Hala M; Bakr, Alaa Eldin A; Hashad, Mahmoud E; Alzohairy, Mohammad A

2015-01-01

Epidemiological and molecular data on community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) are still scarce in both Egypt and Saudi Arabia. There is almost no data regarding methicillin resistant Staphylococcus aureus (MRSA) prevalence in both countries. This study was conducted to investigate the prevalence and molecular epidemiology of S. aureus and MRSA nasal carriage among outpatients attending primary health care centers in two big cities in both countries. A total of 206 nasal swabs were obtained, 103 swabs from each country. S. aureus isolates were characterized by antibiotic susceptibility, presence of mecA and PVL genes, SCCmec-typing and spa typing, the corresponding Multi locus sequence typing clonal complex was assigned for each spa type based on Ridom StaphType database. MRSA was detected in 32% of the Egyptian outpatients while it was found in 25% of the Saudi Arabian outpatients. All MRSA isolates belonged to SCCmec type V and IVa, where some isolates in Saudi Arabia remained nontypeable. Surprisingly PVL(+) isolates were low in frequency: 15% of MRSA Egyptian isolates and 12% of MRSA isolates in Saudi Arabia. Two novel spa types were detected t11839 in Egypt, and t11841 in Saudi Arabia. We found 8 spa types among 20 isolates from Egypt, and 12 spa types out of 15 isolates from Saudi Arabia. Only two spa types t008 and t223 coexisted in both countries. Four clonal complexes (CC5, CC8, CC22, and CC80) were identified in both Egypt and Saudi Arabia. However, the data collected lacked a representation of isolates from different parts of each country as only one health center from each country was included, it still partially illustrates the CA-MRSA situation in both countries. In conclusion a set of control measures is required to prevent further increase in MRSA prevalence. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

Sevoflurane with or without antiemetic prophylaxis of dexamethasone in spontaneously breathing patients undergoing outpatient anorectal surgery.

PubMed

Wu, Jyh-I; Lu, Shao-Fong; Chia, Yuan-Yi; Yang, Lin-Cheng; Fong, Wen-Po; Tan, Ping-Heng

2009-11-01

To evaluate the prophylactic use of dexamethasone with sevoflurane in outpatient anorectal surgery. Randomized, controlled study. Operating room and Postanesthesia Care Unit of a general hospital. 60 adult, ASA physical status I and II outpatients undergoing anorectal surgery. Patients were randomized to receive either dexamethasone 5 mg intravenously (IV; Group D; n = 30) or an equal volume of saline (Group S; n = 30) before anesthesia induction. Anesthesia was induced with propofol 2.5 mg.kg(-1), fentanyl two microg.kg(-1), and 2% lidocaine one mg.kg(-1) followed by placement of a Laryngeal Mask Airway. Frequency of postoperative nausea and vomiting (PONV), visual analog scale (VAS) pain scores, and patient satisfaction were recorded. Frequency of PONV and VAS pain scores were significantly lower in Group D than Group S (P < 0.05). The time required for "home readiness" was significantly shorter in Group D than Group S (P < 0.05). The prophylactic administration of 5 mg dexamethasone IV can reduce the frequency of PONV, lower VAS pain scores, facilitate recovery to home readiness, and improve satisfaction in outpatients undergoing anorectal surgery.

A review of nasal polyposis

PubMed Central

Newton, Jonathan Ray; Ah-See, Kim Wong

2008-01-01

Nasal polyps are common, affecting up to four percent of the population. Their etiology remains unclear, but they are known to have associations with allergy, asthma, infection, cystic fibrosis, and aspirin sensitivity. They present with nasal obstruction, anosmia, rhinorrhoea, post nasal drip, and less commonly facial pain. Clinical examination reveals single or multiple grey polypoid masses in the nasal cavity. Computerized tomography allows evaluation of the extent of the disease and is essential if surgical treatment is to be considered. Management of polyposis involves a combination of medical therapy and surgery. There is good evidence for the use of corticosteroids (systemic and topical) both as primary treatment and as postoperative prophylaxis against recurrence. Surgical treatment has been refined significantly over the past twenty years with the advent of endoscopic sinus surgery and, in general, is reserved for cases refractory to medical treatment. Recurrence of the polyposis is common with severe disease recurring in up to ten percent of patients. PMID:18728843

Outpatient Follow-Up versus 30-day Readmission among General and Vascular Surgery Patients: A Case for Redesigning Transitional Care

PubMed Central

Saunders, Richard Scott; Fernandes-Taylor, Sara; Rathouz, Paul J.; Saha, Sandeep; Wiseman, Jason T.; Havlena, Jeffrey; Matsumura, Jon; Kent, K. Craig

2014-01-01

Background The association between early outpatient follow-up and 30-day readmission has not been evaluated in any surgical population. Our study characterizes the relationship between outpatient follow-up and early readmissions among surgical patients. Methods We queried the medical record at a large, tertiary care institution (July 2008-December 2012) to determine rates of 30-day outpatient follow-up and readmission for general or vascular surgical procedures. Results The majority of discharges for general (84% of 7552) and vascular (75% of 2362) surgery had a follow-up visit before readmission or within 30 days of discharge. General surgery patients who were not readmitted had high rates of follow-up (88%) and received follow-up at approximately 2-weeks post-discharge (median time 11 days after discharge). In contrast, readmitted general surgery patients received first follow-up at one week (a median time of 8 days); 49% had follow-up. Vascular surgery patients showed a similar trend. Over half of patients readmitted after follow-up were readmitted within 24 hours of their most recent outpatient visit. Conclusions Current routine follow-up does not occur early enough to detect adverse events and prevent readmission. Early outpatient care may prevent readmission in some patients, but often serves as a conduit for readmission among patients already experiencing complications. PMID:25239351

Impact of Middle versus Inferior Total Turbinectomy on Nasal Aerodynamics.

PubMed

Dayal, Anupriya; Rhee, John S; Garcia, Guilherme J M

2016-09-01

This computational study aims to (1) use virtual surgery to theoretically investigate the maximum possible change in nasal aerodynamics after turbinate surgery, (2) quantify the relative contributions of the middle and inferior turbinates to nasal resistance and air conditioning, and (3) quantify to what extent total turbinectomy impairs the nasal air-conditioning capacity. Virtual surgery and computational fluid dynamics. Academic tertiary medical center. Ten patients with inferior turbinate hypertrophy were studied. Three-dimensional models of their nasal anatomies were built according to presurgery computed tomography scans. Virtual surgery was applied to create models representing either total inferior turbinectomy (TIT) or total middle turbinectomy (TMT). Airflow, heat transfer, and humidity transport were simulated at a steady-state inhalation rate of 15 L/min. The surface area stimulated by mucosal cooling was defined as the area where heat fluxes exceed 50 W/m(2). In both virtual total turbinectomy models, nasal resistance decreased and airflow increased. However, the surface area where heat fluxes exceed 50 W/m(2) either decreased (TIT) or did not change significantly (TMT), suggesting that total turbinectomy may reduce the stimulation of cold receptors by inspired air. Nasal heating and humidification efficiencies decreased significantly after both TIT and TMT. All changes were greater in the TIT models than in the TMT models. TIT yields greater increases in nasal airflow but also impairs the nasal air-conditioning capacity to a greater extent than TMT. Radical resection of the turbinates may decrease the surface area stimulated by mucosal cooling. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Impact of Middle vs. Inferior Total Turbinectomy on Nasal Aerodynamics

PubMed Central

Dayal, Anupriya; Rhee, John S.; Garcia, Guilherme J. M.

2016-01-01

Objectives This computational study aims to: (1) Use virtual surgery to theoretically investigate the maximum possible change in nasal aerodynamics after turbinate surgery; (2) Quantify the relative contributions of the middle and inferior turbinates to nasal resistance and air conditioning; (3) Quantify to what extent total turbinectomy impairs the nasal air conditioning capacity. Study Design Virtual surgery and computational fluid dynamics (CFD). Setting Academic tertiary medical center. Subjects and Methods Ten patients with inferior turbinate hypertrophy were studied. Three-dimensional models of their nasal anatomies were built based on pre-surgery computed tomography scans. Virtual surgery was applied to create models representing either total inferior turbinectomy (TIT) or total middle turbinectomy (TMT). Airflow, heat transfer, and humidity transport were simulated at a 15 L/min steady-state inhalation rate. The surface area stimulated by mucosal cooling was defined as the area where heat fluxes exceed 50 W/cm2. Results In both virtual total turbinectomy models, nasal resistance decreased and airflow increased. However, the surface area where heat fluxes exceed 50 W/cm2 either decreased (TIT) or did not change significantly (TMT), suggesting that total turbinectomy may reduce the stimulation of cold receptors by inspired air. Nasal heating and humidification efficiencies decreased significantly after both TIT and TMT. All changes were greater in the TIT models than in the TMT models. Conclusion TIT yields greater increases in nasal airflow, but also impairs the nasal air conditioning capacity to a greater extent than TMT. Radical resection of the turbinates may decrease the surface area stimulated by mucosal cooling. PMID:27165673

The birth of plastic surgery: the story of nasal reconstruction from the Edwin Smith Papyrus to the twenty-first century.

PubMed

Whitaker, Iain S; Karoo, Richard O; Spyrou, George; Fenton, Oliver M

2007-07-01

The nose is the central and most prominent feature on the human face; and on its shape, size, and appearance depends the relative facial beauty of the person. The objective of this article was to give a succinct and interesting account of the development of nasal reconstruction from antiquity to the present day. The authors present the story of nasal reconstruction, including those contributions not often cited in the English literature using articles sourced from MEDLINE, ancient manuscripts, original quotes, techniques, and illustrations. The story of rhinoplasty is one of peaks of achievement by individuals such as Sushruta, Branca, Tagliocozzi, Roe, and Joseph. Since Roe introduced the concept of cosmetic rhinoplasty, the evolution of nasal reconstructive techniques has reached such a level that the expectation is not only to restore form and function, but also to achieve excellent cosmetic appearance. Although repair of nasal injuries is the oldest form of reconstructive surgery, being cited in Egyptian papyrus inscriptions such as the Edwin Smith Papyrus dating back to 2500 to 3000 BC, its complexity continues to challenge surgeons today. This article is dedicated to those individuals who have devoted their lives and work to the advancement of the field of plastic surgery for the benefit of mankind.

Administering of pregabalin and acetaminophen on management of postoperative pain in patients with nasal polyposis undergoing functional endoscopic sinus surgery.

PubMed

Rezaeian, Ahmad

2017-12-01

Management of postoperative pain is a common problem in endoscopic sinus surgery. The objective of this study is the evaluation of pregabalin and acetaminophen effects on the management of postoperative pain in patients with nasal polyposis undergoing functional endoscopic sinus surgery (FESS). In this clinical trial, double-blinded study, 70 patients with nasal polyposis who have indication of FESS were enrolled to this study. After operation, patients were divided randomly into pregabalin and acetaminophen therapy groups. The pregabalin group (n = 35) was treated under pregabalin 50 mg TDS and the acetaminophen group (n = 35) was treated under tablet acetaminophen 500 mg/6 h. Each group was administered for 3 d. The visual analogue scale (VAS) was measured in onset, 12, 24, 48 and 72 h after surgery. All data were entered into SPSS software (SPSS Inc., Chicago, IL) and appropriate statistical tests were assessed to every relation. In this study, there was no significant difference between two groups according to VAS in onset (p = .37); however, VAS in 12, 24, 48 and 72 h after operation was significantly lower in the pregabalin group compared with the acetaminophen group (p < .0001, for every four). Also in the pregabalin group, adverse effects were significantly lower than the acetaminophen group (p < .03). Pregabalin has more effect, safely and usefully than acetaminophen on the management of postoperative pain in the patients with nasal polyposis undergoing functional endoscopic sinus surgery.

Effect of lidocaine-soaked nasal packing on pain relief after endoscopic sinus surgery.

PubMed

Mo, Ji-Hun; Park, Young-Min; Chung, Young-Jun

2013-01-01

Nasal packing is usually performed to control bleeding after endoscopic sinus surgery (ESS). Although new packing materials have been developed, they still cause pain. This study was designed to evaluate the effect of lidocaine-soaked packs on pain after ESS. A prospective, randomized, double-blind controlled trial was conducted in 63 patients with CRS undergoing ESS. At the conclusion of the operation, 2% lidocaine-soaked biodegradable synthetic polyurethane foam and saline-soaked polyurethane foam were inserted in both nasal cavities of 31 patients and 32 control patients, respectively. The same lidocaine or saline was reapplied into the nasal packs at postoperative 8 hours. Pain was evaluated using a visual analog scale at postoperative 1, 4, 8, 16, 20, and 24 hour(s). The number of gauze that cleaned the blood around the nose was counted. Heart rate, rhythm, and blood pressures were checked preoperatively and postoperatively to evaluate the influence of lidocaine on vital signs. Postoperative pain decreased in lidocaine group at all of the postoperative time periods (p < 0.05). Lidocaine reduced postoperative bleeding at postoperative 8 and 24 hours. Changes of blood pressure from preoperative values in the lidocaine group were not different from those in the control group (p > 0.05). Heart rate in the lidocaine group was more stable than that in the control group (p < 0.05). Lidocaine-soaked packs significantly reduced postoperative pain without serious changes on vital sign. These findings suggest that topical lidocaine application to nasal packs could be a useful method to reduce pain during the early postoperative period after ESS.

Outpatient cataract surgery: incident and procedural risk analysis do not support current clinical ophthalmology guidelines.

PubMed

Koolwijk, Jasper; Fick, Mark; Selles, Caroline; Turgut, Gökhan; Noordergraaf, Jeske I M; Tukkers, Floor S; Noordergraaf, Gerrit J

2015-02-01

To evaluate whether an ophthalmologist-led, non-anesthesia-supported, limited monitoring pathway for phacoemulsification/intraocular lens cataract surgery, can be performed safely with only a medical emergency team providing support. Retrospective, observational, cohort study. All patients who underwent elective phacoemulsification/intraocular lens surgery under topical anesthesia in the ophthalmology outpatient unit between January 1, 2011, and December 31, 2012. Cataract surgery was performed by phacoemulsification under topical anesthesia. The intake process mainly embraced ophthalmic evaluation, obtaining a medical history, and proposing the procedure. A staff ophthalmologist performed the procedure assisted by 2 registered nurses in an independent outpatient clinic operating room within the hospital. The clinical pathway was without dedicated presence of or access to anesthesia service. Perioperative monitoring was limited to blood pressure and plethysmography preoperatively and intraoperatively. Patients were offered supportive care and instructed to avoid fasting and continue all their chronic medication. The primary outcome measure was the incidence of adverse events requiring medical emergency team (MET) interventions throughout the pathway. Secondary outcome measures were surgical ocular complication rates, use of oral sedatives, and reported reasons to perform the surgery in the classical operation room complex. Within the cataract pathway, 6961 cases (4347 patients) were eligible for analysis. Three MET interventions related to the phacoemulsification/intraocular lens pathway occurred in the 2-year study period, resulting in an intervention rate of 0.04%. None of the interventions was intraoperative. All 3 patients were diagnosed as vasovagal collapse and recuperated uneventfully. No hospital admittance was required. Eight other incidents occurred within the general ophthalmology outpatient unit population during the study period. Cataract surgery can

Nasal mucosa healing after endoscopic sinus surgery in chronic rhinosinusitis of elderly patients: role of topic alpha-tocopherol acetate.

PubMed

Testa, Domenico; Marcuccio, Giuseppina; Panin, Giorgio; Bianco, Andrea; Tafuri, Domenico; Thyrion, Francesco Zappoli; Nunziata, Michele; Piombino, Pasquale; Guerra, Germano; Motta, Gaetano

2017-02-01

Chronic rhinosinusitis (CRS) in European country ranges in elderly patients from 4.5 to 12% of population and has a significant effect on quality of life. In these patients, rhinosinusitis is linked to immune functions changes with age and to mucosal paraphysiological alterations such as crusting formations with atrophic epithelium, variations of nasal airflow and modifications of the mucociliary clearance. Failure of medical treatments leads to surgery in patients with persistent symptoms and radiographic signs of CRS. The choice of appropriate post-surgical topic treatments is important for healing time and for preventing mucosal complications such as synechiae, crusting formation and atrophy with secondary bacterial and fungal infections. Defining the effects of topic alpha-tocopherol acetate administration on nasal mucosa healing after endoscopic sinus surgery in CRS of elderly patients. In this study were included 32 patients, mean age 68.6, who underwent FESS because affected by CRS not responsive to medical treatments. After surgical treatment, we distinguish two groups basing on local nasal therapy. We investigated, in the postoperative time, the role of alpha-tocopherol acetate compared to gomenol oil. Follow-up was performed at 7-15 days and 1-3 months after surgery. We evaluated mucosal restoration using Rhinoscopy Sum Score and quality of life using Nasal Six Items Symptom Questionnaire. We observed a faster healing time and less recurrence of complications in patients who underwent topic treatment with alpha-tocopherol acetate. In our research, we observed that alpha-tocopherol acetate has no contraindications and side effects. Our study showed the effectiveness of alpha-tocopherol acetate topic treatment in elderly patients affected by CRS after FESS, in improving and speeding up the process of restoring the sinonasal mucosa, compared to another topic medication.

Oxymetazoline plus dexpanthenol in nasal congestion.

PubMed

Jagade, Mohan V; Langade, Deepak G; Pophale, Rupesh R; Prabhu, Arun

2008-12-01

To compare the efficacy and tolerability of Oxymetazoline 0.05 % plus Dexpanthanol 5% versus Xylometazoline 0.1 % nasal drops in patients with nasal congestion due to allergic rhinitis and following nasal surgery. An investigator-blind, randomized, controlled, phase IV clinical trial conducted in 100 patients with acute allergic rhinitis or patients post-nasal surgery. Patients received either Oxymetazoline 0.05% with Dexpanthanol 5% (OD) or Xylometazoline 0.1% (XO) nasal drops. Relief from nasal congestion was significantly better in the OD group then in the XO group (mean nasal scores 1.24 vs 1.86). Significantly more improvement in sneezing and decrease in nasal discharge was seen in the OD group than the XO group. Nasal irritation in the OD group was significantly less as compared to XO group (0.38 v/s 1.12 on second day and 0.10 vs 0.36 on the fourth day). The recovery time for OD group was 1.08 hours, which was significantly (46 min) lesser than that of the XO group. Rebound congestion was significantly less in OD as compared to XO group (6.25% vs 82.98%). 93.75% of the physicians in the OD group and 51.28% in XO group reported response to therapy as good to excellent. 95.83% patients in the OD group and only 52.91% patients in the XO group rated tolerability to therapy as good to excellent. Oxymetazoline and dexpanthenol combination has a better efficacy, shorter recovery time, causes lesser rebound congestion and has better tolerability than xylometazoline.

Laser-assisted surgery of endonasal diseases

NASA Astrophysics Data System (ADS)

Sroka, Ronald; Leunig, Andreas; Janda, P.; Rosler, P.; Grevers, G.; Baumgartner, Reinhold

2000-06-01

Clinical studies were performed to assess the clinical outcome of laser assisted endonasal turbinate surgery in long-term. By means of a pulsed Ho:YAG laser emitting at (lambda) equals 2100nm 57 patients suffering form nasal obstruction due to allergic rhinitis and vasomotoric rhinitis were treated under local anesthesia. Furthermore 50 patients were treated by means of light of a diode laser. The light was fed into a fiber being introduced into a fiber guidance system which serves for suction of smoke and pyrolyse products. The distal part of this system could be bent in the range of -5 degrees up to 45 degrees due to the optical axes of the fiber. The study was conducted by a standardized questionnaire, photo documentation, allergy test, mucocilliar function test, rhinomanometry, radiology and histology. Within 2 weeks after laser treatment a significant improvement of nasal airflow correlating to the extent of the ablated turbinate tissue could be determined. This effect lasted up until 1 year post treatment resulting in an improved quality of life in more than 80 percent of the patients. Side effects like nasal dryness and pain were rare, no immediate complications were observed. The total treatment time took 3-8 minutes/turbinate and nasal packing was not necessary after the laser procedure. In conclusion laser treatment by means of the fiber guidance system can be performed as an outpatient procedure under local anesthesia with excellent ablation of soft tissue in a short treatment time with promising results. It will become a time and cost effective treatment modality in endonasal laser surgery.

Evaluation of modified nasal to oral endotracheal tube switch-For modified alar base cinching after maxillary orthognathic surgery.

PubMed

Shaik, Taj Nizam Shakeel; Meka, Sridhar; Ch, Pavan Kumar; Kolli, Naga Neelima Devi; Chakravarthi, P Srinivas; Kattimani, Vivekanand S; L, Krishna Prasad

2017-01-01

Soft tissue changes secondary to Maxillary orthognathic surgery are many fold. The alar flare is one among them, which affects the appearance of the patient. Cinch suture has been used to prevent alar flare; but the presence of anaesthetic tube hinders cinching. So, the study was aimed to assess an efficacy of modified nasal to oral tube switch technique for modified alar cinching to prevent alar flare after orthognathic and nasal corrective surgeries. Patients were randomly allocated in each group, who underwent modified alar base cinching with and without nasal to oral tube switch. Changes in alar base width, upper lip length was measured with Digital Vernier Caliper and nasolabial angle (Cotg-Sn-Ls) on lateral cephalogram at 1st, 3rd, 6th, and 12th months after surgery. The time taken and ease of tube switch were noted. The data obtained were tabulated and interpreted using a test of significance. Study results showed no statistical significant difference in perinasal soft changes among both groups. But tube switch appears to be beneficial to prevent alar flare. Modified alar base cinching was performed effectively in patients with a modified tube switch technique. It increased positive results in comparison with non-shift. The technique of tube switch used is effective in prevention of alar flare. Because of small sample size and limited period of follow up, our study suggests multi centre, randomized studies to know the technical difficulties of tube switch for cinching and aesthetic results with varying anaesthetist and the surgeon's experience.

[The effect of parecoxib sodium for preemptive analgesia on nasal endoscopic surgery].

PubMed

Kong, Yonggang; Yang, Xilin; Li, Xinchu

2015-08-01

To evaluate the perioperative analgesic effects of parecoxib sodium in patients undergoing nasal endoscopic surgery. In the randomized, double blind, controlled study, 120 patients undergoing septoplasty were divided into 3 groups (n = 40): A group received parecoxib at a dose of 40 mg by muscle injection 30 min before the operation followed by saline at the same volume every 24 h for 48 h; B group received parecoxib at a dose of 40 mg by muscle injection 30 min before the operation followed by 40 mg every 24 h for 48 h; C group received an equal volume of 0.9% saline at the same time points. Patients were assessed with respect to pain score (VAS), rescue analgesia requirement and the side effects during the operation as well as at 3, 24, 48 h after the surgery. Intra-operative as well as the postoperative pain scores were less in the A group and B group than in the.control group. Compared with group A, group B had significantly lower VAS score at 24 h after the operation, however there were no significant difference on other time points. Fewer participants of both the A and B groups required rescue medication after operation. Administration of parecoxib can provide ideal analgesic effects without serious adverse side effects at the perioperative period for patients who received nasal endoscopic operation. Intramuscular parecoxib (40 mg 30 min before the operation followed 40 mg qd for 48 h) designed as preoperative analgesia mode resulted in sufficient perioperative analgesia that deserves popularization in the clinical works.

A randomized trial of Rapid Rhino Riemann and Telfa nasal packs following endoscopic sinus surgery.

PubMed

Cruise, A S; Amonoo-Kuofi, K; Srouji, I; Kanagalingam, J; Georgalas, C; Patel, N N; Badia, L; Lund, V J

2006-02-01

To compare Telfa with the Rapid Rhino Riemann nasal pack for use following endoscopic sinus surgery. Prospective, randomized, double-blind, paired trial. Tertiary otolaryngology hospital. Forty-five adult patients undergoing bilateral endoscopic sinus surgery for either chronic rhinosinusitis or nasal polyps. A visual analogue scale was used to assess discomfort caused by the presence of the packs in the nose and by their removal. The amount of bleeding was noted with the packs in place and following their removal. Crusting and adhesions were assessed 2 and 6 weeks following surgery. Both packs performed well giving good haemostasis and causing little bleeding on removal. Both packs caused only mild discomfort while in the nose. On the visual analogue scale of 0-10 cm the mean visual analogue score for Rapid Rhino Riemann pack was 1.7 and for Telfa 2.0 (P = 0.371). The Rapid Rhino Riemann pack caused significantly less pain on removal compared with the Telfa pack with a mean visual analogue score of 2.0 in comparison with 3.7 for Telfa (P = 0.001). There were less adhesions with the Rapid Rhino Riemann than Telfa pack but this was not statistically significant (P = 0.102). Both Telfa and Rapid Rhino Riemann packs can be recommended as packs that control postoperative haemorrhage, do not cause bleeding on removal and cause little discomfort while in the nose. The Rapid Rhino Riemann pack has the advantage of causing significantly less pain on removal.

Outpatient-based scalp surgery without shaving and allowing use of shampoo.

PubMed

Hwang, Sun-Chul; Kim, Soon-Kwon; Park, Kwan-Woong; Im, Soo-Bin; Shin, Won-Han; Kim, Bum-Tae

2012-02-01

To assess the authors' experience of wound management following scalp mass surgery after introducing a policy of leaving hair unshaved and allowing patients to use shampoo. The authors retrospectively reviewed 93 patients who underwent outpatient-based excision of a scalp or skull mass. Surgical complications, mass depth, and maximal mass size were analyzed. All of the surgeries were performed without shaving around the lesion; the hair was simply parted along the proposed incision, and the parting was maintained using adhesive plasters. Routine antiseptic scalp preparations, skin closure with staples after mass excision, and topical ointment on the day following surgery were used, and use of shampoo was allowed. The staples were removed on postoperative days 7-10. The masses were located in the skin (23 cases), subcutaneously (64 cases), and subgaleally (6 cases). All patients except one had satisfactory wound healing. No infections occurred. Leaving hair unshaved and allowing patients to use shampoo can be applied in wound management after scalp mass surgery. Copyright © 2012 Elsevier Inc. All rights reserved.

Patient specific CFD models of nasal airflow: overview of methods and challenges.

PubMed

Kim, Sung Kyun; Na, Yang; Kim, Jee-In; Chung, Seung-Kyu

2013-01-18

Respiratory physiology and pathology are strongly dependent on the airflow inside the nasal cavity. However, the nasal anatomy, which is characterized by complex airway channels and significant individual differences, is difficult to analyze. Thus, commonly adopted diagnostic tools have yielded limited success. Nevertheless, with the rapid advances in computer resources, there have been more elaborate attempts to correlate airflow characteristics in human nasal airways with the symptoms and functions of the nose by computational fluid dynamics study. Furthermore, the computed nasal geometry can be virtually modified to reflect predicted results of the proposed surgical technique. In this article, several computational fluid mechanics (CFD) issues on patient-specific three dimensional (3D) modeling of nasal cavity and clinical applications were reviewed in relation to the cases of deviated nasal septum (decision for surgery), turbinectomy, and maxillary sinus ventilation (simulated- and post-surgery). Clinical relevance of fluid mechanical parameters, such as nasal resistance, flow allocation, wall shear stress, heat/humidity/NO gas distributions, to the symptoms and surgical outcome were discussed. Absolute values of such parameters reported by many research groups were different each other due to individual difference of nasal anatomy, the methodology for 3D modeling and numerical grid, laminar/turbulent flow model in CFD code. But, the correlation of these parameters to symptoms and surgery outcome seems to be obvious in each research group with subject-specific models and its variations (virtual- and post-surgery models). For the more reliable, patient-specific, and objective tools for diagnosis and outcomes of nasal surgery by using CFD, the future challenges will be the standardizations on the methodology for creating 3D airway models and the CFD procedures. Copyright © 2012 Elsevier Ltd. All rights reserved.

Effect of Fentanyl Nasal Packing Treatment on Patients With Acute Postoperative Pain After Nasal Operation: A Randomized Double-Blind Controlled Trial.

PubMed

Kim, Kwan-Sub; Yeo, Nam-Kyung; Kim, Seong-Su; Park, Woong-Sub; Kwak, Su-Hyun; Cho, Sang-Hyeon; Sung, Gyu-Wan; Kim, Hae-Sook; Yi, Sang-Wook; Cho, Hae Jun

2018-05-01

Nasal packing is an option for bleeding control after endoscopic sinus surgery and septoplasty. Although new packing materials have been developed, patients still suffer from pain and require additional analgesics treatments. In this study, a prospective, randomized, and double-blind controlled trial was designed to evaluate the effect of fentanyl-soaked packing on pain after endoscopic sinus surgery and septoplasty. One hundred fifty-two patients who underwent nasal surgeries due to chronic rhinosinusitis or nasal septal deviation were enrolled in this study. At the end of operation, 50 mcg fentanyl-soaked biodegradable synthetic polyurethane foams packing Nasopore or Merocel were applied to a group of 79 patients, and saline-soaked ones were applied to another group of 73 patients. To evaluate the influence of fentanyl on postoperative nasal pain, patients' conditions were assessed via means of Numeric Rating Scale, patient satisfaction, and Ramsay Sedation Scale. In addition, symptoms of headache or sore throat and any signs of cardiopulmonary-relevant indicators were monitored. The fentanyl group had significantly decreased Numeric Rating Scale and increased patient satisfaction in every operation type for the majority of postoperative time periods ( P < .05) with reduced postoperative headache and sore throat compared to the control group. The fentanyl group showed a higher score on Ramsay Sedation Scale than the control group ( P < .05 in group including endoscopic sinus surgery). There were no significant differences in cardiopulmonary-relevant indicators between the 2 groups ( P > .05). Fentanyl group showed significantly reduced postoperative pain without serious adverse effects. We suggest that topical fentanyl application to nasal packs can be a useful method to reduce pain during the early postoperative period after endoscopic sinus surgery and septoplasty.

Effect size comparison of ketorolac nasal spray and commonly prescribed oral combination opioids for pain relief after third molar extraction surgery.

PubMed

Niebler, Gwendolyn; Dayno, Jeffrey

2016-01-01

Opioids are frequently used for treatment of moderate to severe short-term pain, but concerns exist about this treatment approach. Ketorolac tromethamine nasal spray, a nonsteroidal anti-inflammatory, is indicated for the short-term management of moderate to moderately severe pain requiring analgesia at the opioid level. However, there are no direct comparison studies between ketorolac nasal spray and opioids. The objective of this study was to use an effect size analysis to compare the effectiveness of ketorolac nasal spray with oral combination opioid formulations in treating moderate to severe short-term pain. An effect size analysis of three randomized, double-blind, placebo-controlled studies of third molar extraction surgery compared pain relief with ketorolac nasal spray and commonly prescribed combination opioids including hydrocodone/acetaminophen (APAP), oxycodone/APAP, oxycodone/ibuprofen and tramadol HCl/APAP. Effect size comparisons were made using total pain relief scores (TOTPAR6 or TOTPAR8; the weighted sum of pain relief scores through 6 or 8 h). Pain relief was measured using a five-point categorical rating scale (0 = none; 4 = complete). The effect size equivalent correlation, r, was determined using an online effect size calculator. The treatment effect size r compared with placebo was classified using established criteria (small = 0.20-0.49, moderate = 0.50-0.79 and large = ≥ 0.80). TOTPAR6 data indicated a moderate effect size for ketorolac nasal spray 31.5 mg (0.51) and oxycodone/ibuprofen 5/400 mg (0.64) and a small effect size for hydrocodone/APAP 7.5/500 mg (0.24) and oxycodone/APAP 5/325 mg (0.32). TOTPAR8 data indicated small effect sizes for ketorolac nasal spray (0.48), hydrocodone/APAP 10/650 mg (0.43), tramadol HCl/APAP 75/650 mg (0.35) and tramadol HCl/APAP 37.5/325 mg (0.17). The treatment effect sizes of ketorolac nasal spray were similar to or higher than the opioid comparators after third molar surgery, a well-accepted pain

Physician Assistants Improve Efficiency and Decrease Costs in Outpatient Oral and Maxillofacial Surgery.

PubMed

Resnick, Cory M; Daniels, Kimberly M; Flath-Sporn, Susan J; Doyle, Michael; Heald, Ronald; Padwa, Bonnie L

2016-11-01

To determine the effects on time, cost, and complication rates of integrating physician assistants (PAs) into the procedural components of an outpatient oral and maxillofacial surgery practice. This is a prospective cohort study of patients from the Department of Plastic and Oral Surgery at Boston Children's Hospital who underwent removal of 4 impacted third molars with intravenous sedation in our outpatient facility. Patients were separated into the "no PA group" and PA group. Process maps were created to capture all activities from room preparation to patient discharge, and all activities were timed for each case. A time-driven activity-based costing method was used to calculate the average times and costs from the provider's perspective for each group. Complication rates were calculated during the periods for both groups. Descriptive statistics were calculated, and significance was set at P < .05. The total process time did not differ significantly between groups, but the average total procedure cost decreased by $75.08 after the introduction of PAs (P < .001). The time that the oral and maxillofacial surgeon was directly involved in the procedure decreased by an average of 19.2 minutes after the introduction of PAs (P < .001). No significant differences in postoperative complications were found. The addition of PAs into the procedural components of an outpatient oral and maxillofacial surgery practice resulted in decreased costs whereas complication rates remained constant. The increased availability of the oral and maxillofacial surgeon after the incorporation of PAs allows for more patients to be seen during a clinic session, which has the potential to further increase efficiency and revenue. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Does Nasal Carriage of Staphylococcus aureus Increase the Risk of Postoperative Infections After Elective Spine Surgery: Do Most Infections Occur in Carriers?

PubMed

Adogwa, Owoicho; Vuong, Victoria D; Elsamadicy, Aladine A; Lilly, Daniel T; Desai, Shyam A; Khalid, Syed; Cheng, Joseph; Bagley, Carlos A

2018-05-14

Wound infections after adult spinal deformity surgery place a high toll on patients, providers, and the healthcare system. Staphylococcus aureus is a common cause of postoperative wound infections, and nasal colonization by this organism may be an important factor in the development of surgical site infections (SSIs). The aim is to investigate whether post-operative surgical site infections after elective spine surgery occur at a higher rate in patients with methicillin-resistant S. aureus (MRSA) nasal colonization. Consecutive patients undergoing adult spinal deformity surgery between 2011-2013 were enrolled. Enrolled patients were followed up for a minimum of 3 months after surgery and received similar peri-operative infection prophylaxis. Baseline characteristics, operative details, rates of wound infection, and microbiologic data for each case of post-operative infection were gathered by direct medical record review. Local vancomycin powder was used in all patients and sub-fascial drains were used in the majority (88%) of patients. 1200 operative spine cases were performed for deformity between 2011 and 2013. The mean ± standard deviation age and body mass index were 62.08 ± 14.76 years and 30.86 ± 7.15 kg/m 2 , respectively. 29.41% had a history of diabetes. All SSIs occurred within 30 days of surgery, with deep wound infections accounting for 50% of all SSIs. Of the 34 (2.83%) cases of SSIs that were identified, only 1 case occurred in a patient colonized with MRSA. Our study suggests that the preponderance of SSIs occurred in patients without nasal colonization by methicillin-resistant S. aureus. Future prospective multi-institutional studies are needed to corroborate our findings. Copyright © 2018 Elsevier Inc. All rights reserved.

Cosmetic rostral nasal reconstruction after nasal planum and premaxilla resection: technique and results in two dogs.

PubMed

Gallegos, Javier; Schmiedt, Chad W; McAnulty, Jonathan F

2007-10-01

To describe a novel reconstructive technique after nasal planum and premaxilla resection. Case report. Dogs (n=2) with squamous cell carcinoma (SCC) of the nasal planum. A 9-year-old neutered female Labrador retriever (dog 1) and an 11-year-old neutered male Golden retriever (dog 2) had resection of the nasal planum and premaxilla for treatment of locally invasive SCC. Reconstruction of a nasal planum facsimile was based on use of the nonhaired pigmented margins of bilateral labial mucocutaneous rotation-advancement flaps. Reconstruction of the premaxilla by construction of a nasal planum facsimile resulted in uncomplicated wound healing and improved cosmesis. There was no tumor recurrence at 1290 (dog 1) and 210 (dog 2) days after surgery. Reconstruction of a nasal planum facsimile was successfully performed without complications in 2 dogs with high owner satisfaction with cosmetic appearance. This technique represents a significant advancement in surgical cosmetic outcome, may potentially reduce postoperative complications, and should be considered for dogs requiring nasal reconstruction after nasal planum resection with premaxillectomy.

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty.

PubMed

Ishii, Lisa E; Tollefson, Travis T; Basura, Gregory J; Rosenfeld, Richard M; Abramson, Peter J; Chaiet, Scott R; Davis, Kara S; Doghramji, Karl; Farrior, Edward H; Finestone, Sandra A; Ishman, Stacey L; Murphy, Robert X; Park, John G; Setzen, Michael; Strike, Deborah J; Walsh, Sandra A; Warner, Jeremy P; Nnacheta, Lorraine C

2017-02-01

Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice

Prevalence and Predictive Factors of Chronic Postsurgical Pain and Poor Global Recovery 1 Year After Outpatient Surgery.

PubMed

Hoofwijk, Daisy M N; Fiddelers, Audrey A A; Peters, Madelon L; Stessel, Björn; Kessels, Alfons G H; Joosten, Elbert A; Gramke, Hans-Fritz; Marcus, Marco A E

2015-12-01

To prospectively describe the prevalence and predictive factors of chronic postsurgical pain (CPSP) and poor global recovery in a large outpatient population at a university hospital, 1 year after outpatient surgery. A prospective longitudinal cohort study was performed. During 18 months, patients presenting for preoperative assessment were invited to participate. Outcome parameters were measured by using questionnaires at 3 timepoints: 1 week preoperatively, 4 days postoperatively, and 1 year postoperatively. A value of >3 on an 11-point numeric rating scale was considered to indicate moderate to severe pain. A score of ≤80% on the Global Surgical Recovery Index was defined as poor global recovery. A total of 908 patients were included. The prevalence of moderate to severe preoperative pain was 37.7%, acute postsurgical pain 26.7%, and CPSP 15.3%. Risk factors for the development of CPSP were surgical specialty, preoperative pain, preoperative analgesic use, acute postoperative pain, surgical fear, lack of optimism, and poor preoperative quality of life. The prevalence of poor global recovery was 22.3%. Risk factors for poor global recovery were recurrent surgery because of the same pathology, preoperative pain, preoperative analgesic use, surgical fear, lack of optimism, poor preoperative and acute postoperative quality of life, and follow-up surgery during the first postoperative year. Moderate to severe CPSP after outpatient surgery is common, and should not be underestimated. Patients at risk for developing CPSP can be identified during the preoperative phase.

Years Versus Days Between Successive Surgeries, After an Initial Outpatient Procedure, for the Median Patient Versus the Median Surgeon in the State of Iowa.

PubMed

Dexter, Franklin; Jarvie, Craig; Epstein, Richard H

2018-03-01

Previously, we studied the relative importance of different institutional interventions that the largest hospital in Iowa could take to grow the anesthesia department's outpatient surgical care. Most (>50%) patients having elective surgery had not previously had surgery at the hospital. Patient perioperative experience was unimportant for influencing total anesthesia workload and numbers of patients. More important was the availability of surgical clinic appointments within several days. These results would be generalizable if the median time from surgery to a patient's next surgical procedure was large (eg, >2 years), among all hospitals in Iowa with outpatient surgery, and without regard to the hospital where the next procedure was performed. There were 37,172 surgical cases at hospital outpatient departments of any of the 117 hospitals in Iowa from July 1, 2013, to September 30, 2013. Data extracted about each case included its intraoperative work relative value units. The 37,172 cases were matched to all inpatient and outpatient records for the next 2 years statewide using patient linkage identifiers; from these were determined whether the patient had surgery again within 2 years. Furthermore, the cases' 1820 surgeons were matched to the surgeon's next outpatient or inpatient case, both including and excluding other cases performed on the date of the original case. By patient, the median time to their next surgical case, either outpatient or inpatient, exceeded 2 years, tested with weighting by intraoperative relative value units and repeated when unweighted (both P < .0001). Specifically, with weighting, 65.9% (99% confidence interval [CI], 65.2%-66.5%) of the patients had no other surgery within 2 years, at any hospital in the state. The median time exceeded 2 years for multiple categories of patients and similar measures of time to next surgery (all P < .01). In comparison, by surgeon, the median time to the next outpatient surgical case was 1 calendar day

Comparison of Parecoxib and Proparacetamol in Endoscopic Nasal Surgery Patients

PubMed Central

Casati, Andrea; Rapotec, Alessandro; Dalsasso, Massimiliano; Barzan, Luigi; Fanelli, Guido; Pellis, Tommaso

2008-01-01

Purpose The aim of the study was to compare the efficacy of parecoxib for postoperative analgesia after endoscopic turbinate and sinus surgery with the prodrug of acetaminophen, proparacetamol. Materials and Methods Fifty American Society of Anesthesiology (ASA) physical status I-II patients, receiving functional endoscopic sinus surgery (FESS) and endoscopic turbinectomy, were investigated in a prospective, randomized, double-blind manner. After local infiltration with 1% mepivacaine, patients were randomly allocated to receive intravenous (IV) administration of either 40 mg of parecoxib (n = 25) or 2 g of proparacetamol (n = 25) 15 min before discontinuation of total IV anaesthesia with propofol and remifentanil. A blinded observer recorded the incidence and severity of pain at admission to the post anaesthesia care unit (PACU) at 10, 20, and 30 min after PACU admission, and every 1 h thereafter for the first 6 postoperative h. Results The area under the curve of VAS (AUCVAS) calculated during the study period was 669 (28 - 1901) cm·min in the proparacetamol group and 635 (26 - 1413) cm·min in the parecoxib group (p = 0.34). Rescue morphine analgesia was required by 14 patients (56%) in the proparacetamol group and 12 patients (48%) in the parecoxib (p ≥ 0.05), while mean morphine consumption was 5 - 3.5 mg and 5 - 2.0 mg in the proparacetamol groups and parecoxib, respectively (p ≥ 0.05). No differences in the incidence of side effects were recorded between the 2 groups. Patient satisfaction was similarly high in both groups, and all patients were uneventfully discharged 24 h after surgery. Conclusion In patients undergoing endoscopic nasal surgery, prior infiltration with local anaesthetics, parecoxib administered before discontinuing general anaesthetic, is not superior to proparacetamol in treating early postoperative pain. PMID:18581586

Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases.

PubMed

Adamson, Tim; Godil, Saniya S; Mehrlich, Melissa; Mendenhall, Stephen; Asher, Anthony L; McGirt, Matthew J

2016-06-01

OBJECTIVE In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed, and the frequency of its performance is rapidly increasing as the aging population grows. Although ASCs offer significant cost advantages over hospital-based surgical centers, concern over the safety of outpatient ACDF has slowed its adoption. The authors intended to 1) determine the safety of the first 1000 consecutive ACDF surgeries performed in their outpatient ASC, and 2) compare the safety of these outpatient ACDFs with that of consecutive ACDFs performed during the same time period in the hospital setting. METHODS A total of 1000 consecutive patients who underwent ACDF in an ACS (outpatient ACDF) and 484 consecutive patients who underwent ACDF at Vanderbilt University Hospital (inpatient ACDF) from 2006 to 2013 were included in this retrospective study of patients' medical records. Data were collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. Perioperative morbidity and hospital readmission were compared between the outpatient and inpatient ACDF groups. RESULTS Of the first 1000 outpatient ACDF cases performed in the authors' ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDFs. Mean patient age was 49.5 ± 8.6, and 484 (48.4%) were males. All patients were observed postoperatively at the ASC postanesthesia care unit (PACU) for 4 hours before being discharged home. Eight patients (0.8%) were transferred from the surgery center to the hospital postoperatively (for pain control [n = 3], chest pain and electrocardiogram changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], and profound postoperative weakness and surgical reexploration [n = 1]). No perioperative

[Psychometric properties of scales of professional competence and treatment by health personnel in outpatient hospital surgeries].

PubMed

Bermejo Alegría, Rosa M; Hidalgo Montesinos, M Dolores; Parra Hidalgo, Pedro; Más Castillo, Adelia; Gomis Cebrián, Rafael

2011-04-01

The aim of this study was to analyze the psychometric properties of two scales that assess the perceived quality and patient satisfaction with outpatient surgery in the Health Service of Murcia. These scales assess the degree of Professional Competence (PC) and Personnel Treatment (PT). The scales were administered to a sample of 2017 users of outpatient surgery in the Health Service of Murcia during the years 2008 and 2009. Exploratory factor analysis indicates a unidimensional structure for each scale. Internal consistency was adequate: .68 for PC and .75 for PT. The correlation between the PC scale and patients' global satisfaction was positive and statistically significant. The correlation between the PT scale and patients' global satisfaction was also statistically significant. The scales have shown their utility to detect areas of improvement and to plan intervention strategies.

Nose and Nasal Planum Neoplasia, Reconstruction.

PubMed

Worley, Deanna R

2016-07-01

Most intranasal lesions are best treated with radiation therapy. Computed tomographic imaging with intravenous contrast is critical for treatment planning. Computed tomographic images of the nose will best assess the integrity of the cribriform plate for central nervous system invasion by a nasal tumor. Because of an owner's emotional response to an altered appearance of their dog's face, discussions need to include the entire family before proceeding with nasal planectomy or radical planectomy. With careful case selection, nasal planectomy and radical planectomy surgeries can be locally curative. Copyright © 2016 Elsevier Inc. All rights reserved.

Nasal Base Retraction: A Treatment Algorithm.

PubMed

Tas, Süleyman; Colakoglu, Salih; Lee, Bernard Travis

2017-06-01

Nasal base retraction results from cephalic malposition of the alar base in the vertical plane, which causes disharmony of the alar base with the rest of the nose structures. Correcting nasal base retraction is very important for improved aesthetic outcomes; however, there is a limited body of literature about this deformity and its treatment. Create a nasal base retraction treatment algorithm based on a severity classification system. This is a retrospective case review study of 53 patients who underwent rhinoplasty with correction of alar base retraction by the senior author (S.T.). The minimum follow-up time was 6 months. Levator labii alaque nasi muscle dissection or alar base release with or without a rim graft on the effected side were performed based on the severity of the alar base retraction. Aesthetic results were assessed with objective grading of preoperative and postoperative patient photographs by two independent plastic surgeons. Functional improvement was assessed with patient self-evaluations of nasal patency. Also, a rhinoplasty outcomes evaluation (ROE) questionnaire was distributed to patients. Comparison of preoperative and postoperative photographs demonstrated that nasal base asymmetry was significantly improved in all cases, and 85% of the patients had complete symmetry. Nasal obstruction was also significantly reduced after surgery (P < 0.001). The majority of patients reported satisfaction (92.5%), with an ROE total score greater than or equal to 20. New techniques and a treatment algorithm for correcting nasal base retraction deformities that will help rhinoplasty surgeons obtain aesthetically and functionally pleasing outcomes for patients. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Inpatient or outpatient rehabilitation after herniated disc surgery? - Setting-specific preferences, participation and outcome of rehabilitation.

PubMed

Löbner, Margrit; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans J; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C; König, Hans-Helmut; Riedel-Heller, Steffi G

2014-01-01

To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes. The longitudinal observational study referred to 534 consecutive disc surgery patients (18-55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001). The results suggest a "pre-selection" of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and improve rehabilitation effects such as return

Ambulatory Surgery Centers and Prices in Hospital Outpatient Departments.

PubMed

Carey, Kathleen

2017-04-01

Specialty providers claim to offer a new competitive benchmark for efficient delivery of health care. This article explores this view by examining evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). I studied the impact of ASC market presence on actual prices paid to HOPDs during 2007-2010 for four common surgical procedures that were performed in both provider types. For the procedures examined, HOPDs received payments from commercial insurers in the range of 3.25% to 5.15% lower for each additional ASC per 100,000 persons in a market. HOPDs may have less negotiating leverage with commercial insurers on price in markets with high ASC market penetration, resulting in relatively lower prices.

Web-Based Education Prior to Outpatient Orthopaedic Surgery Enhances Early Patient Satisfaction Scores: A Prospective Randomized Controlled Study.

PubMed

van Eck, Carola F; Toor, Aneet; Banffy, Michael B; Gambardella, Ralph A

2018-01-01

A good patient-surgeon relationship relies on adequate preoperative education and counseling. Several multimedia resources, such as web-based education tools, have become available to enhance aspects of perioperative care. The purpose of this study was to evaluate the effect of an interactive web-based education tool on perioperative patient satisfaction scores after outpatient orthopaedic surgery. It was hypothesized that web-based education prior to outpatient orthopaedic surgery enhances patient satisfaction scores. Randomized controlled trial; Level of evidence, 1. All patients undergoing knee arthroscopy with meniscectomy, chondroplasty, or anterior cruciate ligament reconstruction or shoulder arthroscopy with rotator cuff repair were eligible for inclusion and were randomized to the study or control group. The control group received routine education by the surgeon, whereas the study group received additional web-based education. At the first postoperative visit, all patients completed the OAS CAHPS (Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems) survey. Differences in patient satisfaction scores between the study and control groups were determined with an independent t test. A total of 177 patients were included (104 [59%] males; mean age, 42 ± 14 years); 87 (49%) patients were randomized to receive additional web-based education. Total patient satisfaction score was significantly higher in the study group (97 ± 5) as compared with the control group (94 ± 8; P = .019), specifically for the OAS CAHPS core measure "recovery" (92 ± 13 vs 82 ± 23; P = .001). Age, sex, race, workers' compensation status, education level, overall health, emotional health, procedure type and complexity, and addition of a video did not influence patient satisfaction scores. Supplemental web-based patient education prior to outpatient orthopaedic surgery enhances patient satisfaction scores.

Nasal reconstruction after epithelioma.

PubMed

Rodríguez-Camps, S

2001-01-01

In this paper we present our procedure for the treatment, histopathological diagnosis, and resection of skin cancer in the nasal pyramid and its subsequent reconstruction. Because we are dealing with the most important anatomical feature of the face our goal is an aesthetic reconstruction [2,4] according to the anatomical subunits criterion of Burget [3]. First, a histopathological diagnosis is made to determine the nature of the tumor. Then, we proceed with the resection according to the Mohs Micrographic Surgery [1,5,7]. Then we begin with the first step of the nasal reconstruction.

Rare Location for Pilonidal Sinus: the Nasal Dorsum.

PubMed

Kars, Ayhan; Atalay, Fatma; Kilic, Korhan; Bingöl, Fatih; Can, Yusuf

2018-05-14

Pilonidal sinuses are recurrent chronic inflammatory lesions which may occur due to penetration of hair particles into skin. Herein, the authors report a pilonidal sinus case that is unusually seen on nasal dorsum and totally excised with the open technique rhinoplasty method. A 20-year-old male patient was admitted to the authors' outpatient clinic with complaints of dysmorphism and discharge from nasal dorsum. Physical examination revealed a swelling in nasal dorsum and hair-containing fistula. Excision was performed with an open rhinoplasty approach. Histo-pathology examination revealed pilonidal sinus. While pilonidal sinus is usually located in sacro-coccygeal region, it may also be seen in atypical localizations like nasal dorsum. Although the prediagnosis of a hair-containing lesion usually includes dermoid cyst, pilonidal sinus should also be considered and histo-pathological examination should certainly be performed. It is a problematic condition when it is symptomatic; however, management and treatment of the disease is easy when correct diagnosis is made.

Virtual surgery for patients with nasal obstruction: Use of computational fluid dynamics (MeComLand®, Digbody® & Noseland®) to document objective flow parameters and optimise surgical results.

PubMed

Burgos, Manuel A; Sevilla García, Maria Agustina; Sanmiguel Rojas, Enrique; Del Pino, Carlos; Fernández Velez, Carlos; Piqueras, Francisco; Esteban Ortega, Francisco

Computational fluid dynamics (CFD) is a mathematical tool to analyse airflow. We present a novel CFD software package to improve results following nasal surgery for obstruction. A group of engineers in collaboration with otolaryngologists have developed a very intuitive CFD software package called MeComLand®, which uses the patient's cross-sectional (tomographic) images, thus showing in detail results originated by CFD such as airflow distributions, velocity profiles, pressure, or wall shear stress. NOSELAND® helps medical evaluation with dynamic reports by using a 3D endoscopic view. Using this CFD-based software a patient underwent virtual surgery (septoplasty, turbinoplasty, spreader grafts, lateral crural J-flap and combinations) to choose the best improvement in nasal flow. To present a novel software package to improve nasal surgery results. To apply the software on CT slices from a patient affected by septal deviation. To evaluate several surgical procedures (septoplasty, turbinectomy, spreader-grafts, J-flap and combination among them) to find the best alternative with less morbidity. The combination of all the procedures does not provide the best nasal flow improvement. Septoplasty plus turbinoplasty obtained the best results. Turbinoplasty alone rendered almost similar results to septoplasty in our simulation. CFD provides useful complementary information to cover diagnosis, prognosis, and follow-up of nasal pathologies based on quantitative magnitudes linked to fluid flow. MeComLand®, DigBody® and NoseLand® represent a non-invasive, low-cost alternative for the functional study of patients with nasal obstruction. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

[Surgical treatment of snoring by correction of nasal and oropharyngeal obstruction].

PubMed

Martin, F

1986-10-01

32 patients with habitual snoring and 2 patients with obstructive sleep apnea syndrome underwent nasal and/or palatopharyngeal surgery. 12 patients with combined nasal septoplasty, submucous resection of the inferior turbinate bones and palatopharyngoplasty gained total relief from snoring. The same result was achieved in 10 children with removal of extremes of tonsillar and adenoid enlargement. From 7 patients with nasal surgery alone 4 experienced total improvement in the snoring, 3 perceived no long-term relief. 3 adults with PPP alone gained some change in their snoring. Uvulectomy in 2 adults had no influence on the snoring situation.

Facility cost analysis in outpatient plastic surgery: implications for the academic health center.

PubMed

Pacella, Salvatore J; Comstock, Matthew C; Kuzon, William M

2008-04-01

The authors examined the economic patterns of outpatient aesthetic and reconstructive plastic surgical procedures performed within an academic health center. For fiscal years 2003 and 2004, the University of Michigan Health System's accounting database was queried to identify all outpatient plastic surgery cases (aesthetic and reconstructive) from four surgical facilities. Total facility charges, cost, revenue, and margin were calculated for each case. Contribution margin (total revenue minus variable direct cost) was compared with total case time to determine average contribution margin per operating suite case minute for subsets of aesthetic and reconstructive procedures. A total of 3603 cases (3457 reconstructive and 146 aesthetic) were identified. Payer mix included Blue Cross (36.7 percent), health maintenance organization (28.7 percent), other commercial payers (17.4 percent), Medicare/Medicaid (13.5 percent), and self-pay (3.7 percent). The most profitable cases were reconstructive laser procedures ($66.20; n = 361), scar revision ($36.01; n = 25), and facial trauma ($32.17; n = 64). The least profitable were hand arthroplasty ($13.93; n = 35), arthroscopy ($17.25; n = 15), and breast reduction ($17.46; n = 210). Aesthetic procedures (n = 144) yielded a significantly higher contribution margin per case minute ($24.21) compared with reconstructive procedures ($22.28; n = 3093) (p = 0.01). Plastic surgical cases performed at dedicated ambulatory surgery centers ($28.60; n = 1477) yielded significantly higher contribution margin per case minute compared with those performed at hospital-based facilities ($25.58; n = 2123) (p < 0.01). Use of standardized accounting (contribution margin per case minute) can be a strategically effective method for determining the most profitable and appropriate case mix. Within academic health centers, aesthetic surgery can be a profitable enterprise; dedicated ambulatory surgery centers yield higher profitability.

Registration and fusion quantification of augmented reality based nasal endoscopic surgery.

PubMed

Chu, Yakui; Yang, Jian; Ma, Shaodong; Ai, Danni; Li, Wenjie; Song, Hong; Li, Liang; Chen, Duanduan; Chen, Lei; Wang, Yongtian

2017-12-01

This paper quantifies the registration and fusion display errors of augmented reality-based nasal endoscopic surgery (ARNES). We comparatively investigated the spatial calibration process for front-end endoscopy and redefined the accuracy level of a calibrated endoscope by using a calibration tool with improved structural reliability. We also studied how registration accuracy was combined with the number and distribution of the deployed fiducial points (FPs) for positioning and the measured registration time. A physically integrated ARNES prototype was customarily configured for performance evaluation in skull base tumor resection surgery with an innovative approach of dynamic endoscopic vision expansion. As advised by surgical experts in otolaryngology, we proposed a hierarchical rendering scheme to properly adapt the fused images with the required visual sensation. By constraining the rendered sight in a known depth and radius, the visual focus of the surgeon can be induced only on the anticipated critical anatomies and vessel structures to avoid misguidance. Furthermore, error analysis was conducted to examine the feasibility of hybrid optical tracking based on point cloud, which was proposed in our previous work as an in-surgery registration solution. Measured results indicated that the error of target registration for ARNES can be reduced to 0.77 ± 0.07 mm. For initial registration, our results suggest that a trade-off for a new minimal time of registration can be reached when the distribution of five FPs is considered. For in-surgery registration, our findings reveal that the intrinsic registration error is a major cause of performance loss. Rigid model and cadaver experiments confirmed that the scenic integration and display fluency of ARNES are smooth, as demonstrated by three clinical trials that surpassed practicality. Copyright © 2017 Elsevier B.V. All rights reserved.

Factors associated with emergency room visits within 30 days of outpatient foot and ankle surgeries

PubMed Central

Shibuya, Naohiro; Patel, Himani; Graney, Colin; Jupiter, Daniel C.

2018-01-01

ABSTRACT The number of emergency department (ED) visits within 30 days after elective surgery has been utilized as a quality measure by many institutions. The significance of the measure as a postoperative complication in foot and ankle surgery, and risk factors for it, are unknown. We conducted a retrospective cohort study involving 386 patients to determine risk factors associated with ED visits after outpatient foot and ankle surgeries. After adjusting for clinically relevant covariates, we found that previous ED visits within 6 months of surgery, and nonelective surgeries were associated with the postoperative ED visit. Having private insurance was protective against postoperative ED visits. Though these risk factors may not be easily modifiable by surgeons, understanding them may improve patient education and transitional care to prevent overcrowding of the ED. PMID:29706806

Factors associated with emergency room visits within 30 days of outpatient foot and ankle surgeries.

PubMed

Shibuya, Naohiro; Patel, Himani; Graney, Colin; Jupiter, Daniel C

2018-04-01

The number of emergency department (ED) visits within 30 days after elective surgery has been utilized as a quality measure by many institutions. The significance of the measure as a postoperative complication in foot and ankle surgery, and risk factors for it, are unknown. We conducted a retrospective cohort study involving 386 patients to determine risk factors associated with ED visits after outpatient foot and ankle surgeries. After adjusting for clinically relevant covariates, we found that previous ED visits within 6 months of surgery, and nonelective surgeries were associated with the postoperative ED visit. Having private insurance was protective against postoperative ED visits. Though these risk factors may not be easily modifiable by surgeons, understanding them may improve patient education and transitional care to prevent overcrowding of the ED.

[Study on the preemptive analgesia effects of both the parecoxib sodium and the pentazocine in patients undergoing nasal endoscopic surgery].

PubMed

Kong, Yonggang; Yang, Xilin

2014-09-01

To evaluate the preemptive analgesia effects of both the parecoxib sodium and the pentazocine in patients undergoing nasal endoscopic surgery. In the randomized, double blind, controlled study, 120 patients undergoing septoplasty were divided into 3 groups (n = 40): group A received parecoxib 40 mg by muscle injection 30 min before the operation; group B received pentazocine 30 mg; group C received an equal volume of saline. The preemptive analgesia effect was evaluated with VAS scores which recorded at different time points. The proportion of participants using rescue analgesia after the operation were recorded as additional measures of preemptive analgesia. Intra-operative as well as the postoperative pain scores were less in the group A and group B than in the control group. Fewer participants required rescue medication after operation with parecoxib as well as pentazocine than placebo. However there were no difference in the preemptive effects between the group A and group B. Administration of both the parecoxib and pentazocine before the nasal endoscopic surgery can provide preemptive analgesia without serious adverse side effects that deserves popularization in the clinic.

Inpatient or Outpatient Rehabilitation after Herniated Disc Surgery? – Setting-Specific Preferences, Participation and Outcome of Rehabilitation

PubMed Central

Löbner, Margrit; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans J.; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C.; König, Hans-Helmut; Riedel-Heller, Steffi G.

2014-01-01

Objective To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes. Methods The longitudinal observational study referred to 534 consecutive disc surgery patients (18–55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. Results The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001). Conclusion The results suggest a “pre-selection” of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and

Do Changes in Hospital Outpatient Payments Affect the Setting of Care?

PubMed Central

He, Daifeng; Mellor, Jennifer M

2013-01-01

Objective To examine whether decreases in Medicare outpatient payment rates under the Outpatient Prospective Payment System (OPPS) caused outpatient care to shift toward the inpatient setting. Data Sources/Study Setting Hospital inpatient and outpatient discharge files from the Florida Agency for Health Care Administration from 1997 through 2008. Study Design This study focuses on inguinal hernia repair surgery, one of the most commonly performed surgical procedures in the United States. We estimate multivariate regressions of inguinal hernia surgery counts in the outpatient setting and in the inpatient setting. The key explanatory variable is the time-varying Medicare payment rate specific to the procedure and hospital. Control variables include time-varying hospital and county characteristics and hospital and year-fixed effects. Principal Findings Outpatient hernia surgeries fell in response to OPPS-induced rate cuts. The volume of inpatient hernia repair surgeries did not increase in response to reductions in the outpatient reimbursement rate. Conclusions Potential substitution from the outpatient setting to the inpatient setting does not pose a serious threat to Medicare's efforts to contain hospital outpatient costs. PMID:23701048

Does Intravenous Midazolam Dose Influence the Duration of Recovery Room Stay Following Outpatient Third Molar Surgery?

PubMed

Ettinger, Kyle S; Jacob, Adam K; Viozzi, Christopher F; Van Ess, James M; Fillmore, W Jonathan; Arce, Kevin

2015-12-01

To evaluate the impact of intravenous midazolam dose on the duration of recovery room stay for patients undergoing outpatient third molar surgery. Using a retrospective cohort study design, a sample of patients undergoing outpatient third molar surgery under intravenous sedation at Mayo Clinic from 2010 to 2014 was identified. All patients underwent extraction of all 4 third molars during a single operative procedure and the age range was limited to 14 to 29 years. The primary predictor variable was the total dose of intravenous midazolam administered during sedation. The primary outcome variable was recovery room length of stay (LOS) after completion of surgery. Multiple covariates also abstracted included patient age, gender, American Society of Anesthesiologists (ASA) score, duration of surgical procedure, complexity of surgical procedure, types and dosages of all intravenous medications administered during sedation, and volume of crystalloid fluid administered perioperatively. Univariable and multivariable models were developed to evaluate associations between the primary predictor variable and covariates relative to the primary outcome variable. The study sample was composed of 2,610 patients. Mean age was 18.3 years (SD, 3.0 yr; range, 14 to 29 yr) and gender distribution was 52% female. Mean dosage of midazolam administered was 4.1 mg (SD, 1.1 mg; range, 0.5 to 10.0 mg). Variables predicting shorter LOS at multivariable analysis included older age (P < .001), male gender (P = .004), and administration of larger crystalloid fluid volumes (P < .001). Variables predicting longer LOS included higher ASA score (P < .001), administration of ketamine (P < .001), and administration of ketorolac (P < .001). The dose of midazolam administered during sedation was not found to be significantly associated with prolonged recovery room LOS in univariable or multivariable settings. Dosage of intravenous midazolam does not appear to significantly impact the

The Efficacy of Aromatherapy in the Treatment of Postdischarge Nausea in Patients Undergoing Outpatient Abdominal Surgery.

PubMed

Mcilvoy, Laura; Richmer, Linda; Kramer, Deborah; Jackson, Rita; Shaffer, Leslee; Lawrence, Jeffrey; Inman, Kevin

2015-10-01

The purpose of this study was to explore the effectiveness of the aromatherapy product QueaseEASE (QE) for decreasing postdischarge nausea (PDN) in patients undergoing outpatient abdominal surgery. Prospective exploratory study. Informed Consent was obtained preoperatively from a convenience sample of adult patients scheduled for outpatient abdominal surgery procedures. Prior to discharge, subjects were instructed in the use of QE and given instructions on how to rate their nausea on a 0-10 scale. They recorded nausea scales > 0 any time they occurred for the next 24 hours, used the QE, and recorded their nausea scales 3 minutes later. A study nurse called subjects the next day to collect the information. The sample included 70 outpatients who underwent abdominal surgery. Twenty-five participants (36%) reported experiencing PDN and their concomitant use of QE. There was a significant difference in mean age of those reporting PDN (37 years) versus those without nausea (48 years, P = .004) as well as a significant difference in mean intravenous fluid intake during hospitalization of those reporting PDN (1,310 mL) versus those without nausea (1,511 mL, P = .04). The PDN group had more female participants (72% vs 42%, P = .02), more participants that were less than 50 years of age (84% vs 53%, P = .02), and received more opioids (100% vs 76%, P = .006) than the no nausea group. The 25 PDN participants reported 47 episodes of PDN in which they used QE. For all of the 47 PDN episodes experienced, participants reported a decrease in nausea scale (0 to 10) after the use of QE; for 22 (47%) of the PDN episodes experienced, a nausea scale of 0 after using QE was reported. The mean decrease in nausea scale for all 25 participants was 4.78 (±2.12) after using QE. This study found that the aromatherapy QE was an effective treatment of PDN in select same-day abdominal surgery patients. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc

Presurgical Nasoalveolar Molding for Correction of Cleft Lip Nasal Deformity: Experience From Northern India

PubMed Central

Mishra, Brijesh; Singh, Arun K.; Zaidi, Javed; Singh, G. K.; Agrawal, Rajiv; Kumar, Vijay

2010-01-01

Context: The cleft lip type nasal deformity presents one of the most complex surgical challenges. The long-term postoperative results are still not satisfactory despite an emphasis on primary nasal correction. This is attributed to tissue memory and healing. Nasoalveolar molding is used effectively to reshape the nasal cartilage and to mold the maxillary arch before cleft lip repair. Aims: This study was undertaken to evaluate the role of presurgical nasoalveolar molding in correction of cleft lip nasal deformity for patients with unilateral and bilateral clefts of the lip. Settings and Design: Twenty-three cases of clefts of lip and palate with nasal deformity were subjected to present study from May 2004 to May 2006. These cases were initially treated on outpatient basis, and they were admitted at the time of operation. All of these patients were children of less than 1 year of age, belonging to north Indian population. Material and Methods: Study consisted of patients of cleft lip and palate who were given presurgical nasoalveolar splints at early age. Lip repair was done after at least 2 months of molding. These patients along with control group (without presurgical nasoalveolar molding) were followed up for 1 year. Measurements were taken at different intervals in study over dental cast and on patients. Data obtained from comparison of 2 groups were analyzed using “MSTAT” analysis software (developed by Dr Russel Freed, Professor & Director, Crop & Soil Sciences Department, Michigan State University, East Lansing, Michigan). Results: In our study, we found that nostril height was more in patients of experimental group (P = .18), while nostril width and alar perimeter were not changed significantly. Children with nasoalveolar molding had significant lengthening of columella (P = .02). Patients of unilateral cleft lip had more reduction in alveolar gap (P = .08) than bilateral group (P = .15). Conclusions: Nasoalveolar molding can be a useful adjunct for

[Early hypertrophic scar after surgery on the nasal region: value of long-acting corticosteroid injections].

PubMed

Amici, J-M

2014-01-01

"Pincushioning" is a complication of post-surgical scarring following use of transposition flaps particularly when surgery is performed on the nasal region. The transposition flap technique is very useful for the repair of certain defects of the tip of the nose, the medial canthus or of the ala nasi. The aim of this study is to define the clinical characteristics of this scarring dystrophy, which we propose to call "early hypertrophy scarring", to clarify the nature thereof and to assess the efficacy of intralesional injection of corticosteroids at the first signs of hypertrophy. A prospective, open, non-comparative, single-centre study examined the clinical and histological characteristics of early hypertrophy scarring and the effectiveness of therapy with one or two injections of corticosteroids performed on the 15th day post-operatively and optionally repeated at D45 depending on the outcome. From January 2011 to January 2013, 12 consecutive patients with early hypertrophy scarring were included (ten men and two women - mean age: 64 years). All had undergone surgery for basal cell carcinoma under local anaesthesia with one-stage repair by means of a rhombic flap or a bilobed flap located in the nasal area. Scars were injected strictly intra-lesionally with triamcinolone acetate (40 mg/1 mL) until whitening occurred. A single injection was performed in three cases of rhombic flap while a second injection was given at D45 in the remaining nine cases. Complete regression of the early hypertrophy scarring was obtained in ten of the 12 patients by D90. Incomplete regression was observed but with a marked improvement in the other two patients. Early hypertrophy scarring is distinguished by its clinical characteristics of hypertrophic or keloid scars. Biopsy performed in two cases showed the fibrous but non-fatty nature of early hypertrophy scarring. Biomechanical factors particular to the nasal region and the transposition flap technique could account for the early

Nasolabial Perforator Flap for One-stage Reconstruction of Nasal Defects

PubMed Central

Prakash, Siddharth; Panda, Ritesh; Kumar, Vivek; Saha, Shiv Shankar; Choudhary, Lalit; Pandey, Anurag; Reddy, J. Sasidhar

2017-01-01

Background: The excellent freedom of movement and range of this flap when based on a the nasolabial perforator flap have not been sufficiently explored. In this study, along with demonstrating the other key advantages of this flap over its traditional counterpart, we will endeavour to fill these lacunae in the available literature. Materials and Methods: From February 2009 to February 2012, twenty patients with nasal defects were repaired with a nasolabial perforator flap in the Department of Plastic and Cosmetic Surgery at Sir Ganga Ram Hospital, New Delhi. Of these, two patients (10%) underwent the procedure bilaterally. Thus, a total of 22 nasolabial perforator flap procedures were carried out. Prospectively, collected clinical records and data of each patient were retrospectively retrieved and reviewed to study the nasal defect and surgery done. Results: All the twenty (100%) patients had good functional and aesthetic outcome. All patients who had nasal stenosis preoperatively had very good improvement in the patency of the nasal passages, breathing and nasal blockage with complete recovery of symptoms. The patients were entirely satisfied with the functional recovery. Conclusions: The reliability and versatility of the nasolabial perforator flap exceed its recognised application in reconstruction of nasal defects and it must form a part of every plastic surgeon's armamentarium. PMID:28529417

Predictors and causes of unplanned re-operations in outpatient plastic surgery: a multi-institutional analysis of 6749 patients using the 2011 NSQIP database.

PubMed

Lim, Seokchun; Jordan, Sumanas W; Jain, Umang; Kim, John Y S

2014-08-01

Studies that evaluate the predictors and causes of unplanned re-operation in outpatient plastic surgery. This study retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and identified all plastic surgery outpatient cases performed in 2011. Multiple logistic regression analysis was utilised to identify independent risk factors and causes of unplanned reoperations. Of the 6749 outpatient plastic surgery cases identified, there were 125 (1.9%) unplanned re-operations (UR). Regression analysis demonstrated that body mass index (BMI, OR = 1.041, 95% CI = 1.019-1.065), preoperative open wound/wound infection (OR = 3.498, 95% CI = 1.593-7.678), American Society of Anesthesiologists (ASA) class 3 (OR = 2.235, 95% CI = 1.048-4.765), and total work relative value units (RVU, OR = 1.014, 95% CI = 1.005-1.024) were significantly predictive of UR. Additionally, the presence of any complication was significantly associated with UR (OR = 15.065, 95% CI = 5.705-39.781). In an era of outcomes-driven medicine, unplanned re-operation is a critical quality indicator for ambulatory plastic surgery facilities. The identified risk factors will aid in surgical planning and risk adjustment.

Opportunities to improve the value of outpatient surgical care.

PubMed

Erhun, Feryal; Malcolm, Elizabeth; Kalani, Maziyar; Brayton, Kimberly; Nguyen, Christine; Asch, Steven M; Platchek, Terry; Milstein, Arnold

2016-09-01

Nearly 57 million outpatient surgeries-invasive procedures performed on an outpatient basis in hospital outpatient departments (HOPDs) or ambulatory surgery centers (ASCs)-produced annually in the United States account for roughly 7% of healthcare expenditures. Although moving inpatient surgeries to outpatient settings has lowered the cost of care, substantial opportunities to improve the value of outpatient surgery remain. To exploit these remaining opportunities, we composed an evidence-based care delivery composite for national discussion and pilot testing. Evidence-based care delivery composite. We synthesized peer-reviewed publications describing efforts to improve the value of outpatient surgical care, interviewed patients and clinicians to understand their most deeply felt discontents, reviewed potentially relevant emerging science and technology, and observed surgeries at healthcare organizations nominated by researchers as exemplars of efficiency and effectiveness. Primed by this information, we iterated potential new designs utilizing criticism from practicing clinicians, health services researchers, and healthcare managers. We found that 3 opportunities are most likely to improve value: 1) maximizing the appropriate use of surgeries via decision aids, clinical decision support, and a remote surgical coach for physicians considering a surgical referral; 2) safely shifting surgeries from HOPDs to high-volume, multi-specialty ASCs where costs are much lower; and 3) standardizing processes in ASCs from referral to recovery. Extrapolation based on published studies of the effects of each component suggests that the proposed 3-part composite may lower annual national outpatient surgical spending by as much as one-fifth, while maintaining or improving outcomes and the care experience for patients and clinicians. Pilot testing and evaluation will allow refinement of this composite.

Extranasopharyngeal angiofibroma of the posterior nasal septum: a rare clinical entity.

PubMed

Atmaca, Sinan; Bayraktar, Cem; Yıldız, Levent

2013-01-01

Angiofibroma of extranasopharyngeal origin is very rare. Although it is usually originated from any mucosal structure in the head and neck region, maxilla is the most common involvement site. The nasal septum is an exceptional anatomic site of an angiofibroma. Surgery is the best treatment modality and recurrence is very rare. Nasal septal angiofibromas must be considered in the differential diagnosis of nasal vascular masses arising from the nasal septum. In this article, we report a 37-year-old male case with nasal septal angiofibroma who underwent surgical resection of the tumor. This is the 16th case in the literature.

Early experience with high-flow nasal oxygen therapy (HFNOT) in pediatric endoscopic airway surgery.

PubMed

Riva, Thomas; Theiler, Lorenz; Jaquet, Yves; Giger, Roland; Nisa, Lluís

2018-05-01

Reporting our institutional experience with high-flow nasal oxygen therapy (HFNOT), a recently-introduced technique, for endoscopic airway approaches. Prospective collection of data of children (<16 years) undergoing endoscopic between January 2016 and August 2017 at a tertiary referral university hospital. HFNOT was used in 6 children who underwent 14 procedures for different forms and causes of upper airway obstruction of various origins. No intraoperative complications; related to oxygenation were observed, and the surgical procedures could be carried out as; initially planned. We found that HFNOT is an effective and safe technique with a variety of potential applications in the field of endoscopic pediatric airway surgery. Copyright © 2018 Elsevier B.V. All rights reserved.

Retrospective study of orthovoltage radiation therapy for nasal tumors in 42 dogs.

PubMed

Northrup, N C; Etue, S M; Ruslander, D M; Rassnick, K M; Hutto, D L; Bengtson, A; Rand, W; Moore, A S

2001-01-01

Megavoltage radiation therapy currently is the standard of care for dogs with nasal tumors. Some studies report that surgery and adjunctive orthovoltage radiation therapy result in longer control of these tumors than does megavoltage radiation therapy alone. This study reports less effective control of nasal tumors in dogs treated with surgery and orthovoltage radiation than previously observed, supporting the superiority of megavoltage radiation therapy for these tumors. In addition, this study suggests 2 new prognostic indicators for dogs with nasal tumors and describes toxicity associated with surgery and orthovoltage therapy. Forty-two dogs with nasal tumors were treated with surgical cytoreduction and 48 Gy orthovoltage radiation therapy administered in twelve 4-Gy fractions. Median survival was 7.4 months. One- and 2-year survival rates were 37% and 17%, respectively. Dogs with facial deformity had shorter survival than those without deformity (P = .005). Dogs with resolution of clinical signs after treatment had longer survival than those with chronic nasal signs (P = .0001). Acute radiation toxicity was moderate to severe for skin and eye and negligible for oral mucosa. Toxicity healed within 1 month after radiation therapy. Late toxicity was mild, but 70% of evaluable dogs experienced persistent ocular signs. Only 39% of dogs achieved a disease-free period.

Stimulatory effects of histamine on migration of nasal fibroblasts.

PubMed

Hong, Sung-Moon; Park, Il-Ho; Um, Ji-Young; Shin, Jae-Min; Lee, Heung-Man

2015-10-01

Fibroblast migration is crucial for normal wound repair after sinonasal surgery. Histamine is known to be involved in wound healing by its effects on cell proliferation and migration. This study aimed to determine whether histamine affects the migration of nasal fibroblasts and to investigate the mechanism of action of histamine on nasal fibroblasts. Primary cultures of nasal fibroblasts were established from inferior turbinate samples. Fibroblast migration was evaluated with scratch assays. Cells were treated with histamine and/or histamine receptor-selective antagonists. U-73122 and pertussis toxin, which are selective inhibitors of the lower signaling pathway of H1R and H4R, were used to confirm the modulation of nasal fibroblast migration by histamine. Fibroblast cytoskeletal structures were visualized with immunocytochemistry. Histamine significantly stimulated the migration of nasal fibroblasts. Antagonists selective for HR1 and HR4 significantly reduced nasal fibroblast migration. In immunocytochemical staining, histamine treatment increased membrane ruffling and pyrilamine, diphenhydramine, fexofenadine, and JNJ7777120 decreased histamine-induced membrane ruffling. U-73122 and pertussis toxin also decreased histamine-induced migration of fibroblasts. Histamine maintains its stimulatory effects on fibroblast migration in the presence of mitomycin C, which blocks proliferation of cells. We showed that histamine stimulates fibroblast migration in nasal fibroblasts. This effect appeared to be mediated by HR1 and HR4. However, because fibroblast migration also can be involved in scaring and fibrosis, more research is necessary to determine the effects of antihistamine on wound healing after sinus surgery. © 2015 ARS-AAOA, LLC.

Oral mask ventilation is more effective than face mask ventilation after nasal surgery.

PubMed

Yazicioğlu, Dilek; Baran, Ilkay; Uzumcugil, Filiz; Ozturk, Ibrahim; Utebey, Gulten; Sayın, M Murat

2016-06-01

To evaluate and compare the face mask (FM) and oral mask (OM) ventilation techniques during anesthesia emergence regarding tidal volume, leak volume, and difficult mask ventilation (DMV) incidence. Prospective, randomized, crossover study. Operating room, training and research hospital. American Society of Anesthesiologists physical status I and II adult patients scheduled for nasal surgery. Patients in group FM-OM received FM ventilation first, followed by OM ventilation, and patients in group OM-FM received OM ventilation first, followed by FM ventilation, with spontaneous ventilation after deep extubation. The FM ventilation was applied with the 1-handed EC-clamp technique. The OM was placed only over the mouth, and the 1-handed EC-clamp technique was used again. A child's size FM was used for the OM ventilation technique, the mask was rotated, and the inferior part of the mask was placed toward the nose. The leak volume (MVleak), mean airway pressure (Pmean), and expired tidal volume (TVe) were assessed with each mask technique for 3 consecutive breaths. A mask ventilation grade ≥3 was considered DMV. DMV occurred more frequently during FM ventilation (75% with FM vs 8% with OM). In the FM-first sequence, the mean TVe was 249±61mL with the FM and 455±35mL with the OM (P=.0001), whereas in the OM-first sequence, it was 276±81mL with the FM and 409±37mL with the OM (P=.0001). Regardless of the order used, the OM technique significantly decreased the MVleak and increased the TVe when compared to the FM technique. During anesthesia emergence after nasal surgery the OM may offer an effective ventilation method as it decreases the incidence of DMV and the gas leak around the mask and provides higher tidal volume delivery compared with FM ventilation. Copyright © 2016 Elsevier Inc. All rights reserved.

Variation in day-case nasal surgery - why cannot we improve our day-case rates?

PubMed

Hopkins, C; Browne, J; Slack, R; Brown, P

2007-02-01

The NHS plan states that 75% of all elective operations should be performed as day-cases. We set out to evaluate day surgery rates in sinonasal surgery and to identify factors limiting current practice. Prospective multicentre cohort study. 3128 patients undergoing sinonasal surgery during 2000 and 2001. Same day discharge, complication and readmission rates. There is potential selection bias due to the non-random selection of NHS Trusts and patients in this study. However, as results are similar to Hospital Episode Statistics data such bias is probably small. Only 15.5% of all procedures are performed as day surgery. We are achieving day-case rates of 18, 20 and 6% for nasal polypectomy, intranasal antrostomy and extensive FESS respectively, compared with recently published targets of 90%, 80% and 50%. Factors significantly associated with overnight admission were use of packs, extensive surgery, excess post-operative bleeding and high ASA grade. There was considerable unexplained variation in day-case rates and the use of packs between different surgeons. A third of consultants pack all patients post-operatively. More than 51% of consultants admit all patients, while 5% discharge all patients on the day of surgery. There were no excess adverse events or readmissions amongst the day surgery patients. However, only 17% of in-patients would have liked to be discharged on the day of surgery. Both patient and surgeon must overcome resistance to day case surgery before targets can be reached. Strategies for improving day-case rates in sinonasal surgery. All ASA grade 1 and 2 patients could be considered for day-case surgery, but particularly those with less extensive disease on radiography, and those planned to undergo less extensive procedures. Excess peri-operative bleeding was reported in 6% of patients. There must therefore be provision for overnight admission if required. Greater utilisation of day-case units, selective use of packs, and earlier removal may

The activity of N-acetyl-β-d-hexosaminidase A and B and β-glucuronidase in nasal polyps and hypertrophic nasal concha.

PubMed

Chojnowska, Sylwia; Minarowska, Alina; Waszkiewicz, Napoleon; Kępka, Alina; Zalewska-Szajda, Beata; Gościk, Elżbieta; Kowal, Krzysztof; Olszewska, Ewa; Konarzewska-Duchnowska, Emilia; Minarowski, Łukasz; Zwierz, Krzysztof; Ładny, Jerzy Robert; Szajda, Sławomir Dariusz

2014-01-01

Nasal polyps and hypertrophic lower nasal conchae are common disorders of nasal cavity. The majority of etiopathogenetic theories indicate inflammatory background of polyps and hypertrophic concha. N-acetyl-β-D-hexosaminidase and β-glucuronidase are lysosomal exoglycosidases revealing accelerated activity in inflammatory processes. The aim of the study was to evaluate the catabolism of glycoconjugates in nasal polyps and hypertrophic nasal concha basing on the activity of N-acetyl-β-D-hexosaminidase (HEX) and β-glucuronidase (GLU). Material consisted of nasal polyps taken from 40 patients during polypectomy in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and hypertrophic lower nasal conchae taken from 20 patients during mucotomy. The activity of HEX, HEX A, HEX B and GLU in supernatant of homogenates of nasal polyps and hypertrophic lower nasal concha tissues has been estimated using colorimetric method. Statistically significant decrease has been observed in concentration of the activity (per 1mg of tissue) of HEX (p<0.05), HEX B (p<0.001) and specific activity (per 1mg of protein) of HEX B (p<0.001) in nasal polyps tissue in comparison to hypertrophic lower nasal conchae tissue. Decrease in the activity and specific activity concentration of the majority of examined lysosomal exoglycosidases (increasing in inflammations) in comparison to hypertrophic lower nasal conchae suggests electrolytes disorders and questions the inflammatory background of nasal polyps. Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

Evidence-based management of nasal polyposis by intranasal corticosteroids: from the cause to the clinic.

PubMed

Bachert, Claus

2011-01-01

Nasal polyposis is an inflammatory disorder involving the mucosa of the nose and paranasal sinuses and affecting approximately 2-4% of the general population. A literature search of Medline and Embase was conducted to obtain an overview of the epidemiology, pathophysiology, and current treatment of nasal polyposis, focusing on evidence-based efficacy of intranasal corticosteroids (INSs) as primary and postoperative therapy. Recent research on INSs in nasal polyp treatment, along with notable historic findings, was reviewed. Nasal polyps are mostly characterized by eosinophil infiltration, a complex inflammation of nasal mucosa, and possibly production of polyclonal IgE. Current treatment modalities include INSs, oral corticosteroids, and surgery; surgery is generally limited to those with an insufficient response to medical treatment. Because of their effects on eosinophil-dominated inflammation, INSs and oral corticosteroids are the primary medical treatment strategies. The very low (≤1%) systemic bioavailability of newer INSs minimizes the systemic adverse effects seen with oral corticosteroids. Based on randomized, controlled trials, guidelines recommend INSs as first-line therapy for nasal polyps and for care after polypectomy. Clinical data suggest INSs are effective in reducing polyp size and relieving nasal symptoms. INS treatment has also reduced nasal polyp recurrence in patients undergoing functional endoscopic sinus surgery. Treatment with these mainstay options has been found to improve quality of life, which, along with symptom improvement, is a key factor in disease treatment. Copyright © 2011 S. Karger AG, Basel.

Randomized Controlled Trial of Antiseptic Hand Hygiene Methods in an Outpatient Surgery Clinic.

PubMed

Therattil, Paul J; Yueh, Janet H; Kordahi, Anthony M; Cherla, Deepa V; Lee, Edward S; Granick, Mark S

2015-12-01

Outpatient wound care plays an integral part in any plastic surgery practice. However, compliance with hand hygiene measures has shown to be low, due to skin irritation and lack of time. The objective of this trial was to determine whether single-use, long-acting antiseptics can be as effective as standard multiple-use hand hygiene methods in an outpatient surgical setting. A prospective, randomized controlled trial was performed in the authors' outpatient plastic surgery clinic at Rutgers New Jersey Medical School, Newark, NJ to compare the efficacy of an ethyl alcohol-based sanitizer (Avagard D Instant Hand Aniseptic, 3M Health Care, St. Paul, MN), a benzalkonium chloride-based sanitizer (Soft & Shield, Bioderm Technologies, Inc, Trenton, NJ, distributed by NAPP Technologies, Hackensack, NJ ), and soap and- water handwashing. Subjects included clinic personnel, who were followed throughout the course of a 3-hour clinic session with hourly hand bacterial counts taken. During the course of the trial, 95 subjects completed the clinic session utilizing 1 of the hand hygiene methods (36 ethyl alcohol-based sanitizer, 38 benzalkonium chloride-based sanitizer, and 21 soap-and-water handwashing). There was no difference between hand bacterial counts using the different methods at 4 hourly time points (P greater than 0.05). Hand bacterial counts increased significantly over the 3-hour clinic session with the ethyl alcohol-based sanitizer (9.24 to 21.90 CFU, P less than 0.05), benzalkonium chloride-based sanitizer (6.69 to 21.59 CFU, P less than 0.05), and soap-and-water handwashing (8.43 to 22.75 CFU, P less than 0.05). There does not appear to be any difference in efficacy between single-use, long-acting sanitizer, and standard multiple-use hand hygiene methods. Hand bacterial counts increased significantly over the course of the 3-hour clinic session regardless of the hand hygiene measure used. Hand condition of subjects was improved with the ethyl alcohol

Distilled water nasal provocation in hyperreactive patients.

PubMed

Baudoin, T; Anzic, S A; Kalogjera, L

1999-01-01

Nonisotonic aerosol may act as a provocation agent in the upper and lower airways of hyperreactive individuals. The purpose of the study was to compare the results of nasal challenge with distilled water in patients with allergic rhinitis to those with noninfective nonallergic rhinitis (NINAR), with respect to the potential clinical use of the obtained data. A group of 68 ambulatory patients with allergic rhinitis or NINAR (39 perennial allergic, 6 seasonal, 23 NINAR) were challenged with 10 mL of distilled water aerosol after the baseline active anterior rhinomanometry. Patients with nasal polyposis at endoscopy, significant unilateral septal deviation, positive bacteriologic swab, recent nasal surgery, and uncertain anamnestic data about the medication taken 6 weeks before the provocation were excluded from the study. After 10 minutes of nasal provocation, rhinomanometry was repeated to assess the response. In 15 patients of the perennial allergic group, the same measurements were performed after a 2-week oral antihistamine and topical steroid therapy. Nasal resistance was significantly increased on the more patent side of the nose after nasal provocation with distilled water aerosol in allergic patients in comparison to the nasal resistance before provocation. In the patients with NINAR, the provocation resulted in a significant rise on the more patent side, but the total nasal airway resistance (NAR) levels were also significantly increased. The systemic antihistamine and topical steroid 2-week therapy in patients with perennial allergic rhinitis significantly reduced the response to nasal distilled water provocation. Nasal provocation with distilled water aerosol is a cheap, simple, and acceptable method that provides useful clinical data on the level of nonspecific nasal hyperreactivity and the therapy success.

Effects of different types of pharyngeal packing in patients undergoing nasal surgery: A comparative study.

PubMed

Rizvi, Mohd Meesam; Singh, Raj Bahadur; Rasheed, Mohd Asim; Sarkar, Arindam

2015-01-01

Postoperative throat complaints such as postoperative sore throat (POST), dysphagia, and hoarseness frequently arises after tracheal intubation and throat packing for patient undergoing general anesthesia. This condition is very disturbing to patient. Avoiding POST is a major priority for these patients because preventing postoperative complications contributes to patient satisfaction. To describe and analyze the postoperative throat effects of nasopharyngeal packing and oropharyngeal packing in patients undergoing nasal surgery. A randomized comparative study. After obtaining approval of Ethical Committee 40 patients were included in study. After this patient were randomly allocated into two groups of 20 each. Group A - in which the oropharynx was packed and Group B - inwhich the nasopharynx was packed. General anesthesia were given and throat packing was done and patients were interviewed postoperatively for any throat complications such as sore throat, difficulty in swallowing (dysphagia), hoarseness of voice, throat irritation, and any other symptom pertaining to the study were noted and data were analyzed. T-test to compare the age, while Chi-square test and Fisher's exact test were used to compare sex distribution, sore throat, dysphagia, hoarseness, and throat irritation. Results showed statistically significant difference in incidence and severity of POST in Group A patients when compared to Group B patients to be more. Patients in Group A had a higher incidence of dysphagia when compared to their Group B counterparts. With respect to the incidence of hoarseness and throat irritation, there was no statistical significance between the groups. We concluded that the site of pharyngeal packing influences the incidence and severity of POST and as well as the incidence of dysphagia after general anesthesia. The use of nasopharyngeal packing in the patients undergoing nasal surgeries might lead to a reduction of the same.

A randomized controlled trial comparing acetaminophen plus ibuprofen versus acetaminophen plus codeine plus caffeine after outpatient general surgery.

PubMed

Mitchell, Alex; van Zanten, Sander Veldhuyzen; Inglis, Karen; Porter, Geoffrey

2008-03-01

Narcotics are used extensively in outpatient general surgery but are often poorly tolerated with variable efficacy. Acetaminophen combined with NSAIDs is a possible alternative. The objective of this study was to compare the efficacy of acetaminophen, codeine, and caffeine (Tylenol No. 3) with acetaminophen and ibuprofen for management of pain after outpatient general surgery procedures. A double-blind randomized controlled trial was performed in patients undergoing outpatient inguinal/umbilical/ventral hernia repair or laparoscopic cholecystectomy. Patients were randomized to receive acetaminophen plus codeine plus caffeine (Tylenol No. 3) or acetaminophen plus ibuprofen (AcIBU) 4 times daily for 7 days or until pain-free. Pain intensity, measured four times daily by visual analogue scale, was the primary outcome. Secondary end points included incidence of side effects, patient satisfaction, number of days until patient was pain-free, and use of alternative analgesia. One hundred forty-six patients were randomized (74 Tylenol No. 3 and 72 AcIBU), and 139 (95%) patients completed the study. No significant differences in mean or maximum daily visual analogue scale scores were identified between the 2 groups, except on postoperative day 2, when pain was improved in AcIBU patients (p = 0.025). During the entire week, mean visual analogue scale score was modestly lower in AcIBU patients (p = 0.018). More patients in the AcIBU group, compared with Tylenol No. 3, were satisfied with their analgesia (83% versus 64%, respectively; p = 0.02). There were more side effects with Tylenol No. 3 (57% versus 41%, p = 0.045), and the discontinuation rate was also higher in Tylenol No. 3-treated patients (11% versus 3%, p = 0.044). When compared with Tylenol No. 3, AcIBU was not an inferior analgesic and was associated with fewer side effects and higher patient satisfaction. AcIBU is an effective, low-cost, and safe alternative to codeine-based narcotic analgesia for outpatient

Nasoalveolar molding improves long-term nasal symmetry in complete unilateral cleft lip-cleft palate patients.

PubMed

Barillas, Ingrid; Dec, Wojciech; Warren, Stephen M; Cutting, Court B; Grayson, Barry H

2009-03-01

Nasoalveolar molding was developed to improve dentoalveolar, septal, and lower lateral cartilage position before cleft lip repair. Previous studies have documented the long-term maintenance of columella length and nasal dome form and projection. The purpose of the present study was to determine the effect of presurgical nasoalveolar molding on long-term unilateral complete cleft nasal symmetry. A retrospective review of 25 consecutively presenting nonsyndromic complete unilateral cleft lip-cleft palate patients was conducted. Fifteen patients were treated with presurgical nasoalveolar molding for 3 months before surgical correction, and 10 patients were treated by surgical correction alone. The average age at the time of follow-up was 9 years. Four nasal anthropometric distances and two angular relationships were measured to assess nasal symmetry. All six measurements demonstrated a greater degree of nasal symmetry in nasoalveolar molding patients compared with the patients treated with surgery alone. Five symmetry measurements were significantly more symmetric in the nasoalveolar molding patients and one measurement demonstrated a nonsignificant but greater degree of symmetry compared with the patients treated with surgery alone. The data demonstrate that the lower lateral and septal cartilages are more symmetric in the nasoalveolar molding patients compared with the surgery-alone patients. Furthermore, the improved symmetry observed in nasoalveolar molding-treated noses during the time of the primary surgery is maintained at 9 years of age.

Bipolar microdebrider may reduce intraoperative blood loss and operating time during nasal polyp surgery.

PubMed

Kumar, Nishant; Sindwani, Raj

2012-08-01

Bleeding during endoscopic sinus surgery (ESS) can interrupt the flow of the procedure and increase the risk of complications. Advances in microdebrider design now allow for bleeding to be controlled by bipolar energy during the suctioning and shaving of polyps. We conducted a retrospective study to examine the effects of this technology on blood loss and operating times during ESS for chronic rhinosinusitis with nasal polyps (CRS+P). Our patient population was made up of 80 patients who had undergone ESS for CRS+P by the same surgeon from January 2007 through May 2008. All surgeries were performed with either the PK diego bipolar microdebrider (Gyrus ACMI, ENT Division; Bartlett, Tenn.) or a standard microdebrider. There were 40 patients in each group. The PK group was made up of 23 males and 17 females, aged 14 to 66 years (mean: 43.1), and the control group included 21 males and 19 females, aged 17 to 71 years (mean: 43.1); there were no statistically significant differences between the two groups in terms of sex and age. In addition to demographic data, the charts were reviewed for comorbidities and operative variables; the latter included blood loss, operating room (OR) time, and complications. The preoperative treatment and anesthesia protocols were similar for all patients, and all patients demonstrated a similar disease burden on imaging (mean Harvard CT stage: 3.12 for the PK group and 3.15 for the controls; p > 0.05). We found that during ESS, the PK group experienced significantly less intraoperative blood loss than did the controls (means: 86.0 and 123.0 ml, respectively; p = 0.015). In addition, the PK device was associated with significantly shorter OR times (means: 88.9 and 101.4 min, respectively; p = 0.026). There were no complications in either group. We conclude that using a microdebrider with bipolar capabilities during ESS may offer the advantages of less blood loss and shorter operating times in patients with nasal polyps.

Antibiotic susceptibility profiles of ocular and nasal flora in patients undergoing cataract surgery in Taiwan: an observational and cross-sectional study

PubMed Central

Lin, Yun-Hsuan; Kang, Yu-Chuan; Hou, Chiun-Ho; Huang, Yhu-Chering; Chen, Chih-Jung; Shu, Jwu-Ching; Hsieh, Pang-Hsin; Hsiao, Ching-Hsi

2017-01-01

Objective To investigate the conjunctival and nasal flora and the antibiotic susceptibility profiles of isolates from patients undergoing cataract surgery. Design Observational and cross-sectional study. Setting A single-centre study in Taiwan. Participants 128 consecutive patients precataract surgery. Primary and secondary outcome measures methods Conjunctival and nasal cultures were prospectively obtained from 128 patients on the day of cataract surgery before instillation of ophthalmic solutions in our hospital. Isolates and antibiotic susceptibility profiles were identified through standard microbiological techniques. Participants were asked to complete a questionnaire on healthcare-associated factors. Results The positive culture rate from conjunctiva was 26.6%, yielding 84 isolates. Coagulase-negative Staphylococci were the most commonly isolated organisms (45.2%), and 35% of staphylococcal isolates were methicillin-resistant. Among staphylococcal isolates, all were susceptible to vancomycin, and 75%–82.5% were susceptible to fluoroquinolones. Methicillin-resistant isolates were significantly less susceptible than their methicillin-sensitive counterparts to tobramycin, the most commonly used prophylactic antibiotic in our hospital (28.6% vs 69.2%; p=0.005). The positive culture rate from nares for Staphylococcus aureus was 21.9%, and six isolates were methicillin-resistant. No subjects had S. aureus colonisation on conjunctiva and nares simultaneously. There were no associated risk factors for colonisation of methicillin-resistant Staphylococci. Conclusion The most common conjunctival bacterial isolate of patients undergoing cataract surgery was coagulase-negative Staphylococci in Taiwan. Because of predominant antibiotic preferences and selective antibiotic pressures, Staphylococci were more susceptible to fluoroquinolones but less to tobramycin than in other reports. Additionally, methicillin-resistant Staphylococci exhibited co-resistance to tobramycin

Numerical simulation and nasal air-conditioning

PubMed Central

Keck, Tilman; Lindemann, Jörg

2011-01-01

Heating and humidification of the respiratory air are the main functions of the nasal airways in addition to cleansing and olfaction. Optimal nasal air conditioning is mandatory for an ideal pulmonary gas exchange in order to avoid desiccation and adhesion of the alveolar capillary bed. The complex three-dimensional anatomical structure of the nose makes it impossible to perform detailed in vivo studies on intranasal heating and humidification within the entire nasal airways applying various technical set-ups. The main problem of in vivo temperature and humidity measurements is a poor spatial and time resolution. Therefore, in vivo measurements are feasible only to a restricted extent, solely providing single temperature values as the complete nose is not entirely accessible. Therefore, data on the overall performance of the nose are only based on one single measurement within each nasal segment. In vivo measurements within the entire nose are not feasible. These serious technical issues concerning in vivo measurements led to a large number of numerical simulation projects in the last few years providing novel information about the complex functions of the nasal airways. In general, numerical simulations merely calculate predictions in a computational model, e.g. a realistic nose model, depending on the setting of the boundary conditions. Therefore, numerical simulations achieve only approximations of a possible real situation. The aim of this review is the synopsis of the technical expertise on the field of in vivo nasal air conditioning, the novel information of numerical simulations and the current state of knowledge on the influence of nasal and sinus surgery on nasal air conditioning. PMID:22073112

Effect of septoplasty and per-operative antibiotic prophylaxis on nasal flora.

PubMed

Karaman, E; Alimoglu, Y; Aygun, G; Kilic, E; Yagiz, C

2012-01-01

Septoplasty is one of the most commonly performed procedures in otolaryngology practice. Prophylactic use of antibiotics is controversial. Disruption of nasal flora may predispose individuals to infection. We investigated the effect of antibiotic prophylaxis and septoplasty on nasal flora. We included 115 consecutive patients who underwent septoplasty because of symptomatic nasal septal deviation. Patients were divided into study and control groups. Study patients received prophylactic parenteral sodium cefazoline twice a day beginning intra-operatively and while the nasal packing remained in the nose for 48 h, and expandable polyvinyl acetate (Merocel) packing covered with antibiotic ointment containing 0.2% nitrofurazone was inserted into each nostril at the end of the operation. Control patients received neither parenteral antibiotic prophylaxis nor antibiotic ointment around the Merocel packs. Both groups received oral prophylactic cefuroxime axetil for 5 d after nasal packing was removed. Nasal flora was determined pre-operatively, post-operatively when nasal packing was removed, and 3 mo after surgery. Study patients were compared to control patients at pack removal and 1 mo after surgery The effect of antibiotic use in septoplasty on nasal flora was as follows: Increased isolation rate of gram-positive rods (p = 0.007), decreased methicillin-sensitive coagulase-negative staphylococci (p = 0.002). Pre-operative and post-operative culture results at 3 mo were compared. The effect of septoplasty on nasal flora was as follows: Decreased coagulase-negative staphylococci (p = 0.05), decreased Klebsiella (p < 0.001), decreased gram-positive rods (p < 0.001), increased methicillin-sensitive Staphylococcus aureus (p < 0.001). Septoplasty increases S. aureus colonization and decreases normal flora. Antibiotics do not protect against S. aureus colonization and contribute to a decrease in normal flora. Antibiotics do not seem to confer benefit in terms of flora changes

Evidence for intranasal antinuclear autoantibodies in patients with chronic rhinosinusitis with nasal polyps.

PubMed

Tan, Bruce K; Li, Quan-Zhen; Suh, Lydia; Kato, Atsushi; Conley, David B; Chandra, Rakesh K; Zhou, Jinchun; Norton, James; Carter, Roderick; Hinchcliff, Monique; Harris, Kathleen; Peters, Anju; Grammer, Leslie C; Kern, Robert C; Mohan, Chandra; Schleimer, Robert P

2011-12-01

Chronic rhinosinusitis (CRS) with nasal polyps is an inflammatory condition of the nasal passage and paranasal sinuses characterized by T(H)2-biased inflammation with increased levels of B-cell activating factor of the TNF family (BAFF), B lymphocytes, and immunoglobulins. Because high levels of BAFF are associated with autoimmune diseases, we assessed for evidence of autoimmunity in patients with CRS. The objective of this study was to investigate the presence of autoantibodies in sinonasal tissue from patients with CRS. Standardized nasal tissue specimens were collected from patients with CRS and control subjects and assayed for immunoglobulin production, autoantibody levels, tissue distribution of immunoglobulins, and binding potential of antibodies in nasal tissue with a multiplexed autoantibody microarray, ELISA, and immunofluorescence. Increased levels of several specific autoantibodies were found in nasal polyp tissue in comparison with levels seen in control tissue and inflamed tissue from patients with CRS without nasal polyps (P < .05). In particular, nuclear-targeted autoantibodies, such as anti-dsDNA IgG and IgA antibodies, were found at increased levels in nasal polyps (P < .05) and particularly in nasal polyps from patients requiring revision surgery for recurrence. Direct immunofluorescence staining demonstrated diffuse epithelial and subepithelial deposition of IgG and increased numbers of IgA-secreting plasma cells not seen in control nasal tissue. Autoantibodies, particularly those against nuclear antigens, are present at locally increased levels in nasal polyps. The presence of autoantibodies suggests that the microenvironment of a nasal polyp promotes the expansion of self-reactive B-cell clones. Although the pathogenicity of these antibodies remains to be elucidated, the presence of increased anti-dsDNA antibody levels is associated with a clinically more aggressive form of CRS with nasal polyps requiring repeated surgery. Copyright © 2011

Vaginal hysterectomy, an outpatient procedure.

PubMed

Engh, Marie Ellström; Hauso, Wenche

2012-11-01

To report our experience of treating women undergoing vaginal hysterectomy in an outpatient setting and to identify risk factors for hospital admission and women dissatisfied with care. Prospective observational report. department of obstetrics and gynecology, university hospital in Norway. 150 women who underwent vaginal hysterectomy at the outpatient clinic from February 2009 to April 2010. Perioperative data were collected prospectively and case notes were searched for complications. On the first postoperative day all women were contacted by telephone by a nurse. A visual analogue scale (VAS) was used to monitor pain and nausea during the stay at the outpatient clinic and the day after surgery. VAS was also used to specify the women's degree of satisfaction with care the day after surgery. The number of women who could be discharged from the outpatient unit and had a satisfaction score of ≥7 the day after surgery. Of the 150 women, 84% could be discharged after a mean observation period of 276 min (SD ± 80 min). The mean satisfaction score was 9.0, SD ± 1.4, and 92.6% of the women reported ≥7 points in the satisfaction score. No women with serious complications were sent home. Using a multivariable logistic regression model only pain at discharge was found as significant (p= 0.009) for admittance to hospital. Vaginal hysterectomy is a feasible outpatient procedure and the majority of women were satisfied with the care they received. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Combined resection of the nasal planum and premaxilla in three dogs.

PubMed

Kirpensteijn, J; Withrow, S J; Straw, R C

1994-01-01

Surgical techniques for removal of tumors that affect the nasal planum or the premaxilla have been described. For extensively invasive malignancies, these techniques may be inadequate if used alone to achieve wide surgical margins. An operative technique that combines resection of the nasal planum and premaxilla has been developed for extensive malignant tumors of the nasal planum or premaxilla. This technique was used in three dogs and resulted in an acceptable cosmetic appearance and good function and tumor control. Complications after surgery included minor bleeding and partial dehiscence of the suture lines in two dogs and stenosis of the nasal orifice in one dog.

A randomized trial of prewarming on patient satisfaction and thermal comfort in outpatient surgery.

PubMed

Akhtar, Zohaib; Hesler, Brian D; Fiffick, Alexa N; Mascha, Edward J; Sessler, Daniel I; Kurz, Andrea; Ayad, Sabry; Saager, Leif

2016-09-01

To test the primary hypothesis that forced-air prewarming improves patient satisfaction after outpatient surgery and to evaluate the effect on core temperature and thermal comfort. Prospective randomized controlled trial. Preoperative area, operating room, and postanesthesia care unit. A total of 115 patients aged 18 to 75 years with American Society of Anesthesiologists status <4 and body mass index of 15 to 36kg/m(2) who were undergoing outpatient surgery (duration <4 hours). Patients were randomized to active prewarming with a Mistral-Air warming system initially set to 43°C or no active prewarming. All patients were warmed intraoperatively. Demographic and morphometric characteristics, perioperative core temperature, ambient temperature, EVAN-G satisfaction score, thermal comfort via visual analog scales. Data from 102 patients were included in the final analysis. Prewarming did not significantly reduce redistribution hypothermia, with prewarmed minus not prewarmed core temperature differing by only 0.18°C (95% confidence interval [CI], -0.001 to 0.37) during the initial hour of anesthesia (P=.052). Prewarming increased the mean EVAN-G satisfaction score, although not significantly, with an overall difference (prewarmed minus not prewarmed) of 5.6 (95% CI, -0.9 to 12.2; P=.09). Prewarming increased thermal comfort, with an overall difference of 6.6 mm (95% CI, 1.0-12.9; P=.02). Active prewarming increased thermal comfort but did not significantly reduce redistribution hypothermia or improve postoperative patient satisfaction. Copyright © 2016 Elsevier Inc. All rights reserved.

Nasal Involvement in Obstructive Sleep Apnea Syndrome

PubMed Central

Michels, Daniel de Sousa; Rodrigues, Amanda da Mota Silveira; Nakanishi, Márcio; Sampaio, André Luiz Lopes; Venosa, Alessandra Ramos

2014-01-01

Numerous studies have reported an association between nasal obstruction and obstructive sleep apnea syndrome (OSAS), but the precise nature of this relationship remains to be clarified. This paper aimed to summarize data and theories on the role of the nose in the pathophysiology of sleep apnea as well as to discuss the benefits of surgical and medical nasal treatments. A number of pathophysiological mechanisms can potentially explain the role of nasal pathology in OSAS. These include the Starling resistor model, the unstable oral airway, the nasal ventilatory reflex, and the role of nitric oxide (NO). Pharmacological treatment presents some beneficial effects on the frequency of respiratory events and sleep architecture. Nonetheless, objective data assessing snoring and daytime sleepiness are still necessary. Nasal surgery can improve the quality of life and snoring in a select group of patients with mild OSAS and septal deviation but is not an effective treatment for OSA as such. Despite the conflicting results in the literature, it is important that patients who are not perfectly adapted to CPAP are evaluated in detail, in order to identify whether there are obstructive factors that could be surgically corrected. PMID:25548569

Value of outpatient follow-up after curative surgery for carcinoma of the large bowel.

PubMed

Cochrane, J P; Williams, J T; Faber, R G; Slack, W W

1980-03-01

The records were reviewed of 406 patients with carcinoma of the large bowel who had been treated at the Middlesex Hospital during 1958-62. Of these patients, 180 were followed up regularly in this hospital after radical surgery, and from six months to 15 years after operation they were seen 2319 times; 71 developed a recurrent carcinoma but, of these, 41 recurrences (58%) were diagnosed at times other than those of the patients' routine outpatient appointments, although they were being regularly reviewed. Only one patient with recurrence appeared to have been cured by further surgery. For the present, adequate education of patients in the symptoms of early recurrence, with instruction to return if any of these develop, is likely to be more effective than the unsatisfactory and time-consuming routine follow-up still used in many hospitals.

Treatment of nasal fractures by Paul of Aegina.

PubMed

Skoulakis, Charalampos E; Manios, Andreas G; Theos, Evangelos A; Papadakis, Chariton E; Stavroulaki, Pelagia S

2008-03-01

The most exact description of the management of nasal fractures given by any physician of ancient times belongs to Paul of Aegina (AD 625-690). The goal of this article is to describe the therapeutic methods and surgical techniques used by Paul of Aegina in the treatment of nasal injuries. We studied the original Greek texts and the translation published in Venice, titled "The seven books of excellent doctor Paul of Aegina." The sixth book of his medical compendium is devoted to surgery. We identified the treatments and techniques applied to the restoration of injured noses. In this historical article we present the management of nasal fractures by Paul of Aegina. Paul of Aegina's conservative and surgical management for each form of injury was adopted by later physicians and influenced European medicine, a management surprisingly identical with the way nasal fractures are managed nowadays.

A randomized, controlled trial comparing acetaminophen plus ibuprofen versus acetaminophen plus codeine plus caffeine (Tylenol 3) after outpatient breast surgery.

PubMed

Mitchell, Alex; McCrea, Patrick; Inglis, Karen; Porter, Geoffrey

2012-11-01

The combination of acetaminophen, codeine, and caffeine (Tylenol 3, T3) is a standard postoperative analgesia after breast surgery despite the adverse effects and variable efficacy of narcotics. This study compared the efficacy of a nonnarcotic approach (acetaminophen and ibuprofen; AcIBU) to T3 after outpatient breast surgery. This double-blind randomized equivalence trial involved patients undergoing outpatient breast surgery. Patients were randomized (stratified by procedure type) to receive AcIBU or T3 four times daily for 7 days, or until free of pain. Pain intensity, measured four times daily by the visual analog scale, was the primary outcome; secondary outcomes were pain relief with analgesic, days until freedom from pain, adverse effects, discontinuation of drug as a result of adverse effects, and patient satisfaction. There were 71 patients randomized to AcIBU and 70 patients to T3. Repeated measures analysis showed no significant difference in average pain intensity over 7 days (AcIBU 19.9 mm vs. T3 20.6 mm; P = 0.78). Similarly, there was no significant difference in pain relief with analgesic (P = 0.46). Although no difference in the incidence of adverse effects was observed (P = 0.94), discontinuation of the study drug as a result of adverse effects was more common with T3 (19 % vs. 6 %; P = 0.018). No significant differences were identified in days until freedom from pain or patient satisfaction; 92 % of AcIBU and 89 % of T3 patients were satisfied with their pain control (P = 0.55). AcIBU is a safe, effective method of pain control after outpatient breast surgery. Compared to T3, it provides at least equivalent analgesia and has a more tolerable adverse effect profile.

[The use of hypertonic sea-water solution in patients after surgery of the nose and paranasal sinuses].

PubMed

Rapiejko, Piotr; Jurkiewicz, Dariusz

2010-01-01

Surgical operations on the nose are very common otorhinolaryngological procedures. The surgical outcome depends not only on the performance of the procedure itself but also on the postoperative care of the nasal cavities. Clinicians continue their search for agents which would promote cleansing of the nasal cavities and regeneration of the nasal mucosa postoperatively. was a retrospective evaluation of the effect of the product Marimer Hypertonic on symptoms in patients who had undergone nasal surgery (septoplasty, functional endoscopic sinus surgery, surgical removal of nasal polyps). The medical records included details of full history and physical examination on postoperative days 1, 7 and 14.The medical records of 120 patients were randomly selected from all records. The records were consecutively selected using the following criteria: 1-Operation type; septoplasty group A and B, FESS group C and D or classical surgical removal of nasal polyps group E and F , 2- Use (group B, D, F) or non-use (group A, C, E) of the hypertonic sea water solution aerosol for nasal douching (Marimer Hypertonic 2.2% sea-water solution). All patients included in the postoperative follow-up at the ENT Outpatient Clinic assess their symptoms by completing a standard self-assessment chart. The symptoms include nasal obstruction, discharge and crusting in the nasal cavities, pain in the nose and paranasal sinuses, reduction of smell, and general health (disease severity) and are assessed on day 1 after removal of nasal packing and on treatment days 7 and 14. At the same time, a clinician assesses their condition, including general health, nasal blockage, discharge and crusting in the nasal cavities, appearance of the nasal mucosa, and sense of smell evaluated by a scratch test using a smell book and a felt-tip pen test. A statistically significance difference in the severity of disease between group A (control) and group B (using Marimer Hypertonic) indicates a statistically significant

Move to outpatient settings may boost medical hotels.

PubMed

Burns, J

1992-06-08

The shift of surgeries to outpatient settings could be healthy for medical hotels, those amenity-equipped facilities originally developed to ease patients out of costly acute-care beds. Because fewer hospitals have a pressing need to use such alternative lodging, some medical hotels are hoping to hitch their fortunes to the outpatient trade, keeping patients overnight after surgeries that don't require hospital admission.

A randomized, prospective, double-blind study of the efficacy of dexpanthenol nasal spray on the postoperative treatment of patients with chronic rhinosinusitis after endoscopic sinus surgery.

PubMed

Tantilipikorn, Pongsakorn; Tunsuriyawong, Prayuth; Jareoncharsri, Perapun; Bedavanija, Anan; Assanasen, Paraya; Bunnag, Chaweewan; Metheetrairut, Choakchai

2012-01-01

To assess the efficacy of dexpanthenol nasal spray compared with normal saline spray in the postoperative treatment of patients with chronic rhinosinusitis (CRS) who underwent endoscopic sinus surgery (ESS). A prospective, randomized controlled study was conducted in CRS patients who underwent ESS. The enrolled patients had never been operated intranasally. These patients received either dexpanthenol or normal saline nasal spray intranasally four times a day for six weeks post-operatively. Fifty CRS patients were recruited in the present study. Age ranged from 23 to 63 years (means 43.4 +/- 11.2 years). Forty-four percent of patients were diagnosed as CRS without nasal polyps (NP) (CRSs NP) and 56% were CRS with NP (CRSw NP). Twenty-five cases were randomly assigned to use dexpanthenol nasal spray whereas the other 25 cases used normal saline nasal spray. The preoperative severity of CRS, determined by the computerized tomography (CT) scan scoring system of Lund-McKay was 13.9 +/- 6.2 in the dexpanthenol group and 13.6 +/- 6.9 in the normal saline group, which were not statistically different (p > 0.05). The endoscopic scoring was 10.2 +/- 2 in the dexpanthenol group and 10.7 +/- 3 in the normal saline group, which were not statistically different (p > 0.05). The mucociliary transit time improvement (time difference between pre- and post-treatment by nasal spray) was 8.4 +/- 3.3 minutes in the dexpanthenol group and 1.7 +/- 1.2 minutes in the normal saline group, which were statistically different (p < 0.05). The majority of the postoperative symptom scores and all of the endoscopic scores of the dexpanthenol group were not statistically different from those of the normal saline group. However, dexpanthenol nasal spray has superior efficacy compared with normal saline nasal spray on improvement of mucociliary clearance and nasal discharge in the postoperative care of CRS patients after ESS.

Effects of mobile phone WeChat services improve adherence to corticosteroid nasal spray treatment for chronic rhinosinusitis after functional endoscopic sinus surgery: a 3-month follow-up study.

PubMed

Feng, Shaoyan; Liang, Zibin; Zhang, Rongkai; Liao, Wei; Chen, Yuan; Fan, Yunping; Li, Huabin

2017-03-01

The objective of the study is to investigate the impact of receiving daily WeChat services on one's cell phone on adherence to corticosteroid nasal spray treatment in chronic rhinosinusitis (CRS) patients after functional endoscopic sinus surgery (FESS). This study was a two-arm, randomized, follow-up investigation. Patients with chronic rhinosinusitis with/without nasal polyps following bilateral FESS were randomised to receive, or to not receive, daily WeChat service on their cell phone to take corticosteroid nasal spray treatment. A prescription of budesonide aqueous nasal spray 128 µg bid was given to all the subjects. Then they returned to the clinic after 30, 60, 90 days. The primary study outcome was adherence to nasal spray treatment, whereas secondary outcomes were change in endoscopic findings and SinoNasal Outcome Test-20 (SNOT-20). On the whole, there was a significant inter-group difference in the change of adherence rate (F = 90.88, p = 0.000). The WeChat group had much higher adherence rate than the control group during the follow-up. In terms of postoperative endoscopic scores and SNOT-20, except granulation score, no significant differences were observed between the two randomization groups. WeChat services are already after a short period of observation associated with improved adherence to corticosteroid nasal spray treatment in CRS patients after FESS.

Finite Element Model and Validation of Nasal Tip Deformation

PubMed Central

Manuel, Cyrus T; Harb, Rani; Badran, Alan; Ho, David; Wong, Brian JF

2016-01-01

Nasal tip mechanical stability is important for functional and cosmetic nasal airway surgery. Palpation of the nasal tip provides information on tip strength to the surgeon, though it is a purely subjective assessment. Providing a means to simulate nasal tip deformation with a validated model can offer a more objective approach in understanding the mechanics and nuances of the nasal tip support and eventual nasal mechanics as a whole. Herein we present validation of a finite element (FE) model of the nose using physical measurements recorded using an ABS plastic-silicone nasal phantom. Three-dimensional photogrammetry was used to capture the geometry of the phantom at rest and while under steady state load. The silicone used to make the phantom was mechanically tested and characterized using a linear elastic constitutive model. Surface point clouds of the silicone and FE model were compared for both the loaded and unloaded state. The average Hausdorff distance between actual measurements and FE simulations across the nose were 0.39mm ± 1.04 mm and deviated up to 2mm at the outermost boundaries of the model. FE simulation and measurements were in near complete agreement in the immediate vicinity of the nasal tip with millimeter accuracy. We have demonstrated validation of a two-component nasal FE model, which could be used to model more complex modes of deformation where direct measurement may be challenging. This is the first step in developing a nasal model to simulate nasal mechanics and ultimately the interaction between geometry and airflow. PMID:27633018

Finite Element Model and Validation of Nasal Tip Deformation.

PubMed

Manuel, Cyrus T; Harb, Rani; Badran, Alan; Ho, David; Wong, Brian J F

2017-03-01

Nasal tip mechanical stability is important for functional and cosmetic nasal airway surgery. Palpation of the nasal tip provides information on tip strength to the surgeon, though it is a purely subjective assessment. Providing a means to simulate nasal tip deformation with a validated model can offer a more objective approach in understanding the mechanics and nuances of the nasal tip support and eventual nasal mechanics as a whole. Herein we present validation of a finite element (FE) model of the nose using physical measurements recorded using an ABS plastic-silicone nasal phantom. Three-dimensional photogrammetry was used to capture the geometry of the phantom at rest and while under steady state load. The silicone used to make the phantom was mechanically tested and characterized using a linear elastic constitutive model. Surface point clouds of the silicone and FE model were compared for both the loaded and unloaded state. The average Hausdorff distance between actual measurements and FE simulations across the nose were 0.39 ± 1.04 mm and deviated up to 2 mm at the outermost boundaries of the model. FE simulation and measurements were in near complete agreement in the immediate vicinity of the nasal tip with millimeter accuracy. We have demonstrated validation of a two-component nasal FE model, which could be used to model more complex modes of deformation where direct measurement may be challenging. This is the first step in developing a nasal model to simulate nasal mechanics and ultimately the interaction between geometry and airflow.

Analyses and treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms

PubMed Central

Cheng, You; Xue, Fei; Wang, Tian-You; Ji, Jun-Feng; Chen, Wei; Wang, Zhi-Yi; Xu, Li; Hang, Chun-Hua; Liu, Xin-Feng

2017-01-01

Abstract In this study, we analyze and discuss the treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms (PNs). We performed 129 endonasal transsphenoidal resections of PNs and analyzed and treated cases with nasal complications. After endonasal transsphenoidal resection of PNs, there were 26 cases of postoperative nasal complications (20.1%), including nasal hemorrhage (4.8%), cerebrospinal fluid rhinorrhea (6.9%), sphenoid sinusitis (2.3%), atrophic rhinitis (1.6%), olfactory disorder (1.6%), perforation of nasal septum (0.8%), and nasal adhesion (2.3%). All patients clinically recovered after therapy, which included treatment of the cavity through nasal endoscopy, intranasal corticosteroids, and nasal irrigation. We propose that regular nasal endoscopic review, specific nasal medications, and regular nasal irrigation can effectively clear nasal mucosal hyperemia-induced edema and nasal/nasoantral secretions, as well as promote regeneration of nasal mucosa, prevent nasal adhesion, maintain the sinus cavity drainage, and accelerate the recovery of the physiological function of the paranasal sinus. Timely treatment of patients with nasal complications after endonasal transsphenoidal resections of PNs could greatly relieve the clinical symptoms. Nasal cleaning is very beneficial to patients after surgery recovery. PMID:28403108

Comparative Study of Early Secondary Nasal Revisions and Costs in Patients With Clefts Treated With and Without Nasoalveolar Molding.

PubMed

Patel, Parit A; Rubin, Marcie S; Clouston, Sean; Lalezaradeh, Frank; Brecht, Lawrence E; Cutting, Court B; Shetye, Pradip R; Warren, Stephen M; Grayson, Barry H

2015-06-01

The present study aims to determine the risk of early secondary nasal revisions in patients with complete unilateral and bilateral cleft lip and palate (U/BCLP) treated with and without nasoalveolar molding (NAM) and examine the associated costs of care. A retrospective cohort study from 1990 to 1999 was performed comparing the risk of early secondary nasal revision surgery in patients with a CLP treated with NAM and surgery (cleft lip repair and primary surgical nasal reconstruction) versus surgery alone in a private practice and tertiary level clinic. The NAM treatment group consisted of 172 patients with UCLP and 71 patients with BCLP, whereas the non-NAM-prepared group consisted of 28 patients with UCLP and 5 with BCLP. The risk of secondary nasal revision for patients with UCLP was 3% in the NAM group and 21% in the non-NAM group. The risk of secondary nasal revision for patients with BCLP was 7% in the NAM group compared with 40% in the non-NAM group. Using multicenter averages, the non-NAM revision rates were calculated at 37.8% and 48.5% for U/BCLP, respectively. Applying these risks of revision, NAM treatment led to an estimated savings of between $491 and $4893 depending on the type of cleft. In conclusion, NAM can reduce the number of early secondary nasal revision surgeries and, therefore, reduce the overall cost of care.

Increased frequency of rhinitis medicamentosa due to media advertising for nasal topical decongestants.

PubMed

Archontaki, M; Symvoulakis, E K; Hajiioannou, J K; Stamou, A K; Kastrinakis, S; Bizaki, A J; Kyrmizakis, D E

2009-01-01

The aim of this study was to investigate the frequency of rhinitis medicamentosa (RM) in patients attending the ENT outpatient clinic of the General Hospital of Rethymnon (Crete, Greece) before and after the launch of an intensive nasal decongestant advertising campaign in Greece. We reviewed the medical records of the patients with RM seen at the ENT outpatient clinic in May, June and July of 2003 and 2006. We analyzed and recorded the gender, age, and related clinical information of the patients with RM. In May, June and July of 2003, 41 patients out of a total of 1780 patients attending the ENT outpatient clinic were diagnosed with RM (2.3%). In the same months in 2006, 161 patients out a total of 1898 patients were diagnosed with RM (8.5%). The frequency of RM in these groups was therefore found to have increased significantly between 2003 and 2006. In 2006, 8 out of 10 patients with RM reported that they had made their purchasing decision solely on the basis of the information supplied by the drug advertisement without consulting their doctor or pharmacist. We suggest that the intensive media advertising campaign for nasal topical decongestants (particularly on TV) which started in 2004 is probably the main reason for this "endemic" RM.

[Otorhinolaryngology in the field of demography, growing outpatient care and regionalization].

PubMed

Schmidt, C E; Schuldt, T; Kaiser, A; Letzgus, P; Liebeneiner, J; Schmidt, K; Öner, A; Mlynski, R

2017-01-01

Otorhinolaryngology (ENT) departments are strongly affected by current changes in the reimbursement schemes for inpatients. The study was designed to investigate these effects on the ENT Department in Rostock and selected comparison clinics, as well as to outline solutions. We analyzed diagnosis-related group (DRG) reports of the ENT Clinic at Rostock University Medical Center from 2013 to 2015, according to the size of the outpatient potential. Comparisons were made with other surgical departments such as maxillofacial surgery and ophthalmology in terms of average length of stay and the resulting deductibles. We also compared billing as day surgery and complete outpatient surgery for the main small surgical procedures such as tonsillectomy and septum surgery. Finally, we compared the discounts with 22 ENT departments in other maximum care hospitals. The average case mix index of an ENT department in Germany is 0.75, case load average of 2,500 patients and common length of stay 4.1 days. In a typical academic ENT department as in Rostock, health plans usually discount around 500 T€ (thousand euro), which is considerably higher than comparable departments, e.g., oral and maxillofacial surgery or ophthalmology departments. However, discounts on a DRG for inpatient surgery is still approximately 1,000 € more revenue than surgery in an outpatient setting. The benchmark analysis shows that health plans in rural areas are more likely to accept inpatient surgery with discounts for small procedures than strict billing according to outpatient reimbursement schemes. These effects can result in an insufficient cost effectiveness of ENT departments in Germany. As a consequence, substantial restructuring of the in- and outpatient treatment seems necessary, also for academic ENT departments, e.g., in the form of day surgery or ambulatory surgical centers, outpatient clinics with special contracts and specialized inpatient surgery. However, this results in greater

An unusual co-presentation of rhinolithiasis and squamous cell carcinoma in the nasal cavity.

PubMed

Özdemir, Süleyman; Görgülü, Orhan; Akbaş, Yücel; Selçuk, Tahsin; Sayar, Hamide; Tarkan, Özgür

2012-07-01

Rhinoliths are nasal stones that result from mineralisation of salts around an endogenous or exogenous nidus within the nasal cavity. They are uncommon nasal masses and usually unilateral and single, situated in the floor of the nose. The patient typically presents with nasal obstruction, facial pain and foul-smelling nasal secretion. To the best of our knowledge, the occurrence of squamous cell carcinoma with rhinolithiasis has not been previously reported in the English-language literature. In this article, we present a 63-year-old man, who had unilateral rhinolithiasis with squamous cell carcinoma within the nasal cavity. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study.

PubMed

Brolin, Tyler J; Mulligan, Ryan P; Azar, Frederick M; Throckmorton, Thomas W

2017-02-01

Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations. Two-tailed t-tests were used to evaluate differences, and differences of P < .05 were considered statistically significant. No significant differences were found between the ASC and hospital cohorts regarding average age, preoperative American Society of Anesthesiologists score, operative indications, or body mass index. No patient required reoperation. There were no hospital admissions from the ASC cohort and no readmissions from the hospital cohort. Minor complications in the ASC cohort were arthrofibrosis in 2 patients and mild asymptomatic anterior subluxation in 1 patient; the only major complication was in an outpatient who fell 11 weeks after surgery and disrupted his subscapularis repair. Three minor complications in the hospital cohort were mild asymptomatic anterior subluxation, blood transfusion, and superficial venous thrombosis. The complication rates (13% vs. 10%) were not significantly different. Outpatient TSA is a safe alternative to hospital admission in appropriately selected patients. Further investigation is warranted to evaluate the longer term outcomes and cost-effectiveness of outpatient TSA. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Comparing nasal packing with trans-septal suturing following septoplasty: a randomized clinical trial.

PubMed

Dadgarnia, Mohammadhossein; Meybodian, Mojtaba; Karbasi, Akbar; Baradaranfar, Mohammadhossein; Atighechi, Saeid; Zand, Vahid; Vaziribozorg, Sedighe

2017-09-01

It has been shown that nasal packing after septoplasty is associated with several complications. Our aim was to compare post-septoplasty nasal packing and trans-septal suturing, in terms of complications and outcome of operation. This randomized clinical trial was performed on patients with deviated nasal septum who were candidates for septoplasty. Patients were visited three times after operation (on the first 48 h, first week, and third post-operative month). Participants were checked for having common complications. Rhinomanometric evaluation was performed to measure nasal air flow and airway resistance, as indicators of operation efficacy, both prior to and after surgery. A total of 72 patients were allocated into the two trial arms. Patients in nasal pack group reported higher pain scores on the first 48 h (P < 0.001) and one week after surgery (P < 0.001). Epiphora (P = 0.028), sleep disturbance (P = 0.012), and dyspnea (P < 0.001) were also more commonly observed in patients using nasal pack. Objective evaluation of bleeding demonstrated that more severe bleeding occurred in patients with trans-septal sutures (P = 0.001). No differences were found comparing the indices of rhinomanometry between the two groups. Using trans-septal sutures after septoplasty compared to nasal packing, might be associated with lower frequencies of several specific complications and a lower rate of patients' discomfort. Nevertheless, increase in the risk of bleeding and hematoma was noted in the trans-septal suture group. No differences were observed between the nasal air flow and resistance of patients in the two groups.

Chondrosarcoma of the nasal septum.

PubMed

Magnano, Mauro; Boffano, Paolo; Machetta, Giacomo; Garibaldi, Elisabetta; Delmastro, Elena; Gabriele, Pietro

2015-03-01

Chondrosarcomas are non-epithelial malignant, slow growing tumors that usually involve pelvis, ribs, and long bones of extremities, scapula and sternum. Median age at diagnosis for head and neck chondrosarcomas is in the fourth decade. The etiopathogenesis of chondrosarcomas remains unknown. Treatment of choice is surgical, with adjuvant therapy having a limited role. In fact, radiation therapy and chemotherapy are reserved for residual or recurrent disease and palliation. As for surgery, several surgical procedures have been described. Recently, endoscopic surgery has allowed for the successful and less invasive treatment of inverting papillomas and even nasopharyngeal angiofibromas, lesions previously requiring extended external approaches. The aim of this paper was to present a case of nasal septal chondrosarcoma that was successfully treated with endoscopic surgery and radiation adjuvant therapy.

The role of nervus intermedius in side specific nasal responses.

PubMed

Nichani, J R; Malik, V; Woolford, T J; Ramsden, R T; Homer, J J

2010-03-02

Nervus intermedius (NI) dysfunction is common in patients who have had vestibular schwannoma (VS) surgery. Such patients have a unilateral parasympathetic-denervated nasal cavity. A number of side-specific nasal reflexes have been demonstrated in normal individuals, including hand cold-water immersion. It is not understood whether these reflexes have parasympathetic or sympathic efferent pathways. We aimed to evaluate the side specific nasal reflex to cold-water immersion in post-operative VS patients with NI dysfunction, in order to determine the nature of the efferent pathway of these reflexes. Side specific responses to cold-water immersion were tested by acoustic rhinometry in 10 normal individuals and 18 patients with NI dysfunction (proven by Schirmer s test) after VS surgery. A consistent pattern of ipsilateral congestion and contralateral decongestion after the cold-water immersion was seen in normal individuals (p smaller than 0.001). We found no consistent response in VS patients both ipsilateral and contralateral to the side of NI dysfunction. We confirm the consistent side-specific nasal reflexes to cold-water hand immersion in normal individuals. This is disturbed in patients with NI dysfunction. We have also shown unexpectantly that the contralateral side-specific reflex is disturbed in these patients. These data suggest that the reflex is parasympathetic and crosses the midline.

[Sclerotherapy and hydrocelectomy for the management of hydrocele in outpatient and day-surgery setting].

PubMed

Erdas, Enrico; Pisano, Giuseppe; Pomata, Mariano; Pinna, Giovanni; Secci, Lucia; Licheri, Sergio; Daniele, Giovanni Maria

2006-01-01

The purpose of this report was to compare two different procedures in the treatment of idiopathic hydrocele, namely, hydrocelectomy and percutaneous sclerotherapy, both of which performed in the outpatient or day surgery setting. A detailed description of the technical local anaesthesia steps is reported together with the sclerotherapy method. The study was conducted in 71 patients with a total of 77 hydroceles treated from 1993 to 2004. Surgery was carried out in 53 cases and sclerotherapy in 24. The latter was more frequently opted for elderly subjects as well as in those patients who requested it. Local or locoregional anaesthesia was reserved to patients treated surgically. The two treatments were compared on the basis of the following parameters: age, operative time, length of hospital stay, success rate and complications. The efficacy of the two procedures was comparable (sclerotherapy 95.8% vs surgery 100%), but sclerotherapy proved more favourable in terms of simplicity, rapidity of execution, shortness of hospital stay and risk of complications. However, 41.7% of patients required more than one treatment to obtain a radical cure, whereas surgery was effective in all cases in just one step. Hospital stay and morbidity were almost the same when surgery was performed under local anaesthesia. Sclerotherapy is an efficient alternative to the classic hydrocelectomy. The choice between the two treatment modalities should be made, taking into account above all the patient's individual preference.

Corrective Septorhinoplasty in Acute Nasal Bone Fractures.

PubMed

Kim, Jisung; Jung, Hahn Jin; Shim, Woo Sub

2018-03-01

Closed reduction is generally recommended for acute nasal bone fractures, and rhinoplasty is considered in cases with an unsatisfactory outcome. However, concomitant rhinoplasty with fracture reduction might achieve better surgical outcomes. This study investigated the surgical techniques and outcomes in patients who underwent rhinoplasty and fracture reduction concomitantly, during the acute stage of nasal bone fracture. Forty-five patients who underwent concomitant rhinoplasty and fracture reduction were enrolled. Nasal bone fractures were classified into three major types (type I, simple fracture; type II, fracture line that mimics nasal osteotomy; and type III, comminuted fracture) based on computed tomography images and preoperative facial images. Two independent otolaryngology-head and neck surgeons evaluated the surgical outcomes and telephone based survey were made to evaluate patients satisfaction. Among 45 patients, there were 39 males and 6 females. Type I was the commonest type of fracture with 18 patients (40%), while the most frequently used surgical technique for corrective surgery was dorsal augmentation with 44 patients (97.8%). The mean visual analogue scale satisfaction score of the surgeons and patients were 7.62 and 8, respectively, with no significant differences between fracture types. Concomitant rhinoplasty with fracture reduction can be performed for acute nasal bone fracture patients, and it might lead to better aesthetic outcomes.

Effects of pre-surgical nasoalveolar moulding on maxillary arch and nasal form in unilateral cleft lip and palate before lip surgery.

PubMed

Fuchigami, T; Kimura, N; Kibe, T; Tezuka, M; Amir, M S; Suga, H; Takemoto, Y; Hashiguchi, M; Maeda-Iino, A; Nakamura, N

2017-11-01

To investigate the effects of pre-surgical nasoalveolar moulding (PNAM) on the maxillary arch and nasal form in patients with unilateral cleft lip and palate (UCLP). This is a retrospective case series study. The subjects were infants with complete UCLP who were treated with PNAM (n = 18) at Kagoshima University Medical and Dental Hospital (Japan) between 2006 and 2013. Maxillary dental casts and facial photographs were taken at the time of the first visit and immediately prior to lip surgery to evaluate the maxillary arch and nasal form changes. The dental casts were scanned with a laser scanner, and changes in the 3-Dimensional coordinates of anatomical landmarks and alveolar cleft width were analysed. Moreover, we investigated the correlation between the changes in the maxillary alveolar arch and nasal form. Regarding the maxillary alveolar arch form, the anterior points of the major segment had moved significantly to the cleft side just prior to the time of lip repair, and the alveolar cleft width was significantly decreased. For nasal form, the inclination and displacement of the columella were significantly improved. The improvement of columella inclination was moderately correlated with the posterior movement of the anterior points of the major segment. These findings indicate that PNAM for infants with UCLP enhanced symmetry in the maxillary alveolar arch and nasolabial form. In addition, the posterior movement of the anterior points of the maxillary alveolar arch was correlated with the improvement of columella deformation. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Manipulation of nasal fractures with local anaesthetic: a 'how to do it' with online video tutorial.

PubMed

Repanos, Costa; Anderson, Daniel; Earnshaw, James; Mitchell, David; Coman, William

2010-06-01

Nasal fractures are the most common facial fractures and displaced fractures may cause considerable cosmetic concern. Traditionally, displaced nasal fractures have been manipulated under general anaesthesia (GA) performed within 2 weeks of the injury. Despite evidence for the benefit of local anaesthesia (LA), nasal fractures are still most commonly reduced under GA. We have presented a method of reduction of simple nasal fractures under LA in an outpatient setting. This has the advantage of being painless, simple to attempt and cost-effective. If reduction is inadequate then a general anaesthetic reduction is still possible. A recent comprehensive systematic review of all the available evidence did not show any significant difference (in terms of cosmesis, pain or nasal obstruction) between using LA and GA methods and highlighted the evidence base to support LA. We describe our method of assessment and treatment of displaced nasal fractures and provide an online tutorial (http://sciencestage.com/v/22194/local-anaesthetic-nasal-fracture-reduction.html). It is important to keep in mind that any concerns should be referred to an otolaryngology specialist for further management and that practitioners attempting this technique should first receive training from an otolaryngologist.

Tennis elbow surgery

MedlinePlus

Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is often an outpatient surgery. This means you will not stay in the hospital overnight. You will be given ...

Invasive group A Streptococcus infections associated with liposuction surgery at outpatient facilities not subject to state or federal regulation.

PubMed

Beaudoin, Amanda L; Torso, Lauren; Richards, Katherine; Said, Maria; Van Beneden, Chris; Longenberger, Allison; Ostroff, Stephen; Wendt, Joyanna; Dooling, Kathleen; Wise, Matthew; Blythe, David; Wilson, Lucy; Moll, Mària; Perz, Joseph F

2014-07-01

Liposuction is one of the most common cosmetic surgery procedures in the United States. Tumescent liposuction, in which crystalloid fluids, lidocaine, and epinephrine are infused subcutaneously before cannula-assisted aspiration of fat, can be performed without intravenous or general anesthesia, often at outpatient facilities. However, some of these facilities are not subject to state or federal regulation and may not adhere to appropriate infection control practices. To describe an outbreak of severe group A Streptococcus (GAS) infections among persons undergoing tumescent liposuction at 2 outpatient cosmetic surgery facilities not subject to state or federal regulation. Outbreak investigation (including cohort analysis of at-risk patients), interviews using a standardized questionnaire, medical record review, facility assessment, and laboratory analysis of GAS isolates. Patients undergoing liposuction at 2 outpatient facilities, one in Maryland and the other in Pennsylvania, between July 1 and September 14, 2012. Confirmed invasive GAS infections (isolation of GAS from a normally sterile site or wound of a patient with necrotizing fasciitis or streptococcal toxic shock syndrome), suspected GAS infections (inflamed surgical site and either purulent discharge or fever and chills in a patient with no alternative diagnosis), postsurgical symptoms and patient-reported experiences related to his or her procedure, and emm types, T-antigen types, and antimicrobial susceptibility of GAS isolates. We identified 4 confirmed cases and 9 suspected cases, including 1 death (overall attack rate, 20% [13 of 66]). One instance of likely secondary GAS transmission to a household member occurred. All confirmed case patients had necrotizing fasciitis and had undergone surgical debridement. Procedures linked to illness were performed by a single surgical team that traveled between the 2 locations; 2 team members (1 of whom reported recent cellulitis) were colonized with a GAS strain

Profile of patients with completion thyroidectomy and assessment of their suitability for outpatient surgery.

PubMed

Wu, Gaosong; Pai, Sara I; Agrawal, Nishant; Richmon, Jeremy; Dackiw, Alan; Tufano, Ralph P

2011-11-01

Outpatient thyroid surgery for thyroid lobectomy has been shown to be safe and feasible. The safety of outpatient completion thyroidectomy in patients who have previously undergone thyroid lobectomy has not been extensively evaluated in the medical literature to date. The authors sought to evaluate postoperative complications associated with completion thyroidectomy in their institution to determine if it would be safe and feasible to perform as an outpatient procedure. Case series with chart review. Tertiary care teaching hospital. Two hundred four consecutive patients, who underwent completion thyroidectomy after previous thyroid lobectomy from January 2000 to June 2010, comprised the study population. Medical records were reviewed for preoperative and postoperative serum calcium levels, preoperative and postoperative fiber-optic laryngoscopic examination of vocal fold mobility, associated comorbidities, length of hospital stay, drain use, seroma or hematoma formation, final thyroid pathology, and postoperative follow-up. Overall, 9 patients (4.4%) developed postoperative complications, including transient symptomatic hypocalcemia in 4 patients (2.0%), transient laboratory hypocalcemia in 3 patients (1.5%), seroma formation in 1 patient (0.5%), and hematoma development in 1 patient (0.5%). There were no cases with permanent or temporary vocal fold paralysis. No significant difference was found in the overall complication rate before and after 4 hours of observation (P = .50). Selected patients who undergo completion thyroidectomy after previous thyroid lobectomy can be safely discharged after 4 hours of postoperative observation with appropriate instructions.

Dissatisfaction with Nasal Tip Shape: Secondary Tip Maneuvers.

PubMed

Moyer, Jeffrey S

2018-06-01

Dissatisfaction with the appearance of the nasal tip is a common compliant in patients seeking revision surgery after rhinoplasty. Revision rhinoplasty is more technically difficult and unpredictable given the frequent presence of scar contracture, impaired skin envelope quality, and missing alar cartilage. This article describes some of the more common causes for tip revision surgery and techniques to address these abnormalities. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Asymmetrically pressing nasal splint for crooked nose deformity.

PubMed

Tugrul, Selahattin; Dogan, Remzi; Kocak, Ilker; Ozturan, Orhan

2015-01-01

Correcting crooked nose deformity is one of the most difficult procedure in rhinoplastic surgery. For that reason, the authors have been designed an asymmetrically pressing nasal splint. In this prospective study, the aim was to compare the effects of applying asymmetrically pressing nasal splint and normal symmetrically splint on the crooked nose. This study included 129 patients who were operated on for crooked nose deformity. Patients were divided into 2 groups. Normal symmetrically pressing nasal splint was applied to groups 1a (I type) and 1b (C type). Asymmetrically pressing nasal splint was applied to groups 2a (I type) and 2b (C type). All groups were compared according to deflection angle from the midline, the percentage of postoperative improvement, patient satisfaction with visual analog scale, and complication rate. I-type noses in both groups at postoperative angle values were reduced, and C-type noses in both groups at postoperative angle values were increased significantly compared with preoperative values. I-type noses of group 2 at postoperative angle values compared with group 1 were reduced, and C-type noses were increased in group 2 significantly. Patient satisfaction rate in group 2 were significantly better than in group 1. The closeness ratios to the ideal angles in group 1 were in "good" and "moderate" levels, whereas in group 2, it was in "excellent" level. There was no significant difference in complication rate in both groups. Asymmetrically pressing splint (novel design) showed increasing success rate clearly in crooked nose surgery than in normal splints.

Nasal carriage of multi-drug resistant Panton-Valentine leucocidin-positive methicillin-resistant Staphylococcus aureus in children in Tripoli-Libya.

PubMed

Al-haddad, Omaima H; Zorgani, Abdulaziz; Ghenghesh, Khalifa Sifaw

2014-04-01

Methicillin-resistant Staphylococcus aureus (MRSA) colonized children are at an increased risk of developing infections than methicillin-sensitive S. aureus colonized children. Nasal specimens from inpatient children, mothers of inpatient children, healthcare workers, and outpatient children at Tripoli Children Hospital (TCH) were examined for MRSA by chromogenic MRSA ID medium. Susceptibility of MRSA isolates to antibiotics was determined by the disc diffusion method. The nasal carriage rate of MRSA among inpatient children (8.3%, 24 of 289), their mothers (11%, 22 of 200), and healthcare workers (12.4%, 22 of 178) was significantly higher than among outpatient children (2.2%, 2 of 91) (P < 0.05, P < 0.02, and P < 0.006, respectively). Of the examined MRSA isolates (N = 35) 10 (28.6%) were positive for Panton-Valentine leucocidin genes by polymerase chain reaction. Multidrug resistance was found in 24.3% (17 of 70) of MRSA isolates. Nasal carriage of multidrug-resistant Panton-Valentine leucocidin-positive MRSA is not uncommon among inpatient children and their mothers in Tripoli.

Frontal sinus revision rate after nasal polyposis surgery including frontal recess clearance and middle turbinectomy: A long-term analysis.

PubMed

Benkhatar, Hakim; Khettab, Idir; Sultanik, Philippe; Laccourreye, Ollivier; Bonfils, Pierre

2018-08-01

To determine the frontal sinus revision rate after nasal polyposis (NP) surgery including frontal recess clearance (FRC) and middle turbinectomy (MT), to search for predictive factors and to analyse surgical management. Longitudinal analysis of 153 patients who consecutively underwent bilateral sphenoethmoidectomy with FRC and MT for NP with a minimum follow-up of 7 years. Decision of revision surgery was made in case of medically refractory chronic frontal sinusitis or frontal mucocele. Univariate and multivariate analysis incorporating clinical and radiological variables were performed. The frontal sinus revision rate was 6.5% (10/153). The mean time between the initial procedure and revision surgery was 3 years, 10 months. Osteitis around the frontal sinus outflow tract (FSOT) was associated with a higher risk of frontal sinus revision surgery (p=0.01). Asthma and aspirin intolerance did not increase the risk, as well as frontal sinus ostium diameter or residual frontoethmoid cells. Among revised patients, 60% required multiple procedures and 70% required frontal sinus ostium enlargement. Our long-term study reports that NP surgery including FRC and MT is associated with a low frontal sinus revision rate (6.5%). Patients developing osteitis around the FSOT have a higher risk of frontal sinus revision surgery. As mucosal damage can lead to osteitis, FSOT mucosa should be preserved during initial NP surgery. However, as multiple procedures are common among NP patients requiring frontal sinus revision, frontal sinus ostium enlargement should be considered during first revision in the hope of reducing the need of further revisions. Copyright © 2018 Elsevier B.V. All rights reserved.

Chondrosarcoma of the nasal septum.

PubMed

Indudharan, R; Das, P K; Azman, A A; Suhaiza, S

1998-08-01

A case of chondrosarcoma of the nasal septum is presented with the result of treatment. The patient was admitted for a growth in the nose of four years' duration. Fine needle aspiration for cytological examination was suggestive of squamous cell carcinoma. She was treated with lateral rhinotomy and wide excision followed by septorhinoplasty. Histological examination showed that the lesion was chondrosarcoma. The patient remained free of disease 26 months after surgery.

Outcome of definitive fractionated radiation followed by exenteration of the nasal cavity in dogs with sinonasal neoplasia: 16 cases.

PubMed

Bowles, K; DeSandre-Robinson, D; Kubicek, L; Lurie, D; Milner, R; Boston, S E

2016-12-01

Local control is a major challenge in treating canine nasal tumours. Surgical cytoreduction prior to radiation therapy has not been shown to offer a survival advantage. Only one study has previously evaluated the outcome when surgery is performed after radiation, which demonstrated an improved survival time compared with radiation alone. The purpose of this study was to investigate the outcome of surgery after definitive radiation on survival times in dogs with sinonasal tumours. Medical records were retrospectively reviewed for dogs with nasal tumours that received definitive radiation followed by surgery. Information obtained from medical record review included signalment, diagnosis, treatment and outcome. The median survival time was 457 days. No long-term side effects were observed. These findings suggest that exenteration of the nasal cavity following definitive radiation for treatment of dogs with nasal tumours is well-tolerated and provides a similar survival duration to previous reports of radiation alone. © 2014 John Wiley & Sons Ltd.

Trans-septal suturing following septoplasty: an alternative for nasal packing.

PubMed

Ghimire, A; Limbu, T R; Bhandari, R

2012-09-01

Septoplasty is one of the most common otorhinolaryngologic surgical procedure. It is customary to place a pack in the nose as a part of nasal surgery to stop bleeding, enhance apposition of mucosal flaps, and stabilize the operated septal cartilage and bones. But nasal packing is not an innocuous procedure. The most common problem encountered by the patients after septoplasty with nasal pack is the pain and discomfort in post operative period. The study has been performed to compare the complications and outcome of septoplasty with or without nasal packing. Forty four patients were randomly allocated into two groups, Group A (n = 21) and Group B (n = 23). In Group A trans-septal suture and in Group B intranasal pack was used following septoplasty. Both groups were compared for postoperative pain, postoperative complications and surgical outcome. Among 44 patients 31 patients were male and 13 patients were female. Most of the patients ie 79.5% were operated for nasal obstruction. Only one patient had postoperative nasal bleeding requiring nasal pack in Group A. Higher Postoperative pain score, longer hospital stay and more complications were observed in Group B patients. No difference was found in patients' satisfaction after the operation. Septoplasty can be safely performed without postoperative nasal packing and is preferred to avoid postoperative pain, discomfort and other complications.

[Aggressive fibromatosis of the nasal sinuses].

PubMed

Artazkoz del Toro, J J; Pons Rocher, F; Dalmau Galofré, J; Mompó Romero, L; Guallart Domènech, F; Serrano Badía, E

1994-01-01

A case report of a feminine patient who complained of nasal ventilatory obstruction and nasosinusal polyposis is presented. She underwent surgery and the pathological study revealed the existence of an aggressive fibromatosis. The AA. review the literature dealing with this illness and explain an update state of the clinical features, treatment and the course of this rare entity, closely related to fibrosarcoma.

The golden ratio of nasal width to nasal bone length.

PubMed

Goynumer, G; Yayla, M; Durukan, B; Wetherilt, L

2011-01-01

To calculate the ratio of fetal nasal width over nasal bone length at 14-39 weeks' gestation in Caucasian women. Fetal nasal bone length and nasal width at 14-39 weeks' gestation were measured in 532 normal fetuses. The mean and standard deviations of fetal nasal bone length, nasal width and their ratio to one another were calculated in normal fetuses according to the gestational age to establish normal values. A positive and linear correlation was detected between the nasal bone length and the gestational week, as between the nasal width and the gestational week. No linear growth pattern was found between the gestational week and the ratio of nasal width to nasal bone length, nearly equal to phi, throughout gestation. The ratio of nasal width to nasal bone length, approximately equal to phi, can be calculated at 14-38 weeks' gestation. This might be useful in evaluating fetal abnormalities.

Open reduction of nasal bone fractures through an intercartilaginous incision.

PubMed

Kim, Ji Heui; Lee, Jun Ho; Hong, Seok Min; Park, Chan Hum

2013-01-01

Open reduction through an intercartilaginous incision was useful for treating delayed-diagnosed nasal bone fractures because it resulted in a successful outcome with minimal complications. Nasal bone fractures are generally managed with closed reduction, which is usually inadequate and results in airway obstruction with a delayed diagnosis of nasal bone fracture when bone healing and fibrotic adhesions around the bone fragment have progressed. This study investigated the surgical outcome of open reduction through an intercartilaginous incision for delayed-diagnosis nasal bone fractures. The study enrolled 18 patients who underwent open reduction through an intercartilaginous incision to correct delayed-diagnosis nasal bone fractures. Three independent otorhinolaryngologists evaluated the outcomes 4-35 months (average 12.7 months) postoperatively as excellent, fair or poor. The time from injury to surgery was 11-39 days (20-39 days in adults and 11-30 days in children). The 18 cases included 16 primary repairs and two revisions. A Kirschner wire was inserted in six (33.3%) patients who had unstable reduced nasal bones. Postoperatively, l5 (83%) patients had excellent results, two (11%) had fair, and one (6%) had a poor outcome. No patient experienced any complication.

Nasal polyps

MedlinePlus

... get rid of nasal polyps. Nasal steroid sprays shrink polyps. They help clear blocked nasal passages and ... is stopped. Corticosteroid pills or liquid may also shrink polyps, and can reduce swelling and nasal congestion. ...

Velocity Measurements in Nasal Cavities by Means of Stereoscopic Piv - Preliminary Tests

NASA Astrophysics Data System (ADS)

Cozzi, Fabio; Felisati, Giovanni; Quadrio, Maurizio

2017-08-01

The prediction of detailed flow patterns in human nasal cavities using computational fluid dynamics (CFD) can provide essential information on the potential relationship between patient-specific geometrical characteristics of the nasal anatomy and health problems, and ultimately led to improved surgery. The complex flow structure and the intricate geometry of the nasal cavities make achieving such goals a challenge for CFD specialists. The need for experimental data to validate and improve the numerical simulations is particularly crucial. To this aim an experimental set-up based on Stereo PIV and a silicon phantom of nasal cavities have been designed and realized at Politecnico di Milano. This work describes the main features and challenges of the set-up along with some preliminary results.

Comparison of Nasal Acceleration and Nasalance across Vowels

ERIC Educational Resources Information Center

Thorp, Elias B.; Virnik, Boris T.; Stepp, Cara E.

2013-01-01

Purpose: The purpose of this study was to determine the performance of normalized nasal acceleration (NNA) relative to nasalance as estimates of nasalized versus nonnasalized vowel and sentence productions. Method: Participants were 18 healthy speakers of American English. NNA was measured using a custom sensor, and nasalance was measured using…

Topical Drug Delivery in Chronic Rhinosinusitis Patients before and after Sinus Surgery Using Pulsating Aerosols

PubMed Central

Möller, Winfried; Schuschnig, Uwe; Celik, Gülnaz; Münzing, Wolfgang; Bartenstein, Peter; Häussinger, Karl; Kreyling, Wolfgang G.; Knoch, Martin

2013-01-01

Objectives Chronic rhinosinusitis (CRS) is a common chronic disease of the upper airways and has considerable impact on quality of life. Topical delivery of drugs to the paranasal sinuses is challenging, therefore the rate of surgery is high. This study investigates the delivery efficiency of a pulsating aerosol in comparison to a nasal pump spray to the sinuses and the nose in healthy volunteers and in CRS patients before and after sinus surgery. Methods 99mTc-DTPA pulsating aerosols were applied in eleven CRSsNP patients without nasal polyps before and after sinus surgery. In addition, pulsating aerosols were studied in comparison to nasal pump sprays in eleven healthy volunteers. Total nasal and frontal, maxillary and sphenoidal sinus aerosol deposition and lung penetration were assessed by anterior and lateral planar gamma camera imaging. Results In healthy volunteers nasal pump sprays resulted in 100% nasal, non-significant sinus and lung deposition, while pulsating aerosols resulted 61.3+/-8.6% nasal deposition and 38.7% exit the other nostril. 9.7+/-2.0 % of the nasal dose penetrated into maxillary and sphenoidal sinuses. In CRS patients, total nasal deposition was 56.7+/-13.3% and 46.7+/-12.7% before and after sinus surgery, respectively (p<0.01). Accordingly, maxillary and sphenoidal sinus deposition was 4.8+/-2.2% and 8.2+/-3.8% of the nasal dose (p<0.01). Neither in healthy volunteers nor in CRS patients there was significant dose in the frontal sinuses. Conclusion In contrast to nasal pump sprays, pulsating aerosols can deliver significant doses into posterior nasal spaces and paranasal sinuses, providing alternative therapy options before and after sinus surgery. Patients with chronic lung diseases based on clearance dysfunction may also benefit from pulsating aerosols, since these diseases also manifest in the upper airways. PMID:24040372

Nasal deposition of ciclesonide nasal aerosol and mometasone aqueous nasal spray in allergic rhinitis patients.

PubMed

Emanuel, Ivor A; Blaiss, Michael S; Meltzer, Eli O; Evans, Philip; Connor, Alyson

2014-01-01

Sensory attributes of intranasal corticosteroids, such as rundown to the back of the throat, may influence patient treatment preferences. This study compares the nasal deposition and nasal retention of a radiolabeled solution of ciclesonide nasal aerosol (CIC-hydrofluoroalkane [HFA]) with a radiolabeled suspension of mometasone furoate monohydrate aqueous nasal spray (MFNS) in subjects with either perennial allergic rhinitis (AR) or seasonal AR. In this open-label, single-dose, randomized, crossover scintigraphy study, 14 subjects with symptomatic AR received a single dose of radiolabeled 74-μg CIC-HFA (37 μg/spray, 1 spray/each nostril) via a nasal metered-dose inhaler or a single dose of radiolabeled 200-μg MFNS (50 μg/spray, 2 sprays/each nostril), with a minimum 5-day washout period between treatments. Initial deposition (2 minutes postdose) of radiolabeled CIC-HFA and MFNS in the nasal cavity, nasopharynx, and on nasal wipes, and retention of radioactivity in the nasal cavity and nasal run-out on nasal wipes at 2, 4, 6, 8, and 10 minutes postdose were quantified with scintigraphy. At 2 and 10 minutes postdose, deposition of radiolabeled CIC-HFA was significantly higher in the nasal cavity versus radiolabeled MFNS (99.42% versus 86.50% at 2 minutes, p = 0.0046; and 81.10% versus 54.31% at 10 minutes, p < 0.0001, respectively; p values unadjusted for multiplicity). Deposition of radioactivity on nasal wipes was significantly higher with MFNS versus CIC-HFA at all five time points, and posterior losses of radiolabeled formulation were significantly higher with MFNS at 6, 8, and 10 minutes postdose. In this scintigraphic study, significantly higher nasal deposition and retention of radiolabeled aerosol CIC-HFA were observed versus radiolabeled aqueous MFNS in subjects with AR.

Patients' perceptions of awake and outpatient craniotomy for brain tumor: a qualitative study.

PubMed

Khu, Kathleen Joy; Doglietto, Francesco; Radovanovic, Ivan; Taleb, Faisal; Mendelsohn, Daniel; Zadeh, Gelareh; Bernstein, Mark

2010-05-01

Routine and nonselective use of awake and outpatient craniotomy for supratentorial tumors has been shown to be safe and effective from a medical standpoint. In this study the authors aim was to explore patients' perceptions about awake and outpatient craniotomy. Qualitative research methodology was used. Two semistructured, open-ended interviews were conducted with 27 participants, who were ambulatory adult patients who underwent craniotomy for brain tumor excision between October 2008 and April 2009. The participants were each assigned to one of the following categories: 1) awake outpatient; 2) awake inpatient; 3) outpatient under general anesthesia; and 4) inpatient under general anesthesia. Interviews were audiotaped and transcribed, and the data were subjected to thematic analysis. The following 6 overarching themes emerged from the data: 1) patients had a positive experience with awake craniotomy; 2) patient satisfaction with outpatient surgery was high; 3) patients understood the rationale behind awake surgery; 4) patients were surprised that brain surgery can be done on an outpatient basis; 5) trust in one's surgeon was important; and 6) patients were more concerned about the disease than the procedure. The results reflected positively on the patients' awake and outpatient surgery experience, but there were some areas that require improvement, specifically perioperative pain control and postoperative care. These insights on patients' perspectives can lead to better delivery of care, and ultimately, improved health outcomes.

Novel application for electrochemotherapy: Immersion of nasal cavity in dog.

PubMed

Suzuki, Daniela O H; Berkenbrock, José A; de Oliveira, Krishna D; Freytag, Jennifer O; Rangel, Marcelo M M

2017-08-01

Electrochemotherapy is a new modality of local cancer treatment that increases the delivery of chemotherapy drugs into tumor cells by applying intense electric fields. This novel electrochemotherapy application was applied as an adjuvant to surgery and eliminated intranasal tumors in dog. The treatment challenges are the surgery limitations due to anatomy and residual tumor in the bone cavity. Most of the tumoral mass on nasal cavity was surgically removed. The internal nasal cavity was immersed in liquid and bleomycin before applying electric field. The solution was necessary to increase the superficial contact between plate electrodes and residual tumor. The numerical study demonstrated electrochemotherapy efficiency in different clinical situations. The proximity between electrodes and bone (<3 mm) and bone irregularities affect the electric field distribution on tumoral tissue. The tumoral tissue around bone protuberances tends to be eliminated. Electrochemotherapy with plate electrodes inside the cavity might not be effective. Different values of electric conductivity solution were studied; the ideal value was 0.5 S/m. The numerical and experimental results confirm the successful application of electrochemotherapy on dog nasal cavity. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

[Influence of different surgeries on growth and development of alar cartilage in young-rabbit].

PubMed

Jiang, Lian; Dong, Xiqian; Song, Qinggao; Chen, Shang; Zou, Sihai

2011-01-01

The purpose of this study is to observe the affection of different clinical surgeries on alar nasal cartilages' growth and development. The experimental results can provide some theory basis for clinical surgeries. Twenty-eight New Zealand immature rabbits were used in this study, and divided into normal control group, hidden dissection group and cutting off alar nasal cartilages group randomly, which included 4,12 and 12 rabbits, separately. Arc incision were made on the mucous membrane of nasal cavity,and then dissect the alar nasal cartilages hidden or cut off the alar nasal cartilages, separately. The growth and development of the alar cartilage were observed at different stages after the surgery using histological and immuno-histochemical methods. Four weeks, eight weeks, twelve weeks and sixteen weeks after surgery, there were no significant differences in the indexes of chondrocytes between hidden dissection group and control group. In cutting off alar nasal cartilages group, fiber tissue were observed in the vacancy left after being cut off cartilages, and even mucous membrane tissue could be seen in some slices. There is no adverse influence on the growth and development of the alar cartilage after being hidden dissected. Contrarily, the restoring capability of transparent cartilage cannot counteract the injury resulted form the surgery after the alar nasal cartilages being cut off.

Changes in the palatal dimensions of mouth breathing children caused by nasal obstruction

NASA Astrophysics Data System (ADS)

Indiarti, I. S.; Setyanto, D. B.; Kusumaningrum, A.; Budiardjo, S. B.

2017-08-01

During children’s growth and development, the breathing process plays an important role in craniofacial growth, especially of the palate. Nose breathing can stimulate the lateral growth of the maxilla, thus making the palate flat. Disturbances in nose breathing caused by nasal obstruction such as allergic rhinitis, adenoid hypertrophy, rhinosinusitis, nasal polyps, and obstructive sleep apnea can lead to a mouth breathing habit in children. This habit can cause palatal dimension changes such as a narrow V-shaped maxillary arch and a high palatal vault. This study analyzed the relationship between the mouth breathing habit in children who have nasal obstruction and palatal dimension changes. A cross-sectional descriptive study was conducted with a consecutive sampling method on children 7-18 years old with a history of allergic rhinitis, adenoid hypertrophy, rhinosinusitis, nasal polyps, and obstructive sleep apnea in the Pediatric Respirology and Pediatric Immunology Allergy Outpatient Clinic Kiara Maternal and Child Health Center at Cipto Mangunkusumo Hospital in Jakarta. The palatal dimensions were measured by the height and transversal width of the hard palate of castings of each child’s upper dental arch using vernier calipers. Palatal dimension changes were found in children with a mouth breathing habit due to nasal obstruction.

Safety and Efficacy of Rocuronium With Sugammadex Reversal Versus Succinylcholine in Outpatient Surgery-A Multicenter, Randomized, Safety Assessor-Blinded Trial.

PubMed

Soto, Roy; Jahr, Jonathan S; Pavlin, Janet; Sabo, Daniel; Philip, Beverly K; Egan, Talmage D; Rowe, Everton; de Bie, Joris; Woo, Tiffany

Complex surgical procedures are increasingly performed in an outpatient setting, with emphasis on rapid recovery and case turnover. In this study, the combination of rocuronium for neuromuscular blockade (NMB) reversed by single-dose sugammadex was compared with succinylcholine followed by spontaneous recovery in outpatient surgery. This multicenter, randomized, safety assessor-blinded study enrolled adults undergoing a short elective outpatient surgical procedure requiring NMB and tracheal intubation. Patients were randomized to NMB with either rocuronium 0.6 mg/kg for tracheal intubation with incremental doses of rocuronium 0.15 mg/kg and subsequent reversal with sugammadex 4.0 mg/kg at 1-2 posttetanic counts or succinylcholine 1.0 mg/kg for intubation with spontaneous recovery. The primary efficacy end point was the time from sugammadex administration to recovery of the train-of-four ratio to 0.9; for succinylcholine, time from administration to recovery of the first twitch (T1) to 90% was assessed. From 167 patients enrolled, 150 received treatment. The all-subjects-treated population comprised 70 patients in the rocuronium-sugammadex group and 80 in the succinylcholine group. Geometric mean (95% confidence interval) time from the start of sugammadex administration to recovery of the train-of-four ratio to 0.9 was 1.8 (1.6-2.0) minutes. Geometric mean (95% confidence interval) time from succinylcholine administration to recovery of T1 to 90% was 10.8 (10.1-11.5) minutes. Health outcome variables were similar between the groups. Adverse events were reported in 87.1% and 93.8% of patients for rocuronium-sugammadex and succinylcholine, respectively. In conclusion, rocuronium for intubation followed by sugammadex for reversal of NMB offers a viable treatment option in outpatient surgery without prolonging recovery duration or jeopardizing safety.

Chondrosarcoma of the nasal septum: A case report.

PubMed

Kainuma, Kazuyuki; Netsu, Kiminori; Asamura, Kenji; Hayashi, Keiko; Takumi, Yutaka; Ota, Hiroyoshi; Usami, Shin-ichi

2009-10-01

Chondrosarcoma make up only 10-20% of malignant primary bone tumors, with 5-10% located in the head and neck (Downey TJ, Clark SK, Moore DW. Chondrosarcoma of the nasal septum. Otolaryngol Head Neck Surg 2001;125:98-100), and nasal septal chondrosarcoma is extremely rare. Surgical excision is the only curative treatment and radiation and chemotherapy have a limited role for palliation. We used a navigation system in endoscopic surgery without complications for a case of chondrosarcoma of the nasal septum by means of a midfacial degloving approach at primary operation and an external incision approach at salvage operation for local recurrence. To our knowledge, this is the first report of the use of such a system for this surgical approach along with a salvage operation. We discuss the clinical presentation, diagnosis, and treatment of this case as well as present a review of the literature.

Nasal polyposis (or chronic olfactory rhinitis).

PubMed

Jankowski, R; Rumeau, C; Gallet, P; Nguyen, D T

2018-06-01

The concept of chronic rhinosinusitis with or without polyps is founded on the structural and functional unicity of the pituitary mucosa and its united response to environmental aggression by allergens, viruses, bacteria, pollution, etc. The present review sets this concept against the evo-devo three-nose theory, in which nasal polyposis is distinguished as specific to the olfactory nose and in particular to the non-olfactory mucosa of the ethmoid, which is considered to be not a sinus but rather the skull-base bone harboring the olfactory mucosa. The evo-devo approach enables simple and precise positive diagnosis of nasal polyposis and its various clinical forms, improves differential diagnosis by distinguishing chronic diseases of the respiratory nose and those of the paranasal sinuses, hypothesizes an autoimmune origin specifically aimed at olfactory system auto-antigens, and supports the surgical concept of nasalization against that of functional sinus and ostiomeatal-complex surgery. The ventilation function of the sinuses seems minor compared to their production, storage and active release of nitric oxide (NO) serving to oxygenate arterial blood in the pulmonary alveoli. This respiratory function of the paranasal sinuses may indeed be their most important. NO trapped in the ethmoidal spaces also accounts for certain radiographic aspects associated with nasal polyposis. Copyright © 2018. Published by Elsevier Masson SAS.

New surgical concepts: nasal tip function.

PubMed

Galli, J J; Zavalla, C A; Vivas, D G; Prado, C; Zanetta, G C

1997-01-01

Since the birth of plastic surgery, rhinoplasty has been an outstanding chapter. Facial balance has been endeavoured with two parameters: size and shape. Now, however, the criterion for harmony has involved two more parameters; position and function. Position is related to other facial elements, such as, upper maxilla, upper lip, forehead, and frontonasal sulcus. Function is important because nasal superficial musculoaponeurotic system (SMAS) muscles are important for Nasal tip movement. To understand this better, we must analyze the nasal SMAS, which consists of primary or intrinsic and secondary or extrinsic muscles. When the extrinsics contract, they allow function of the intrinsics. They are the ala nasalis dilator, the ala nasalis elevator, the tranversus, and the tip depressor. Obvious hypertrophies of the dilator and the elevator has been observed in young athletes. Our method combines conventional, new, and modern aspects. It is conventional because the alar cartilages have been completely freed by intercartilaginous and marginal approaches, and the upper or lower border trimmed according to the case. It is more important to measure how much cartilage is left, than how much is removed. The new aspect is consideration of nasal SMAS to treat short noses that display a tendency to descend with laughter, and the modern aspect is the evaluation of dynamic surgical results, apart from the static.

Effect of nasal deviation on quality of life.

PubMed

de Lima Ramos, Sueli; Hochman, Bernardo; Gomes, Heitor Carvalho; Abla, Luiz Eduardo Felipe; Veiga, Daniela Francescato; Juliano, Yara; Dini, Gal Moreira; Ferreira, Lydia Masako

2011-07-01

Nasal deviation is a common complaint in otorhinolaryngology and plastic surgery. This condition not only causes impairment of nasal function but also affects quality of life, leading to psychological distress. The subjective assessment of quality of life, as an important aspect of outcomes research, has received increasing attention in recent decades. Quality of life is measured using standardized questionnaires that have been tested for reliability, validity, and sensitivity. The aim of this study was to evaluate health-related quality of life, self-esteem, and depression in patients with nasal deviation. Sixty patients were selected for the study. Patients with nasal deviation (n = 32) were assigned to the study group, and patients without nasal deviation (n = 28) were assigned to the control group. The diagnosis of nasal deviation was made by digital photogrammetry. Quality of life was assessed using the Medical Outcomes Study 36-Item Short Form Health Survey questionnaire; the Rosenberg Self-Esteem/Federal University of São Paulo, Escola Paulista de Medicina Scale; and the 20-item Self-Report Questionnaire. There were significant differences between groups in the physical functioning and general health subscales of the Medical Outcomes Study 36-Item Short Form Health Survey (p < 0.05). Depression was detected in 11 patients (34.4 percent) in the study group and in two patients in the control group, with a significant difference between groups (p < 0.05). Nasal deviation is an aspect of rhinoplasty of which the surgeon should be aware so that proper psychological diagnosis can be made and suitable treatment can be planned because psychologically the patients with nasal deviation have significantly worse quality of life and are more prone to depression. Risk, II.(Figure is included in full-text article.).

Surgical technique for reconstruction of the nasal septum: the pericranial flap.

PubMed

Paloma, V; Samper, A; Cervera-Paz, F J

2000-01-01

We describe a new technique for the surgical reconstruction of large-sized anterior septal perforations based on the pericranial flap. The technique requires a standard open rhinoplasty combined with a pericranial flap harvested after a bicoronal approach and tunnelled to the nasal cavity. We present the case of a man with complete destruction of the nasal septum as a result of chronic cocaine abuse. Surgery resulted in a permanent and complete closure of the perforation. The main advantage of this technique is the use of well-vascularized autogenous tissue and the minimal donor site morbidity. This technique provides a new method to close large nasal perforations. Copyright 2000 John Wiley & Sons, Inc. Head Neck 22: 90-94, 2000.

Alar batten cartilage graft: treatment of internal and external nasal valve collapse.

PubMed

Cervelli, Valerio; Spallone, Diana; Bottini, J Davide; Silvi, Erminia; Gentile, Pietro; Curcio, Beniamino; Pascali, Michele

2009-07-01

The aim of this study was to describe the efficacy of alar batten graft in correcting internal and external nasal valve collapse (i.n.v. and e.n.v.) and evaluate the functional and aesthetic results. From July 2006 to September 2008, 80 patients (54 females and 26 males) underwent alar batten cartilage grafting. The patients were divided into three groups: (1) 55 patients with iatrogenic nasal valve collapse (80% i.n.v., 20% e.n.v.), (2) 15 patients with posttraumatic nasal valve collapse (45% i.n.v., 55% e.n.v.), and (3) 10 patients with congenital nasal valve collapse (100% e.n.v.). Patients were evaluated at 6, 12, 24, and some at 36 months after surgery. The final follow-up was at least 24 months. The results of this study revealed a significant increase in the size of the aperture at the internal or external nasal valve after the application of alar batten grafts. All the patients noted improvement in their nasal airway breathing and in their cosmetic appearance. No major complication was observed. The alar batten graft is a simple, versatile technique for long-term reshaping, repositioning, and reconstruction of the nasal valve collapse.

Effects of nasal septum perforation repair on nasal airflow: An analysis using computational fluid dynamics on preoperative and postoperative three-dimensional models.

PubMed

Nomura, Tsutomu; Ushio, Munetaka; Kondo, Kenji; Kikuchi, Shigeru

2018-10-01

The purpose of this research is to examine the changes in nasal airflow dynamics before and after the nasal perforation repair. Three dimensional (3D) models of the nasal cavity before and after septal perforation repair was reconstructed using preoperative and postoperative computed tomography (CT) images of a patient. The numerical simulation was carried out using ANSYS CFX V15.0. Pre- and post-operative models were compared by their velocity, pressure (P), pressure gradient (PG), wall shear (WS), shear strain rate (SSR) and turbulence kinetic energy (TKE) in three plains. In the post-operative state, the cross flows disappeared. In preoperative state, there were areas showing high PG, WS, SSR at the posterior border of the perforation, which exactly correspond to the area showing erosive mucosa on endoscopic inspection of the patient. In postoperative state, such high PG, WS and SSR areas disappeared. High TKEs also disappeared after surgery. The effects of septal perforation repair on airflow dynamics were evaluated using computer fluid dynamics (CFD). High WS, PG and SSR observed at the edge of the septal perforation may be related to the clinical symptom such as nasal bleeding and pain. TKE was considered to cause nasal symptom. Copyright © 2018 Elsevier B.V. All rights reserved.

Objective Measure of Nasal Air Emission Using Nasal Accelerometry

ERIC Educational Resources Information Center

Cler, Meredith J.; Lien, Yu-An, S.; Braden, Maia N.; Mittleman, Talia; Downing, Kerri; Stepp, Cara, E.

2016-01-01

Purpose: This article describes the development and initial validation of an objective measure of nasal air emission (NAE) using nasal accelerometry. Method: Nasal acceleration and nasal airflow signals were simultaneously recorded while an expert speech language pathologist modeled NAEs at a variety of severity levels. In addition, microphone and…

Pre-operative assessment of patients undergoing endoscopic, transnasal, transsphenoidal pituitary surgery.

PubMed

Lubbe, D; Semple, P

2008-06-01

To demonstrate the importance of pre-operative ear, nose and throat assessment in patients undergoing endoscopic, transsphenoidal surgery for pituitary tumours. Literature pertaining to the pre-operative otorhinolaryngological assessment and management of patients undergoing endoscopic anterior skull base surgery is sparse. We describe two cases from our series of 59 patients undergoing endoscopic pituitary surgery. The first case involved a young male patient with a large pituitary macroadenoma. His main complaint was visual impairment. He had no previous history of sinonasal pathology and did not complain of any nasal symptoms during the pre-operative neurosurgical assessment. At the time of surgery, a purulent nasal discharge was seen emanating from both middle meati. Surgery was abandoned due to the risk of post-operative meningitis, and postponed until the patient's chronic rhinosinusitis was optimally managed. The second patient was a 47-year-old woman with a large pituitary macroadenoma, who presented to the neurosurgical department with a main complaint of diplopia. She too gave no history of previous nasal problems, and she underwent uneventful surgery using the endoscopic, transnasal approach. Two weeks after surgery, she presented to the emergency unit with severe epistaxis. A previous diagnosis of hereditary haemorrhagic telangiectasia was discovered, and further surgical and medical intervention was required before the epistaxis was finally controlled. Pre-operative otorhinolaryngological assessment is essential prior to endoscopic pituitary or anterior skull base surgery. A thorough otorhinolaryngological history will determine whether any co-morbid diseases exist which could affect the surgical field. Nasal anatomy can be assessed via nasal endoscopy and sinusitis excluded. Computed tomography imaging is a valuable aid to decisions regarding additional procedures needed to optimise access to the pituitary fossa.

Evaluation of polyvinylidene fluoride nasal sensor to assess deviated nasal septum in comparision with peak nasal inspiratory flow measurements.

PubMed

Manjunatha, Roopa G; Rajanna, K; Mahapatra, D Roy; Prakash, Surya

2014-01-01

Deviated nasal septum (DNS) is one of the major causes of nasal obstruction. Polyvinylidene fluoride (PVDF) nasal sensor is the new technique developed to assess the nasal obstruction caused by DNS. This study evaluates the PVDF nasal sensor measurements in comparison with PEAK nasal inspiratory flow (PNIF) measurements and visual analog scale (VAS) of nasal obstruction. Because of piezoelectric property, two PVDF nasal sensors provide output voltage signals corresponding to the right and left nostril when they are subjected to nasal airflow. The peak-to-peak amplitude of the voltage signal corresponding to nasal airflow was analyzed to assess the nasal obstruction. PVDF nasal sensor and PNIF were performed on 30 healthy subjects and 30 DNS patients. Receiver operating characteristic was used to analyze the DNS of these two methods. Measurements of PVDF nasal sensor strongly correlated with findings of PNIF (r = 0.67; p < 0.01) in DNS patients. A significant difference (p < 0.001) was observed between PVDF nasal sensor measurements and PNIF measurements of the DNS and the control group. A cutoff between normal and pathological of 0.51 Vp-p for PVDF nasal sensor and 120 L/min for PNIF was calculated. No significant difference in terms of sensitivity of PVDF nasal sensor and PNIF (89.7% versus 82.6%) and specificity (80.5% versus 78.8%) was calculated. The result shows that PVDF measurements closely agree with PNIF findings. Developed PVDF nasal sensor is an objective method that is simple, inexpensive, fast, and portable for determining DNS in clinical practice.

A reliable absorbable intranasal bolster for proper maintenance of fractured nasal bone position.

PubMed

Ducic, Y; Hilger, P A

1999-06-01

The maintenance of comminuted or otherwise unstable nasal bones in proper position following adequate operative reduction, may, on occasion, be a frustrating experience for both the patient and the surgeon. Migration of the fragments may compromise the aesthetic and functional results of well executed corrective nasal surgery. In this article, we will outline our successful, inexpensive approach to this occasionally challenging problem utilising an absorbable intranasal customised Surgicel bolster.

Inpatient versus outpatient cleft lip repair and alveolar bone grafting: a cost analysis.

PubMed

Albert, Mark Graham; Babchenko, Oksana Olegovna; Lalikos, Janice Fay; Rothkopf, Douglas Miller

2014-12-01

"day surgery" from a reimbursement perspective. For outpatient surgery, a greater percentage of CLR and ABG charges were successfully recouped compared to inpatient surgery. Awareness of higher payment for inpatient surgery and potential savings through use of the outpatient setting is crucial for hospitals and the US health care system as a whole.

Outpatient and Inpatient Single-Level Cervical Total Disc Replacement: A Comparison of 30-day Outcomes.

PubMed

Segal, Dale N; Wilson, Jacob M; Staley, Christopher; Yoon, Tim S

2018-06-11

Retrospective cohort study. To compare 30-day postoperative outcomes between patients undergoing outpatient and inpatient single-level cervical total disc replacement surgery. Cervical total disc replacement (TDR) is a motion sparing treatment for cervical radiculopathy and myelopathy. It is an alternative to anterior cervical discectomy and fusion (ACDF) with a similar complication rate. Like ACDF, it may be performed in the inpatient or outpatient setting. Efforts to reduce healthcare costs are driving spine surgery to be performed in the outpatient setting. As cervical total disc replacement surgery continues to gain popularity, the safety of treating patients on an outpatient basis needs to be validated. The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent single-level cervical disc replacement surgery between 2006-2015. Complication data including 30-day complications, reoperation rate, readmission rate, and length of stay data was compared between the inpatient and outpatient cohort using univariate analysis. There were 531 (34.2%) patients treated as outpatients and 1,022 (65.8%) were treated on an inpatient basis. The two groups had similar baseline characteristics. The overall 30-day complication rate was 1.4% for inpatients and 0.6% for outpatients. Reoperation rate was 0.6% for inpatient and 0.4% for outpatients. Readmission rate was 0.9% and 0.8% for inpatient and outpatient, respectively. There were no statistical differences identified in rates of readmission, reoperation, or complication between the inpatient and outpatient cohorts. There was no difference between 30-day complications, readmission and reoperation rates between inpatients and outpatients who underwent a single-level cervical total disc replacement. Furthermore, the overall 30-day complication rates were low. This study supports that single-level cervical TDR can be performed safely in an outpatient setting. 3.

The Effect of Nasal Functions on the Integrity of Grafts after Myringoplasty

PubMed Central

Eser, Başak Çaypınar; Yılmaz, Aslı Şahin; Toros, Sema Zer; Oysu, Çağatay

2017-01-01

Objective We aimed to evaluate the effects of nasal functions for the integrity of grafts after myringoplasty. Methods In our study 78 patients who underwent myringoplasty operation between 2011–2013 were included. Group I was defined as the group with an intact tympanic membrane following surgery. Group II was defined as the group with a tympanic membrane perforation following surgery. Group I consisted of 44 and Group II consisted of 34 patients. Subjective and objective measurements of nasal functions, Eustachian tube function (ETF), and allergic status were performed using nasal obstruction symptom evaluation (NOSE) scale, visual analog scale (VAS), and the score for allergic rhinitis (SFAR) questionnaires and acoustic rhinometry and saccharin test. It was investigated whether there was any difference between these two groups in terms of these parameters. Results There was statistically no significant difference between groups according to the age, sex and the presence of tubal dysfunction and allergic rhinitis (p>0.05). In the group of intact tympanic membranes, the likelihood of right ear being the operated one was significantly higher compared to the group of myringoplasty failures (p=0.037). The VAS and NOSE scales did not show any significant difference between groups in terms of successful outcome of myringoplasty (p>0.05). The nasal congestion index (NCI) and the mucociliary clearance (MCC) did not show any significant difference between groups in terms of successful outcome of myringoplasty (p>0.05). Conclusion This study has shown that nasal functions measured by objective and subjective methods had no effects on the success of myringoplasty. PMID:29515926

The Effect of Nasal Functions on the Integrity of Grafts after Myringoplasty.

PubMed

Eser, Başak Çaypınar; Yılmaz, Aslı Şahin; Önder, Serap Şahin; Toros, Sema Zer; Oysu, Çağatay

2017-12-01

We aimed to evaluate the effects of nasal functions for the integrity of grafts after myringoplasty. In our study 78 patients who underwent myringoplasty operation between 2011-2013 were included. Group I was defined as the group with an intact tympanic membrane following surgery. Group II was defined as the group with a tympanic membrane perforation following surgery. Group I consisted of 44 and Group II consisted of 34 patients. Subjective and objective measurements of nasal functions, Eustachian tube function (ETF), and allergic status were performed using nasal obstruction symptom evaluation (NOSE) scale, visual analog scale (VAS), and the score for allergic rhinitis (SFAR) questionnaires and acoustic rhinometry and saccharin test. It was investigated whether there was any difference between these two groups in terms of these parameters. There was statistically no significant difference between groups according to the age, sex and the presence of tubal dysfunction and allergic rhinitis (p>0.05). In the group of intact tympanic membranes, the likelihood of right ear being the operated one was significantly higher compared to the group of myringoplasty failures (p=0.037). The VAS and NOSE scales did not show any significant difference between groups in terms of successful outcome of myringoplasty (p>0.05). The nasal congestion index (NCI) and the mucociliary clearance (MCC) did not show any significant difference between groups in terms of successful outcome of myringoplasty (p>0.05). This study has shown that nasal functions measured by objective and subjective methods had no effects on the success of myringoplasty.

Nasal base, maxillary, and infraorbital implants--alloplastic.

PubMed

Hinderer, U T

1991-01-01

The aesthetic surgery of the facial skeletal contour requires either the performance of ostectomies of excessively prominent segments or the augmentation of retruded segments with organic or synthetic material, in order to achieve balanced tridimensional relations of each segment with regard to the total facial unit. Craniomaxillofacial surgeries are necessary in major malformations or in those combined with malocclusion. In the nasal dorsum or tip, the author prefers the use of cartilage, because synthetic materials need adequate soft-tissue bulk for cover to be inserted without tension and absence of passive mobility of the reception site. For malar augmentation, first proposed by the author and independently by Spadafora in 1971, for chin augmentation up to 8 mm, and for augmentation of the mandibular angle, the author prefers silicone implants because they do not change in shape or volume, may be premanufactured or custom-made, have a similar consistency to that of bone, and do not support bacterial growth. On the other hand, autologous bone grafts adapt less to curved bony surfaces, have an erratic rate of resorption, and need an additional surgical step for removal with the corresponding morbidity and scar. Subperiosteal insertion is preferred because it confers greater stability and the cavity is easier to dissect without soft-tissue damage. Although bone erosion may occur, with over 1200 implants clinically no major change in the soft-tissue contour has been observed, nor has the author been consulted for late complication. In the malar region this may be due to the large surface of the implant and absence of muscular pressure. In the chin, an insertion over the site of the dental roots is avoided. For midface augmentation the following implants are used: (1) The premaxillary lower nasal base implant, proposed in 1971, is indicated to correct a concave midfacial profile, frequent in Asian, black, and Mestizo patients from Latin America and in Caucasian

Plastic surgery outpatient audit: principles and practice of "consultant only" clinics.

PubMed

Griffiths, R W

1990-11-01

The effect of instituting "consultant only" clinics on plastic surgery outpatient activity was to produce a 19% reduction in both clinic sessions and new patient bookings, but a 50% reduction in booked follow-up patients; non-attender rates reduced from 20% to 11% (Northern General Hospital, April 1986-March 1989). Mean clinic attendances reduced from 35 to 26 (Northern General Hospital) and from 33 to 27 (Barnsley District Hospital)--26% and 18%, respectively. Analysis of new referrals to such clinics in the 6 months January-June 1989 showed 41% of patients came from general practitioners, although 80% of "aesthetic" conditions came from this source. 31% of referrals were for malignancy, 51/72 (70%) being basal cell carcinomas. Malignancies waited on average 4 weeks, benign conditions 15 weeks, and "aesthetic" conditions 28 weeks from referral to consultation. Such clinic management has dramatically reduced follow-up episodes, but regulation of new patient attendances is associated with appreciable waiting times for non-malignant conditions. To reduce such waiting times and pursue a "consultant only" clinic policy nationally requires many more consultants.

Similarity and Enhancement: Nasality from Moroccan Arabic Pharyngeals and Nasals

ERIC Educational Resources Information Center

Zellou, Georgia Eve

2012-01-01

Experimental studies of the articulation, acoustics, and perception of nasal and pharyngeal consonants and adjacent vowels were conducted to investigate nasality in Moroccan Arabic (MA). The status of nasality in MA is described as coarticulatorily complex, where two phoneme types (pharyngeal segments and nasal segments) yield similar…

Nasal Morphology of the Chinese: Three-Dimensional Reference Values for Rhinoplasty.

PubMed

Jayaratne, Yasas S N; Deutsch, Curtis K; Zwahlen, Roger A

2014-06-01

To determine normative nasal measurements for Chinese young adults, conditioned on demographics. A cross-sectional descriptive study. A university hospital. Three-dimensional (3D) photographs were captured from 103 Chinese subjects between 18 and 35 years of age using a commercial stereophotographic system. Anthropometric landmarks were identified on these 3D surface images, and measurements suitable for nasal analysis were performed and contrasted against established Caucasian norms. Gender differences in anthropometric dimensions were also analyzed. Normative data for these measurements are made available. Linear nasal measurements, except those for mid-columella length, were significantly larger in men than in women; further, the nasal tip angle and nasofrontal angle were significantly larger in Chinese women. Contrasts of these new data against published Caucasian norms revealed dimensions that differ for these 2 groups. The Chinese normative mean values for morphological nose width, nasal tip angle, nasofrontal angle, and alar slope angle exceeded those reported for North American Caucasians. Gender-specific normative data for the Chinese nose were established in this study to provide a useful tool for surgeons in dealing with rhinoplasty. Moreover, the Chinese nasal anthropometric measurements in this study are broader and flatter than those reported for North American Caucasians. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Idiopathic osseous hyperplasia of the nasal turbinates in a Welsh terrier.

PubMed

Rutherford, S; Whitbread, T; Ness, M

2011-09-01

A three-year-old Welsh terrier was presented with a 6-month history of progressive stertor, exercise intolerance and sneezing which was unresponsive to symptomatic treatment. A large calcified mass occupying the entire rostral right nasal cavity was defined with computed tomography. The mass was completely removed via a dorsal rhinotomy. Histopathological examination of the mass revealed osseous hyperplasia of the nasal turbinates. The excision led to complete resolution of clinical signs and there has been no recurrence 18 months after surgery. © 2011 British Small Animal Veterinary Association.

Saline nasal washes

MedlinePlus

... nasal wash helps flush pollen, dust, and other debris from your nasal passages. It also helps remove excess mucus (snot) and adds moisture. Your nasal passages are open spaces behind your nose. Air passes through your nasal ...

A Review of Perioperative Complications of Outpatient Total Ankle Arthroplasty.

PubMed

Borenstein, Todd R; Anand, Kapil; Li, Quanlin; Charlton, Timothy P; Thordarson, David B

2018-02-01

Total ankle arthroplasty (TAA) is commonly pursued for patients with painful arthritis. Outpatient TAA are increasingly common and have been shown to decrease costs compared to inpatient surgery. However, there are very few studies examining the safety of outpatient TAA. In this study, we retrospectively reviewed 65 consecutive patients who received outpatient TAA to identify complication rates. The medical records of 65 consecutive outpatient TAA from October 2012 to May 2016 with a minimum 6-month follow-up were reviewed. All patients received popliteal and saphenous blocks prior to surgery and were managed with oral pain medication postoperatively. All received a STAR total ankle. Demographics, comorbidities, American Society of Anesthesiologists (ASA) class, and perioperative complications including wound breakdown, infection, revision, and nonrevision surgeries were observed. Mean follow-up was 16.6 ± 9.1 months (range, 6-42 months). There were no readmissions for pain control and 1 patient had a wound infection. The overall complication rate was 15.4%. One ankle (1.5%) had a wound breakdown requiring debridement and flap coverage. This patient thrombosed a popliteal artery stent 1 month postop. The 1 ankle (1.5%) with a wound infection occurred in a patient with diabetes, obesity, hypertension, and rheumatoid arthritis. This study demonstrates the safety of outpatient TAA. The combination of regional anesthesia and oral narcotics provided a satisfactory experience with no readmissions for pain control and 1 wound infection. The 1 wound breakdown complication (1.5%) was attributed to arterial occlusion and not outpatient management. Level IV, retrospective case series.

Spindle Cell Carcinoma of Nasal Cavity- A Case Report

PubMed Central

Mittal, Abhishek; Nagpal, Tapan

2016-01-01

Spindle Cell Carcinoma (SpCC), also known as Sarcomatoid Carcinoma, is a rare and peculiar biphasic malignant neoplasm that occurs mainly in the upper aero-digestive tract, mostly in larynx. SCC accounts for 3% of all squamous cell carcinomas (SCCs) in the head and neck region. It is a rare variant of SCC which shows spindled or pleomorphic tumour cells simulating a true sarcoma. We present a case report of SpCC nasal cavity in a 50-year-old female patient, presented with intermittent epistaxis from left nasal cavity. On physical examination, the patient had an ulcero-exophytic type of mass in the left nasal cavity and a smooth bulge on the left side of anterior hard palate. Patient underwent excision of nasal mass along with partial palatectomy by facial degloving approach and reconstruction of palate with naso-labial flap. The postoperative histopathological report showed SCC. Surgery forms the mainstay of treatment. Radiotherapy and Chemotherapy is warranted in order to improve treatment results. As only few cases have been reported, we report a case of this rare entity to contribute for better understanding and awareness of this rare malignancy. PMID:27190843

Prevalence of antimicrobial drug resistant bacteria carried by in- and outpatients attending a secondary care hospital in Zambia.

PubMed

Nagelkerke, Marjolijn M B; Sikwewa, Kapembwa; Makowa, Dennis; de Vries, Irene; Chisi, Simon; Dorigo-Zetsma, J Wendelien

2017-08-10

Antimicrobial resistance is an increasing global health problem. Very little data on resistance patterns of pathogenic bacteria in low-income countries exist. The aim of this study was to measure the prevalence of antimicrobial drug resistant bacteria carried by in- and outpatients in the resource constraint setting of a secondary care hospital in Zambia. Nasal and rectal samples from 50 in- and 50 outpatients were collected. Patients were randomly selected and informed consent was obtained. Nasal samples were tested for the presence of methicillin-resistant Staphylococcus aureus (MRSA), and rectal samples for Gram-negative rods (family of Enterobacteriaceae) non-susceptible to gentamicin, ciprofloxacin and ceftriaxone. Additionally, E-tests were performed on ceftriaxone-resistant Enterobacteriaceae to detect extended-spectrum β-lactamases (ESBLs). 14% of inpatients carried S. aureus, and 18% of outpatients. No MRSA was found. 90% of inpatients and 48% of outpatients carried one or more Enterobacteriaceae strains (75% Escherichia coli and Klebsiella pneumonia) resistant to gentamicin, ciprofloxacin and/or ceftriaxone (p < 0.001). Among inpatients gentamicin resistance was most prevalent (in 78%), whereas among outpatients ciprofloxacin resistance prevailed (in 38%). All ceftriaxone-resistant Enterobacteriaceae were ESBL-positive; these were present in 52% of inpatients versus 12% of outpatients (p < 0.001). We conclude it is feasible to perform basic microbiological procedures in the hospital laboratory in a low-income country and generate data on antimicrobial susceptibility. The high prevalence of antimicrobial drug resistant Enterobacteriaceae carried by in- and outpatients is worrisome. In order to slow down antimicrobial resistance, surveillance data on local susceptibility patterns of bacteria are a prerequisite to generate guidelines for antimicrobial therapy, to guide in individual patient treatment and to support implementation of infection control

Esthesioneuroblastoma of the nasal cavity.

PubMed

Hollen, Tyler R; Morris, Christopher G; Kirwan, Jessica M; Amdur, Robert J; Werning, John W; Vaysberg, Mikhail; Mendenhall, William M

2015-06-01

Esthesioneuroblastoma is an uncommon cancer of the nasal cavity. We describe the outcomes for 26 patients treated with curative intent with photon radiotherapy (RT) at the University of Florida. Between May 1972 and June 2007, 26 patients received RT for previously untreated esthesioneuroblastoma of the nasal cavity. Sixteen patients were males and 10 were females with a median age of 55 years (range, 3 to 82 y). The modified Kadish stage distribution was: B, 7 patients; C, 17 patients; and D, 2 patients. Treatment modalities included the following: definitive RT, 5 patients; preoperative RT, 2 patients; and postoperative RT after resection, 19 patients. Elective neck irradiation (ENI) was performed in 17 (71%) of 24 N0 patients. Rates of local control, cause-specific survival, and absolute overall survival at 5 years were 79%, 72%, and 69%, respectively. Overall survival among patients treated with definitive RT was 20% at 5 years, compared with 81% among those who underwent surgery and adjuvant RT (P=0.01). One (6%) of 17 patients who received ENI developed a recurrence in the neck and was successfully salvaged. Ultimate neck control was 100% at 5 years for patients who received ENI versus 69% among those not receiving ENI (P=0.0173). Resection combined with adjuvant RT is more effective than surgery or RT alone in the treatment of esthesioneuroblastoma. ENI reduces the risk of regional relapse in patients with Kadish stage B and C cancers.

Assessment of Nasal Carriage of Staphylococcus Aureus and Axillar Flora in Patients With Acromegaly.

PubMed

Gen, Ramazan; Horasan, Elif Şahin; Çinkir, Ümit; Sezer, Kerem; Akbay, Esen

2017-05-01

Recent study showed that patients with acromegaly have typical skin findings including increased sebum secretion, decreased transepidermal water loss, more alkaline, and colder skin surface correlated with serum growth hormone and insulin-like growth factor 1 levels. Different anatomic localizations and texture of the skin differ in bacterial concentrations.Nasal carriage of Staphylococcus aureus and axillar flora in patients with acromegaly was compared with normal population with regard to duration of acromegaly as well as the growth hormone and insulin-like growth factor 1 levels. This patient-control prospective study was conducted in university hospitals in Mersin, Turkey. The study consisted of 30 active acromegalic patients and 60 healthy adults who had no previously diagnosed chronic illness as a control group. A total of 90 volunteers were enrolled in this study; nasal and axillar cultures were obtained. Axillar and nasal specimens from anterior nares of the individuals were taken using sterile swabs. Nasal colonization of Staphylococcus aureus was 13.3% in acromegalic patients, but 43.4% in control group. This difference was statistically significant (P = 0.004). Patients and control group compared according to axillar cultures, the authors determined proteus colonization 16.7% in patients with acromegaly but no proteus colonization in control group. This result was statistically significant (P = 0.001). Proteus colonization was negatively correlated only with disease duration in acromegalic patients (P = 0.017). The authors demonstrated that compared with healthy subjects, acromegalic patients had low percentage of nasal carriage of Staphylococcus aureus and more gram-negative basili in the axillar flora. These nasal and axillar flora changes should be considered for prophylactic antibiotics use before surgery and ampiric antibiotics use after surgery.

Case report and surgical solution for nasal spine agenesis in a woman with Binder syndrome.

PubMed

Kansu, Leyla; Akkuzu, Babur; Avci, Suat

2008-07-01

Binder syndrome is an uncommon disorder of unknown etiology. It is characterized by hypoplasia of the nose and maxilla and altered morphology of the associated soft tissue. We report a 19-year-old Binder syndrome patient with short-nose deformity and anterior nasal spine agenesis. We present a surgical technique for nasal spine agenesis treatment. We used a titanium screw without a graft, which supported the nasal tip and increased tip projection. As there is good soft-tissue coverage over the screw, infection or extrusion was not encountered, and the patient had no complaints 1 year after surgery.

The measurable cost of complications for outpatient cosmetic surgery in patients with mental health diagnoses.

PubMed

Wimalawansa, Sunishka M; Fox, Justin P; Johnson, R Michael

2014-02-01

Mental health conditions, including psychiatric and substance abuse diagnoses, have been associated with poor postoperative outcomes, but no studies have quantified the relationship to date. The authors examine the association between mental health conditions and immediate postoperative outcomes as defined by further hospital-based acute care within 30 days of surgery. California State Ambulatory Surgery, Inpatient, and Emergency Department Databases were used to identify all adult patients undergoing outpatient cosmetic plastic surgery between January 2007 and October 2011. Patients were subgrouped by the presence of mental health or substance abuse conditions. Primary outcome was the need for hospital-based acute care (admission or emergency department visit) within 30 days after surgery. Multivariable logistic regression models compared outcomes between groups. Of 116,597 patients meeting inclusion criteria, 3.9% and 1.4% had either a psychiatric or substance abuse diagnosis, respectively. Adjusting for medical comorbidities, patients with psychiatric disorders more frequently required hospital-based acute care within 30 days postoperatively than those without mental illness diagnoses (11.1% vs 3.6%; adjusted odds ratio [AOR], 1.78 [95% confidence interval, 1.59-1.99]). This was true both for hospital admissions (3.5% vs 1.1%; AOR, 1.61 [1.32-1.95]) and emergency department visits (8.8% vs 2.7%; AOR, 1.88 [1.66-2.14]). The most common acute diagnoses were surgical in nature, including postoperative infection, hemorrhage, and hematoma; the median hospital admission charge was $35 637. Similar findings were noted among patients with a substance abuse diagnosis. Mental health conditions are independently associated with the need for more frequent hospital-based acute care following surgery, thus contributing to added costs of care. A patient's mental health should be preoperatively assessed and appropriately addressed before proceeding with any elective procedure

Assessment of nasalance and nasality in patients with a repaired cleft palate.

PubMed

Sinko, Klaus; Gruber, Maike; Jagsch, Reinhold; Roesner, Imme; Baumann, Arnulf; Wutzl, Arno; Denk-Linnert, Doris-Maria

2017-07-01

In patients with a repaired cleft palate, nasality is typically diagnosed by speech language pathologists. In addition, there are various instruments to objectively diagnose nasalance. To explore the potential of nasalance measurements after cleft palate repair by NasalView ® , we correlated perceptual nasality and instrumentally measured nasalance of eight speech items and determined the relationship between sensitivity and specificity of the nasalance measures by receiver-operating characteristics (ROC) analyses and AUC (area under the curve) computation for each single test item and specific item groups. We recruited patients with a primarily repaired cleft palate receiving speech therapy during follow-up. During a single day visit, perceptive and instrumental assessments were obtained in 36 patients and analyzed. The individual perceptual nasality was assigned to one of four categories; the corresponding instrumental nasalance measures for the eight specific speech items were expressed on a metric scale (1-100). With reference to the perceptual diagnoses, we observed 3 nasal and one oral test item with high sensitivity. However, the specificity of the nasality indicating measures was rather low. The four best speech items with the highest sensitivity provided scores ranging from 96.43 to 100%, while the averaged sensitivity of all eight items was below 90%. We conclude that perceptive evaluation of nasality remains state of the art. For clinical follow-up, instrumental nasalance assessment can objectively document subtle changes by analysis of four speech items only. Further studies are warranted to determine the applicability of instrumental nasalance measures in the clinical routine, using discriminative items only.

Web-based tailored intervention for preparation of parents and children for outpatient surgery (WebTIPS): development.

PubMed

Kain, Zeev N; Fortier, Michelle A; Chorney, Jill MacLaren; Mayes, Linda

2015-04-01

As a result of cost-containment efforts, preparation programs for outpatient surgery are currently not available to the majority of children and parents. The recent dramatic growth in the Internet presents a unique opportunity to transform how children and their parents are prepared for surgery. In this article, we describe the development of a Web-based Tailored Intervention for Preparation of parents and children undergoing Surgery (WebTIPS). A multidisciplinary taskforce agreed that a Web-based tailored intervention consisting of intake, matrix, and output modules was the preferred approach. Next, the content of the various intake variables, the matrix logic, and the output content was developed. The output product has a parent component and a child component and is described in http://surgerywebtips.com/about.php. The child component makes use of preparation strategies such as information provision, modeling, play, and coping skills training. The parent component of WebTIPS includes strategies such as information provision, coping skills training, and relaxation and distraction techniques. A reputable animation and Web design company developed a secured Web-based product based on the above description. In this article, we describe the development of a Web-based tailored preoperative preparation program that can be accessed by children and parents multiple times before and after surgery. A follow-up article in this issue of Anesthesia & Analgesia describes formative evaluation and preliminary efficacy testing of this Web-based tailored preoperative preparation program.

Web-based Tailored Intervention for Preparation of Parents and Children for Outpatient Surgery (WebTIPS): Development

PubMed Central

Kain, Zeev N.; Fortier, Michelle A.; Chorney, Jill MacLaren; Mayes, Linda

2014-01-01

Background Due to cost-containment efforts, preparation programs for outpatient surgery are currently not available to the majority of children and parents. The recent dramatic growth in the Internet presents a unique opportunity to transform how children and their parents are prepared for surgery. In this article we describe the development of a Web-based tailored preparation program for children and parents undergoing surgery (WebTIPS). Development of Program A multidisciplinary taskforce agreed that a Web-based tailored intervention comprised of intake, matrix and output modules was the preferred approach. Next, the content of the various intake variables, the matrix logic and the output content was developed. The output product has a parent component and a child component and is described in http://surgerywebtips.com/about.php. The child component makes use of preparation strategies such as information provision, modeling, play and coping skills training. The parent component of WebTIPS includes strategies such as information provision, coping skills training, relaxation and distraction techniques. A reputable animation and Web-design company developed a secured Web-based product based on the above description. Conclusions In this article we describe the development of a Web-based tailored preoperative preparation program that can be accessed by children and parents multiple times before and after surgery. A follow-up article in this issue of Anesthesia & Analgesia describes formative evaluation and preliminary efficacy testing of this Web-based tailored preoperative preparation program. PMID:25790212

Very short/short-term benefit of inpatient/outpatient cardiac rehabilitation programs after coronary artery bypass grafting surgery.

PubMed

Spiroski, Dejan; Andjić, Mojsije; Stojanović, Olivera Ilić; Lazović, Milica; Dikić, Ana Djordjević; Ostojić, Miodrag; Beleslin, Branko; Kostić, Snežana; Zdravković, Marija; Lović, Dragan

2017-05-01

Exercise-based rehabilitation is an important part of treatment patients following coronary artery bypass graft (CABG) surgery. To evaluate effect of very short/short-term exercise training on cardiopulmonary exercise testing (CPET) parameters. We studied 54 consecutive patients with myocardial infarction (MI) treated with CABG surgery referred for rehabilitation. The study population consisted of 50 men and 4 women (age 57.72 ± 7.61 years, left ventricular ejection fraction 55% ± 5.81%), who participated in a 3-week clinical and 6-month outpatient cardiac rehabilitation program. The Inpatient program consisted of cycling 7 times/week and daily walking for 45 minutes. The outpatient program consisted mainly of walking 5 times/week for 45 minutes and cycling 3 times/week. All patients performed symptom-limited CPET on a bicycle ergometer with a ramp protocol of 10 W/minute at the start, for 3 weeks, and for 6 months. After 3 weeks of an exercise-based cardiac rehabilitation program, exercise tolerance improved as compared to baseline, as well as peak respiratory exchange ratio. Most importantly, peak VO 2 (16.35 ± 3.83 vs 17.88 ± 4.25 mL/kg/min, respectively, P < 0.05), peak VCO 2 (1.48 ± 0.40 vs 1.68 ± 0.43, respectively, P < 0.05), peak ventilatory exchange (44.52 ± 11.32 vs 52.56 ± 12.37 L/min, respectively, P < 0.05), and peak breathing reserve (52.00% ± 13.73% vs 45.75% ± 14.84%, respectively, P < 0.05) were also improved. The same improvement trend continued after 6 months (respectively, P < 0.001 and P < 0.0001). No major adverse cardiac events were noted during the rehabilitation program. Very short/short-term exercise training in patients with MI treated with CABG surgery is safe and improves functional capacity. © 2017 Wiley Periodicals, Inc.

Anaesthesia for the paediatric outpatient.

PubMed

Jöhr, Martin; Berger, Thomas M

2015-12-01

The aim of this review was to discuss recent developments in paediatric anaesthesia, which are particularly relevant to the practitioner involved in paediatric outpatient anaesthesia. The use of a pharmacological premedication is still a matter of debate. Several publications are focussing on nasal dexmedetomidine; however, its exact place has not yet been defined. Both inhalational and intravenous anaesthesia techniques still have their advocates; for diagnostic imaging, however, propofol is emerging as the agent of choice. The disappearance of codeine has left a breach for an oral opioid and has probably worsened postoperative analgesia following tonsillectomy. In recent years, a large body of evidence for the prevention of postoperative agitation has appeared. Alpha-2-agonists as well as the transition to propofol play an important role. There is now some consensus that for reasons of practicability prophylactic antiemetics should be administered to all and not only to selected high-risk patients. Perfect organization of the whole process is a prerequisite for successful paediatric outpatient anaesthesia. In addition, the skilled practitioner is able to provide a smooth anaesthetic, minimizing complications, and, finally, he has a clear concept for avoiding postoperative pain, agitation and vomiting.

[TREATMENT OBSERVATION OF NASAL TIP DEFECTS RECONSTRUCTED BY BILOBED FLAPS AFTER GAINT NEVI EXCISION].

PubMed

Li, Zhengyong; Pu, Yi; Cen, Ying; Wu, Junliang; Zhang, Zhenyu

2016-11-08

To discuss a reliable and aesthetic surgery method for the reconstruction of large defects on the top of nose after giant nevi resection. Between January 2011 and June 2015, 46 cases of nasal tip defects caused by giant nevi resection were treated. Of 46 cases, 22 were male and 24 were female, aged 15-59 years (median, 28 years). The right ala nasi was involved in 28 cases, the apex nasi in 8 cases, and the left ala nasi in 10 cases. The diameters of nevi were from 8 to 12 mm (mean, 9.75 mm); no alar cartilage was invaded. Hair growth was seen in 14 cases. The duration of nasal nevi was from 3 years to 49 years (mean, 9.8 years). There were 9 recurrent patients who received laser therapy before surgery. The defects sizes after excision were from 10 mm×10 mm to 14 mm×14 mm. The bilobed flaps were used for one-stage reconstruction, which sizes were from 11 mm×10 mm to 15 mm×14 mm and from 10 mm×10 mm to 15 mm×14 mm. All the incisions healed by first intention, and the flaps survived. No complication of intracranial hemorrhage or subdural hemorrhage occurred. The patients were followed up 6 months to 5 years (mean, 18 months). The appearance of nasal tip and nasolabial fold was satisfactory, and no recurrence was found during follow-up. One-stage bilobed flap reconstruction for nasal tip defects after giant nevus resection is one of the effective, safe, and aesthetic surgery methods.

Rare occupational cause of nasal septum perforation: Nickel exposure.

PubMed

Bolek, Ertugrul Cagri; Erden, Abdulsamet; Kulekci, Cagri; Kalyoncu, Umut; Karadag, Omer

2017-10-06

Many etiologies are held accountable for nasal septum perforations. Topical nasal drug usage, previous surgeries, trauma, nose picking, squamous cell carcinoma, some rheumatological disorders such as granulomatosis with polyangiitis (Wegener granulomatosis), some infectious diseases such as syphilis and leprosy are among the causes of the perforations. Occupational heavy metal exposures by inhalation rarely may also cause nasal septum perforation. Here, we present a 29-year-old patient without any known diseases, who is a worker at a metallic coating and nickel-plating factory, referred for investigation of his nasal cartilage septum perforation from an otorhinolaryngology clinic. The patient questioning, physical examination and laboratory assessment about rheumatic and infectious diseases were negative. There was a metallic smell in the breath during the physical examination. The analysis showed serum nickel level at 31 μg/l and urine nickel at 18 μg/l (84.11 μg/g creatinine). Other possible serum and urine heavy metal levels were within normal ranges. Nickel exposure is usually together with other heavy metals (chromium or cadmium), it is rarely alone. Nickel ingested by inhalation usually leads to respiratory problems such as reduced olfactory acuity, ulcers, septum perforation or tumors of the nasal sinuses. This case demonstrates the importance of occupational anamnesis and awareness of diagnosis. Int J Occup Med Environ Health 2017;30(6):963-967. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Safety of minimally invasive pituitary surgery (MIPS) compared with a traditional approach.

PubMed

White, David R; Sonnenburg, Robert E; Ewend, Matthew G; Senior, Brent A

2004-11-01

Transsphenoidal hypophysectomy is becoming progressively less invasive. Recent endoscopic techniques avoid nasal or intraoral incisions, use of nasal speculums, and nasal packing. Several case series of endoscopic endonasal pituitary surgery have been reported, but relatively little data exists comparing complication rates to more traditional approaches. We compare the complications of our first 50 cases of endoscopic, minimally invasive pituitary surgery (MIPS) to our last 50 sublabial transseptal (SLTS) procedures. Retrospective case control study. Fifty consecutive MIPS procedures and 50 consecutive SLTS procedures were reviewed retrospectively. Complication rates were analyzed and compared. Total complications per patient (P = .005), postoperative epistaxis (P = .031), lip anesthesia (P = .013), and deviated septum (P = .028) occurred more often in the SLTS group. No significant difference was seen in cerebrospinal fluid leak, meningitis, ophthalmoplegia, visual acuity loss, diabetes insipidus, intracranial hemorrhage, or death. In the MIPS group, length of stay (P < .001), use of lumbar drainage (P = .007), and nasal packing (P < .001) were also significantly reduced. Endoscopic endonasal pituitary surgery provides improved complication rates when compared with SLTS approaches. In addition, we note advantages of the MIPS approach, including reduced length of hospital stay and decreased use of lumbar drainage and nasal packing.

Congenital nasal neuroglial heterotopia and encephaloceles: An update on current evaluation and management.

PubMed

Adil, Eelam; Robson, Caroline; Perez-Atayde, Antonio; Heffernan, Colleen; Moritz, Ethan; Goumnerova, Liliana; Rahbar, Reza

2016-09-01

To describe our experience and current management approach for congenital nasal neuroglial heterotopia (NGH) and encephaloceles. Retrospective chart review at a tertiary pediatric hospital from 1970 to 2013. Thirty patients met inclusion criteria: 21 NGH and nine encephaloceles. Data including demographics, pathology, imaging modality, surgical approach, resection extent, outcomes, and complications were analyzed. Fourteen NGH patients (67%) presented with an internal nasal mass and nasal obstruction. Three patients (14%) presented with an external nasal mass and four (19%) had a mixed lesion. Median age at surgery was 0.51 years (interquartile range 1.32 years). Thirteen (62%) had an intranasal endoscopic approach. Median operative time was 1.6 hours (interquartile range 1.2 hours), and there were no major complications. Nine patients with encephalocele were identified: six (67%) presented with transethmoidal encephaloceles, two (22%) presented with nasoethmoidal encephaloceles, and one (11%) presented with a nasofrontal lesion. The median age at surgery was 1.25 years (interquartile range 1.4 years). All patients required a craniotomy for intracranial extension. Median operative time was 5 hours (interquartile range 1.9 hours), and eight patients (88%) had a total resection. Length of stay ranged from 3 to 14 days. Nasal neuroglial heterotopia and encephaloceles are very rare lesions that require multidisciplinary evaluation and management. At our institution, there has been a shift to magnetic resonance imaging alone for the evaluation of NGH to avoid radiation exposure. Endoscopic extracranial resection is feasible for most intranasal and mixed NGH without an increase in operative time, residual disease, or complications. 4. Laryngoscope, 126:2161-2167, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Does the Supine Position Affect the Nasal Profile in Rhinoplasty Patients? A Comparison of Nasal Anthropometric Measurements in Different Body Positions.

PubMed

Kim, Su Jin; Ryu, In Yong; Kim, Sung Wan; Lee, Kun Hee

2017-10-16

Rhinoplasty surgeons are aware that the nasal profile differs according to body position, namely, the erect position in the consultation room vs the supine position on the operating table. It is not clear whether this difference is caused by an optical illusion or skin laxity due to positional change. To evaluate anthropometric measurements of the nose with different body positions and determine whether the supine position affects the nasal profile. In this retrospective study, 103 patients who underwent primary rhinoplasty were enrolled. Preoperatively, all patients underwent lateral cephalography in the erect position, and facial computed tomography (CT), in the supine position. We measured four nasal anthropometric parameters (the nasofrontal, nasolabial, and nasomental angles, and Simon's ratio) on lateral cephalograms and facial CT images, and compared these parameters between the two body positions. The nasofrontal angle was greater on facial CT than on cephalograms (P < 0.01). This difference was not related to age, sex, or body mass index (P > 0.05 each). We found no significant difference (P > 0.05) between the two positions in the nasolabial angle, nasomental angle, or Simon's ratio. The supine position does affect the nasal profile, especially in the radix area. Surgeons need to consider this difference in patients undergoing rhinoplasty. 2. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Nasal dermoid cyst extending through the frontal bone with no sinus tract in a Dalmatian.

PubMed

van der Peijl, G J W; Schaeffer, I G F

2011-02-01

A Dalmatian was presented with a subcutaneous swelling in the dorsal midline between the eyes. No opening in the skin was identified at the dorsal nasal planum and there was no discharge. Positive contrast sinography showed contrast material filling a cyst that extended to the frontal bone. At surgery, the cyst had a tubular shape and was embedded in a fibrous dermal tissue strand running into the bony nasal septum. The nasal dermoid sinus cyst was surgically removed by limited dorsal rhinotomy, followed by excision of the remaining strand from a bony recess in the lamina perpendicularis ethmoidalis. It is proposed that this nasal dermoid cyst that extends through the frontal bone with no sinus tract is classified as a type V subtype c. © 2011 British Small Animal Veterinary Association.

The Implications of Nasal Substitutions in the Early Phonology of Toddlers With Repaired Cleft Palate.

PubMed

Hardin-Jones, Mary A; Chapman, Kathy L

2018-01-01

To examine the implications of nasal substitutions in the early words of toddlers with cleft palate. Retrospective. Thirty-four toddlers with nonsyndromic cleft palate and 20 noncleft toddlers, followed from ages 13 to 39 months. The groups were compared for the percentage of toddlers who produced nasal substitutions in their early words. The percentage of toddlers with repaired cleft palate who produced nasal substitutions and were later suspected of having velopharyngeal dysfunction (VPD) was also examined. Seventy-six percent of the toddlers in the cleft group (n = 26) and 35% of toddlers in the noncleft group (n = 7) produced nasal substitutions on one or more of their early words. Only 38% (10/26) of the toddlers with cleft palate who produced nasal substitutions in their early words were later diagnosed as having moderate-severe hypernasality and suspected VPD. The presence of nasal substitutions following palatal surgery was not always an early sign of VPD. These substitutions were present in the early lexicon of children with and without cleft palate.

Population‐based incidence rate of inpatient and outpatient surgical procedures in a high‐income country

PubMed Central

Jarnheimer, A.; Rose, J.; Björk, J.; Meara, J. G.; Hagander, L.

2017-01-01

Background The WHO and the World Bank ask countries to report the national volume of surgery. This report describes these data for Sweden, a high‐income country. Methods In an 8‐year population‐based observational cohort study, all inpatient and outpatient care in the public and private sectors was detected in the Swedish National Patient Register and screened for the occurrence of surgery. The entire Swedish population was eligible for inclusion. All patients attending healthcare for any disease were included. Incidence rates of surgery and likelihood of surgery were calculated, with trends over time, and correlation with sex, age and disease category. Results Almost one in three hospitalizations involved a surgical procedure (30·6 per cent). The incidence rate of surgery exceeded 17 480 operations per 100 000 person‐years, and at least 58·5 per cent of all surgery was performed in an outpatient setting (range 58·5 to 71·6 per cent). Incidence rates of surgery increased every year by 5·2 (95 per cent c.i. 4·2 to 6·1) per cent (P < 0·001), predominantly owing to more outpatient surgery. Women had a 9·8 (95 per cent c.i. 5·6 to 14·0) per cent higher adjusted incidence rate of surgery than men (P < 0·001), mainly explained by more surgery during their fertile years. Incidence rates peaked in the elderly for both women and men, and varied between disease categories. Conclusion Population requirements for surgery are greater than previously reported, and more than half of all surgery is performed in outpatient settings. Distributions of age, sex and disease influence estimates of population surgical demand, and should be accounted for in future global and national projections of surgical public health needs. PMID:29131303

Paranasal Sinus and Nasal Cavity Cancer Treatment (PDQ®)—Health Professional Version

Cancer.gov

Paranasal sinus and nasal cavity cancer treatment often is a combination of surgery and radiation therapy for operable tumors. Chemotherapy may be used as palliation in recurrent disease. Get detailed treatment information for newly diagnosed and recurrent disease in this clinician summary.

Septoplasty and Turbinate Surgery

MedlinePlus

... RESOURCES Medical Societies Patient Education About this Website Font Size + - Home > TREATMENTS > Septoplasty & Turbinate Surgery Nasal/Sinus ... they are too large. There are several different types of turbinates in the nose. The ones that ...

Elasticity measurement of nasal cartilage as a function of temperature using optical coherence elastography

NASA Astrophysics Data System (ADS)

Liu, Chih Hao; Skryabina, M. N.; Singh, Manmohan; Li, Jiasong; Wu, Chen; Sobol, E.; Larin, Kirill V.

2015-03-01

Current clinical methods of reconstruction surgery involve laser reshaping of nasal cartilage. The process of stress relaxation caused by laser heating is the primary method to achieve nasal cartilage reshaping. Based on this, a rapid, non-destructive and accurate elasticity measurement would allow for a more robust reshaping procedure. In this work, we have utilized a phase-stabilized swept source optical coherence elastography (PhSSSOCE) to quantify the Young's modulus of porcine nasal septal cartilage during the relaxation process induced by heating. The results show that PhS-SSOCE was able to monitor changes in elasticity of hyaline cartilage, and this method could potentially be applied in vivo during laser reshaping therapies.

The benefits of digital thoracic drainage system for outpatients undergoing pulmonary resection surgery.

PubMed

Mier, J M; Fibla, J J; Molins, L

2011-01-01

Since digital thoracic drainage system (DTDS) came onto the market, a number of its advantages have become clear, for example that of eliminating the differences between observers. The withdrawal of thoracic drainage has been found to be comfortable, safe and well tolerated by patients; it helps to reduce or eliminate the cost of hospital stay, because, according to the different series published in recent months, it is possible to withdraw drainage sooner and thus discharge patients earlier. Prospective studies are underway, but as yet nothing has been written about the possible benefits in outpatient surgery programmes. In this report we present our findings of 3 cases of patients undergoing pulmonary resection who were treated with continuous intra-domiciliary DTDS. Pending the results of a prospective study now underway our observation is that with properly selected patients this is a safe method. Copyright © 2010 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

Thiolated polycarbophil as an adjuvant for permeation enhancement in nasal delivery of antisense oligonucleotides.

PubMed

Vetter, A; Martien, R; Bernkop-Schnürch, A

2010-03-01

The purpose of this study was to investigate the effect of thiolated polycarbophil as an adjuvant to enhance the permeation and improve the stability of a phosphorothioate antisense oligonucleotide (PTO-ODN) on the nasal mucosa. Polycarbophil-cysteine (PCP-Cys) was synthesized by the covalent attachment of L-cysteine to the polymeric backbone. Cytotoxicity tests were examined on human nasal epithelial cells from surgery of nasal polyps confirmed by histological studies. Deoxyribonuclease I activity in respiratory region of the porcine nasal cavity was analyzed by an enzymatic assay. The enzymatic degradation of PTO-ODNs on freshly excised porcine nasal mucosa was analyzed and protection of PCP-cysteine toward DNase I degradation was evaluated. Permeation studies were performed in Ussing-type diffusion chambers. PCP-Cys/GSH did not arise a remarkable mortal effect. Porcine respiratory mucosa was shown to possess nuclease activity corresponding to 0.69 Kunitz units/mL. PTO-ODNs were degraded by incubation with nasal mucosa. In the presence of 0.45% thiolated polycarbophil and 0.5% glutathione (GSH), this degradation process could be lowered. In the presence of thiolated polycarbophil and GSH the uptake of PTO-ODNs from the nasal mucosa was 1.7-fold improved. According to these results thiolated polycarbophil/GSH might be a promising excipient for nasal administration of PTO-ODNs. 2009 Wiley-Liss, Inc. and the American Pharmacists Association

Feasibility of outpatient total hip and knee arthroplasty in unselected patients

PubMed Central

Gromov, Kirill; Kjærsgaard-Andersen, Per; Revald, Peter; Kehlet, Henrik; Husted, Henrik

2017-01-01

Background and purpose The number of patients who are suitable for outpatient total hip and knee arthroplasty (THA and TKA) in an unselected patient population remains unknown. The purpose of this prospective 2-center study was to identify the number of patients suitable for outpatient THA and TKA in an unselected patient population, to investigate the proportion of patients who were discharged on the day of surgery (DOS), and to identify reasons for not being discharged on the DOS. Patients and methods All consecutive, unselected patients who were referred to 2 participating centers and who were scheduled for primary THA and TKA were screened for eligibility for outpatient surgery with discharge to home on DOS. If patients did not fulfill the discharge criteria, the reasons preventing discharge were noted. Odds factors with relative risk intervals for not being discharged on DOS were identified while adjusting for age, sex, ASA score, BMI and distance to home. Results Of the 557 patients who were referred to the participating surgeons during the study period, 54% were potentially eligible for outpatient surgery. Actual DOS discharge occurred in 13–15% of the 557 patients. Female sex and surgery late in the day increased the odds of not being discharged on the DOS. Interpretation This study shows that even in unselected THA and TKA patients, same-day discharge is feasible in about 15% of patients. Future studies should evaluate safety aspects and economic benefits. PMID:28426262

Effect of Deviated Nasal Septum on Mean Platelet Volume: A Prospective Study.

PubMed

Poorey, Vijay Kumar; Thakur, Pooja

2014-12-01

In E.N.T clinical practice, patients with nasal obstruction due to deviated nasal septum is a common presentation. Nasal airway obstruction is a common cause of upper airway obstruction further leading to obstructive and hypoxic manifestations. Mean platelet volume (MPV) levels increase in hypoxic conditions. MPV is one of the platelet activation index which reflects the platelet production rate. Present prospective study conducted in the department of Otorhinolaryngology and Head and Neck surgery, Gandhi Medical College and Hamidia Hospital, Bhopal, on 63 patients with the clinical evidence of DNS and 63 healthy age matched subjects as control group, aimed to evaluate the relationship between MPV levels and nasal obstruction due to deviated nasal septum (DNS). The diagnosis of patients with DNS was based on anterior rhinoscopy and endoscopic nasal examination. Blood samples were collected before surgical correction. In present study, the authors found that there is preponderance of DNS in the age group of 25-45 years being the most active age group, males having the higher incidence. Majority of cases of DNS being left sided and of obstructed type. MPV were significantly higher in patients with DNS than the control group. Among the cases MPV being higher in females and in the impacted type of DNS. Present study reemphasized the concept that MPV is increased in chronic nasal obstruction due to DNS and this increase is in accordance with the severity of DNS.

Nasal Anatomy and Function.

PubMed

Patel, Ruchin G

2017-02-01

The nose is a complex structure important in facial aesthetics and in respiratory physiology. Nasal defects can pose a challenge to reconstructive surgeons who must re-create nasal symmetry while maintaining nasal function. A basic understanding of the underlying nasal anatomy is thus necessary for successful nasal reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[Dexpanthenol nasal spray as an effective therapeutic principle for treatment of rhinitis sicca anterior].

PubMed

Kehrl, W; Sonnemann, U

1998-09-01

Controlled clinical studies on medical treatment of rhinitis sicca anterior have not yet been published. Therapy recommendations are based on experiences but not on results of controlled clinical studies. The aim of this study was to examine the efficacy and tolerance of a new form of application of Dexpanthenol in physiologic saline solution (Nasicur). A randomized comparison of parallel groups was performed. One group was treated with the nasal spray while the control group received a placebo. The assessment of nasal breathing resistance and the extent of crust formation according to scores were defined as target parameters. Statistical analysis was carried out according to Wilcoxon at alpha < or = 0.05. Forty-eight outpatients diagnosed with rhinitis sicca anterior were included in this study. Twenty-four received the medication, and 29 were treated with a placebo. The superiority of the dexpanthenol nasal spray in comparison to the placebo medication was demonstrated for both target parameters as clinically relevant and statistically significant. The placebo spray showed clinical improvement of the other treatment outcome parameters. Dexpanthenol nasal spray showed no statistically significant difference in comparison to placebo. The clinically proven efficacy is emphasized by good tolerance of both treatments which was validated by the objective rhinoscopy findings. Good compliance was confirmed. The result of the controlled clinical study confirms that the dexpanthenol nasal spray is an effective medicinal treatment of rhinitis sicca anterior and is more effective than common medications.

Island composite nasal flap for nasal dorsum skin defects.

PubMed

Skitarelić, Neven; Mladina, Ranko; Mraovic, Boris; Simurina, Tatjana; Skitarelić, Nataa; Vuković, Katarina

2009-08-01

Skin defects on the nasal dorsum remain a challenge for the plastic surgeon. There are few local nasal flap options for the repair of proximally positioned nasal skin defects. During a 3-year period, 22 patients were treated after excision of skin cancer in the proximal two-thirds of the nose. Nine patients (41%) were female and 13 (59%) were male, with an average age of 69 years. All patients were operated on under local anesthesia. The average follow-up was 25 months. In all patients, after tumor ablation, the skin defect was closed with an island composite nasal skin flap. Pathohistologic analysis confirmed that the margins of the removed tumor were free of malignant cells. Six patients (27.3%) had squamous cell and 16 (72.7%) had basal cell carcinoma. There was no total or partial flap loss. None of the patients has suffered from recurrence of the tumor. The island composite nasal flap is a reliable technique for the closure of proximal nasal skin defects. Complications in the elevation of the island composite flap were rare, and the final result was acceptable.

Correlation of Nasal Mucosal Temperature With Subjective Nasal Patency in Healthy Individuals

PubMed Central

Bailey, Ryan S.; Casey, Kevin P.; Pawar, Sachin S.; Garcia, Guilherme J. M.

2016-01-01

Importance Historically, otolaryngologists have focused on nasal resistance to airflow and minimum airspace cross-sectional area as objective measures of nasal obstruction using methods such as rhinomanometry and acoustic rhinometry. However, subjective sensation of nasal patency may be more associated with activation of cold receptors by inspired air than with respiratory effort. Objective To investigate whether subjective nasal patency correlates with nasal mucosal temperature in healthy subjects. Design, Setting, and Participants Twenty-two healthy adults were recruited for this study. Subjects first completed the Nasal Obstruction Symptom Evaluation (NOSE) and a unilateral visual analog scale (VAS) to quantify subjective nasal patency. A miniaturized thermocouple sensor was then used to record nasal mucosal temperature bilaterally in two locations along the nasal septum: at the vestibule and across from the inferior turbinate head. Results The range of temperature oscillations during the breathing cycle, defined as the difference between end-expiratory and end-inspiratory temperatures, was greater during deep breaths (ΔTexp-insp = 6.2 ± 2.6°C) than during resting breathing (ΔTexp-insp = 4.2 ± 2.3°C) in both locations (p < 10−13). Mucosal temperature measured at the right vestibule had a statistically significant correlation with both right-side VAS score (Pearson r = −0.55, p=0.0076) and NOSE score (Pearson r = −0.47, p=0.028). No other statistically significant correlations were found between mucosal temperature and subjective nasal patency scores. Nasal mucosal temperature was lower in the first cavity to be measured, which was the right cavity in all subjects. Conclusions and Relevance The greater mucosal temperature oscillations during deep breathing is consistent with the common experience that airflow sensation is enhanced during deep breaths, thus supporting the hypothesis that mucosal cooling plays a central role in nasal airflow sensation

Influence of cooling face masks on nasal air conditioning and nasal geometry.

PubMed

Lindemann, J; Hoffmann, T; Koehl, A; Walz, E M; Sommer, F

2017-06-01

Nasal geometries and temperature of the nasal mucosa are the primary factors affecting nasal air conditioning. Data on intranasal air conditioning after provoking the trigeminal nerve with a cold stimulus simulating the effects of an arctic condition is still missing. The objective was to investigate the influence of skin cooling face masks on nasal air conditioning, mucosal temperature and nasal geometry. Standardized in vivo measurements of intranasal air temperature, humidity and mucosal temperature were performed in 55 healthy subjects at defined detection sites before and after wearing a cooling face mask. Measurements of skin temperature, rhinomanometry and acoustic rhinometry were accomplished. After wearing the face mask the facial skin temperature was significantly reduced. Intranasal air temperature did not change. Absolute humidity and mucosal temperature increased significantly. The acoustic rhinometric results showed a significant increase of the volumes and the cross-sectional areas. There was no change in nasal airflow. Nasal mucosal temperature, humidity of inhaled air, and volume of the anterior nose increased after application of a cold face mask. The response is mediated by the trigeminal nerve. Increased mucosal temperatures as well as changes in nasal geometries seem to guarantee sufficient steady intranasal nasal air conditioning.

Erbium:YAG laser contouring of the nasal dorsum: a preliminary investigation

NASA Astrophysics Data System (ADS)

Truong, Mai T.; Majaron, Boris; Pandoh, Nidhi S.; Wong, Brian J.

2001-05-01

In conventional aesthetic rhinoplasty operations, manual or powered rasps are used to reduce the osseo-cartilagenous nasal dorsum. This tactile method requires palpation of the instrument and the dorsum during surgery to estimate the degree of volume reduction, and often requires forceful manipulation of the dorsum which may illicit pain during surgery and contribute to post-operative edema and echymosis. In this preliminary study, we investigated the use of the Erbium:YAG laser ((lambda) equals294 micrometers ) to reduce bone and cartilage using ex-vivo porcine nasal dorsum and human cadaveric tissues. The short pulsed length and high absorption of this laser in biologic tissues results in minimization of thermal injury which are ideal for non- contact optical contouring of osseous and cartilagenous tissues in the face. Two Erbium:YAG lasers were used to ablate fresh porcine nasal bone and compared for their use. One Erbium:YAG laser, the Fidelis Laser, Fontana Medical Lasers, Ljubljana, Slovenija with variable pulse repetition rates (2 to 50 Hz), pulse energy (80 to 1000 mJ), and pulse duration (100, 300, 750 and 1000 microsecond(s) ) was used and compared to the Ultrafine Erbium:YAG laser, Coherent Inc., Santa Clara California, with variable pulse repetition rate (2 to 10 Hz), pulse energy (2-16 J/cm2), and spot diameter (2-6 mm). Only laser parameters approximating the conditions for thermal confinement were evaluated.

Infrasellar craniopharyngioma of the posterior nasal septum: a rare entity.

PubMed

Chiun, Kian Chai; Tang, Ing Ping; Vikneswaran, Tharumalingam; Nurshaline Pauline, H Kipli

2012-02-01

To report an unusual location of infrasellar craniopharyngioma in a peadiatric patient. A six-year-old boy presented with persistent bilateral nasal obstruction for one year. Clinical examination revealed a posterior choanal mass arising from septum and the finding was confirmed by paranasal sinuses computed tomography scan. He then underwent wide local excision. Histopathological examination confirmed the diagnosis of craniopharyngioma (adamantinomatous type). There were no signs and symptoms of recurrence after a year of followup. Infracranial craniopharyngioma without sellar involvement is extremely rare. Persistent nasal obstruction without endocrine dysfunction is the common presentation. Radiological imaging is important to diagnose and assess the extent. The mainstay of treatment for infrasellar craniopharyngioma is surgery. Regular follow up is mandatory.

Translation, cross-cultural adaptation and validation of SinoNasal Outcome Test (SNOT): 22 to Brazilian Portuguese.

PubMed

Kosugi, Eduardo Macoto; Chen, Vitor Guo; Fonseca, Viviane Maria Guerreiro da; Cursino, Milena Martins Pellogia; Mendes Neto, José Arruda; Gregório, Luís Carlos

2011-01-01

Quality of life questionnaires have been increasingly used in clinical trials to help establish the impact of medical intervention or to assess the outcome of health care services. Among disease-specific outcome measures, SNOT-22 was considered the most suitable tool for assessing chronic rhinosinusitis and patients with nasal polyps. To perform translation, cross-cultural adaptation and validation of the SNOT-22 to Brazilian Portuguese. Prospective study involving eighty-nine patients with chronic rhinosinusitis or nasal polyps submitted to functional endoscopic sinus surgery, who answered the questionnaire before and after surgery. Furthermore, 113 volunteers without sinonasal disease also answered the questionnaire. Internal consistency, test-retest reliability, measure validity, responsiveness and clinical interpretability were assessed. Mean preoperative, postoperative and no sinonasal disease scores were 62.39, 23.09 and 11.42, respectively (p<0.0001); showing validity and responsiveness. Internal consistency was high (Cronbach's alpha = 0.9276). Reliability was sufficiently good, considering inter-interviewers (r=0.81) and intra-interviewers within a 10 to 14 day-interval (r=0.72). Surgery effect size was 1.55. Minimally important difference was 14 points; and scores up to 10 points were considered normal. The Brazilian Portuguese SNOT-22 version is a valid instrument to assess patients with chronic rhinosinusitis and nasal polyps.

Frequency of simultaneous nasal procedures in endoscopic dacryocystorhinostomy.

PubMed

Figueira, Edwin; Al Abbadi, Zaid; Malhotra, Raman; Wilcsek, Geoffrey; Selva, Dinesh

2014-01-01

To assess the frequency of simultaneous nasal procedures in powered endoscopic dacryocystorhinostomy performed by oculoplastic surgeons. Retrospective, multicenter study. Demographic, clinical, and surgical data of consecutive endoscopic dacryocystorhinostomy cases at 3 oculoplastic centers, over periods of 6, 4, and 2.2 years, respectively, were reviewed. The rates of simultaneous nasal procedures (septoplasty, turbinectomy, and polypectomy) were studied. Complication rates in the patients who had simultaneous endonasal procedures were analyzed. Five hundred seventy-six cases (mean age: 63.2 years [16.2-94 years], women: 67.3%). Of the total cohort of patients, 14.1% required a simultaneous endonasal procedure during endoscopic dacryocystorhinostomy, 11.9% (range among surgeons: 5.2%-15%) required septoplasty, 1.5% required middle turbinate surgery, and 0.34% required polypectomy. Of the 81 patients with concomitant procedures, 1 had postoperative epistaxis, and 1 had an asymptomatic septal adhesion. The anatomical and functional success rates for the entire cohort were 95.6% and 87.8%, respectively. A significant proportion of patients undergoing endoscopic dacryocystorhinostomy may require concomitant endonasal procedures. Hence, endonasal lacrimal surgeons using techniques that aim to marsupialize the entire lacrimal sac may benefit from expertize in the management of concomitant nasal pathologic study.

Nasalance and nasality at experimental velopharyngeal openings in palatal prosthesis: a case study

PubMed Central

LIMA-GREGIO, Aveliny Mantovan; MARINO, Viviane Cristina de Castro; PEGORARO-KROOK, Maria Inês; BARBOSA, Plinio Almeida; AFERRI, Homero Carneiro; DUTKA, Jeniffer de Cassia Rillo

2011-01-01

The use of prosthetic devices for correction of velopharyngeal insufficiency (VPI) is an alternative treatment for patients with conditions that preclude surgery and for those individuals with a hypofunctional velopharynx (HV) with a poor prognosis for the surgical repair of VPI. Understanding the role and measuring the outcome of prosthetic treatment of velopharyngeal dysfunction requires the use of tools that allow for documenting pre- and post-treatment outcomes. Experimental openings in speech bulbs have been used for simulating VPI in studies documenting changes in aerodynamic, acoustic and kinematics aspects of speech associated with the use of palatal prosthetic devices. The use of nasometry to document changes in speech associated with experimental openings in speech bulbs, however, has not been described in the literature. Objective This single-subject study investigated nasalance and nasality at the presence of experimental openings drilled through the speech bulb of a patient with HV. Material and Methods Nasometric recordings of the word "pato" were obtained under 4 velopharyngeal conditions: no-opening (control condition), no speech bulb, speech bulb with a 20 mm2 opening, and speech bulb with 30 mm2 opening. Five speech-language pathologists performed auditory-perceptual ratings while the subject read an oral passage under all conditions. Results Kruskal-Wallis test showed significant difference among conditions (p=0.0002), with Scheffé post hoc test indicating difference from the no-opening condition. Conclusion The changes in nasalance observed after drilling holes of known sizes in a speech bulb suggest that nasometry reflect changes in transfer of sound energy related to different sizes of velopharyngeal opening. PMID:22230996

Oxymetazoline Nasal Spray

MedlinePlus

... is recommended by a doctor. Children 6 to 12 years of age should use oxymetazoline nasal spray carefully and under adult supervision. Oxymetazoline is in a class of medications called nasal decongestants. It works by narrowing the blood vessels in the nasal passages.

Validation of polyvinylidene fluoride nasal sensor to assess nasal obstruction in comparison with subjective technique.

PubMed

Roopa Manjunatha, G; Mahapatra, D Roy; Prakash, Surya; Rajanna, K

2015-01-01

The aim of this study is to validate the applicability of the PolyVinyliDene Fluoride (PVDF) nasal sensor to assess the nasal airflow, in healthy subjects and patients with nasal obstruction and to correlate the results with the score of Visual Analogue Scale (VAS). PVDF nasal sensor and VAS measurements were carried out in 50 subjects (25-healthy subjects and 25 patients). The VAS score of nasal obstruction and peak-to-peak amplitude (Vp-p) of nasal cycle measured by PVDF nasal sensors were analyzed for right nostril (RN) and left nostril (LN) in both the groups. Spearman's rho correlation was calculated. The relationship between PVDF nasal sensor measurements and severity of nasal obstruction (VAS score) were assessed by ANOVA. In healthy group, the measurement of nasal airflow by PVDF nasal sensor for RN and LN were found to be 51.14±5.87% and 48.85±5.87%, respectively. In patient group, PVDF nasal sensor indicated lesser nasal airflow in the blocked nostrils (RN: 23.33±10.54% and LN: 32.24±11.54%). Moderate correlation was observed in healthy group (r=-0.710, p<0.001 for RN and r=-0.651, p<0.001 for LN), and moderate to strong correlation in patient group (r=-0.751, p<0.01 for RN and r=-0.885, p<0.0001 for LN). PVDF nasal sensor method is a newly developed technique for measuring the nasal airflow. Moderate to strong correlation was observed between PVDF nasal sensor data and VAS scores for nasal obstruction. In our present study, PVDF nasal sensor technique successfully differentiated between healthy subjects and patients with nasal obstruction. Additionally, it can also assess severity of nasal obstruction in comparison with VAS. Thus, we propose that the PVDF nasal sensor technique could be used as a new diagnostic method to evaluate nasal obstruction in routine clinical practice. Copyright © 2015 Elsevier Inc. All rights reserved.

Anatomy and Surgical Approaches to the Rabbit Nasal Septum.

PubMed

Badran, Karam W; Chang, John C; Kuan, Edward C; Wong, Brian J F

2017-09-01

The rabbit is the primary animal model used to investigate aspects of nasal surgery. Although several studies have used this model, none has provided a comprehensive analysis of the surgical anatomy and techniques used to gain access to the rabbit nasal fossae and septum. To describe and optimize the surgical anatomy and approach to the rabbit nasal vault and septal cartilage. In an ex vivo animal study conducted at an academic medical center, preliminary cadaveric dissections were performed on rabbit head specimens to establish familiarity with relevant anatomy and rehearse various approaches. Live Pasteurella-free New Zealand white rabbits (3.5-4.0 kg) were used to further develop this surgical technique developed here. Access of the nasal vault was gained through a midline nasal dorsum incision and creation of an osteoplastic flap with a drill. Submucosal resection was performed with preservation of the mucoperichondrium. All rabbits were monitored daily for 4 weeks in the postoperative period for signs of infection, pain, and complications. The study was conducted from June 1, 2014, to December 1, 2014. Surgical anatomy and techniques used to gain access to the rabbit nasal vault and harvest septal cartilage. Four Pasteurella-free New Zealand white rabbits (Western Organ Rabbit Co), ranging in age from 9 to 12 months and weighing between 3.5 and 4.0 kg, were used in this study. Initial dissections demonstrated the feasibility of harvesting septal cartilage while preserving the mucoperichondrial envelope. Access to the nasal vault through this 3-osteotomy approach allowed for maximal exposure to the nasal cavity bilaterally while maintaining the integrity of the mucoperichondrium following septal cartilage harvest. The maximum amount of bulk, en bloc, cartilage harvested was 1.0 × 2.5 cm. Following surgical dissection, all animals maintained adequate airway patency and support to midface structures. Furthermore, all specimens preserved the integrity of the

Correlation of Nasal Mucosal Temperature With Subjective Nasal Patency in Healthy Individuals.

PubMed

Bailey, Ryan S; Casey, Kevin P; Pawar, Sachin S; Garcia, Guilherme J M

2017-01-01

Historically, otolaryngologists have focused on nasal resistance to airflow and minimum airspace cross-sectional area as objective measures of nasal obstruction using methods such as rhinomanometry and acoustic rhinometry. However, subjective sensation of nasal patency may be more associated with activation of cold receptors by inspired air than with respiratory effort. To investigate whether subjective nasal patency correlates with nasal mucosal temperature in healthy individuals. Healthy adult volunteers first completed the Nasal Obstruction Symptom Evaluation (NOSE) and a unilateral visual analog scale to quantify subjective nasal patency. A miniaturized thermocouple sensor was then used to record nasal mucosal temperature bilaterally in 2 locations along the nasal septum: at the vestibule and across from the inferior turbinate head. Nasal mucosal temperature and subjective patency scores in healthy individuals. The 22 healthy adult volunteers (12 [55%] male; mean [SD] age, 28.3 [7.0] years) had a mean (SD) NOSE score of 5.9 (8.4) (range, 0-30) and unilateral VAS score of 1.2 (1.4) (range, 0-5). The range of temperature oscillations during the breathing cycle, defined as the difference between end-expiratory and end-inspiratory temperatures, was greater during deep breaths (mean [SD] change in temperature, 6.2°C [2.6°C]) than during resting breathing (mean [SD] change in temperature, 4.2°C [2.3°C]) in both locations (P < .001). Mucosal temperature measured at the right vestibule had a statistically significant correlation with both right-side visual analog scale score (Pearson r = -0.55; 95% CI, -0.79 to -0.17; P = .008) and NOSE score (Pearson r = -0.47; 95% CI, -0.74 to -0.06; P = .03). No other statistically significant correlations were found between mucosal temperature and subjective nasal patency scores. Nasal mucosal temperature was lower (mean of 1.5°C lower) in the first cavity to be measured, which was the right cavity in all

Levator alae nasi muscle V-Y island flap for nasal tip reconstruction.

PubMed

La Padula, Simone; Abbate, Vincenzo; Di Monta, Gianluca; Schonauer, Fabrizio

2017-03-01

Nasal tip reconstruction can be very challenging. It requires close attention to skin texture, colour and thickness matching, with the respect of the nasal aesthetic units and symmetry. Flaps are usually preferred to skin grafts where possible. Based on different donor areas, various flaps have been described for reconstruction of this region. Here we present a new V-Y myocutaneous island flap based on the levator alae nasi muscle (LAN muscle) blood supply. This flap may represent an alternative to the nasalis myocutaneous sliding V-Y flap previously described by Rybka. As its pivot point it is located more cranially than the nasalis flap, and it can advance more medially than the Rybka flap, with the possibility of covering larger defects of the nasal tip area, up to 1.8 cm in diameter. Over the past 5 years, 24 patients received nasal tip reconstruction with this flap following the resection of basal cell carcinomas. Good tip projection was maintained, and the aesthetic outcome was satisfactory, with well healed scars. We recommend this technique as an alternative to other flaps for nasal tip defects, especially if paramedian. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Creation of an idealized nasopharynx geometry for accurate computational fluid dynamics simulations of nasal airflow in patient-specific models lacking the nasopharynx anatomy

PubMed Central

Borojeni, Azadeh A.T.; Frank-Ito, Dennis O.; Kimbell, Julia S.; Rhee, John S.; Garcia, Guilherme J. M.

2016-01-01

Virtual surgery planning based on computational fluid dynamics (CFD) simulations has the potential to improve surgical outcomes for nasal airway obstruction (NAO) patients, but the benefits of virtual surgery planning must outweigh the risks of radiation exposure. Cone beam computed tomography (CBCT) scans represent an attractive imaging modality for virtual surgery planning due to lower costs and lower radiation exposures compared with conventional CT scans. However, to minimize the radiation exposure, the CBCT sinusitis protocol sometimes images only the nasal cavity, excluding the nasopharynx. The goal of this study was to develop an idealized nasopharynx geometry for accurate representation of outlet boundary conditions when the nasopharynx geometry is unavailable. Anatomically-accurate models of the nasopharynx created from thirty CT scans were intersected with planes rotated at different angles to obtain an average geometry. Cross sections of the idealized nasopharynx were approximated as ellipses with cross-sectional areas and aspect ratios equal to the average in the actual patient-specific models. CFD simulations were performed to investigate whether nasal airflow patterns were affected when the CT-based nasopharynx was replaced by the idealized nasopharynx in 10 NAO patients. Despite the simple form of the idealized geometry, all biophysical variables (nasal resistance, airflow rate, and heat fluxes) were very similar in the idealized vs. patient-specific models. The results confirmed the expectation that the nasopharynx geometry has a minimal effect in the nasal airflow patterns during inspiration. The idealized nasopharynx geometry will be useful in future CFD studies of nasal airflow based on medical images that exclude the nasopharynx. PMID:27525807

[Dexpanthenol nasal spray in comparison to dexpanthenol nasal ointment. A prospective, randomised, open, cross-over study to compare nasal mucociliary clearance].

PubMed

Verse, T; Klöcker, N; Riedel, F; Pirsig, W; Scheithauer, M O

2004-07-01

Recent technical developments in metered pump systems allow the production and use of preservative-free nasal products. The aim of the current study is to compare the tolerability of a preservative-free dexpanthenol (5%) nasal spray with that of the established dexpanthenol (5%) nasal ointment, also without preservatives. The main outcome measure was in vivo mucociliary clearance. Mucociliary clearance was assessed by saccharin migration time in 20 volunteers. Wash-out phases were 7 days and the spray or ointment was always applied 20 min before the saccharin test. The study was designed to test for non-inferiority. Saccharin migration time was slightly longer after ointment administration, however, these were not significantly different to nasal spray. The saccharin migration time showed a significant correlation with the age of the volunteers. The upper confidence limit of dexpanthenol nasal spray was markedly less than that of the ointment. Therefore, dexpanthenol nasal spray is at least equal to if not better than dexpanthenol nasal ointment. Due to its ease of administration, preservative-free dexpanthenol nasal spray offers a valuable therapeutic alternative.

Nasal Cancer

MedlinePlus

... the way to your throat as you breathe. Cancer of the nasal cavity and paranasal sinuses is ... be like those of infections. Doctors diagnose nasal cancer with imaging tests, lighted tube-like instruments that ...

The mini-incision technique for carpal tunnel release using nasal instruments in Chinese patients.

PubMed

Chen, Yanhua; Ji, Wei; Li, Tao; Cong, Xiaobin; Chen, Zhenbing

2017-08-01

Treatment of carpal tunnel syndrome (CTS) remains a challenge for hand surgeons. Carpal tunnel release (CTR) using nasal instruments has the advantages of both endoscopy and open surgery. In this study we aimed to explore the effectiveness of CTR using nasal instruments in Chinese patients.We present a case series of 49 cases of idiopathic CTS treated with the mini-incision technique using nasal instruments. The average recovery days before return to normal work and complications were recorded. The mean grip strength, pinch strength, and sensation were evaluated. Subjective results were evaluated using the visual analogue scale (VAS), Levine Carpal Tunnel Syndrome Questionnaire (LCTSQ), Disabilities of the Arm, Shoulder, and Hand (DASH), and Medical Outcomes Study (MOS) 36-item short-form health survey (SF-36).The mean follow-up was 13 months. No return of symptoms or blood vessel injury occurred. The incidence of scar tenderness was only 8.1%, later pillar pain (after 4 weeks) was 18.4%, and average recovery time to return to normal work was 23.7 days. The mean grip strength, pinch strength, and sensation were significantly improved (P < .001). The VAS, LCTSQ, and DASH survey postoperative mean scores were lower than the preoperative scores (P < .001). SF-36 scores were significantly increased following surgery (P < .001).We conclude that the mini-incision technique for CTR using nasal instruments in Chinese patients is safe, effective, and low cost. It is worthwhile for the technique to be promoted and used.

Nasal Physiology

MedlinePlus

... Anatomy Virtual Anatomy Disclosure Statement Printer Friendly Nasal Physiology Jeremiah A. Alt, MD, PhD Noam Cohen, MD, ... control the inflammation. CONCLUSION An understanding of the physiology of the nose is critical to understand nasal ...

Sinonasal outcomes following endoscopic anterior skull base surgery with nasoseptal flap reconstruction: a prospective study.

PubMed

Hanson, M; Patel, P M; Betz, C; Olson, S; Panizza, B; Wallwork, B

2015-07-01

To assess nasal morbidity resulting from nasoseptal flap use in the repair of skull base defects in endoscopic anterior skull base surgery. Thirty-six patients awaiting endoscopic anterior skull base surgery were prospectively recruited. A nasoseptal flap was used for reconstruction in all cases. Patients were assessed pre-operatively and 90 days post-operatively via the Sino-Nasal Outcome Test 20 questionnaire and visual analogue scales for nasal obstruction, pain, secretions and smell; endoscopic examination findings and mucociliary clearance times were also recorded. Sino-Nasal Outcome Test 20 questionnaire data and visual analogue scale scores for pain, smell and secretions showed no significant differences between pre- and post-operative outcomes, with visual analogue scale scores for nasal obstruction actually showing a significant improvement (p = 0.0007). A significant deterioration for both flap and non-flap sides was demonstrated post-operatively on endoscopic examination (p = 0.002 and p = 0.02 respectively). Whilst elevation of a nasoseptal flap in endoscopic surgery of the anterior skull base engendered significant clinical deterioration on examination post-operatively, quality of life outcomes showed that no such deterioration was subjectively experienced by the patient. In fact, there was significant nasal airway improvement following nasoseptal flap reconstruction.

Systematic Review and Meta-analysis of SNOT-22 Outcomes after Surgery for Chronic Rhinosinusitis with Nasal Polyposis.

PubMed

Le, Phong T; Soler, Zachary M; Jones, Rabun; Mattos, Jose L; Nguyen, Shaun A; Schlosser, Rodney J

2018-04-01

Objective Wide variation exists regarding reported outcomes after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). This study seeks to combine data across studies to generate a summary measure and explore factors that might lead to variation. Data Sources OVID Medline, Scopus, EbscoHost, Database of Abstracts and Reviews of Effects, Health Technology Assessment, and National Health Service Economic Evaluation Database. Review Methods A search was performed following the PRISMA guidelines. Two independent researchers conducted a search using the mentioned data sources. Studies published before August 29, 2016, that involved ESS to treat CRSwNP were included. Mean changes in Sinonasal Outcome Test-22 (SNOT-22) scores were determined through metaregression of the following independent variables: publication year, sex, age, allergy status, asthma, tobacco use, prior surgery, follow-up length, and preoperative SNOT-22. Results Fifteen articles with 3048 patients treated with ESS met inclusion criteria. Pooled analyses of SNOT-22 scores revealed a mean change of 23.0 points (95% CI, 20.2-25.8; P < .001). A metaregression of patient factor effects on the mean change of SNOT-22 scores demonstrated that age ( r = 0.71, P = .01), asthma ( r = 0.21, P = .01), prior ESS ( r = 0.29, P = .01), and preoperative SNOT-22 score ( r = 0.4, P < .01) correlated with greater improvement in SNOT-22 scores. Tobacco use ( r = -0.91, P = .01) and longer lengths of follow-up ( r = -0.45, P < .01) were associated with less improvement in SNOT-22 scores. Conclusions Quality-of-life outcomes are significantly improved after ESS among patients with CRSwNP. Patient-specific factors may affect the degree of SNOT-22 change after surgery.

[Clinical symptoms and immunology inspection characteristics of nasal cavity local allergy].

PubMed

Yin, Z X; Zhu, Y; Zhai, X; Zhang, J L; Liu, G

2017-08-05

were positive, could be diagnosised as local allergic rhinitis. After three years, all of the observation group patients were detected with SPT and serum allergen SIgE test. Five patients diagnosed as local allergic rhinitis before three years were positive. Six patients diagnosed as NAR before three years were negative. Conclusion: For patients with the typical medical history and symptoms of AR, but allergen SPT and serum allergen SIgE test were negative, there was local specific hypersensitivity in nasal mucosa, but the reaction was not accompanied by systemic sensitization. Combined with nasal secretions allergen SIgE test or allergen nasal mucosa proocation tests positive, could be diagnosed as local allergic rhinitis. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

[Effect of absorption enhancers on nasal ginsenoside Rg1 delivery and its nasal ciliotoxicity].

PubMed

Chen, Xin-mei; Zhu, Jia-bi; Sun, Wei-dong; Zhang, Li-jian

2006-02-01

The enhancing activity and safety of several absorption enhancers were evaluated as potential nasal absorption enhancers to increase intranasal absorption of ginsenoside Rg1. Nasal circulatory perfusion test in vivo had been employed to investigate the effect of absorption enhancers for nasal mucosa absorption of ginsenoside Rgl in rats. The safety of the absorption enhancers were evaluated by testing cilia movement of the in situ toad palate model, the hemolysis of erythrocyte membrane of the rabbit, leaching of protein and LDH from the mice nasal mucosa and the effect on cilia structural and specific cellular changes of nasal mucosa. Absorption enhancers were necessary to facilitate ginsenoside Rg1 absorption by nasal mucosa. Among the absorption enhancers 1% sodium deoxycholate had great effect to facilite ginsenoside Rgl absorption by nasal mucosa; 1% dipotassium glycyrrhizinate and 1% azone had moderate effect to facilitate ginsenoside Rg1 absorption by nasal mucosa; 1% Tween-80, 2% beta-cyclodextrin, 0.5% borneol (dissolved in paraffin liquid), 0.5% chitosan, 5% hydroxypropyl-beta-cyclodextrin and 0.1% EDTA had low effect to facilitate ginsenoside Rgl absorption by nasal mucosa. 1% sodium deoxycholate, 1% azone and 1% dipotassium glycyrrhizinate had serious nasal toxicity; 1% Tween-80, 2% beta-cyclodextrin, 5% hydroxypropyl-beta-cyclodextrin had moderate nasal toxicity; 0.5% borneol (dissolved in paraffin liquid), 0.5% chitosan and 0.1% EDTA have little nasal toxicity. 0.5% borneol and 0.5% chitosan were the promising candidates having a good balance between enhancing activity and safety for nasal ginsenoside Rg1 delivery.

Expression of membrane-bound mucins in human nasal mucosa: different patterns for MUC4 and MUC16.

PubMed

Woo, Hyun-Jae; Bae, Chang Hoon; Song, Si-Youn; Lee, Heung-Man; Kim, Yong-Dae

2010-06-01

To acquire basic information concerning the function of the membrane-bound mucin MUC16 in nasal mucosa compared with the best-characterized membrane-bound mucin, MUC4. In vitro study using semiquantatitive reverse transcription-polymerase chain reaction analysis and immunoassay. Yeungnam University College of Medicine. We examined the nasal polyps obtained during endoscopic sinus surgery in 10 patients, the normal ethmoid sinus mucosa obtained from 10 patients, and human nasal polyp epithelial (HNPE) cells. Gene expression of MUC4 and MUC16 in nasal polyps and normal nasal mucosa. In addition, we evaluated the effect of 4 physiologically relevant agents, including retinoic acid, interleukin 1beta, phorbol 12-myristate 13-acetate (PMA), and dexamethasone, on the expression of MUC4 and MUC16 in HNPE cells at the gene and protein levels. In nasal polyps, MUC4 was upregulated compared with normal nasal mucosa (P = .009), whereas MUC16 expression did not differ between nasal polyps and normal nasal mucosa. Retinoic acid and interleukin 1beta increased MUC4 expression at the gene and protein level in HNPE cells, whereas MUC16 expression was not affected. Unlike retinoic acid and interleukin 1beta, PMA and dexamethasone increased MUC16 expression, whereas they had no significant effect on MUC4 expression. Expression of MUC4 and MUC16 are regulated differently in nasal mucosa. Dexamethasone and PMA are potent mediators for the expression of MUC16 in nasal polyps.

[Usefulness of endovascular treatment for delayed massive epistaxis following endoscopic endonasal transsphenoidal surgery: a case report].

PubMed

Oka, Tetsuo; Sugiu, Kenji; Ishida, Joji; Hishikawa, Tomohito; Ono, Shigeki; Tokunaga, Koji; Date, Isao

2012-01-01

We report here a case of massive nasal bleeding from the sphenopalatine artery three weeks after endonasal transsphenoidal surgery. This 66-year-old male suffered from massive nasal bleeding with the status of hypovolemic shock. Under general anesthesia, an emergent angiography revealed an extravasation from the sphenopalatine artery. Trans-arterial embolization using coil and n-butyl-cyanoacrylate (NBCA) was performed following the diagnostic angiography. Complete occlusion of the injured artery was achieved. The patient showed good recovery from general anesthesia. Delayed nasal bleeding after endonasal transsphenoidal surgery is a rare but important complication. The sphenopalatine artery and its branch are located in the hidden inferior lateral corner of the sphenoid sinus and may be injured during enlargement of the sphenoid opening. When massive delayed nasal bleeding follows transsphenoidal surgery and damage of the internal carotid artery has been ruled out, endovascular treatment of the external carotid artery should be considered.

Nasal computed tomography.

PubMed

Kuehn, Ned F

2006-05-01

Chronic nasal disease is often a challenge to diagnose. Computed tomography greatly enhances the ability to diagnose chronic nasal disease in dogs and cats. Nasal computed tomography provides detailed information regarding the extent of disease, accurate discrimination of neoplastic versus nonneoplastic diseases, and identification of areas of the nose to examine rhinoscopically and suspicious regions to target for biopsy.

[Upper Age Limit in Outpatient Anesthesia: Opportunities and Risks].

PubMed

Hüppe, Tobias; Kneller, Nicole; Raddatz, Alexander

2018-05-01

Ambulatory surgery in elderly patients continues to increase - avoiding hospitalization and thus postoperative cognitive dysfunction in older patients being its major objectives. An upper age limit in outpatient anesthesia does not exist to date. However, functional rather than chronological age is crucial in patient selection. In consensus discussion, baseline functional status should be evaluated regularly - defined as everyday behaviors necessary to maintain daily life and encompassing areas of physical, cognitive, and social functioning. Moreover, frailty in elderly patients can be quantified objectively and is associated with increased perioperative morbidity in ambulatory general surgery. The decision for or against outpatient anesthesia therefore remains a case-by-case decision which should be discussed within a team. Georg Thieme Verlag KG Stuttgart · New York.

Increased net water loss by oral compared to nasal expiration in healthy subjects.

PubMed

Svensson, Sophie; Olin, Anna Carin; Hellgren, Johan

2006-03-01

To compare the difference in respiratory water loss during expiration through the nose and through the mouth, in healthy subjects. The study included 19 healthy, non-smoking volunteers without any present history of non-infectious rhinitis, presenting with symptoms of rhinitis, asthma or previous nasal surgery. Nasal and oral expiratory breath condensates were collected using a breath condenser during tidal respiration at indoor resting conditions. During the nasal breath condensate sampling, the subjects were breathing into a transparent face mask covering the nose and the mouth with the mouth closed. During the oral breath condensate sampling, the subjects inhaled through the nose and exhaled through a mouthpiece connected to the condenser. The airflow during the sampling was assessed with a dry-spirometer connected to the condenser. Sampling was stopped after 100 litres of expired air for each breathing mode. Nasal sampling was done before and after decongestion of the nasal mucosa with oxymetazoline, 0.5 mg/ml. The effect on the nasal mucosa was assessed with acoustic rhinometry. The mean loss of expired water was 42% less by nasal expiration before decongestion than by oral expiration (1.9 x 10(-3) g/L min compared to 2.7 x 10(-3) g/L min, p < 0.001). The mean expiratory minute ventilation was 9.0 L/min by nasal respiration and 9.8 L/min by oral respiration. Decongestion of the nasal mucosa showed a mean increase of the cross-sectional area at 4 cm from the nostril (1.44 to 1.67 cm2, p = 0.0024), but there was no effect on the net water loss (1.9 x 10(-3) g/Lmin vs 1.9 x 10(-3) g/Lmin). This study showed that the net water loss increased by 42% when the breathing mode was switched from nasal to oral expiration during tidal breathing in healthy subjects. Increased water and energy loss by oral breathing could be a contributing factor to the symptoms seen in patients suffering from nasal obstruction.

Combined Rostrolateral Rhinotomy for Removal of Rostral Nasal Septum Squamous Cell Carcinoma: Long-Term Outcome in 10 Dogs.

PubMed

Ter Haar, Gert; Hampel, Rachel

2015-10-01

To report a surgical technique for combined rostrolateral rhinotomy (vestibulotomy) and long-term outcome for treatment of squamous cell carcinoma (SCC) of the rostral nasal septum in dogs. Retrospective case series. Medium sized, mixed breed dogs (n = 10), aged 7-12.5 years, with SCC of the rostral nasal septum that did not invade the superficial nasal planum. Disease extent was assessed with computed tomography and tumor resection achieved solely with central nasal planum elevation and lateral rhinotomy. Owners were interviewed 60-2,555 days (median, 548 days) postoperatively to determine outcome and survival time. Vestibulotomy facilitated full-thickness resection of the nasal septum and tumor mass in 10 dogs and nasal floor resection in 4 dogs. There were no major intraoperative complications and all dogs had an excellent cosmetic outcome. Tumor removal was complete in 8 dogs and incomplete in 2 dogs. There was no recurrence in 6 dogs. Of the 4 dogs with recurrence, 3 had required nasal floor resection at initial surgery. A combined rostrolateral rhinotomy technique may be used to achieve complete resection of SCC limited to the nasal septum with acceptable cosmetic results. This technique may not be suitable for tumors extending into the nasal floor. © Copyright 2015 by The American College of Veterinary Surgeons.

The effects of flow on airway pressure during nasal high-flow oxygen therapy.

PubMed

Parke, Rachael L; Eccleston, Michelle L; McGuinness, Shay P

2011-08-01

Nasal high-flow oxygen therapy increases the mean nasopharyngeal airway pressure in adults, but the relationship between flow and pressure is not well defined. To determine the relationship between flow and pressure with the Optiflow nasal high-flow oxygen therapy system. We invited patients scheduled for elective cardiac surgery to participate. Measurements were performed with nasal high-flow oxygen at flows of 30, 40, and 50 L/min, with the patient's mouth both open and closed. Pressures were recorded over one minute of breathing, and average flows were calculated via simple averaging. With the mouth closed, the mean ± SD airway pressures at 30, 40, and 50 L/min were 1.93 ± 1.25 cm H(2)O, 2.58 ± 1.54 cm H(2)O, and 3.31 ± 1.05 cm H(2)O, respectively. There was a positive linear relationship between flow and pressure. The mean nasopharyngeal pressure during nasal high-flow oxygen increases as flow increases. Australian Clinical Trials Registry http://www.adhb.govt.nz/achicu/hot_2_airway_pressure.htm.

New CFD tools to evaluate nasal airflow.

PubMed

Burgos, M A; Sanmiguel-Rojas, E; Del Pino, C; Sevilla-García, M A; Esteban-Ortega, F

2017-08-01

Computational fluid dynamics (CFD) is a mathematical tool to analyse airflow. As currently CFD is not a usual tool for rhinologists, a group of engineers in collaboration with experts in Rhinology have developed a very intuitive CFD software. The program MECOMLAND ® only required snapshots from the patient's cross-sectional (tomographic) images, being the output those results originated by CFD, such as airflow distributions, velocity profiles, pressure, temperature, or wall shear stress. This is useful complementary information to cover diagnosis, prognosis, or follow-up of nasal pathologies based on quantitative magnitudes linked to airflow. In addition, the user-friendly environment NOSELAND ® helps the medical assessment significantly in the post-processing phase with dynamic reports using a 3D endoscopic view. Specialists in Rhinology have been asked for a more intuitive, simple, powerful CFD software to offer more quality and precision in their work to evaluate the nasal airflow. We present MECOMLAND ® and NOSELAND ® which have all the expected characteristics to fulfil this demand and offer a proper assessment with the maximum of quality plus safety for the patient. These programs represent a non-invasive, low-cost (as the CT scan is already performed in every patient) alternative for the functional study of the difficult rhinologic case. To validate the software, we studied two groups of patients from the Ear Nose Throat clinic, a first group with normal noses and a second group presenting septal deviations. Wall shear stresses are lower in the cases of normal noses in comparison with those for septal deviation. Besides, velocity field distributions, pressure drop between nasopharynx and the ambient, and flow rates in each nostril were different among the nasal cavities in the two groups. These software modules open up a promising future to simulate the nasal airflow behaviour in virtual surgery intervention scenarios under different pressure or

[Clinical effects of nasal glucocorticoid on amelioration of nasal obstruction in patients with persistent non-allergic rhinitis].

PubMed

Sail, Giyab A; Zuo, Ke-jun; Xu, Geng

2009-09-01

To observe the efficacy of nasal glucocorticoid continuously used for 12 weeks on nasal obstruction in patients with persistent non-allergic rhinitis (PNAR). The changes of nasal obstruction, nasal resistance, nasal mucous membrane and quality of life in 47 patients with PNAR were observed. The efficacy of nasal glucocorticoid (Mometasone Furoate Nasal Spray, MFNS 200 microg/day) on patients with PNAR was evaluated. The results of nasal glucocorticoid (MFNS) continuously used for 12 weeks demonstrated: (1) After treatment, the nasal obstruction, nasal discharge, nasal obstruction related dizziness, headache, hyposmia, daily life activity, whole body fatigue, mental status were significantly improved (P < 0.05). (2) Nasal resistance showed significant amelioration (pre-treatment = 0.28 +/- 0.10, post- treatment = 0.16 +/- 0.05; F = 91.471, P < 0.05). (3) SF-36 questionnaire revealed that role physical, bodily pain, general health, role emotional had significant amelioration (P < 0.01). (4) SNOT-20 questionnaire revealed that the defatigation, impaired concentration, pinch the nose, nasal discharging into the throat, sleep quality had significant amelioration (P < 0.01). (5) Continued treatment for 12 weeks was better than 4 weeks, continued treatment had good effect. The study shows that nasal glucocorticoid improved the nasal obstruction, nasal resistance, nasal mucous membrane and quality of life in patients with PNAR.

The Development of Dorsal Nasal Cyst Formation after Rhinoplasty and Its Reconstruction with Conchal Cartilage

PubMed Central

Kumral, Tolgar Lütfi; Yıldırım, Güven; Berkiten, Güler; Ataç, Enes

2014-01-01

The dorsal nasal cyst formation is a rare and late complication of rhinoplasty. It has been rarely reported in the literature and it is usually mucous cysts. Migration and planting to the subcutaneous space during the surgical procedure has been recognized as the formation mechanism. This case report has presented 42-year-old male patient with a destructing dorsal nasal mucous cyst that developed 10 years after the rhinoplasty operation. There was no complication in the primary rhinoplasty and the patient was satisfied with his appearance. There was a swelling of the nasal dorsum over the past year and surgical excision of the cyst was performed. During the surgery, the defect was reconstructed with conchal cartilage. There was no recurrence during follow-up. PMID:24891965

[Endoscopic sinus surgery in flowing water].

PubMed

Noda, K; Doi, K; Noiri, T; Koizuka, I; Kubo, T

2000-05-01

A balloon has been developed that completely fills the choana, preventing water from leaking into the pharynx even when the water is entering into the nasal cavity at a rate of 1000 ml per minute. The balloon enables endoscopic sinus surgery (ESS) to be safely performed in "flowing water". This surgical technique is similar to that used in transurethral resections of the prostate because the tip of the endoscope is kept clean, and blood, debris and resected tissues are continuously removed by the water flow. In addition, the water pressure helps to suppress bleeding. This technique enables ESS to be performed with greater ease and efficiency. We have performed ESS in flowing water on 38 patients with chronic sinusitis under local anaesthesia. No complications, such as water leakage into the pharynx, were encountered, and only a few patients felt discomfort from the insertion of the balloon. Even if the balloon had burst, an emergency could have been easily prevented by withdrawing the endoscope from the nasal cavity and stopping the flow of water. Ultrasonography (USG) was used to examine the water-filled nasal cavity during surgery (SSD-2000 and Micro Tip Radial (ASU-101); Aloka, Ltd., Japan). Using USG, the middle turbinate, the inferior turbinate and the nasal septum could be visualized in a single coronal image. When the sensor was in the posterior ethmoid sinus, the orbit and its optic nerve could also be visualized. Since this surgery is performed under local anesthesia, eye movements can rapidly alter the position of the optic nerve. Thus, visualization of the optic nerve's exact position is extremely important. Unfortunately, USG is not very useful for localizing structures and guiding the surgeon to distant tumors or cysts located behind thick bones, since ultrasound can not penetrate hard masses or bones. In this situation, navigation systems are more reliable than USG. Nevertheless, USG is often useful for depicting surgical sites, especially during a

Ambulatory anesthesia for cosmetic surgery in Brazil.

PubMed

May, Diego Marcelo

2016-08-01

Outpatient plastic surgery is growing around the world. This industry faces unique challenges in terms of patient selection and standards of practice to ensure safety and cost-effectiveness. This review will highlight information about anesthesia practice for outpatient cosmetic surgery in Brazil, especially regarding regulation, legislation, and medical tourism. Medical tourism is growing worldwide, with a flow of patients traveling from developed to developing countries where procedures can be done at a fraction of the cost as in the patient's home country. Though generally well tolerated, there are concerns about incomplete data on outcomes of office-based surgeries and lack of safety standards. Brazil is one of the world's leaders in cosmetic surgery. Strong legislation governing outpatient facilities and continued development of accrediting standards for healthcare facilities are indications of a commitment to patient safety and high quality of care. Although the market for medical tourism in this country is high, there are still barriers to overcome before Brazil reaches its full potential in this industry.

Cost of outpatient endoscopic sinus surgery from the perspective of the Canadian government: a time-driven activity-based costing approach.

PubMed

Au, Jennifer; Rudmik, Luke

2013-09-01

The time-driven activity-based costing (TD-ABC) method is a novel approach to quantify the costs of a complex system. The aim of this study was to apply the TD-ABC technique to define the overall cost of a routine outpatient endoscopic sinus surgery (ESS) from the perspective of the Canadian government payer. Costing perspective was the Canadian government payer. All monetary values are in Canadian dollars as of December 2012. Costs were obtained by contacting staff unions, reviewing purchasing databases and provincial physician fee schedules. Practical capacity time values were collected from the College and Association of Registered Nurses of Alberta. Capacity cost rates ($/min) were calculated for all staff, capital equipment, and hospital space. The overall cost for routine outpatient ESS was $3510.31. The cost per ESS case for each clinical pathway encounter was as follows: preoperative holding ($49.19); intraoperative ($3296.60); sterilization ($90.20); postanesthesia care unit ($28.64); and postoperative day ward ($45.68). The 3 major cost drivers were physician fees, disposable equipment, and nursing costs. The intraoperative phase contributed to 94.5% of the overall cost. This study applied the TD-ABC method to evaluate the cost of outpatient ESS from the perspective of the Canadian government payer and defined the overall cost to be $3510.31 per case. © 2013 ARS-AAOA, LLC.

The effect of corneal anterior surface eccentricity on astigmatism after cataract surgery.

PubMed

Park, Choul Yong; Chuck, Roy S; Channa, Prabjot; Lim, Chi-Yeon; Ahn, Byung-Jin

2011-01-01

To evaluate the effect of cornea eccentricity on induced astigmatism after cataract surgery. The study included 125 eyes of 87 patients. Preoperative corneal astigmatism, pachymetry, and eccentricity were measured. During cataract surgery, the location of the main incision (2.8-mm clear corneal) was selected to be either superior, superior-nasal, superior-temporal, nasal, or temporal to decrease the preexisting corneal astigmatism. Aspheric intraocular lenses were implanted. Keratometry and manifest refraction were recorded 6 months after surgery. Astigmatism was calculated using vector subtraction software. Three parameters significantly affected postoperative astigmatism: preoperative amount of corneal astigmatism, eccentricity of anterior cornea, and location of the main incision. The mean surgically induced astigmatism (SIA) was calculated to be: superior = 0.82 diopters (D), superior-nasal = 0.50 D, superior-temporal = 0.63 D, temporal = 0.45 D, and nasal = 0.55 D. Superior incision induced the greatest SIA and temporal incision induced the smallest SIA. The eccentricity of anterior cornea showed significantly positive correlation with the amount of SIA (P < .001). The preoperative corneal cylinder power showed significantly positive correlation with the amount of SIA (P < .001). Postoperative astigmatism was affected by various factors in cataract surgery. The greatest postoperative astigmatism is expected in corneas with high anterior eccentricity, high preoperative corneal astigmatism, and superior location of the main incision. Copyright 2011, SLACK Incorporated.

Immediate effect of benzalkonium chloride in decongestant nasal spray on the human nasal mucosal temperature.

PubMed

Lindemann, J; Leiacker, R; Wiesmiller, K; Rettinger, G; Keck, T

2004-08-01

Benzalkonium chloride is a preservative commonly used in nasal decongestant sprays. It has been suggested that benzalkonium chloride may be harmful to the nasal mucosa. Decongestion with the vasoconstrictor xylometazoline containing benzalkonium chloride has been shown to cause a significant reduction of the nasal mucosal temperature. The purpose of the present study was to determine the short-term influence of xylometazoline nasal spray with and without benzalkonium chloride on the nasal mucosal temperature. Healthy volunteers (30) were included in the study. Fifteen volunteers received xylometazoline nasal spray (1.0 mg/mL) containing benzalkonium chloride (0.1 mg/mL) and 15 age-matched subjects, received xylometazoline nasal spray without benzalkonium chloride. Using a miniaturized thermocouple the septal mucosal temperature was continuously measured at defined intranasal detection sites before and after application of the nasal spray. The mucosal temperature values did not significantly differ between the group receiving xylometazoline containing benzalkonium chloride and the group receiving xylometazoline spray without benzalkonium chloride before and after decongestion (P > 0.05). In both study groups septal mucosal temperatures significantly decreased after decongestion (P < 0.05) because of a reduction of the nasal mucosal blood flow following vasoconstriction. This study indicates that benzalkonium chloride itself does not seem to influence nasal blood flow and nasal mucosal temperature in topical nasal decongestants.

Peroxisome proliferator-activated receptor-γ is expressed in eosinophils in nasal polyps.

PubMed

Asaka, Chikara; Honda, Kohei; Ito, Eiko; Fukui, Naoko; Chihara, Junichi; Ishikawa, Kazuo

2011-01-01

Peroxisome proliferator-activated receptor-γ (PPARγ) is a member of the nuclear receptors, which regulate fatty acid metabolites. One of the natural ligands for PPARγ is 15-deoxy-Δ(12,14)-prostaglandin J(2) (15d-PGJ(2)), a major metabolite of prostaglandin D(2) (PGD(2)). Recently, PPARγ has been shown to play an important role in anti-inflammatory reactions, including within-airway allergic diseases, in a mouse model. Our aim was to clarify the expression and localization of PPARγ and PGD(2) synthase, which produces ligands of PPARγ, in nasal polyps by immunohistochemical analysis. Nasal polyps of chronic rhinosinusitis patients (6 asthmatic patients and 6 nonasthmatic patients) were obtained during surgery. May-Grünwald-Giemsa staining was performed to evaluate the eosinophil infiltration of the polyps. To identify the cells expressing PPARγ protein and PGD(2) synthase, double immunostaining was performed using anti-PPARγ antibody, monoclonal antileukocyte antibodies, and PGD(2) synthase antibody. The number of eosinophils and the number of PPARγ-positive cells in the nasal polyps of the asthmatic patients were significantly higher than those in the nonasthmatic patients. PPARγ was expressed on eosinophils and T cells of the infiltrating cells in the nasal polyps. PGD(2) synthase was also expressed on PPARγ-positive cells. PPARγ is involved in nasal polyposis pathogenesis, acting on eosinophils and T cells. Copyright © 2011 S. Karger AG, Basel.

Surgical management of nasal obstruction.

PubMed

Moche, Jason A; Palmer, Orville

2012-05-01

The proper evaluation of the patient with nasal obstruction relies on a comprehensive history and physical examination. Once the site of obstruction is accurately identified, the patient may benefit from a trial of medical management. At times however, the definitive treatment of nasal obstruction relies on surgical management. Recognizing the nasal septum, nasal valve, and turbinates as possible sites of obstruction and addressing them accordingly can dramatically improve a patient's nasal breathing. Conservative resection of septal cartilage, submucous reduction of the inferior turbinate, and structural grafting of the nasal valve when appropriate will provide the optimal improvement in nasal airflow and allow for the most stable results. Copyright © 2012. Published by Elsevier Inc.

Snoring and Nasal Congestion

MedlinePlus

... treat the various causes of nasal congestion include: Topical nasal steroid spray Topical nasal antihistamine spray Oral antibiotic (in case of ... include more than just the decrease in oxygen levels at night during the apnea episodes. They also ...

The mini-incision technique for carpal tunnel release using nasal instruments in Chinese patients

PubMed Central

Chen, Yanhua; Ji, Wei; Li, Tao; Cong, Xiaobin; Chen, Zhenbing

2017-01-01

Abstract Treatment of carpal tunnel syndrome (CTS) remains a challenge for hand surgeons. Carpal tunnel release (CTR) using nasal instruments has the advantages of both endoscopy and open surgery. In this study we aimed to explore the effectiveness of CTR using nasal instruments in Chinese patients. We present a case series of 49 cases of idiopathic CTS treated with the mini-incision technique using nasal instruments. The average recovery days before return to normal work and complications were recorded. The mean grip strength, pinch strength, and sensation were evaluated. Subjective results were evaluated using the visual analogue scale (VAS), Levine Carpal Tunnel Syndrome Questionnaire (LCTSQ), Disabilities of the Arm, Shoulder, and Hand (DASH), and Medical Outcomes Study (MOS) 36-item short-form health survey (SF-36). The mean follow-up was 13 months. No return of symptoms or blood vessel injury occurred. The incidence of scar tenderness was only 8.1%, later pillar pain (after 4 weeks) was 18.4%, and average recovery time to return to normal work was 23.7 days. The mean grip strength, pinch strength, and sensation were significantly improved (P < .001). The VAS, LCTSQ, and DASH survey postoperative mean scores were lower than the preoperative scores (P < .001). SF-36 scores were significantly increased following surgery (P < .001). We conclude that the mini-incision technique for CTR using nasal instruments in Chinese patients is safe, effective, and low cost. It is worthwhile for the technique to be promoted and used. PMID:28767593

Utility of Cartilage Grafts Wrapped With Amniotic Membrane in Dorsal Nasal Augmentation.

PubMed

Atespare, Altay; Kara, Hakan; Ilter, Erdin; Boyaci, Zerrin; Çelik, Öner; Midi, Ahmet

2016-06-01

The success of rhinoplasty may be compromised with postoperative problems like rough and rigid nasal dorsum. Biological grafts or alloplastic materials are required to hurdle and correct nasal dorsal deformities and also irregularities. The purpose of this experimental study was to compare pure cartilage graft, cartilage graft wrapped in amniotic membrane, and diced cartilage grafts wrapped in amniotic membrane for soft tissue augmentation. All grafts were transplanted through a subcutaneous tunnel created in the nasal dorsum of 18 rats, 6 in each group. After 3 months follow-up, the histopathological changes in all groups were evaluated by light microscopy and volumetric measurements. With regard to cartilage viability, cartilage wrapped in amniotic membrane had a higher success rate than pure cartilage graft. Also, a further increased success rate was found in the diced group. In the soft tissue augmentation after rhinoplasty surgery, especially diced cartilage wrapped in amniotic membrane keeps the graft viable and adjoined.

Topical nasal decongestant oxymetazoline (0.05%) provides relief of nasal symptoms for 12 hours.

PubMed

Druce, H M; Ramsey, D L; Karnati, S; Carr, A N

2018-05-22

Nasal congestion, often referred to as stuffy nose or blocked nose is one of the most prevalent and bothersome symptoms of an upper respiratory tract infection. Oxymetazoline, a widely used intranasal decongestant, offers fast symptom relief, but little is known about the duration of effect. The results of 2 randomized, double-blind, vehicle-controlled, single-dose, parallel, clinical studies (Study 1, n=67; Study 2, n=61) in which the efficacy of an oxymetazoline (0.05% Oxy) nasal spray in patients with acute coryzal rhinitis was assessed over a 12-hour time-period. Data were collected on both subjective relief of nasal congestion (6-point nasal congestion scale) and objective measures of nasal patency (anterior rhinomanometry) in both studies. A pooled study analysis showed statistically significant changes from baseline in subjective nasal congestion for 0.05% oxymetazoline and vehicle at each hourly time-point from Hour 1 through Hour 12 (marginally significant at Hour 11). An objective measure of nasal flow was statistically significant at each time-point up to 12 hours. Adverse events on either treatment were infrequent. The number of subjects who achieved an improvement in subjective nasal congestion scores of at least 1.0 was significantly higher in the Oxy group vs. vehicle at all hourly time-points on a 6-point nasal congestion scale. This study shows for the first time, that oxymetazoline provides both statistically significant and clinically meaningful relief of nasal congestion and improves nasal airflow for up to 12 hours following a single dose.

Evaluation of nasal IgA secretion in normal subjects by nasal spray and aspiration.

PubMed

Fujimoto, Chisa; Kido, Hiroshi; Sawabuchi, Takako; Mizuno, Dai; Hayama, Masaki; Yanagawa, Hiroaki; Takeda, Noriaki

2009-06-01

Nasal washing (NW) is a popular method for collecting human nasal lavage fluid. However, for NW the subject must be trained, and the method is unsuitable for field studies on untrained subjects. To overcome this problem, we have developed an easy and painless method, a nasal spray and aspiration (NSA) method. This method is different from NW in that the nasal cavity is misted over with saline, and the nasal lavage fluid is aspirated from the nostrils through a silicon tube. First, nasal lavage fluid was obtained twice by NSA with an interval of a week between lavages to evaluate intraindividual variability, and the IgA and protein levels in the nasal lavage fluid were measured by enzyme-linked immunosorbent assay and bicinchoninic acid assay, respectively. Next, the IgA value determined by NSA was compared with that by NW in another 12 normal subjects 2 days after NSA. In 10 normal subjects, mean volume of saline sprayed into the nose was 0.46+/-0.15 ml (mean+/-S.D.). Mean volume of aspirated nasal lavage fluid containing both sprayed saline and nasal secretion was 0.44+/-0.37 ml. The mean IgA level/mg protein in the nasal lavage fluid determined by NSA was 112+/-18 microg/mg protein at the first and 99+/-20 at the second times of measurement, being highly reproducible. The mean value by NSA was 114+/-19 microg/mg protein, being almost the same as that by NW of 99+/-27. These findings suggest that the IgA level/mg protein in nasal lavage fluid determined by NSA instead of NW might be useful for assessing the variability of nasal IgA secretion.

Perceiving nasal patency through mucosal cooling rather than air temperature or nasal resistance.

PubMed

Zhao, Kai; Blacker, Kara; Luo, Yuehao; Bryant, Bruce; Jiang, Jianbo

2011-01-01

Adequate perception of nasal airflow (i.e., nasal patency) is an important consideration for patients with nasal sinus diseases. The perception of a lack of nasal patency becomes the primary symptom that drives these patients to seek medical treatment. However, clinical assessment of nasal patency remains a challenge because we lack objective measurements that correlate well with what patients perceive. The current study examined factors that may influence perceived patency, including air temperature, humidity, mucosal cooling, nasal resistance, and trigeminal sensitivity. Forty-four healthy subjects rated nasal patency while sampling air from three facial exposure boxes that were ventilated with untreated room air, cold air, and dry air, respectively. In all conditions, air temperature and relative humidity inside each box were recorded with sensors connected to a computer. Nasal resistance and minimum airway cross-sectional area (MCA) were measured using rhinomanometry and acoustic rhinometry, respectively. General trigeminal sensitivity was assessed through lateralization thresholds to butanol. No significant correlation was found between perceived patency and nasal resistance or MCA. In contrast, air temperature, humidity, and butanol threshold combined significantly contributed to the ratings of patency, with mucosal cooling (heat loss) being the most heavily weighted predictor. Air humidity significantly influences perceived patency, suggesting that mucosal cooling rather than air temperature alone provides the trigeminal sensation that results in perception of patency. The dynamic cooling between the airstream and the mucosal wall may be quantified experimentally or computationally and could potentially lead to a new clinical evaluation tool.

Kinect based real-time position calibration for nasal endoscopic surgical navigation system

NASA Astrophysics Data System (ADS)

Fan, Jingfan; Yang, Jian; Chu, Yakui; Ma, Shaodong; Wang, Yongtian

2016-03-01

Unanticipated, reactive motion of the patient during skull based tumor resective surgery is the source of the consequence that the nasal endoscopic tracking system is compelled to be recalibrated. To accommodate the calibration process with patient's movement, this paper developed a Kinect based Real-time positional calibration method for nasal endoscopic surgical navigation system. In this method, a Kinect scanner was employed as the acquisition part of the point cloud volumetric reconstruction of the patient's head during surgery. Then, a convex hull based registration algorithm aligned the real-time image of the patient head with a model built upon the CT scans performed in the preoperative preparation to dynamically calibrate the tracking system if a movement was detected. Experimental results confirmed the robustness of the proposed method, presenting a total tracking error within 1 mm under the circumstance of relatively violent motions. These results point out the tracking accuracy can be retained stably and the potential to expedite the calibration of the tracking system against strong interfering conditions, demonstrating high suitability for a wide range of surgical applications.

Modified Activation Technique for Nasal Stent of Nasoalveolar Molding Appliance for Columellar Lengthening in Bilateral Cleft Lip/Palate.

PubMed

Patil, Pravinkumar G; Nimbalkar-Patil, Smita P

2018-01-01

Bilateral cleft lip/cleft palate is associated with nasal deformities typified by a short columella. The presurgical nasoalveolar molding (NAM) therapy approach includes reduction of the size of the intraoral alveolar cleft as well as positioning of the surrounding deformed soft tissues and cartilages. In a bilateral cleft patient, NAM, along with columellar elongation, eliminates the need for columellar lengthening surgery. Thus the frequent surgical intervention to achieve the desired esthetic results can be avoided. This article proposes a modified activation technique of the nasal stent for a NAM appliance for columellar lengthening in bilateral cleft lip/palate patients. The design highlights relining of the columellar portion of the nasal stent and the wire-bending of the nasal stent to achieve desirable results within the limited span of plasticity of the nasal cartilages. With this technique the vertical taping of the premaxilla to the oral plate can be avoided. © 2016 by the American College of Prosthodontists.

Comparison of computed tomography with radiography as a noninvasive diagnostic technique for chronic nasal disease in dogs.

PubMed

Codner, E C; Lurus, A G; Miller, J B; Gavin, P R; Gallina, A; Barbee, D D

1993-04-01

Computed tomography was evaluated as a noninvasive technique for the diagnosis of chronic nasal disease in dogs. Computed tomographic images, radiographs, and histopathologic findings were compared in 11 dogs with chronic nasal disease. Definitive diagnosis was made following traumatic nasal flush, exploratory surgery, or necropsy. The study included 8 dogs with intranasal tumors, 2 dogs with bacterial rhinitis (Pasteurella sp), and 1 dog with mycotic rhinitis (Aspergillus sp). Computed tomography was superior to radiography in defining the extent of the disease process and in differentiating infectious rhinitis from nasal neoplasms. It defined lesions in the palate, nasopharyngeal meatus, maxillary sinus, caudal ethmoturbinates, and periorbital tissues that were difficult to demonstrate by use of conventional radiography. Tumors appeared as space-occupying lesions that obliterated the turbinates, caused deviation of the nasal septum, and eroded bone. Rhinitis appeared as a cavitating lesion that spared the paranasal sinuses, thickened and distorted the turbinates, and widened the meatus. Although morphologically distinct on computed tomographic images, infectious rhinitis and nasal neoplasms could not be differentiated by attenuation measurements or degree of contrast enhancement. Computed tomography appeared to be a reliable, noninvasive technique for the diagnosis of chronic nasal disease in dogs, and a promising alternative to diagnostic techniques currently in use.

Comparison between Perceptual Assessments of Nasality and Nasalance Scores

ERIC Educational Resources Information Center

Brunnegard, Karin; Lohmander, Anette; van Doorn, Jan

2012-01-01

Background: There are different reports of the usefulness of the Nasometer[TM] as a complement to listening, often as correlation calculations between listening and nasalance measurements. Differences between findings have been attributed to listener experience and types of speech stimuli. Aims: To compare nasalance scores from the Nasometer with…

Bilateral Superior Labial Mucosal Transposition Flaps to Correct Stenosis of the Nares Following Bilateral Rostral Maxillectomy Combined with Nasal Planum Resection in a Dog.

PubMed

Séguin, Bernard; Steinke, Julia R

2016-04-01

To describe a technique using labial mucosal flaps to correct stenosis of the nares subsequent to bilateral rostral maxillectomy and nasal planum resection. Case report Client-owned dog. A 10-year-old, neutered male Golden Retriever developed repeated stenosis of the nares, at first after bilateral rostral maxillectomy and nasal planum resection, and again after revision surgery. Bilateral, superior labial mucosal transposition flaps were created and interpolated between the nasal mucosa and skin after debridement of scar tissue. The stenosis did not recur after mucosal flap transposition and the dog returned to normal quality of life (last follow-up 25 months postoperative). Single-stage, superior labial mucosal transposition flaps can be used to correct nares stenosis subsequent to previous surgery. © Copyright 2016 by The American College of Veterinary Surgeons.

Perceiving Nasal Patency through Mucosal Cooling Rather than Air Temperature or Nasal Resistance

PubMed Central

Zhao, Kai; Blacker, Kara; Luo, Yuehao; Bryant, Bruce; Jiang, Jianbo

2011-01-01

Adequate perception of nasal airflow (i.e., nasal patency) is an important consideration for patients with nasal sinus diseases. The perception of a lack of nasal patency becomes the primary symptom that drives these patients to seek medical treatment. However, clinical assessment of nasal patency remains a challenge because we lack objective measurements that correlate well with what patients perceive.The current study examined factors that may influence perceived patency, including air temperature, humidity, mucosal cooling, nasal resistance, and trigeminal sensitivity. Forty-four healthy subjects rated nasal patency while sampling air from three facial exposure boxes that were ventilated with untreated room air, cold air, and dry air, respectively. In all conditions, air temperature and relative humidity inside each box were recorded with sensors connected to a computer. Nasal resistance and minimum airway cross-sectional area (MCA) were measured using rhinomanometry and acoustic rhinometry, respectively. General trigeminal sensitivity was assessed through lateralization thresholds to butanol. No significant correlation was found between perceived patency and nasal resistance or MCA. In contrast, air temperature, humidity, and butanol threshold combined significantly contributed to the ratings of patency, with mucosal cooling (heat loss) being the most heavily weighted predictor. Air humidity significantly influences perceived patency, suggesting that mucosal cooling rather than air temperature alone provides the trigeminal sensation that results in perception of patency. The dynamic cooling between the airstream and the mucosal wall may be quantified experimentally or computationally and could potentially lead to a new clinical evaluation tool. PMID:22022361

Nasal polyposis in cystic fibrosis: follow-up of children and adolescents for a 3-year period.

PubMed

Weber, Silke Anna Theresa; Iyomasa, Renata Mizusaki; Corrêa, Camila de Castro; Florentino, Wellington Novais Mafra; Ferrari, Giesela Fleischer

Nasal polyposis is often found in patients with cystic fibrosis. To assess the incidence of nasal polyposis, the response to medical treatment, recurrence and the need for surgical intervention in children and adolescents with cystic fibrosis during a three-year follow-up. Clinical symptoms (pulmonary, pancreatic insufficiency, malnutrition, nasal obstruction), two positive sweat chloride tests, and genotype findings in 23 patients with cystic fibrosis were analyzed. All patients underwent nasal endoscopy every 12 months from January 2005 to December 2007, to assess the presence and grade of Nasal Polyps. Nasal polyposis, when present, were treated with topical corticosteroids for 6-12 months, with progress being evaluated within the 3 years of follow-up. In the first evaluation, nasal polyposis was diagnosed in 30.43% of patients (3 bilateral and 4 unilateral), recurrent pneumonia in 82.6%, pancreatic insufficiency in 87%, and malnutrition in 74%. The presence of nasal polyposis was not associated with chloride values in the sweat, genotype, clinical signs of severity of cystic fibrosis, or nasal symptoms. In the three-year period of follow up, 13 patients (56.52%) had at least one event of polyposis, with the youngest being diagnosed at 32 months of age. Only one patient underwent surgery (polypectomy), and there was one diagnosis of nasopharyngeal carcinoma. The study showed a high incidence of nasal polyposis. Monitoring through routine endoscopy in patients with cystic fibrosis, even in the absence of nasal symptoms, is highly recommended. The therapy with topical corticosteroids achieved good results. Thus, an interaction between pediatricians and otolaryngologists is necessary. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Nasal carriage and antimicrobial susceptibility of Staphylococcus aureus in healthy preschool children in Ujjain, India.

PubMed

Pathak, Ashish; Marothi, Yogyata; Iyer, Rama V; Singh, Binita; Sharma, Megha; Eriksson, Bo; Macaden, Ragini; Lundborg, Cecilia Stålsby

2010-12-29

There is increasing evidence that community acquired S. aureus infections are spreading among healthy children. Nasal colonization with S. aureus plays pivotal role in the increasing prevalence of resistant community acquired S. aureus infections worldwide. A regular surveillance system is important in ensuring quality of patient care. The aim of the study was to assess the prevalence of and the factors associated with nasal carriage of S. aureus and its antibiotic sensitivity pattern among healthy children in Ujjain, India. A prospective study was done in paediatric outpatient clinics of R.D. Gardi medical college Ujjain, India. Healthy children from 1 month to 59 months of age were included. Information on previously known risk factors for nasal colonization was collected using a pre-tested questionnaire. Swabs from anterior nares were collected and transported in Amies transport media with charcoal and cultured on 5% sheep blood agar. Antibiotic sensitivity tests were performed using Kirby Bauer's disc diffusion method according to performance standards of Clinical and Laboratory Standard Institute guidelines. Of the 1,562 children from 1-month up-to five years of age included in the study 98 children tested positive for nasal carriage of S. aureus. The prevalence of nasal carriage of S. aureus was 6.3% (95% CI 5.1-7.5) out of which 16.3% (95% CI 8.9-23.8) were methicillin-resistant S. aureus (MRSA). The factors associated with nasal carriage were "child attending preschool" (OR 4.26, 95% CI 2.25-8.03; P = 0.007) or "school" (OR 3.02, 95% CI 1.27-7.18; P < 0.001) and "family size more than 10 members" (OR 2.76 95% CI 1.06-7.15; P = 0.03). The sensitivity pattern of isolated S. aureus showed resistance to commonly used oral antibiotics while resistance to glycopeptides was not noted. We found a relatively low rate of nasal carriage of S. aureus in children below five years when compared to children of older age groups in India. Yet, prevalence of MRSA was

Comparison of Early-period Results of Nasal Splint and Merocel Nasal Packs in Septoplasty

PubMed Central

Bingöl, Fatih; Budak, Ali; Şimşek, Eda; Kılıç, Korhan; Bingöl, Buket Özel

2017-01-01

Objective Several types of nasal packs are used postoperatively in septoplasty. In this study, we compared two commonly used nasal packing materials, the intranasal septal splint with airway and Merocel tampon, in terms of pain, bleeding, nasal obstruction, eating difficulties, discomfort in sleep, and pain and bleeding during removal of packing in the early period. Methods The study group included 60 patients undergoing septoplasty. Patients were divided into two groups (n=30 in each group). An intranasal splint with airway was used for the patients in the first group after septoplasty, while Merocel nasal packing was used for the second group. Patients were investigated in terms of seven different factors - pain, bleeding while the tampon was in place, nasal obstruction, eating difficulties, night sleep, pain during removal of the nasal packing, and bleeding after removal of packing. Results There was no statistically significant difference between the groups in terms of pain 24 hours after operation (p=0.05), while visual analog scale (VAS) scores for nasal obstruction, night sleep, eating difficulties, and pain during packing removal were lower in the nasal splint group with a statistically significant difference (p<0.05). There was no statistically significant difference between the groups in terms of postoperative bleeding (p=0.23). Significantly less bleeding occurred during removal of the packing in the nasal splint group (p<0.05). Conclusion Our study indicates that the nasal splint was more comfortable and effective in terms of causing lesser bleeding and pain during removal of packing. PMID:29392071

Nasalance measures in Cantonese-speaking women.

PubMed

Whitehill, T L

2001-03-01

To establish and evaluate stimulus materials for nasalance measurement in Cantonese speakers, to provide normative data for Cantonese-speaking women, and to evaluate session-to-session reliability of nasalance measures. One hundred forty-one Cantonese-speaking women with normal resonance who were students in the Department of Speech and Hearing Sciences, University of Hong Kong. Participants read aloud four speech stimuli: oral sentences, nasal sentences, an oral paragraph (similar to the Zoo Passage), and an oral-nasal paragraph (similar to the Rainbow Passage). Data were collected and analyzed using the Kay Nasometer 6200. Data collection was repeated for a subgroup of speakers (n = 28) on a separate day. Nasalance materials were evaluated by using statistical tests of difference and correlation. Group mean (standard deviation) nasalance scores for oral sentences, nasal sentences, oral paragraph, and oral-nasal paragraph were 16.79 (5.99), 55.67 (7.38), 13.68 (7.16), and 35.46 (6.22), respectively. There was a significant difference in mean nasalance scores for oral versus nasal materials. Correlations between stimuli were as expected, ranging from 0.43 to 0.91. Session-to-session reliability was within 5 points for over 95% of speakers for the oral stimuli but for less than 76% of speakers for the nasal and oral-nasal stimuli. Standard nasalance materials have been developed for Cantonese, and normative data have been established for Cantonese women. Evaluation of materials indicated acceptable differentiation between oral and nasal materials. Two stimuli (nasal sentences and oral paragraph) are recommended for future use. Comparison with findings from other languages showed similarities in scores; possible language-specific differences are discussed. Session-to-session reliability was poorer for nasal than oral stimuli.

Nasal septal hematoma

MedlinePlus

... medlineplus.gov/ency/article/001292.htm Nasal septal hematoma To use the sharing features on this page, please enable JavaScript. A nasal septal hematoma is a collection of blood within the septum ...

Same Noses, Different Nasalance Scores: Data from Normal Subjects and Cleft Palate Speakers for Three Systems for Nasalance Analysis

ERIC Educational Resources Information Center

Bressmann, Tim; Klaiman, Paula; Fischbach, Simone

2006-01-01

Nasalance scores from the Nasometer, the NasalView and the OroNasal System were compared. The data was collected from 50 normal participants and 19 hypernasal patients with cleft palate. The Nasometer had the lowest nasalance scores for the non-nasal Zoo Passage and that the OroNasal System had the lowest nasalance scores for the Nasal Sentences.…

Nasal hydropulsion.

PubMed

Elizabeth, Ashbaugh

2013-08-01

Intranasal tumors of dogs and cats pose a diagnostic and therapeutic challenge for the small animal practitioner. A simplified flushing technique to biopsy and debulk nasal tumors, that often results in immediate clinical relief for the patient is described. This technique can also be utilized to remove nasal foreign bodies. © 2013 Elsevier Inc. All rights reserved.

Primary Overcorrection of the Unilateral Cleft Nasal Deformity: Quantifying the Results.

PubMed

Lonic, Daniel; Morris, David E; Lo, Lun-Jou

2016-02-01

Because primary nasal correction by the time of lip repair has been incorporated into the treatment approach, many patients have benefitted from this combined procedure. However, primary nasal correction cannot guarantee an excellent result. Although overcorrection has been mentioned as a treatment rationale of the unilateral cleft lip nasal deformity, a detailed approach and quantitative evidence of the rationale are rare. This study evaluates whether overcorrection in the primary repair results in a quantitative improvement in nasal appearance. In this retrospective study, the inclusion criteria were patients with complete unilateral cleft lip and palate who underwent primary lip and nose repair by the age of 3 to 4 months. Primary nasal overcorrection was achieved by application of muscle to septal base suture, alar cinching suture and Tajima reversed U incision method. Patients were further divided into an overcorrected (n = 19) and nonovercorrected group (n = 19). The following parameters were identified on basilar photos of all patients taken at least 12 months after repair, ratios of cleft to noncleft side in each patient were taken and the mean for each parameter calculated: Ac angle (ACA/ACA'), alar height (AH/AH'), alar width (AW/AW'), nostril height (NH/NH`), nostril width (NW/NW'), and columellar deviation from the midline (CD/NW). The means of the overcorrected and nonovercorrected groups were then compared using the t test. From all investigated measuremens, Alar height (AH/AH': overcorrected, 0.983 to nonovercorrected, 0.941; P = 0.03) and nostril height ratio (NH/NH') (NH/NH': covercorrected, 0.897 to nonovercorrected, 0.680; P = 0.003) showed statistically significant differences favoring the overcorrected group at least 12 months after surgery. Primary nasal overcorrection including muscle to columella base suture, alar cinch suture, and Tajima method resulted in quantitatively more long-term symmetric alae and nostril height compared to

Patient-based health status assessments in an outpatient psychiatry setting.

PubMed

Adler, D A; Bungay, K M; Cynn, D J; Kosinski, M

2000-03-01

The reliability, validity, and feasibility of the routine use of a generic health status instrument, the Short-Form-36 Health Survey (SF-36), were examined in a psychiatric outpatient clinic of a general hospital. The sample comprised 411 patients referred to an outpatient psychiatry department between April 1994 and March 1995. They filled out the SF-36 along with their admission forms. Scores and reports were generated, and the results were returned to the charts and used at weekly clinical conference discussions. Feasibility was evaluated using subjective and objective data on administration of the instrument, its psychometric properties, and costs. Results from the outpatient psychiatry patients were compared with those from patients scheduled for elective surgery and a healthy normative sample. Routine administration of the SF-36 was successfully achieved with minimal resistance from staff and patients. The SF-36 provided reliable and valid data. As predicted, patients with emotional disorders scored lower, indicating more impairment, on scales measuring mental health than did the elective surgery patients and the normative sample. However, the psychiatric patients' scores on the physical health scale were lower than clinicians expected. Compared with the elective surgery patients, the psychiatric patients were less impaired on only the physical functioning and bodily pain scales; no difference was found between the two groups in role functioning due to physical problems. Routine use of the SF-36 in a general hospital psychiatric outpatient clinic was feasible, and the results were reliable, valid, and helpful to clinicians. Psychiatric patients' significantly lower scores in physical health and social and role functioning provided additional information about their difficulties.

Ipratropium Nasal Spray

MedlinePlus

... follow these steps: Remove the clear plastic dust cap and the safety clip from the nasal spray ... the other nostril. Replace the clear plastic dust cap and safety clip. If the nasal tip becomes ...

Nasal fracture - aftercare

MedlinePlus

... page: //medlineplus.gov/ency/patientinstructions/000554.htm Nasal fracture - aftercare To use the sharing features on this ... that gives your nose its shape. A nasal fracture occurs when the bony part of your nose ...

Nasal Wash Treatment

MedlinePlus

... Guidelines Wash your hands. Make the nasal wash solution. Do not use tap water for the nasal ... Whichever water you use to make the saline solution, replace container or water at least weekly. To ...

Nasal Harmony in Aguaruna.

ERIC Educational Resources Information Center

Moon, Gui-Sun

A discussion of the nasal harmony of Aguaruna, a language of the Jivaroan family in South America, approaches the subject from the viewpoint of generative phonology. This theory of phonology proposes an underlying nasal consonant, later deleted, that accounts for vowel nasalization. Complex rules that suppose a complex system of vowel and…

Evaluation and management of pediatric nasal obstruction: A survey of practice patterns.

PubMed

Kohlberg, Gavriel D; Stewart, Michael G; Ward, Robert F; April, Max M

2016-07-01

Inferior turbinate (IT) hypertrophy and adenoid hypertrophy are both causes of pediatric nasal obstruction. The purpose of this survey was to study nasal obstruction evaluation and management among pediatric otolaryngologists with respect to IT and adenoid hypertrophy. A questionnaire with embedded clinical videos was sent electronically to American Society of Pediatric Otolaryngology members. A total of 435 questionnaires were sent, and 75 were completed. Respondents were presented with scenarios that involved a 7-year-old child with nasal obstruction unresponsive to medical therapy, and the respondents were asked to choose a surgical plan, either IT reduction, adenoidectomy, or combined IT reduction and adenoidectomy. Three questions described the extent of IT and adenoid obstruction in text form, although three questions included a video of the child's nasal endoscopy. In questions with perceived or stated IT hypertrophy, the respondents chose to perform IT reduction significantly more frequently when the perceived or stated adenoid hypertrophy was less severe (p < 0.0001 for video and p = 0.039 for written questions). The decision to perform IT reduction in children is inversely related to the extent of adenoid hypertrophy. Future studies on pediatric IT surgery should include objective descriptions of the IT and adenoid in study subjects.

Restorative procedures in disturbed function of the upper airways - nasal breathing

PubMed Central

Mlynski, Gunter

2005-01-01

These days, functional rhinosurgery is almost always taken to mean the improvement of nasal airflow. However, air should not only pass through the nose without obstruction. It needs to be warmed, moistened and filtered. This requires sufficient air/mucous membrane contact by spreading airflow over the entire turbinate region, as well as regulation of nasal airway resistance and the degree of turbulence within the nasal cycle. These factors are not considered enough in the concept of functional rhinosurgery. There cannot be a rigid concept for functional/aesthetic rhinosurgery, the surgical procedure must be adapted to the individual anatomy and pathology. In spite of this, it must be clear (based on evidence) which surgical steps can solve a functional problem of the nose in the long term. This paper cannot explain evidence-based treatment strategies to restore nasal respiratory function because in all branches of rhinosurgery, there are no prospective studies available with a sufficiently high sample size and long-term results objectivized by functional diagnosis. Studies available on septal surgery show better results for SP after Cottle than for SMR after Killian. However, the success rate of a 70 to 80% improvement in nasal breathing is not satisfactory. The incidence of postoperative, dry nasal mucosa is also too high. The task of rhinology is to stress the functional side of rhinosurgery more. This includes preoperative analysis of the causes of disturbed respiratory function using the functional diagnosis methods available, the use of evidence-based surgical techniques and postoperative, objectivized quality control. More research needs to be done on the physiology and pathophysiology of nasal airflow as well as on the effect of rhinosurgery on airflow. Numerical flow simulation can contribute greatly to this because the effects of shape changes on the flow can be visualized. Methods need to be developed which can be used for routine, diagnostic recording of

External Nasal Neuralgia: A Neuropathic Pain Within the Territory of the External Nasal Nerve.

PubMed

García-Moreno, Héctor; Aledo-Serrano, Ángel; Gimeno-Hernández, Jesús; Cuadrado, María-Luz

2015-10-01

Nasal pain is a challenging diagnosis and very little has been reported in the neurological literature. The nose is a sophisticated structure regarding its innervation, which is supplied by the first and second divisions of the trigeminal nerve. Painful cranial neuropathies are an important group in the differential diagnosis, although they have been described only scarcely. Here, we report a case that can conform a non-traumatic external nasal nerve neuralgia. A 76-year-old woman was referred to our office due to pain in her left nose. She was suffering from daily excruciating attacks, which were strictly limited to the territory supplied by her left external nasal nerve (left ala nasi and apex nasi). She denied previous traumatisms and the ancillary tests did not yield any underlying pathology. An anesthetic blockade of her left external nasal nerve achieved a marked reduction of the number of episodes as well as their intensity. External nasal neuralgia seems a specific neuralgia causing nasal pain. Anesthetic blockades of the external nasal nerve may be a valid treatment for this condition. © 2015 American Headache Society.

Biodegradable Synthetic Polyurethane Foam Nasal Packing After Septoplasty.

PubMed

Shakeel, Muhammad; Karlsson, Therese R; Khan, Imran; Hariharadas, Bobbi; Mansoor, Rashid; Maini, Sangeeta K

2015-06-01

To determine the usefulness of biodegradable Synthetic Polyurethane Foam (SPF) nasal packing as an adjunct to day-case septoplasty. Comparative, observational case series. Aberdeen Royal Infirmary, University of Aberdeen, Scotland, UK, in the year 2011. One-hundred consecutive patients who underwent septoplasty and received SPF packing in 2010 were prospectively audited while one-hundred consecutive patients undergoing septoplasty in the year 2000 were studied retrospectively. Data collected include demographics, type of operation and duration of hospital stay. Excel and SPSS were used for data collection and analysis. In the year 2000, the average age of the patients was 40.6 years. There were 37 females and 63 males. One patient returned home the same day, 22 stayed one night, 69 spent two nights and 8 stayed more than two nights in hospital for their operation. The average length of stay was 1.84 nights. In 2010, the average age of patients was 37.86 years, with 31 patients being female and 69 male. All patients in this cohort received SPF packing postoperatively. Seventy-three patients went home the same day, 24 patients stayed one night and 3 patients spent two nights in hospital for their operation. Average length of hospital stay was 0.3 nights. Results were statistically significant (p < 0.001). SPF was a useful nasal packing option after septoplasty and inferior turbinate surgery, which enabled the surgeons to carry out this surgery safely as a day-case procedure.

Effect of the depressor septi nasi muscle modification on nasal tip rotation and projection.

PubMed

Toutounchi, Javad S; Biroon, Sogol H; Banaem, Samira M; Toutounchi, Neghisa S; Nezami, Nariman; Salari, Behzad

2015-06-01

The nasal tip is an important esthetic feature of the face and surgery on it is the most challenging part of a rhinoplasty. In the present study, we evaluated the effects of modification of the depressor septi nasi muscle on nasal tip rotation and projection. Eighty primary rhinoplasty patients who required nasal tip modifications were enrolled in a randomized clinical trial from October 2008 to March 2012. A study group composed of 40 patients underwent rhinoplasty including cutting and repositioning of the depressor septi nasi muscle and another group of 40 patients (control) underwent rhinoplasty without manipulation of the depressor septi nasi muscle. Nasal tip rotation and projection, and patient satisfaction were evaluated before and 6 months after the operation. Following rhinoplasty including cutting of the depressor septi nasi muscle, nasal tip rotation and projection, and patient satisfaction were improved in 70, 57.5, and 85 % of the patients, respectively; and in the control group, they were improved in 82.5, 55, and 67.5 %, respectively (P = 0.089, 0.607, and 0.069). Cutting and repositioning of the depressor septi nasi muscle as an adjunct to rhinoplasty is not associated with any additional advantage in terms of nasal tip rotation and projection, or patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The importance of side difference in nasal obstruction and rhinomanometry: a retrospective correlation of symptoms and rhinomanometry in 1000 patients.

PubMed

Thulesius, H L; Cervin, A; Jessen, M

2012-02-01

The correlation between subjective and objective outcomes of nasal obstruction is still a matter of controversy. The aim of this study was to determine the minimal level of side difference in nasal airway resistance (NAR measured by Broms'v(2)) between the two nasal cavities, which could be discerned subjectively by the patient on a visual analogue scale (VAS). Nasal airway resistance was calculated from rhinomanometric measurements of nasal airflow and transnasal pressure after decongestion of the nasal mucosa. A retrospective study. ENT department, Vaxjo Central Hospital, Sweden. We studied 1000 active anterior rhinomanometries from patients with nasal obstructions. We compared the side difference of nasal airway resistance with the side difference of VAS estimated immediately prior to the rhinomanometry. Each measurement was performed after nasal decongestion. When the difference in nasal airway resistance between the two nasal cavities was larger than 20° (Broms'v(2)) or R(2) > 0.36 Pa/cm(3) /s, we found a significant correlation between side differences of the objective measurement and the subjective assessment (VAS). With a nasal airway resistance side difference over 20°, an additional 20° difference corresponded to a 0.9 centimetre average VAS change. The more obstructed side of the nose could be determined by VAS in 823 (82.3%) of 1000 patients. Yet, 177 (17.7%) patients had a paradoxical sensation of nasal obstruction with the low resistance side of the nose experienced as the most congested side. A significant correlation between the side differences of nasal airway resistance and VAS can serve as a supplement to rhinoscopy in decisions about nasal surgery. This study also showed that in 17.7% of patients, there was a negative correlation between subjective and objective evaluations of nasal airway resistance. But in this group, the nasal airway resistance side difference was mostly under 20°. © 2011 Blackwell Publishing Ltd.

Axial computed tomography evaluation of the internal nasal valve correlates with clinical valve narrowing and patient complaint.

PubMed

Moche, Jason A; Cohen, Justin C; Pearlman, Steven J

2013-07-01

The objective of this work was to explore the utility of axial computed tomography (CT) imaging to objectively define a narrow internal nasal valve, and compare those findings with clinical examination and patient complaint. Retrospective review from a single facial plastic surgery center. We reviewed 40 consecutive patients evaluated for either sinusitis or nasal airway obstruction for which a CT scan was obtained at a single radiology institution. Thirty-six complete office records were examined for the presence of clinical internal valve narrowing and complaints of nasal obstruction. In total, 72 internal nasal valves were analyzed using axial plane CT and measurements were compared to clinical findings and presence of airway obstruction. Measured valve areas for clinically normal internal nasal valves averaged 0.47 cm(2) vs 0.28 cm(2) for clinically narrow valves, a decrease of 40.4%. In unobstructed nasal airways the valve area averaged 0.51 cm(2) vs 0.38 cm(2) in obstructed airways, a difference of 25.5%. A radiographically measured valve area of <0.30 cm(2) suggests clinical narrowing with a sensitivity of 71.4%, specificity of 88.9%, positive predictive value of 62.5%, and negative predictive value of 92.3%. Using standard axial CT imaging we describe an objective method of radiographically evaluating the nasal valve, demonstrating strong correlation with physical examination and patient complaint. Additionally, radiographic valve areas can be used to screen for clinically narrow nasal valves with good sensitivity and specificity, providing a novel straightforward method for nasal valve assessment. © 2012 ARS-AAOA, LLC.

Management of nasal septal perforation using silicone nasal septal button

PubMed Central

Mullace, M; Gorini, E; Sbrocca, M; Artesi, L; Mevio, N

2006-01-01

Summary Nasal septal perforation may present with various symptoms: epistaxis, crusting, secondary infection, whistling and nasal obstruction. Perforation may be treated by conservative pharmacological treatment or closed by surgical approach. A useful alternative is mechanical obturation, achieved inserting a prosthesis. The present report refers to a study on 15 patients (10 male, 5 female, mean age 38.5 years) treated by insertion of a one-piece or two-piece silicone septal button (Xomed). In the follow-up period, insertion of the nasal button reduced epistaxis, eliminated whistling during inspiration, and reduced nasal obstruction and crusting around the margin of the perforation. Contraindications are presence of acute infection with osteitis, chronic septal disease (Wegener), neoplasia and extremely large perforations. The latest buttons appear to be superior to the conventional type on account of plasticity and adaptability which offer greater conformity to the septum. This study also reveals that the new septal button is well tolerated by patients. PMID:18236638

Ambulatory surgery centers--current business and legal issues.

PubMed

Becker, S; Biala, M

2000-01-01

This article explores a handful of critical trends that have broad implications for ambulatory surgery centers and health care entities as a whole. As of the year 2000, the health care delivery system is experiencing broad changes and reconstruction in a variety of manners. One of the largest changes revolves around the accelerating movement of patient care from inpatient models to outpatient models, and the commensurate investment and development in outpatient systems and outpatient bricks and mortar. This metamorphosis is particularly evident as it relates to freestanding ambulatory surgery centers. This change in health care delivery will prove to have severe economic impacts on many of the nation's hospital systems.

Ambulatory surgery: is the liability risk lower?

PubMed

Metzner, Julia; Kent, Christopher D

2012-12-01

To summarize the currently available data on malpractice claims related to ambulatory anesthesia and provide an insight into the emerging patterns of anesthesia liability in this practice setting. At present, studies are mixed about how the continued growth of outpatient surgery will impact liability for anesthesiologists. Data derived from the ASA Closed Claims Project suggests that malpractice claims for major damaging events are less common in the outpatient settings than in inpatient settings. Correspondingly, the payment amounts for outpatient claims are significantly lower than those for inpatients. Nevertheless, nondisabling adverse events are common and involve respiratory, cardiac, equipment-related, and drug errors. In addition, the vast majority of injuries in outpatient claims was the result of substandard care and judged preventable by better monitoring. Although major incidents leading to malpractice suits are less, new liability exposure may be on the horizon, due to the changing landscape of ambulatory practice that permits care for sicker patients who require more complex surgeries. The areas of potential concern include postoperative discharge criteria, care for the obstructive sleep apnea patient, and the choice of anesthetic techniques such as neuraxial blocks and monitored anesthesia care. With steady increase in outpatient surgery, anesthesiologists are confronted with new areas of liability. More data are needed to identify these risks and reduce exposure to malpractice claims.

Impacts of Fluid Dynamics Simulation in Study of Nasal Airflow Physiology and Pathophysiology in Realistic Human Three-Dimensional Nose Models

PubMed Central

Lee, Heow Peuh; Gordon, Bruce R.

2012-01-01

During the past decades, numerous computational fluid dynamics (CFD) studies, constructed from CT or MRI images, have simulated human nasal models. As compared to rhinomanometry and acoustic rhinometry, which provide quantitative information only of nasal airflow, resistance, and cross sectional areas, CFD enables additional measurements of airflow passing through the nasal cavity that help visualize the physiologic impact of alterations in intranasal structures. Therefore, it becomes possible to quantitatively measure, and visually appreciate, the airflow pattern (laminar or turbulent), velocity, pressure, wall shear stress, particle deposition, and temperature changes at different flow rates, in different parts of the nasal cavity. The effects of both existing anatomical factors, as well as post-operative changes, can be assessed. With recent improvements in CFD technology and computing power, there is a promising future for CFD to become a useful tool in planning, predicting, and evaluating outcomes of nasal surgery. This review discusses the possibilities and potential impacts, as well as technical limitations, of using CFD simulation to better understand nasal airflow physiology. PMID:23205221

[Ambulatory anesthesia in pediatric surgery].

PubMed

Ben Khalifa, S; Hila, S; Hamzaoui, M; el Cadhi, A; Jlidi, S; Nouira, F; Hellal, Y; Houissa, T; Chaouachi, B

2000-04-01

Child is an ideal patient for day care surgery. So more than 60% of paediatric surgery could benefit by ambulatory surgery. Preoperative visit may select patients for ambulatory surgery. Medical exam may lead to choose pre operative screening. The ideal ambulatory anesthesia is locoregional technic or inhalatory one. Tracheal intubation don't contre indicate ambulatory surgery. Recovery of mental abilities following general anesthesia has not the same significance as in adult. Many studies confirm the safety of paediatric outpatients anesthesia.

Tomographic Structural Changes of Retinal Layers after Internal Limiting Membrane Peeling for Macular Hole Surgery.

PubMed

Faria, Mun Yueh; Ferreira, Nuno P; Cristóvao, Diana M; Mano, Sofia; Sousa, David Cordeiro; Monteiro-Grillo, Manuel

2018-01-01

To highlight tomographic structural changes of retinal layers after internal limiting membrane (ILM) peeling in macular hole surgery. Nonrandomized prospective, interventional study in 38 eyes (34 patients) subjected to pars plana vitrectomy and ILM peeling for idiopathic macular hole. Retinal layers were assessed in nasal and temporal regions before and 6 months after surgery using spectral domain optical coherence tomography. Total retinal thickness increased in the nasal region and decreased in the temporal region. The retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) showed thinning on both nasal and temporal sides of the fovea. The thickness of the outer plexiform layer (OPL) increased. The outer nuclear layer (ONL) and outer retinal layers (ORL) increased in thickness after surgery in both nasal and temporal regions. ILM peeling is associated with important alterations in the inner retinal layer architecture, with thinning of the RNFL-GCL-IPL complex and thickening of OPL, ONL, and ORL. These structural alterations can help explain functional outcome and could give indications regarding the extent of ILM peeling, even though peeling seems important for higher rate of hole closure. © 2017 S. Karger AG, Basel.

Cosmetic and Functional Nasal Deformities

MedlinePlus

... nasal complaints. Nasal deformity can be categorized as “cosmetic” or “functional.” Cosmetic deformity of the nose results in a less ... taste , nose bleeds and/or recurrent sinusitis . A cosmetic or functional nasal deformity may occur secondary to ...

Can objective measurements of the nasal form and function represent the clinical picture in unilateral cleft lip and palate?

PubMed

Peroz, Roshan; Holmström, Mats; Mani, Maria

2017-05-01

The present study aimed to evaluate the potential correlations between objective measurements of nasal function and self-assessed nasal symptoms or clinical findings at nasal examination among adults treated for unilateral cleft lip and palate (UCLP), respectively. All UCLP patients born between 1960 and 1987 (n = 109) treated at a tertiary referring center were invited. Participation rate was 76% (n = 83) at a mean of 37 years after the initial surgery. All participants completed the same study protocol including acoustic rhinometry (AR), rhinomanometry (RM), anterior rhinoscopy, and questionnaires regarding self-experienced nasal symptoms. A reduced volume of the anterior nasal cavity on the operated side (measured by AR) correlated to an expressed wish by the patient to change the function of the nose. A similar correlation was seen for the minimal cross-sectional area of anterior nasal cavity on the operated side. Furthermore, correlations were found between smaller volume and area of nasal cavity and a greater frequency of nasal obstruction. No further correlations were found. Objective measurements partly correlate to the clinical picture among adults treated for UCLP. However, these need to be combined with findings at clinical examination and patient self-assessment to represent the complete clinical picture. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Smart Polymers in Nasal Drug Delivery

PubMed Central

Chonkar, Ankita; Nayak, Usha; Udupa, N.

2015-01-01

Nasal drug delivery has now been recognized as a promising route for drug delivery due to its capability of transporting a drug to systemic circulation and central nervous system. Though nasal mucosa offers improved bioavailability and quick onset of action of the drug, main disadvantage associated with nasal drug delivery is mucocilliary clearance due to which drug particles get cleared from the nose before complete absorption through nasal mucosa. Therefore, mucoadhesive polymeric approach can be successfully used to enhance the retention of the drug on nasal mucosal surface. Here, some of the aspects of the stimuli responsive polymers have been discussed which possess liquid state at the room temperature and in response to nasal temperature, pH and ions present in mucous, can undergo in situ gelation in nasal cavity. In this review, several temperature responsive, pH responsive and ion responsive polymers used in nasal delivery, their gelling mechanisms have been discussed. Smart polymers not only able to enhance the retention of the drug in nasal cavity but also provide controlled release, ease of administration, enhanced permeation of the drug and protection of the drug from mucosal enzymes. Thus smart polymeric approach can be effectively used for nasal delivery of peptide drugs, central nervous system dugs and hormones. PMID:26664051

Reducing non-attendance at outpatient clinics.

PubMed

Stone, C A; Palmer, J H; Saxby, P J; Devaraj, V S

1999-03-01

Outpatient non-attendance is a common source of inefficiency in a health service, wasting time and resources and potentially lengthening waiting lists. A prospective audit of plastic surgery outpatient clinics was conducted during the six months from January to June 1997, to determine the clinical and demographic profile of non-attenders. Of 6095 appointments 16% were not kept. Using the demographic information, we changed our follow-up guidelines to reflect risk factors for multiple non-attendances, and a self-referral clinic was introduced to replace routine follow-up for high risk non-attenders. After these changes, a second audit in the same six months of 1998 revealed a non-attendance rate of 11%--i.e. 30% lower than before. Many follow-up appointments are sent inappropriately to patients who do not want further attention. This study, indicating how risk factor analysis can identify a group of patients who are unlikely to attend again after one missed appointment, may be a useful model for the reduction of outpatient non-attendance in other specialties.

Using preoperative unsupervised cluster analysis of chronic rhinosinusitis to inform patient decision and endoscopic sinus surgery outcome.

PubMed

Adnane, Choaib; Adouly, Taoufik; Khallouk, Amine; Rouadi, Sami; Abada, Redallah; Roubal, Mohamed; Mahtar, Mohamed

2017-02-01

The purpose of this study is to use unsupervised cluster methodology to identify phenotype and mucosal eosinophilia endotype subgroups of patients with medical refractory chronic rhinosinusitis (CRS), and evaluate the difference in quality of life (QOL) outcomes after endoscopic sinus surgery (ESS) between these clusters for better surgical case selection. A prospective cohort study included 131 patients with medical refractory CRS who elected ESS. The Sino-Nasal Outcome Test (SNOT-22) was used to evaluate QOL before and 12 months after surgery. Unsupervised two-step clustering method was performed. One hundred and thirteen subjects were retained in this study: 46 patients with CRS without nasal polyps and 67 patients with nasal polyps. Nasal polyps, gender, mucosal eosinophilia profile, and prior sinus surgery were the most discriminating factors in the generated clusters. Three clusters were identified. A significant clinical improvement was observed in all clusters 12 months after surgery with a reduction of SNOT-22 scores. There was a significant difference in QOL outcomes between clusters; cluster 1 had the worst QOL improvement after FESS in comparison with the other clusters 2 and 3. All patients in cluster 1 presented CRSwNP with the highest mucosal eosinophilia endotype. Clustering method is able to classify CRS phenotypes and endotypes with different associated surgical outcomes.

Risk factors for nasal malignancies in German men: the South-German Nasal cancer study.

PubMed

Greiser, Eberhard M; Greiser, Karin Halina; Ahrens, Wolfgang; Hagen, Rudolf; Lazszig, Roland; Maier, Heinz; Schick, Bernhard; Zenner, Hans Peter

2012-11-06

There are few studies of the effects of nasal snuff and environmental factors on the risk of nasal cancer. This study aimed to investigate the impact of using nasal snuff and of other risk factors on the risk of nasal cancer in German men. A population-based case-control study was conducted in the German Federal States of Bavaria and Baden-Württemberg. Tumor registries and ear, nose and throat departments provided access to patients born in 1926 or later. Telephone interviews were conducted with 427 cases (mean age 62.1 years) and 2.401 population-based controls (mean age 60.8 years). Ever-use of nasal snuff was associated with an odds ratio (OR) for nasal cancer of 1.45 (95% confidence interval [CI] 0.88-2.38) in the total study population, whereas OR in smokers was 2.01 (95% CI 1.00-4.02) and in never smokers was 1.10 (95% CI 0.43-2.80). The OR in ever-smokers vs. never-smokers was 1.60 (95% CI 1.24-2.07), with an OR of 1.06 (95% CI 1.05-1.07) per pack-year smoked, and the risk was significantly decreased after quitting smoking. Exposure to hardwood dust for at least 1 year resulted in an OR of 2.33 (95% CI 1.40-3.91) in the total population, which was further increased in never-smokers (OR 4.89, 95% CI 1.92-12.49) in analyses stratified by smoking status. The OR for nasal cancer after exposure to organic solvents for at least 1 year was 1.53 (1.17-2.01). Ever-use of nasal sprays/nasal lavage for at least 1 month rendered an OR of 1.59 (1.04-2.44). The OR after use of insecticides in homes was 1.48 (95% CI 1.04-2.11). Smoking and exposure to hardwood dust were confirmed as risk factors for nasal carcinoma. There is evidence that exposure to organic solvents, and in-house use of insecticides could represent novel risk factors. Exposure to asbestos and use of nasal snuff were risk factors in smokers only.

Nasal obstruction and human communication.

PubMed

Malinoff, R; Moreno, C

1989-04-01

Nasal obstruction may cause a variety of communication disorders, particularly in children. The effects of nasal obstruction on hearing, speech, language, and voice are examined. Methods for assessing the effects of nasal obstruction are delineated, and recommendations for therapeutic interventions are described.

Internal retinal layer thickness and macular migration after internal limiting membrane peeling in macular hole surgery.

PubMed

Faria, Mun Y; Ferreira, Nuno P; Mano, Sofia; Cristóvao, Diana M; Sousa, David C; Monteiro-Grillo, Manuel E

2018-05-01

To provide a spectral-domain optical coherence tomography (SD-OCT)-based analysis of retinal layers thickness and nasal displacement of closed macular hole after internal limiting membrane peeling in macular hole surgery. In this nonrandomized prospective interventional study, 36 eyes of 32 patients were subjected to pars plana vitrectomy and 3.5 mm diameter internal limiting membrane (ILM) peeling for idiopathic macular hole (IMH). Nasal and temporal internal retinal layer thickness were assessed with SD-OCT. Each scan included optic disc border so that distance between optic disc border and fovea were measured. Thirty-six eyes had a successful surgery with macular hole closure. Total nasal retinal thickening (p<0.001) and total temporal retinal thinning (p<0.0001) were observed. Outer retinal layers increased thickness after surgery (nasal p<0.05 and temporal p<0.01). Middle part of inner retinal layers (mIRL) had nasal thickening (p<0.001) and temporal thinning (p<0.05). The mIRL was obtained by deducting ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) thickness from overall thickness of the inner retinal layer. Papillofoveal distance was shorter after ILM peeling in macular hole surgery (3,651 ± 323 μm preoperatively and 3,361 ± 279 μm at 6 months; p<0.0001). Internal limiting membrane peel is associated with important alteration in inner retinal layer architecture, with thickening of mIRL and shortening of papillofoveal distance. These factors may contribute to recovery of disrupted foveal photoreceptor and vision improvement after IMH closure.

Procedural volume, cost, and reimbursement of outpatient incisional hernia repair: implications for payers and providers.

PubMed

Song, Chao; Liu, Emelline; Tackett, Scott; Shi, Lizheng; Marcus, Daniel

2017-06-01

This analysis aimed to evaluate trends in volumes and costs of primary elective incisional ventral hernia repairs (IVHRs) and investigated potential cost implications of moving procedures from inpatient to outpatient settings. A time series study was conducted using the Premier Hospital Perspective ® Database (Premier database) for elective IVHR identified by International Classification of Diseases, Ninth revision, Clinical Modification codes. IVHR procedure volumes and costs were determined for inpatient, outpatient, minimally invasive surgery (MIS), and open procedures from January 2008-June 2015. Initial visit costs were inflation-adjusted to 2015 US dollars. Median costs were used to analyze variation by site of care and payer. Quantile regression on median costs was conducted in covariate-adjusted models. Cost impact of potential outpatient migration was estimated from a Medicare perspective. During the study period, the trend for outpatient procedures in obese and non-obese populations increased. Inpatient and outpatient MIS procedures experienced a steady growth in adoption over their open counterparts. Overall median costs increased over time, and inpatient costs were often double outpatient costs. An economic model demonstrated that a 5% shift of inpatient procedures to outpatient MIS procedures can have a cost surplus of ∼ US $1.8 million for provider or a cost-saving impact of US $1.7 million from the Centers for Medicare & Medicaid Services perspective. The study was limited by information in the Premier database. No data were available for IVHR cases performed in free-standing ambulatory surgery centers or federal healthcare facilities. Volumes and costs of outpatient IVHRs and MIS procedures increased from January 2008-June 2015. Median costs were significantly higher for inpatients than outpatients, and the difference was particularly evident for obese patients. A substantial cost difference between inpatient and outpatient MIS cases

21 CFR 874.3900 - Nasal dilator.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nasal dilator. 874.3900 Section 874.3900 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... nasal airflow. The device decreases airway resistance and increases nasal airflow. The external nasal...

21 CFR 874.3900 - Nasal dilator.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nasal dilator. 874.3900 Section 874.3900 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... nasal airflow. The device decreases airway resistance and increases nasal airflow. The external nasal...

Radiofrequency turbinate volume reduction vs. radiofrequency-assisted turbinectomy for nasal obstruction caused by inferior turbinate hypertrophy.

PubMed

Kumar, Saumitra; Anand, Trivender Singh; Pal, Indranil

2017-02-01

Radiofrequency procedures are a well-accepted treatment for nasal obstruction. We conducted a randomized, noncontrolled study to compare the effectiveness of submucosal bipolar radiofrequency turbinate volume reduction (RFTVR) and bipolar radiofrequency-assisted turbinectomy (RFaT) in patients presenting with nasal obstruction caused by inferior turbinate hypertrophy. A total of 30 patients-15 males and 15 females, aged 15 to 60 years (mean: 32)-were randomly divided into one of the two homogeneous treatment groups. Outcomes were determined by comparisons of subjective symptom scores on a visual analog scale and by anterior active rhinomanometry at postoperative days 7, 14, and 28 and again at 6 months postoperatively. Both groups demonstrated significant and similar improvements in nasal airway function both subjectively and objectively. However, we noted that the incidence of adverse effects and postoperative morbidity was higher in the RFaT group. Therefore, we conclude that when surgery is indicated, RFTVR is the preferred treatment for nasal obstruction secondary to inferior turbinate hypertrophy. RFaT is equally effective, but it is associated with a slightly higher incidence of adverse effects.

[Nasal septal abscess].

PubMed

Barril, María F; Ferolla, Fausto M; José, Pablo; Echave, Cecilia; Tomezzoli, Silvana; Fiorini, Sandra; López, Eduardo Luis

2008-12-01

A nasal septal abscess (NA) is defined as a collection of pus between the cartilage or bony septum and its normally applied mucoperichondrium or mucoperiostium. It is an uncommon disease which should be suspected in a patient with acute onset of nasal obstruction and recent history of nasal trauma, periodontal infection or an inflammatory process of the rhinosinusal region. We report a case of an 8-year-old boy with bilateral NA caused by community-acquired methicillin-resistant Staphylococcus aureus(MR-CO) in order to emphasize the importance of prompt diagnosis and adequate treatment to prevent the potentially dangerous spread of infection and the development of severe functional and cosmetic sequelae.

Basaloid squamous cell carcinoma arising in an inverted papilloma in the nasal cavity: A case report and review.

PubMed

Koyama, Satoshi; Nakamura, Yosuke; Yokoyama, Yuko; Morisaki, Tsuyoshi; Fukuhara, Takahiro; Fujiwara, Kazunori; Kitano, Hiroya; Takeuchi, Hiromi

2017-10-01

Basaloid squamous cell carcinoma (BSCC) is a histologically distinctive variant of squamous cell carcinoma comprising basal cell carcinoma and squamous cell carcinoma. BSCC is aggressive and shows a poor prognosis because of frequent lymph node invasion and distant metastases. BSCC preferentially occurs in the cervix, thymus, and esophagus and is uncommonly found in the head and neck region. BSCC in the nasal cavity or paranasal sinus is particularly rare. Inverted papilloma is an uncommon, benign tumor with a propensity to be associated with malignancy; however, BSCC arising in an inverted papilloma has never been reported. Here we report a case of a 56-year-old woman with BSCC arising in an inverted papilloma in the nasal cavity. The woman was referred to our hospital for epistaxis, nasal congestion, and dysphagia. A tumor was observed to completely occupy the left nasal cavity. The biopsy specimen was histologically diagnosed as papilloma. Computed tomography demonstrated a tumor with heterogeneous contrast effect occupying the left nasal cavity; however, extra-nasal tract extension was not observed. We performed endoscopic excision of the tumor. Microscopic findings confirmed the diagnosis of BSCC arising from an inverted papilloma. No tumor recurrence has been observed for 13 months after surgery. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The effect of prilocaine and prilocaine plus meperidine infiltration on the pain during nasal packing removal.

PubMed

Karaaslan, Kazim; Yilmaz, Fahrettin; Gulcu, Nebahat; Yigit, Beyhan; Kocoglu, Hasan

2007-12-01

Removing the nasal packing after nasal surgery is an uncomfortable and painful procedure. Since there is no controlled trial described in the literature about the local use of meperidine during packing removal, we aimed to compare the analgesic and sedative effects of the meperidine-prilocaine combination, injected into the packing 15 minutes before the procedure, with that of prilocaine during packing removal. Fifty adult patients, for whom nasal packing removal after nasal septoplasty was scheduled, were randomly allocated into one of two groups. In the prilocaine group (Group P, n = 25), 5 ml of 1% prilocaine in saline was injected into the pack 15 minutes before removal. In the prilocaine-meperidine group (Group MP, n = 25), 5 ml fluid combination containing prilocaine (10 mg/ml) and meperidine (1 mg/kg) was injected in nasal packs. Five ml saline was injected into the package in the contra-lateral nostril in both groups as control. Visual analogue scale (VAS) score was recorded during injections (t) and packing removal (t), and the Ramsay sedation score was evaluated. VAS score was not different from the control nostril in Group P (p > 0.05), where as it was significantly lower than the control nostril in Group MP (p < 0.05). Ramsay sedation scores were significantly higher in Group MP compared to the control nostril and actively treated nostril of Group P (p < 0.05). The injection of prilocaine plus meperidine into the nasal pack 15 minutes before nasal packing removal provides effective analgesia and mild sedation during the procedure.

Nasal Glial Heterotopia with Cleft Palate.

PubMed

Chandna, Sudhir; Mehta, Milind A; Kulkarni, Abhishek Kishore

2018-01-01

Congenital midline nasal masses are rare anomalies of which nasal glial heterotopia represents an even rarer subset. We report a case of a 25-day-old male child with nasal glial heterotopia along with cleft palate suggesting embryonic fusion anomaly which was treated with excision and primary closure for nasal mass followed by palatal repair at later date.

[Hemangiopericytoma in nasal cavity: a case report].

PubMed

Hu, Honghai; Shi, Qifeng; Chen, Jidong

2015-05-01

We report a case of a 46 year old female patient with nasal hemangiopericytoma. She complained of left nasal congestion, pus snot for 10 years, sometimes with left nasal bleeding. Physical examination: in the left nasal tract saw red soft neoplasm, roughness surface, easy bleeding when touched. Sinus CT shows: bilateral maxillary sinus, ethmoid sinus, sphenoid sinus and the left posterior nasal cavity lesions, considering inflammation with the formation of polyps, tumor not excluded. The left nasal cavity neoplasm biopsy shows: hemangioma of left nasal cavity. After admission in general anesthesia, we do transnasal endoscopic sinus openning operation and the left nasal cavity neoplasm resection. Postoperative pathological examination shows: the left nasal cavity hemangiopericytoma. Immunohistochemical showed: Vimentin(+), Smooth muscle actin(+), Desmin(-), endothelial cells CD31(-) and CD34(-). No postoperative radiotherapy or chemotherapy, no tumor recurrence. After one year of follow-up, the contact was lost.

Objective measurements for grading the nasal esthetics on Basal view in individuals with secondary cleft nasal deformity.

PubMed

He, Xing; Li, Hua; Shao, Yan; Shi, Bing

2015-01-01

The purpose of this study is to ascertain objective nasal measurements from the basal view that are predictive of nasal esthetics in individuals with secondary cleft nasal deformity. Thirty-three patients who had undergone unilateral cleft lip repair were retrospectively reviewed in this study. The degree of nasal deformity was subjectively ranked by seven surgeons using standardized basal-view measurements. Nine physical objective parameters including angles and ratios were measured. Correlations and regressions between these objective and subjective measurements were then analyzed. There was high concordance in subjective measurements by different surgeons (Kendall's harmonious coefficient = W = .825, P = .006). The strongest predictive factors for nasal aesthetics were the ratio of length of nasal alar (r = .370, P = .034) and the degree of deviation of the columnar axis (r = .451, P = .008). The columellar angle had a more powerful effect in rating nasal esthetics. There was reliable concordance in subjective ranking of nasal esthetics by surgeons. Measurement of the columnar angle may serve as an independent, objective predictor of esthetics of the nose.

Disorders of the neonatal nasal cavity: Fundamentals for practice.

PubMed

Sohal, Maheep; Schoem, Scott R

2016-08-01

Neonatal nasal obstruction is a well-known clinical entity. Fortunately, it is rarely life-threatening and usually resolves with conservative management. As with most conditions, a systematic history and thorough physical examination are crucial for correct diagnosis and management. The initial diagnosis may be elusive and require either serial or more in-depth evaluations. Occasionally, examination may reveal structural abnormalities necessitating surgical intervention. Fortunately most of these abnormalities are amenable to surgery; however, a select few are notoriously difficult to treat. Copyright © 2016. Published by Elsevier Ltd.

Nasal mucosal gene expression in patients with allergic rhinitis with and without nasal polyps.

PubMed

Fritz, Stephen B; Terrell, Jeffrey E; Conner, Edward R; Kukowska-Latallo, Jolanta F; Baker, James R

2003-12-01

Nasal polyps are a common problem that is difficult to diagnose and treat, in part because the cause of nasal polyposis is unknown. Although information on the pathogenesis of polyposis is lacking, there are reports suggesting that a genetic predisposition underlies this disorder. We sought to better understand the basis of nasal polyposis associated with allergic rhinitis. We hypothesize that the expression of unique genes is associated with the nasal polyposis phenotype. We examined 12000 human genes transcribed in the nasal mucosa of patients with allergic rhinitis with and without nasal polyps. Biopsy specimens of the mucosa of patients with and without polyps were obtained after the patients refrained from the use of topical or systemic steroid therapy for 2 weeks. Thirty-four genes were differentially expressed between the patient groups, including those for inflammatory molecules and putative growth factors. The greatest differential expression identified by the array analysis was for a group of genes associated with neoplasia, including mammaglobin, a gene transcribed 12-fold higher in patients with polyps compared with control patients with rhinitis alone. Quantitative RT-PCR confirmed this differential expression and documented that the number of mammaglobin mRNA copies is actually 64-fold greater in tissues of patients with polyps versus control patients. The specificity of mammaglobin protein expression was evaluated by means of immunohistochemistry, which showed specific staining in nasal polyp mucosal goblet cells only in patients with polyps. These data suggest that nasal polyposis involves deregulated cell growth, using gene activation in some ways similar to a neoplasm. In addition, mammaglobin, a gene of unknown function associated with breast neoplasia, might be related to polyp growth.

Bone and Soft Tissue Nasal Angles Discrepancies and Overlying Skin Thickness: A Computed Tomography Study.

PubMed

Alharethy, Sami; Alohali, Sama; Alquniabut, Ibrahim; Jang, Yong Ju

2018-04-11

The aim of this study was to derive the normal values for bone and soft tissue nasal angles as well as the overlying skin thickness and to attempt to determine the correlation between differences in bone and soft tissue angles and overlying skin thickness in Middle Eastern patients. Three-dimensional cephalometric analysis was performed for 100 patients who underwent computed tomography of the paranasal sinuses. The nasofrontal angle, pyramidal angle-nasal root, pyramidal angle-tip of the nasal bone, and overlying skin thickness were measured, and the results were analyzed according to sex, age, and body mass index (BMI). All soft tissue angles were significantly larger than the bone angles, with the mean difference being 11.62°, 30.80°, and 27.05° for the nasofrontal angle (P = 0.000), pyramidal angle-nasal root (P = 0.000), and pyramidal angle-tip of the nasal bone (P = 0.000), respectively. The mean overlying skin thickness was 3.89 ± 1.48 mm at the nasion, 1.16 ± 0.6 mm at the rhinion, and 2.93 ± .97 mm at the nasal tip. Differences in the nasofrontal angle were strongly correlated with the skin thickness at the nasion (P = 0.001). A simple clinical exam of the soft tissue nasal angles does not reflect the underlying bone angles that will be encountered during rhinoplasty. BMI does not influence nasal shape, and rhinoplasty surgery should take into account the ethnic group, age, and sex of the patient. Surgeons should leave a minor skeletal hump at the end of the nasal bone for Middle Eastern patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Visualization and Quantification of Nasal and Olfactory Deposition in a Sectional Adult Nasal Airway Cast.

PubMed

Xi, Jinxiang; Yuan, Jiayao Eddie; Zhang, Yu; Nevorski, Dannielle; Wang, Zhaoxuan; Zhou, Yue

2016-06-01

To compare drug deposition in the nose and olfactory region with different nasal devices and administration techniques. A Sar-Gel based colorimetry method will be developed to quantify local deposition rates. A sectional nasal airway cast was developed based on an MRI-based nasal airway model to visualize deposition patterns and measure regional dosages. Four nasal spray pumps and four nebulizers were tested with both standard and point-release administration techniques. Delivered dosages were measured using a high-precision scale. The colorimetry correlation for deposited mass was developed via image processing in Matlab and its performance was evaluated through comparison to experimental measurements. Results show that the majority of nasal spray droplets deposited in the anterior nose while only a small fraction (less than 4.6%) reached the olfactory region. For all nebulizers considered, more droplets went beyond the nasal valve, leading to distinct deposition patterns as a function of both the nebulizer type (droplet size and initial speed) and inhalation flow rate. With the point-release administration, up to 9.0% (±1.9%) of administered drugs were delivered to the olfactory region and 15.7 (±2.4%) to the upper nose using Pari Sinus. Standard nasal devices are inadequate to deliver clinically significant olfactory dosages without excess drug losses in other nasal epitheliums. The Sar-Gel based colorimetry method appears to provide a simple and practical approach to visualize and quantify regional deposition.

Health risks associated with inhaled nasal toxicants.

PubMed

Feron, V J; Arts, J H; Kuper, C F; Slootweg, P J; Woutersen, R A

2001-05-01

Health risks of inhaled nasal toxicants were reviewed with emphasis on chemically induced nasal lesions in humans, sensory irritation, olfactory and trigeminal nerve toxicity, nasal immunopathology and carcinogenesis, nasal responses to chemical mixtures, in vitro models, and nasal dosimetry- and metabolism-based extrapolation of nasal data in animals to humans. Conspicuous findings in humans are the effects of outdoor air pollution on the nasal mucosa, and tobacco smoking as a risk factor for sinonasal squamous cell carcinoma. Objective methods in humans to discriminate between sensory irritation and olfactory stimulation and between adaptation and habituation have been introduced successfully, providing more relevant information than sensory irritation studies in animals. Against the background of chemoperception as a dominant window of the brain on the outside world, nasal neurotoxicology is rapidly developing, focusing on olfactory and trigeminal nerve toxicity. Better insight in the processes underlying neurogenic inflammation may increase our knowledge of the causes of the various chemical sensitivity syndromes. Nasal immunotoxicology is extremely complex, which is mainly due to the pivotal role of nasal lymphoid tissue in the defense of the middle ear, eye, and oral cavity against antigenic substances, and the important function of the nasal passages in brain drainage in rats. The crucial role of tissue damage and reactive epithelial hyperproliferation in nasal carcinogenesis has become overwhelmingly clear as demonstrated by the recently developed biologically based model for predicting formaldehyde nasal cancer risk in humans. The evidence of carcinogenicity of inhaled complex mixtures in experimental animals is very limited, while there is ample evidence that occupational exposure to mixtures such as wood, leather, or textile dust or chromium- and nickel-containing materials is associated with increased risk of nasal cancer. It is remarkable that these

Nasal budesonide offers superior symptom relief in perennial allergic rhinitis in comparison to nasal azelastine.

PubMed

Stern, M A; Wade, A G; Ridout, S M; Cambell, L M

1998-10-01

Allergic rhinitis is usually treated with oral antihistamines or nasal steroids. Topically active nasal antihistamine is a new treatment modality for allergic rhinitis. The efficacy in comparison to well established topical treatment alternatives is not fully known. To compare the efficacy of intranasally administered azelastine to budesonide, at their respectively recommended dosage, on the symptoms of perennial rhinitis patients. A placebo-controlled, randomized, parallel group study was conducted to compare the efficacy and tolerability of intranasal budesonide aqueous suspension (256 microg once daily) with azelastine hydrochloride nasal spray (280 microg twice daily (560 microg/day)) and with placebo in the treatment of perennial allergic rhinitis. The 195 patients (with at least a 2-year history of perennial allergic rhinitis) recorded individual nasal symptom scores, the degree of symptom control achieved and any adverse events experienced over a 2-week baseline period and a 6-week treatment period. Following treatment, the reductions in mean combined and individual nasal symptom scores from baseline values were significantly greater in the budesonide group compared with the placebo group (P < .0001 for all variables except runny nose P = .01). In patients treated with budesonide, there were also significantly larger reductions from baseline values in combined nasal symptom scores (P < .01) and in scores for all individual nasal symptoms (P < or = .05) compared with those treated with azelastine. The reductions from baseline in both combined and individual nasal symptom scores did not differ between azelastine and placebo. The study medications were well tolerated, producing no unexpected or serious treatment-related adverse events. A once-daily dose of 256 microg of intranasal budesonide aqueous suspension is significantly more effective at relieving the symptoms of perennial allergic rhinitis compared with a twice daily dose of 280 microg of azelastine

Orthognathic surgery in the office setting.

PubMed

Farrell, Brian B; Tucker, Myron R

2014-11-01

The delivery of care by oral and maxillofacial surgeons is becoming more challenging because of escalating health care costs and limited reimbursement from insurance providers. The changing health care landscape forces surgical practices to be flexible and adaptive to change in order to remain viable. The delivery of surgical services continues to evolve as care traditionally performed in a hospital environment is now routinely achieved in an outpatient setting. Outpatient facilities can aid in controlling the perioperative costs associated with orthognathic surgery. Safe and efficient orthognathic surgery completed in the office can aid in controlling the escalation of health care costs. Copyright © 2014 Elsevier Inc. All rights reserved.

Rib Diced Cartilage-Fascia Grafting in Dorsal Nasal Reconstruction: A Randomized Clinical Trial of Wrapping With Rectus Muscle Fascia vs Deep Temporal Fascia.

PubMed

As'adi, Kamran; Salehi, Seyed Hamid; Shoar, Saeed

2014-08-01

Rib cartilage is an abundant source for cartilage grafts when significant dorsal nasal augmentation or structural support is indicated. Diced cartilage wrapped in fascia was developed to counteract warping, visibility, and displacement of rib cartilage as a dorsal solid graft. The technique for wrapping diced cartilage has evolved during the past several years. The authors compared 2 distinct fascial sleeves for wrapping rib diced cartilage in the treatment of patients who required major dorsal nasal augmentation. Thirty-six patients who planned to undergo major dorsal nasal reconstruction with diced costal rib cartilage were assigned randomly to 1 of 2 groups: the intervention group, which received grafts wrapped with rectus muscle fascia from the rib cartilage harvesting site, or the control group, which received deep temporal fascia harvested separately. Outcomes were compared between the groups. Patients in the intervention group had significantly shorter operating times, significantly higher average satisfaction scores, and significantly shorter postoperative hospital stays than did patients in the control group. Harvesting rectus muscle fascia for wrapping diced rib cartilage is a feasible and reliable technique in dorsal nasal reconstruction surgery. It is associated with favorable outcomes and a high level of patient satisfaction. 4. © 2014 The American Society for Aesthetic Plastic Surgery, Inc.

Analysis of factors in successful nasal endoscopic resection of nasopharyngeal angiofibroma.

PubMed

Ye, Dong; Shen, Zhisen; Wang, Guoli; Deng, Hongxia; Qiu, Shijie; Zhang, Yuna

2016-01-01

Endoscopic resection of nasopharyngeal angiofibroma is less traumatic, causes less bleeding, and provides a good curative effect. Using pre-operative embolization and controlled hypotension, reasonable surgical strategies and techniques lead to successful resection tumors of a maximum Andrews-Fisch classification stage of III. To investigate surgical indications, methods, surgical technique, and curative effects of transnasal endoscopic resection of nasopharyngeal angiofibroma, this study evaluated factors that improve diagnosis and treatment, prevent large intra-operative blood loss and residual tumor, and increase the cure rate. A retrospective analysis was performed of the clinical data and treatment programs of 23 patients with nasopharyngeal angiofibroma who underwent endoscopic resection with pre-operative embolization and controlled hypotension. The surgical method applied was based on the size of tumor and extent of invasion. Curative effects were observed. No intra-operative or perioperative complications were observed in 22 patients. Upon removal of nasal packing material 3-7 days post-operatively, one patient experienced heavy bleeding of the nasopharyngeal wound, which was treated compression hemostasis using post-nasal packing. Twenty-three patients were followed up for 6-60 months. Twenty-two patients experienced cure; one patient experienced recurrence 10 months post-operatively, and repeat nasal endoscopic surgery was performed and resulted in cure.

Endoscopic surgery of the nose and paranasal sinus.

PubMed

Palmer, Orville; Moche, Jason A; Matthews, Stanley

2012-05-01

Mucosal preservation is of paramount importance in the diagnosis and surgical management of the sinonasal tract. The endoscope revolutionized the practice of endoscopic nasal surgery. As a result, external sinus surgery is performed less frequently today, and more emphasis is placed on functional endoscopy and preservation of normal anatomy. Endoscopic surgery of the nose and paranasal sinus has provided improved surgical outcomes and has shortened the length of stay in hospital. It has also become a valuable teaching tool. Copyright © 2012 Elsevier Inc. All rights reserved.

Low lymphatic vessel density associates with chronic rhinosinusitis with nasal polyps.

PubMed

Luukkainen, A; Seppälä, M; Renkonen, J; Renkonen, R; Hagstrő M, J; Huhtala, H; Rautiainen, M; Myller, J; Paavonen, T; Ranta, A; Torkkeli, T; Toppila-Salmi, S

2017-06-01

Chronic rhinosinusitis with and without nasal polyps (CRSwNP and CRSsNP) and antrochoanal polyps (ACP) are different upper airway inflammation phenotypes with different pathomechanisms. In order to understand the development of tissue edema, the present study aimed to evaluate lymphatic vessel density in CRSsNP, CRSwNP and ACP. 120 retrospective nasal and maxillary sinus specimens were stained immunohistochemically with a von Willebrand factor polyclonal antibody recognizing vascular and lymphatic endothelium, and with a podoplanin monoclonal antibody recognizing lymphatic endothelium. Vessels were studied by microscopy in a blinded fashion, and the vessel density and the relative density of lymphatic vessels were calculated. Patient characteristic factors and follow-up data of in average 9 years were collected from patient records. In the nasal cavity, the low absolute and relative density of vessels and of lymphatic vessels was associated with CRSwNP and ACP tissues compared to control inferior turbinate. This was observed also in the inflammatory hotspot area. In the maxillary sinus, lower absolute and relative density of lymphatic vessels associated with the CRSwNP phenotype. High lymphatic vessel density in polyp tissue associated with the need for revision CRS-surgery. As a conclusion, low density of lymphatic vessels distinguished patients with CRSwNP not only in the hotspot area of polyp tissue, but also in maxillary sinus mucosa. Yet, higher lymphatic vessel density seems to associate with polyp recurrence. Further studies are still needed to explore if formation of nasal polyps could be diminished by intranasal therapeutics affecting lymphangiogenesis.

Adjuncts to Improve Nasal Reconstruction Results.

PubMed

Gordon, Shayna Lee; Hurst, Eva A

2017-02-01

The final cosmetic appearance of nasal reconstruction scars is of paramount importance to both the patient and surgeon. Ideal postreconstruction nasal scars are flat and indistinguishable from surrounding skin. Unfortunately, even with meticulous surgical execution, nasal scars can occasionally be suboptimal. Abnormal fibroblast response can lead to hypertrophic nasal scars, and excessive angiogenesis may lead to telangiectasias or an erythematous scar. Imperfect surgical closure or poor postoperative management can lead to surgical outcomes with step-offs, depressions, suture marks, or dyspigmentation. Aesthetically unacceptable nasal scars can cause pruritus, tenderness, pain, sleep disturbance, and anxiety and depression in postsurgical patients. Fortunately, there are several minimally invasive or noninvasive techniques that allow for enhancement and improvement of cosmetic results with minimal risk and associated downtime. This article provides an overview of adjuncts to improve nasal reconstruction with a focus on techniques to be used in the postoperative period. Armed with an understanding of relevant available therapies, skillful surgeons may drastically improve the final cosmesis and outcome of nasal reconstruction scars. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Lymphoepithelial carcinoma of the nasal cavity mimicking juvenile angiofibroma.

PubMed

Kim, Young Hyo; Kim, Beom Joon; Jang, Tae Young

2012-10-01

Juvenile angiofibroma, nasopharyngeal carcinoma (NPC) and lymphoepithelial carcinoma of the nasal cavity (LEC NC) all could be found as a hyper-vascular mass in the nasopharynx area. Performing biopsy for histopathologic confirmation is necessary in the case of NPC or LEC NC but could be fatal in the case of angiofibroma. In our case, a 21-year-old male who was suffering from unilateral nasal stuffiness and frequent epistaxis had a mass with an easily bleeding tendency in his right nasal cavity. Juvenile angiofibroma was suspected by clinical and radiologic examinations. We performed preoperative angiography and the feeding vessel from the right internal maxillary artery was obliterated with polyvinyl alcohol nanoparticle. The mass was completely removed endoscopically, and there was profound hemorrhage in spite of the preoperative embolization. The mass turned out to be LEC NC by postoperative histopathologic examination. To avoid this misdiagnosis, the authors suggest that we should perform biopsy under rigid endoscopy 24h after angiographic embolization. If the result of frozen biopsy is juvenile angiofibroma, we could perform surgery another 24h later. If the result is nasopharyngeal carcinoma or LEC NC, we could avoid unnecessary surgical removal and perform radiotherapy. In terms of treatment strategies, we suggest endoscopic removal of gross tumor and postoperative combination of chemoradiotherapy as the more curative regimen with less complications related with radiotherapy. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Subjective cognitive dysfunction in rehabilitation outpatients with musculoskeletal disorders or chronic pain.

PubMed

Schrier, Ernst; Geertzen, Jan H; Dijkstra, Pieter U

2017-08-01

Rehabilitation patients, without brain damage, sometimes complain about poor concentration and problems with their memory. The magnitude and associations, of this cognitive dysfunction, with different factors is unclear. To determine the magnitude of cognitive dysfunction in rehabilitation outpatient and to explore its associations with patient characteristics, diagnosis, surgery, pain, stress, anxiety and depression. Cross-sectional. Rehabilitation outpatients. Between July 2009 and January 2012, 274 rehabilitation outpatients were included and divided in 8 different groups through diagnosis. Cognitive functioning was assessed using the cognitive failure questionnaire and compared with the general Dutch population. Associations of gender, age, diagnosis, recent surgery, pain and stress coping ability with cognitive function was explored. Mediation of depression and anxiety was explored. The rehabilitation patients had a significantly higher score on the CFQ (mean 35.9±13.4) when compared to the general Dutch population (mean 31.8±11.1). Mean difference is 4.1, 95% confidence interval 2.60 to 5.60. In the stepwise linear regression analysis only gender, diagnosis and stress coping ability were significantly associated. A significant mediation effect was found of anxiety (P≤0.001) and depression (P≤0.005) between stress coping ability and cognitive function. Rehabilitation outpatients experience more cognitive problems in comparison to the general Dutch population. Reported dysfunction of cognition in rehabilitation outpatients are associated with stress coping ability and for a small amount to gender and diagnosis. The association of stress coping ability and cognitive dysfunction is mediated by depression and anxiety. Women tend to report more dysfunctional cognition compared to men. Patient characteristics, surgery and experienced pain have no significant influence on the experienced cognitive dysfunction. Cognitive problems reported by patients should be

A cost analysis of orthopedic foot surgery: can outpatient continuous regional analgesia provide the same standard of care for postoperative pain control at home without shifting costs?

PubMed

Saporito, Andrea; Calciolari, Stefano; Ortiz, Laura Gonzalez; Anselmi, Luciano; Borgeat, Alain; Aguirre, José

2016-11-01

Same-day surgery is common for foot surgery. Continuous regional anesthesia for outpatients has been shown effective but the economic impact on the perioperative process-related healthcare costs remains unclear. One hundred twenty consecutive patients were included in this assessor-blinded, prospective cohort study and allocated according to inclusion criteria in the day-care or in the in-patient group. Standardized continuous popliteal sciatic nerve block was performed in both groups for 48 h using an elastomeric pump delivering ropivacaine 0.2 % at a rate of 5 ml/h with an additional 5 ml bolus every 60 min. Outpatients were discharged the day of surgery and followed with standardized telephone interviews. The total direct health costs of both groups were compared. Moreover, the difference in treatment costs and the difference in terms of quality of care and effectiveness between the groups were compared. Total management costs were significantly reduced in the day-care group. There was no difference between the groups regarding pain at rest and with motion, persistent pain after catheter removal and the incidence of PONV. Persistent motor block and catheter inflammation/infection were comparable in both groups. There was neither a difference in the number of unscheduled ambulatory visits nor in the number of readmissions. Day-care continuous regional analgesia leads to an overall positive impact on costs by decreasing the incidence of unplanned ambulatory visits and unscheduled readmissions, without compromising on the quality of analgesia, patients' satisfaction, and safety.

Nasal chondrocyte-based engineered autologous cartilage tissue for repair of articular cartilage defects: an observational first-in-human trial.

PubMed

Mumme, Marcus; Barbero, Andrea; Miot, Sylvie; Wixmerten, Anke; Feliciano, Sandra; Wolf, Francine; Asnaghi, Adelaide M; Baumhoer, Daniel; Bieri, Oliver; Kretzschmar, Martin; Pagenstert, Geert; Haug, Martin; Schaefer, Dirk J; Martin, Ivan; Jakob, Marcel

2016-10-22

Articular cartilage injuries have poor repair capacity, leading to progressive joint damage, and cannot be restored predictably by either conventional treatments or advanced therapies based on implantation of articular chondrocytes. Compared with articular chondrocytes, chondrocytes derived from the nasal septum have superior and more reproducible capacity to generate hyaline-like cartilage tissues, with the plasticity to adapt to a joint environment. We aimed to assess whether engineered autologous nasal chondrocyte-based cartilage grafts allow safe and functional restoration of knee cartilage defects. In a first-in-human trial, ten patients with symptomatic, post-traumatic, full-thickness cartilage lesions (2-6 cm 2 ) on the femoral condyle or trochlea were treated at University Hospital Basel in Switzerland. Chondrocytes isolated from a 6 mm nasal septum biopsy specimen were expanded and cultured onto collagen membranes to engineer cartilage grafts (30 × 40 × 2 mm). The engineered tissues were implanted into the femoral defects via mini-arthrotomy and assessed up to 24 months after surgery. Primary outcomes were feasibility and safety of the procedure. Secondary outcomes included self-assessed clinical scores and MRI-based estimation of morphological and compositional quality of the repair tissue. This study is registered with ClinicalTrials.gov, number NCT01605201. The study is ongoing, with an approved extension to 25 patients. For every patient, it was feasible to manufacture cartilaginous grafts with nasal chondrocytes embedded in an extracellular matrix rich in glycosaminoglycan and type II collagen. Engineered tissues were stable through handling with forceps and could be secured in the injured joints. No adverse reactions were recorded and self-assessed clinical scores for pain, knee function, and quality of life were improved significantly from before surgery to 24 months after surgery. Radiological assessments indicated variable degrees of

Orthognathic Surgery and Rhinoplasty to Address Nasomaxillary Hypoplasia.

PubMed

Veeramani, Anamika; Sawh, Raj; Steinbacher, Derek M

2017-11-01

The treatment of nasomaxillary hypoplasia is challenging. The phenotype of Binder "syndrome" includes the following: midfacial hypoplasia, class III malocclusion, small or absent anterior nasal spine, flattened nose, horizontal nostrils, short columella, acute nasolabial angle, and a flat frontonasal angle. A staged approach is used, with orthognathic surgery to achieve vertical maxillary length and sagittal advancement, followed by rhinoplasty aimed to increase nasal tip projection, rotation, and columellar length. This article details the diagnosis and treatment of nasomaxillary hypoplasia, demonstrating the senior author's (D.M.S.) preferred approach and technical steps. Therapeutic, V.

Presurgical Nasal Molding With a Nasal Spring in Patients With Mild-to-Moderate Nasal Deformity With Incomplete Unilateral Cleft Lip With or Without Cleft Palate.

PubMed

Peanchitlertkajorn, Supakit

2018-01-01

Traditional nasoalveolar molding (NAM) requires steep learning curve for clinicians and significant compliance from parents. Nasal springs have been developed by the author to simplify presurgical nasal molding. This article presents the design, construction, and application of the spring. The treatment goal is to improve nasal deformity prior to primary repair in infants born with incomplete unilateral cleft lip with or without cleft palate. The design, fabrication, and utility of the nasal spring are described. The spring has a simpler design and construction compared to a traditional NAM appliance. Two patients with incomplete unilateral cleft lip with and without cleft palate are presented. The spring is constructed and delivered. The active arm of the spring can be 3-dimensionally (3-D) adjusted to mold the alar cartilage of the affected nostril. The spring does not require an oral plate for adherence as a traditional NAM appliance does, hence an oral impression is not needed. The spring is easy for clinicians to adjust. It also requires less compliance by parents. Main Outcome Measures/Results: The presurgical molding achieved by the use of a nasal spring improved surgical nasolabial aesthetic outcomes. The nasal springs are effective in reducing the initial cleft nasal deformity. This facilitates primary surgical cleft lip and nose correction and improves surgical outcomes in patients with incomplete unilateral cleft lip with or without cleft palate.

[Disturbances of nasal aerodynamics in patients with the curved nasal septum and the rationale for its surgical correction].

PubMed

Tulebaev, R K; Mustafin, A A; Zholdybaeva, Z T

2011-01-01

Serious disturbances of nasal aerodynamics contribute to the development of diseases of the broncho-pulmonary apparatus. The early recognition of ventilation problems in patients with the curved nasal septum is paramount for the efficacious prevention and treatment of respiratory complications. The authors describe principles of rhinosurgical correction of affected nasal aerodynamics in patients with the curved nasal septum.

Web-Based Tailored Intervention for Preparation of Parents and Children for Outpatient Surgery (WebTIPS): Formative Evaluation and Randomized Controlled Trial

PubMed Central

Fortier, Michelle A.; Bunzli, Elizabeth; Walthall, Jessica; Olshansky, Ellen; Saadat, Haleh; Santistevan, Ricci; Mayes, Linda; Kain, Zeev N.

2015-01-01

Background The purpose of this two-phase project was to conduct formative evaluation and test the preliminary efficacy of a newly developed web-based, tailored behavioral preparation program (WebTIPS) for children undergoing outpatient surgery and their parents Methods Phase I enrolled 13 children aged 2–7 years undergoing outpatient elective surgery and their parents for formative evaluation of WebTIPS. Parent participation focus groups which are common in qualitative research and are a method of asking research participants about their perceptions and attitudes regarding a product or concept. In phase II, children age 2–7 years in two medical centers were randomly assigned to receive the WebTIPS program (n = 38) compared to children receiving standard of care (n = 44). The primary outcome of phase II was child and parent preoperative anxiety. Results In phase I, parents reported WebTIPS to be both helpful (p < 0.001) and easy to use (p < 0.001). In phase II, children in the WebTIPS group (36.2 ± 14.1) were less anxious than children in the standard of care group (46.0 ± 19.0) at entrance to the operating room (p = 0.02; Cohen’s d = 0.59) and introduction of the anesthesia mask (43.5 ± 21.7 vs. 57.0 ± 21.2, respectively, p = 0.01; Cohen’s d = 0.63). Parents in the WebTIPS group (32.1 ± 7.4) also experienced less anxiety compared to parents in the control group (36.8 ± 7.1) in the preoperative holding area (p = 0.004; Cohen’s d = 0.65). Conclusions WebTIPS was well received by parents and children and led to reductions in preoperative anxiety. PMID:25790213

A Nasal Epithelial Receptor for Staphylococcus aureus WTA Governs Adhesion to Epithelial Cells and Modulates Nasal Colonization

PubMed Central

Faulstich, Manuela; Grau, Timo; Severin, Yannik; Unger, Clemens; Hoffmann, Wolfgang H.; Rudel, Thomas; Autenrieth, Ingo B.; Weidenmaier, Christopher

2014-01-01

Nasal colonization is a major risk factor for S. aureus infections. The mechanisms responsible for colonization are still not well understood and involve several factors on the host and the bacterial side. One key factor is the cell wall teichoic acid (WTA) of S. aureus, which governs direct interactions with nasal epithelial surfaces. We report here the first receptor for the cell wall glycopolymer WTA on nasal epithelial cells. In several assay systems this type F-scavenger receptor, termed SREC-I, bound WTA in a charge dependent manner and mediated adhesion to nasal epithelial cells in vitro. The impact of WTA and SREC-I interaction on epithelial adhesion was especially pronounced under shear stress, which resembles the conditions found in the nasal cavity. Most importantly, we demonstrate here a key role of the WTA-receptor interaction in a cotton rat model of nasal colonization. When we inhibited WTA mediated adhesion with a SREC-I antibody, nasal colonization in the animal model was strongly reduced at the early onset of colonization. More importantly, colonization stayed low over an extended period of 6 days. Therefore we propose targeting of this glycopolymer-receptor interaction as a novel strategy to prevent or control S. aureus nasal colonization. PMID:24788600

Nasal Obstruction in Children With Cleft Lip and Palate: Results of a Cross-Sectional Study Utilizing the NOSE Scale.

PubMed

Zhang, Rosaline S; Lin, Lawrence O; Hoppe, Ian C; Jackson, Oksana A; Low, David W; Bartlett, Scott P; Swanson, Jordan W; Taylor, Jesse A

2018-01-01

To characterize the epidemiology and risk factors for nasal obstruction among subjects with cleft lip and/or cleft palate (CL/P) utilizing the well-validated Nasal Obstruction Symptom Evaluation (NOSE) survey. Retrospective cross-sectional study. Cleft Lip and Palate Program, Children's Hospital of Philadelphia. Patients, Subjects: One thousand twenty-eight surveys obtained from 456 subjects (mean age: 10.10 (4.48) years) with CL/P evaluated between January 2015 and August 2017 with at least 1 completed NOSE survey. Nasal Obstruction Symptom Evaluation surveys completed at each annual visit. Composite NOSE and individual symptom scores. Sixty-seven percent of subjects had nasal obstruction at some point during the study period, with 49% reporting nasal obstruction at latest follow-up. subjects aged 14 years and older reported the most severe symptoms ( P = .002). Subjects with cleft lip and alveolus (CL+A) and unilateral cleft lip and palate (CLP) reported more severe nasal blockage than other phenotypes ( P = .021). subjects with a history of either posterior pharyngeal flap (PPF) or sphincter pharyngoplasty (SP) had significantly higher NOSE scores than subjects with no history of speech surgery ( P = .006). There was no significant difference ( P > .050) in NOSE scores with regard to history of primary tip rhinoplasty, nasal stent use, or nasoalveolar molding. There are more severe nasal obstructive symptoms among subjects older than 14 years of age, with CL+A or unilateral CLP, and with a history of PPF or SP. Future studies utilizing the NOSE are needed to evaluate and address this prevalent morbidity in the CLP population.

Supplemental oxygen: ensuring its safe delivery during facial surgery.

PubMed

Reyes, R J; Smith, A A; Mascaro, J R; Windle, B H

1995-04-01

Electrosurgical coagulation in the presence of blow-by oxygen is a potential source of fire in facial surgery. A case report of a patient sustaining partial-thickness facial burns secondary to such a flash fire is presented. A fiberglass facial model is then used to study the variables involved in providing supplemental oxygen when an electrosurgical unit is employed. Oxygen flow, oxygen delivery systems, distance from the oxygen source, and coagulation current levels were varied. A nasal cannula and an adapted suction tubing provided the oxygen delivery systems on the model. Both the "displaced" nasal cannula and the adapted suction tubing ignited at a minimum coagulation level of 30 W, an oxygen flow of 2 liters/minute, and a linear distance of 5 cm from the oxygen source. The properly placed nasal cannula did not ignite at any combination of oxygen flow, coagulation current level, or distance from the oxygen source. Facial cutaneous surgery in patients provided supplemental oxygen should be practiced with caution when an electrosurgical unit is used for coagulation. The oxygen delivery systems adapted for use are hazardous and should not be used until their safety has been demonstrated.

[The usefulness of evaluation of: ferritin, ultrasensitive CRP and tissue specific polypeptide 18th (TPS) in assessment of therapy efficacy in patients with nasal polyps].

PubMed

Pałac, Jacek; Bratek, Szczepan; Partyka, Robert; Misiołek, Maciej

2014-01-01

Chronic rhinosinusitis with nasal polyps is social, clinical and cost-effective problem, by reason of bothersome symptoms, chronic nature of the disease, tendency to recur and lack of satisfying treatment. The aim of this study is assessment of suitability of hsCRP, ferritin and blood levels in nasal polyps patients in evaluation of treatment efficacy. The study enrolled 38 patients between 20 and 68 years of age. Patients were divided into 2 groups. Levels of ultrasensitive CRP ferritin and TPS have been measured in all patients. The ultrasensitive CRP levels have been measured by chemiluminescence method. Ferritin levels have been measured by MEIA method. The TPS levels have been measured by chemiluminescence method. Comparison of mean ferritin levels in both study groups in each stage of observation shows the significant difference of mean values in only 6 weeks after surgery. Mean ferritin level is significantly lower in group I than in group II (p<0.05). Mean hsCRP levels vary from one corresponding to ferritin levels. Statistically significant difference between study groups in 2nd and 6th week after surgery has been ascertained (p<0.05). Similarly, like in ferritin levels, the TPS levels are significantly different in 6th week after surgery. Analysis of ferritin, hsCRP and TPS serum levels indicates that these may be useful in assessment of treatment efficacy in patients with nasal polyps. Rise of the chosen inflammatory state parameter level in the postoperative monitoring and anti-inflammatory treatment introduction in nasal polyps patients may inhibit the recurrence of the disease. Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

The Impact of the Nasal Trauma in Childhood on the Development of the Nose in Future

PubMed Central

Kopacheva-Barsova, Gabriela; Arsova, Slavica

2016-01-01

nasal trauma which was not treated on time or it was improperly treated. In 24 (58.54%) of these patients septoplasty was performed and in 17 (41.46%) was performed rhino septoplasty. CONCLUSION: Often, difficult septal deformations in children are followed with deformation of the nasal pyramid (rhino scoliosis, rhino lordosis). In those cases, we cannot solve septal pathology without nasal pyramid intervention in the same time and opposite. Clinical reports have not produced solid evidence for the statement that septal surgery has no negative effect on nasal growth or can serve for correcting abnormal growth. The functional and esthetic problems of the patient, however, mean a continuous stimulus for further clinical and experimental investigations. PMID:27703565

The Impact of the Nasal Trauma in Childhood on the Development of the Nose in Future.

PubMed

Kopacheva-Barsova, Gabriela; Arsova, Slavica

2016-09-15

time or it was improperly treated. In 24 (58.54%) of these patients septoplasty was performed and in 17 (41.46%) was performed rhino septoplasty. Often, difficult septal deformations in children are followed with deformation of the nasal pyramid (rhino scoliosis, rhino lordosis). In those cases, we cannot solve septal pathology without nasal pyramid intervention in the same time and opposite. Clinical reports have not produced solid evidence for the statement that septal surgery has no negative effect on nasal growth or can serve for correcting abnormal growth. The functional and esthetic problems of the patient, however, mean a continuous stimulus for further clinical and experimental investigations.

Temporomandibular joint regeneration: proposal of a novel treatment for condylar resorption after orthognathic surgery using transplantation of autologous nasal septum chondrocytes, and the first human case report.

PubMed

de Souza Tesch, Ricardo; Takamori, Esther Rieko; Menezes, Karla; Carias, Rosana Bizon Vieira; Dutra, Cláudio Leonardo Milione; de Freitas Aguiar, Marcelo; Torraca, Tânia Salgado de Sousa; Senegaglia, Alexandra Cristina; Rebelatto, Cármen Lúcia Kuniyoshi; Daga, Debora Regina; Brofman, Paulo Roberto Slud; Borojevic, Radovan

2018-04-07

Upon orthognathic mandibular advancement surgery the adjacent soft tissues can displace the distal bone segment and increase the load on the temporomandibular joint causing loss of its integrity. Remodeling of the condyle and temporal fossa with destruction of condylar cartilage and subchondral bone leads to postsurgical condylar resorption, with arthralgia and functional limitations. Patients with severe lesions are refractory to conservative treatments, leading to more invasive therapies that range from simple arthrocentesis to open surgery and prosthesis. Although aggressive and with a high risk for the patient, surgical invasive treatments are not always efficient in managing the degenerative lesions. We propose a regenerative medicine approach using in-vitro expanded autologous cells from nasal septum applied to the first proof-of-concept patient. After the required quality controls, the cells were injected into each joint by arthrocentesis. Results were monitored by functional assays and image analysis using computed tomography. The cell injection fully reverted the condylar resorption, leading to functional and structural regeneration after 6 months. Computed tomography images showed new cortical bone formation filling the former cavity space, and a partial recovery of condylar and temporal bones. The superposition of the condyle models showed the regeneration of the bone defect, reconstructing the condyle original form. We propose a new treatment of condylar resorption subsequent to orthognathic surgery, presently treated only by alloplastic total joint replacement. We propose an intra-articular injection of autologous in-vitro expanded cells from the nasal septum. The proof-of-concept treatment of a selected patient that had no alternative therapeutic proposal has given promising results, reaching full regeneration of both the condylar cartilage and bone at 6 months after the therapy, which was fully maintained after 1 year. This first case is being

Effects of topical phenytoin on nasal wound healing after mechanical trauma: An experimental study.

PubMed

Şimşek, Gökçe; Ciftci, Osman; Karadag, Neşe; Karatas, Erkan; Kizilay, Ahmet

2014-12-01

Impaired postoperative wound healing is the second most common morbidity after synechia formation in endoscopic sinus surgery. The aim of this experimental study was to investigate the potential effects of topical phenytoin on wound healing after nasal mucosal trauma in rats. An experimental study at the Inonu University Faculty of Medicine. Twenty-four rats were randomized into three groups: 1) phenytoin group (n = 8), 2) control group (n = 8), and 3) vehicle group (n = 8). After damaging the right nasal cavity, in the phenytoin group, 1% topical phenytoin cream was applied for 7 days. The rats in the control group did not receive any treatment. The vehicle group was treated with daily topical cold cream for 1 week. The rats were sacrificed at the end, and the nasal cavities were excised. Tissue edema and inflammatory cell infiltration were compared among the groups. Additionally, proliferating cell nuclear antigen (PCNA) and cluster of differentiation 31 (CD31) immunoexpression levels were evaluated. Furthermore, in biochemical analysis, the tissue levels of vascular endothelial growth factor and (EGF) of the groups were investigated. In the phenytoin group, tissue edema and inflammatory cell infiltration were significantly decreased, and PCNA and CD31 immunoexpression levels were more prominent (P < .001) and the tissue EGF levels were significantly higher (P < .01). Topical phenytoin treatment may alter the nasal wound healing after mechanical trauma. The potential beneficial effects of topical phenytoin on nasal mucosa should be investigated by further experimental and human trials. NA. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Outpatient total elbow arthroplasty: 90-day outcomes.

PubMed

Stone, Michael A; Singh, Paramjit; Rosario, Santano L; Omid, Reza

2018-05-14

Interest in outpatient arthroplasty has grown in response to increasing emphasis on the efficient delivery of safe, high-quality medical care. This study evaluated 90-day episode-of-care complications after outpatient total elbow arthroplasty (TEA). We retrospectively evaluated 28 patients discharged the same day after primary TEA for 90-day episode-of-care complications, reoperations, and readmissions. Postoperative complications and elbow range of motion measurements were recorded and evaluated at the latest follow-up. All patients were contacted and given a satisfaction survey to assess their outpatient experience. Univariate logistic regression was performed for each risk factor to evaluate the risk for major and minor complications. Statistical significance was set as P < .05. Final follow-up data were available for 28 patients at an average of 14 months. Major complications within 90 days of surgery occurred in 7.1% of patients, ulnar nerve paresthesias occurred in 42.8% of patients, and minor wound problems occurred in 39.2% of patients. Five reoperations occurred after the 90-day postoperative period. All ulnar paresthesias and minor wound complications had resolved by the latest follow-up. Univariate regression analysis revealed a significant correlation between smoking and minor wound complications (P = .038). The satisfaction survey had an 85.7% response rate, with 91.7% of patients stating they were happy they went home the same day, and 95.8% feeling more confident and in control of their lives. The risk profile of carefully selected patients undergoing same-day discharge after TEA is acceptable when combined with close follow-up. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Nasal dermoid sinus cyst.

PubMed

Cauchois, R; Laccourreye, O; Bremond, D; Testud, R; Küffer, R; Monteil, J P

1994-08-01

Nasal dermoid sinus cyst is one of the diagnoses of midline nasal masses in children. This retrospective study analyzes the various theories regarding the origin of this congenital abnormality, the differential diagnosis, and the value of magnetic resonance imaging, as well as the various surgical options available.

Topical Mitomycin C in functional endoscopic sinus surgery.

PubMed

Venkatraman, Vaidyanathan; Balasubramanian, Deepak; Gopalakrishnan, Suria; Saxena, Sunil Kumar; Shanmugasundaram, Nirmal

2012-07-01

In recent literature, there has been an interest in the use of Mitomycin C to reduce post-operative complications following endoscopic sinus surgery. We report our results on a prospective, randomized controlled trial involving 50 patients with chronic bilateral rhino sinusitis. We eliminated various confounding factors by studying a single group of patients, with symmetrical disease, without pre-existing gross anatomical abnormalities. Patients requiring revision sinus surgery were excluded. On completion of the surgery, a cotton pledget soaked in Mitomycin C was placed in one nostril (test) and saline-soaked pledget (control) was placed in the other side of the nose, both in the middle meatus. The side of the nasal cavity receiving the topical Mitomycin C was randomized. The patients were assessed periodically (first week, first month, third month and sixth month) for synechiae formation and presence or absence of their symptoms. At the first week follow up, there was a statistically significant difference in the incidence of synechiae between the saline and Mitomycin C side. Furthermore, there was a statistically significant improvement with regards to patient symptoms (nasal block and discharge) in the Mitomycin C side when compared to the saline side. At the third and sixth month, there was no difference between the two groups. The incidence of adverse tissue reaction (granulation, discharge, polypoidal mucosa and crusting) was less in the Mitomycin C side when compared to the saline side at the first month follow up. Topically applied Mitomycin C reduces the incidence of synechiae in the immediate post-operative period in patients undergoing endoscopic sinus surgery. There is also an improvement in nasal obstruction and discharge with a reduction in the incidence of adverse tissue reaction in the early post-operative period.

Speech rate reduction and "nasality" in normal speakers.

PubMed

Brancewicz, T M; Reich, A R

1989-12-01

This study explored the effects of reduced speech rate on nasal/voice accelerometric measures and nasality ratings. Nasal/voice accelerometric measures were obtained from normal adults for various speech stimuli and speaking rates. Stimuli included three sentences (one obstruent-loaded, one semivowel-loaded, and one containing a single nasal), and /pv/ syllable trains.. Speakers read the stimuli at their normal rate, half their normal rate, and as slowly as possible. In addition, a computer program paced each speaker at rates of 1, 2, and 3 syllables per second. The nasal/voice accelerometric values revealed significant stimulus effects but no rate effects. The nasality ratings of experienced listeners, evaluated as a function of stimulus and speaking rate, were compared to the accelerometric measures. The nasality scale values demonstrated small, but statistically significant, stimulus and rate effects. However, the nasality percepts were poorly correlated with the nasal/voice accelerometric measures.

Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients.

PubMed

Berger, Richard A; Sanders, Sheila A; Thill, Elizabeth S; Sporer, Scott M; Della Valle, Craig

2009-06-01

Advancements in the surgical approach, anesthetic technique, and the initiation of rapid rehabilitation protocols have decreased the duration of hospitalization and subsequent length of recovery following elective total hip arthroplasty. We assessed the feasibility and safety of outpatient total hip arthroplasty in 150 consecutive patients. A comprehensive perioperative anesthesia and rehabilitation protocol including preoperative teaching, regional anesthesia, and preemptive oral analgesia and antiemetic therapy was implemented around a minimally invasive surgical technique. A rapid rehabilitation pathway was started immediately after surgery and patients had the option of being discharged to home the day of surgery if standard discharge criteria were met. All 150 patients were discharged to home the day of surgery, at which time 131 patients were able to walk without assistive devices. Thirty-eight patients required some additional intervention outside the pathway to resolve nausea, hypotension, or sedation prior to discharge. There were no readmissions for pain, nausea, or hypotension yet there was one readmission for fracture and nine emergency room evaluations in the three month perioperative period. This anesthetic and rehabilitation protocol allowed outpatient total hip arthroplasty to be routinely performed in these consecutive patients undergoing primary total hip arthroplasty. With current reimbursement approaches the modest savings to the hospital in length of stay may be outweighed by the additional costs of personnel, thereby making this outpatient system more expensive to implement. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

The Impact of Middle Turbinate Concha Bullosa on the Severity of Inferior Turbinate Hypertrophy in Patients with a Deviated Nasal Septum.

PubMed

Tomblinson, C M; Cheng, M-R; Lal, D; Hoxworth, J M

2016-07-01

Inferior turbinate hypertrophy and concha bullosa often occur opposite the direction of nasal septal deviation. The objective of this retrospective study was to determine whether a concha bullosa impacts inferior turbinate hypertrophy in patients who have nasal septal deviation. The electronic medical record was used to identify sinus CT scans exhibiting nasal septal deviation for 100 adult subjects without and 100 subjects with unilateral middle turbinate concha bullosa. Exclusion criteria included previous sinonasal surgery, tumor, sinusitis, septal perforation, and craniofacial trauma. Nasal septal deviation was characterized in the coronal plane by distance from the midline (severity) and height from the nasal floor. Measurement differences between sides for inferior turbinate width (overall and bone), medial mucosa, and distance to the lateral nasal wall were calculated as inferior turbinate hypertrophy indicators. The cohorts with and without concha bullosa were similarly matched for age, sex, and nasal septal deviation severity, though nasal septal deviation height was greater in the cohort with concha bullosa than in the cohort without concha bullosa (19.1 ± 4.3 mm versus 13.5 ± 4.1 mm, P < .001). Compensatory inferior turbinate hypertrophy was significantly greater in the cohort without concha bullosa than in the cohort with it as measured by side-to-side differences in turbinate overall width, bone width, and distance to the lateral nasal wall (P < .01), but not the medial mucosa. Multiple linear regression analyses found nasal septal deviation severity and height to be significant predictors of inferior turbinate hypertrophy with positive and negative relationships, respectively (P < .001). Inferior turbinate hypertrophy is directly proportional to nasal septal deviation severity and inversely proportional to nasal septal deviation height. The effect of a concha bullosa on inferior turbinate hypertrophy is primarily mediated through influence on septal

The need for an objective measure in septorhinoplasty surgery: are we any closer to finding an answer?

PubMed

Andrews, P J; Choudhury, N; Takhar, A; Poirrier, A L; Jacques, T; Randhawa, P S

2015-12-01

To assess the reliability of nasal inspiratory peak flow (NIPF) in providing a clinically accurate objective measure following functional septorhinoplasty by comparing it to the validated disease-specific quality-of-life questionnaire, SNOT-22. Studies so far have demonstrated poor correlation between bilateral NIPF and symptom-specific nasal questionnaires following septorhinoplasty. To perform a prospective comparative analysis between NIPF and the validated disease-specific quality-of-life questionnaire SNOT-22 and to determine whether a correlation exists following septorhinoplasty surgery. The Royal National Throat Nose and Ear Hospital, London. A total of 122 patients (78 males, 44 females; mean age 33.5 ± 12.2 years) were recruited from the senior authors rhinology clinic and underwent functional septorhinoplasty surgery. Preoperative and postoperative nasal inspiratory peak flow (NIPF) measurements were performed in addition to the completion of three subjective quality-of-life and symptom assessment tool questionnaires; Sinonasal Outcome Test 22 (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scale (VAS: 0-10). The mean preoperative NIPF was 88.2 L/min, and the postoperative value was 101.6 L/min and showed a significant improvement following surgery (P = 0.0064). The mean total SNOT-22 score improved significantly from 48.6 to 26.6 (P < 0.0001); the NOSE score from 14.1 to 6.6 (P < 0.0001); and the Visual Analogue Scale (VAS) blockage score from 6.9 to 3.2 (P < 0.0001). All individual domains assessed showed improvements postoperatively, but no correlation was found between the NIPF and SNOT-22 score. Equally, we did not find a correlation between NIPF and the symptom-specific NOSE questionnaire and the nasal blockage domain on the Visual Analogue Scale (VAS) scale. We have demonstrated that NIPF does not correlate with the SNOT-22 disease-specific questionnaire, although both outcomes significantly improve postoperatively. At

Relative influence on total cancelled operating room time from patients who are inpatients or outpatients preoperatively.

PubMed

Dexter, Franklin; Maxbauer, Tina; Stout, Carole; Archbold, Laura; Epstein, Richard H

2014-05-01

In previous studies, hospitals' operating room (OR) schedules were influenced markedly by decisions made within a few days of surgery. At least half of ORs had their last case scheduled or changed within 2 working days of surgery. In the current investigation, we studied whether many of these changes were due to patients who were admitted before surgery. We differentiated these "inpatients" from "outpatients" having ambulatory surgery or admitted on the day of surgery. From 21 facilities of a nonacademic health system throughout the United States, N = 5 eight-week periods of cancellation data were obtained. From an academic hospital, N = 8 thirteen-week periods of cancellation data were obtained, including detailed audit data with timestamps of the entire scheduling/rescheduling/cancellation history for each case. (1) In the non-academic health system, outpatients accounted for 1.6% ± 0.1% (SEM) of the scheduled minutes that were cancelled, whereas inpatients accounted for 8.1% ± 0.4%. Consequently, even though inpatients represented much less than half the total scheduled minutes of surgery (16.2% ± 0.5%, P < 0.0001), they accounted for approximately half of the total cancelled minutes (overall P = 0.55, 49% ± 2%; hospitals only P = 0.062, 57% ± 3%). (2) In the nonacademic health system, each 10% increase in a facility's percentage of outpatients making a physical visit to a preoperative clinic (versus only a preoperative phone call) was associated with a 0.0% ± 0.1% absolute decrease in cancelled minutes (P = 0.58). (3) In the academic hospital, inpatients accounted for 22.3% ± 0.4% of the scheduled minutes but most of the total cancelled minutes (70% ± 2%, P < 0.0001). Slightly more than half the total inpatient cancelled minutes (54% ± 1%, P = 0.006) were due to cases scheduled within 1 workday prior to the day of surgery (e.g., Friday for Monday, Monday for Tuesday). During this period, inpatient cancellation rates, measured in minutes, were several

Nasal microenvironments and interspecific interactions influence nasal microbiota complexity and S. aureus carriage.

PubMed

Yan, Miling; Pamp, Sünje J; Fukuyama, Julia; Hwang, Peter H; Cho, Do-Yeon; Holmes, Susan; Relman, David A

2013-12-11

The indigenous microbiota of the nasal cavity plays important roles in human health and disease. Patterns of spatial variation in microbiota composition may help explain Staphylococcus aureus colonization and reveal interspecies and species-host interactions. To assess the biogeography of the nasal microbiota, we sampled healthy subjects, representing both S. aureus carriers and noncarriers at three nasal sites (anterior naris, middle meatus, and sphenoethmoidal recess). Phylogenetic compositional and sparse linear discriminant analyses revealed communities that differed according to site epithelium type and S. aureus culture-based carriage status. Corynebacterium accolens and C. pseudodiphtheriticum were identified as the most important microbial community determinants of S. aureus carriage, and competitive interactions were only evident at sites with ciliated pseudostratified columnar epithelium. In vitro cocultivation experiments provided supporting evidence of interactions among these species. These results highlight spatial variation in nasal microbial communities and differences in community composition between S. aureus carriers and noncarriers. Copyright © 2013 Elsevier Inc. All rights reserved.

Nasal microenvironments and interspecific interactions influence nasal microbiota complexity and S. aureus carriage

PubMed Central

Yan, Miling; Pamp, Sünje J.; Fukuyama, Julia; Hwang, Peter H.; Cho, Do-Yeon; Holmes, Susan; Relman, David A.

2013-01-01

Summary The indigenous microbiota of the nasal cavity plays important roles in human health and disease. Patterns of spatial variation in microbiota composition may help explain Staphylococcus aureus colonization, and reveal interspecies and species-host interactions. To assess the biogeography of the nasal microbiota, we sampled healthy subjects, representing both S. aureus carriers and non-carriers, at 3 nasal sites (anterior naris, middle meatus, and sphenoethmoidal recess). Phylogenetic compositional and sparse linear discriminant analyses revealed communities that differed according to site epithelium type and S. aureus culture-based carriage status. Corynebacterium accolens and C. pseudodiphtheriticum were identified as the most important microbial community determinants of S. aureus carriage, with competitive interactions evident only at sites with ciliated pseudostratified columnar epithelium. In vitro co-cultivation experiments provided supporting evidence of interactions among these species. These results highlight spatial variation in nasal microbial communities and differences in community composition between S. aureus carriers and non-carriers. PMID:24331461

Outcome of accelerated radiotherapy alone or accelerated radiotherapy followed by exenteration of the nasal cavity in dogs with intranasal neoplasia: 53 cases (1990-2002).

PubMed

Adams, William M; Bjorling, Dale E; McAnulty, Jonathan E; Green, Eric M; Forrest, Lisa J; Vail, David M

2005-09-15

To compare long-term results of radiotherapy alone versus radiotherapy followed by exenteration of the nasal cavity in dogs with malignant intranasal neoplasia. Retrospective study. 53 dogs with malignant intranasal neoplasia. All dogs underwent radiotherapy consisting of administration of 10 fractions of 4.2 Gy each on consecutive weekdays. For dogs in the surgery group (n=13), follow-up computed tomography was performed, and dogs were scheduled for surgery if persistent or recurrent tumor was seen. Perioperative complications for dogs that underwent surgery included hemorrhage requiring transfusion (2 dogs) and subcutaneous emphysema (8). Rhinitis and osteomyelitis-osteonecrosis occurred significantly more frequently in dogs in the radiotherapy and surgery group (9 and 4 dogs, respectively) than in dogs in the radiotherapy-only group (4 and 3 dogs, respectively). Two- and 3-year survival rates were 44% and 24%, respectively, for dogs in the radiotherapy group and 69% and 58%, respectively, for dogs in the surgery group. Overall median survival time for dogs in the radiotherapy and surgery group (477 months) was significantly longer than time for dogs in the radiotherapy-only group (19.7 months). Results suggest that exenteration of the nasal cavity significantly prolongs survival time in dogs with intranasal neoplasia that have undergone radiotherapy. Exenteration after radiotherapy may increase the risk of chronic complications.

Shark island pedicle flap for repair of combined nasal ala-perialar defects.

PubMed

Cvancara, Joseph L; Wentzell, J Michael

2006-05-01

The combined nasal ala-perialar defect involving the concave intersection of the lateral nasal ala, nasal sidewall, cheek, and upper cutaneous lip is a problem for reconstructive surgery. During repair of combined cheek and nose defects, it is important not to blunt the alar facial sulcus. Defects involving these adjacent cosmetic units can be repaired by using combination procedures such as a flap/graft. Our purpose is to introduce, describe, and illustrate a one-stage flap repair descriptively named the "shark" island pedicle flap (SIPF). The SIPF was developed for a specific combined nasal ala-perialar defect. This reconstruction restores the natural contours, preserves cosmetic boundaries, and eliminates the need for pexing sutures and graft/flap combinations. The SIPF is an island pedicle flap with a superior arm that rotates 90 degrees into the wound. This arm repairs the alar portion of the defect. The advancing island pedicle flap repairs the alar facial sulcus. The 90 degrees rotation of the superior arm forces the alar portion of the flap to tilt 90 degrees relative to the remaining body of the flap, forming an inverted cone of redundancy. Natural re-creation of the lateral ala and the alar facial sulcus results. Illustrative examples with a descriptive technique are provided for the SIPF. A well-planned SIPF reconstruction can provide exceptional cosmetic and functional results. Cutaneous reconstructive surgeons will find the SIPF useful and reproducible in their armamentarium for single-stage aesthetic and functional repair of a specific combined lateral ala-adjacent perialar tissue defect.

Nasal mask ventilation is better than face mask ventilation in edentulous patients.

PubMed

Kapoor, Mukul Chandra; Rana, Sandeep; Singh, Arvind Kumar; Vishal, Vindhya; Sikdar, Indranil

2016-01-01

Face mask ventilation of the edentulous patient is often difficult as ineffective seating of the standard mask to the face prevents attainment of an adequate air seal. The efficacy of nasal ventilation in edentulous patients has been cited in case reports but has never been investigated. Consecutive edentulous adult patients scheduled for surgery under general anesthesia with endotracheal intubation, during a 17-month period, were prospectively evaluated. After induction of anesthesia and administration of neuromuscular blocker, lungs were ventilated with a standard anatomical face mask of appropriate size, using a volume controlled anesthesia ventilator with tidal volume set at 10 ml/kg. In case of inadequate ventilation, the mask position was adjusted to achieve best-fit. Inspired and expired tidal volumes were measured. Thereafter, the face mask was replaced by a nasal mask and after achieving best-fit, the inspired and expired tidal volumes were recorded. The difference in expired tidal volumes and airway pressures at best-fit with the use of the two masks and number of patients with inadequate ventilation with use of the masks were statistically analyzed. A total of 79 edentulous patients were recruited for the study. The difference in expiratory tidal volumes with the use of the two masks at best-fit was statistically significant (P = 0.0017). Despite the best-fit mask placement, adequacy of ventilation could not be achieved in 24.1% patients during face mask ventilation, and 12.7% patients during nasal mask ventilation and the difference was statistically significant. Nasal mask ventilation is more efficient than standard face mask ventilation in edentulous patients.

Tandem alternative polyadenylation events of genes in non-eosinophilic nasal polyp tissue identified by high-throughput sequencing analysis

PubMed Central

TIAN, PENG; LI, JIE; LIU, XIANG; LI, YUXI; CHEN, MEIHENG; MA, YUN; ZHENG, YI QING; FU, YONGGUI; ZOU, HUA

2014-01-01

Nasal polyps (NP) is highly associated with the disorder of immune cells. Alternative polyadenylation (APA) produces mRNA isoforms with different length of 3′-untranslated region (UTR) and regulates gene expression. It has been proven that this APA-mediated regulation of 3′UTR length is an immune-associated phenomenon. The aim of this study was to investigate the genome-wide alternative tandem 3′UTR length switching events in non-eosinophilic nasal polyp tissue. Thirteen patients diagnosed as having non-eosinophilic nasal polyps were included in this study. Nasal polyp tissue and control mucosa were collected during surgery. The 3′ end library of cDNA was constructed. The recovered libraries were sequenced with second sequencing technology, and the sequencing data were analyzed by an in-house bioinformatics pipeline. Tandem 3′UTR length switching between samples was detected by a test of linear trend alternative to independence. We found a significant alteration in the tandem 3′UTR length in 1,920 genes in nasal polyp samples. Functional annotation results showed that several gene ontology (GO) terms were enriched in the list of genes with switched APA sites, including regulation of transcription, macromolecule catabolic localization and mRNA processing. The results suggested that APA-mediated alternative 3′UTR regulation plays an important role in the post-transcriptional regulation of gene expression in non-eosinophilic nasal polyps. PMID:24715051

Bilateral fungiform papilloma with synchronous verrucous carcinoma of the nasal septum: a rare presentation and a literature review.

PubMed

Maithani, T; Dey, D; Pandey, A; Chawla, N

2012-04-01

Fungiform papillomas are benign mucosal neoplasms presenting as a unilateral exophytic mass involving the anterior portion of the nasal septum. In this study, we present an exceptional case of a bilateral fungiform papilloma with a synchronous verrucous carcinoma of the nasal septum. A case study with a review of the literature concerning malignant changes in fungiform papilloma. The general consensus in most of the literature is that malignant change in fungiform papilloma is exceptional. Our patient is probably the third reported case of verrucous carcinoma of the nasal septum, and the first report of a bilateral fungiform papilloma with a synchronous verrucous carcinoma. The tumour was subjected to complete surgical removal in the first instance. There was no recurrence at follow up seven months after surgery. Although fungiform papillomas are generally not premalignant, occasional malignant transformation may occur. Thus, they must be managed with the utmost cautiousness.

[Diagnosis and treatment of strabismus caused by nasal endoscopic surgery].

PubMed

Ai, L K; Wu, X; Wang, J N; Li, J; Wu, Y; Zhou, J; Song, W X; Guo, R L

2017-12-11

Objective: Strabismus with diplopia is the main orbital complication of functional endoscopic sinus surgery (FESS). This study was to analyze clinical findings, treatment and outcomes of such cases. Methods: Retrospective case series. Twenty-three cases were divided into 3 groups based on the disease severity: group A, partial transection of the medial rectus muscle, group B, complete transection of the medical rectus, group C, transection of the medial rectus combined with the other orbital injuries. Complete ophthalmology examinations, including eye alignment, eye motility, force duction test, force generation test, general eye exam, and medical imaging (orbital CT or MRI), were performed for each case. The treatment included botulinum toxin (Botox) injection to the lateral rectus muscle, transposition of the vertical rectus muscle, and orbital surgery if needed. Results: In group A with Botox injection, all the cases achieved single vision in primary position, but still remained some adduction weakness. In group B treated by vertical transposition surgery combined with Botox, 22% of the cases got single vision in primary gaze. In group C, even with more efforts of treatment, the cases with orbital injury can only get cosmetic improvement, and diplopia and adduction dysfunction were found in most cases. Conclusions: Due to the variety of the complications of FESS, force duction test is a crucial exam to detect the direction and severity of synechia in the orbit, which will give solid information to surgery approach as well as prognosis. Botox injection at early stage will minimize the contraction of antagonist lateral rectus, helping to postpone the transposition surgery which may cause anterior segment ischemia when performed right after the medial rectus transection injury. Botox may even reduce the synechia by minimizing the scarring process. Partial vertical rectus transposition combined with muscle resection may effectively correct the eye misalignment in

Sino-Nasal Outcome Test-22: Translation, Cross-cultural Adaptation, and Validation in Hebrew-Speaking Patients.

PubMed

Shapira Galitz, Yael; Halperin, Doron; Bavnik, Yosef; Warman, Meir

2016-05-01

To perform the translation, cross-cultural adaptation, and validation of the Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire to the Hebrew language. A single-center prospective cross-sectional study. Seventy-three chronic rhinosinusitis (CRS) patients and 73 patients without sinonasal disease filled the Hebrew version of the SNOT-22 questionnaire. Fifty-one CRS patients underwent endoscopic sinus surgery, out of which 28 filled a postoperative questionnaire. Seventy-three healthy volunteers without sinonasal disease also answered the questionnaire. Internal consistency, test-retest reproducibility, validity, and responsiveness of the questionnaire were evaluated. Questionnaire reliability was excellent, with a high internal consistency (Cronbach's alpha coefficient, 0.91-0.936) and test-retest reproducibility (Spearman's coefficient, 0.962). Mean scores for the preoperative, postoperative, and control groups were 50.44, 29.64, and 13.15, respectively (P < .0001 for CRS vs controls, P < .001 for preoperative vs postoperative), showing validity and responsiveness of the questionnaire. The Hebrew version of SNOT-22 questionnaire is a valid outcome measure for patients with CRS with or without nasal polyps. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Evaluation of factors associated with survival in dogs with untreated nasal carcinomas: 139 cases (1993-2003).

PubMed

Rassnick, Kenneth M; Goldkamp, Carrie E; Erb, Hollis N; Scrivani, Peter V; Njaa, Bradley L; Gieger, Tracy L; Turek, Michelle M; McNiel, Elizabeth A; Proulx, David R; Chun, Ruthanne; Mauldin, Glenna E; Phillips, Brenda S; Kristal, Orna

2006-08-01

To evaluate factors associated with survival in dogs with nasal carcinomas that did not receive treatment or received only palliative treatment. Retrospective case series. 139 dogs with histologically confirmed nasal carcinomas. Medical records, computed tomography images, and biopsy specimens of nasal carcinomas were reviewed. Only dogs that were not treated with radiation, surgery, chemotherapy, or immunotherapy and that survived > or = 7 days from the date of diagnosis were included. The Kaplan-Meier method was used to estimate survival time. Factors potentially associated with survival were compared by use of log-rank and Wilcoxon rank sum tests. Multivariable survival analysis was performed by use of the Cox proportional hazards regression model. Overall median survival time was 95 days (95% confidence interval [CI], 73 to 113 days; range, 7 to 1,114 days). In dogs with epistaxis, the hazard of dying was 2.3 times that of dogs that did not have epistaxis. Median survival time of 107 dogs with epistaxis was 88 days (95% CI, 65 to 106 days) and that of 32 dogs without epistaxis was 224 days (95% CI, 54 to 467 days). The prognosis of dogs with untreated nasal carcinomas is poor. Treatment strategies to improve outcome should be pursued.

Nosocomial Transmission of Respiratory Syncytial Virus in an Outpatient Cancer Center

PubMed Central

Chu, Helen Y.; Englund, Janet A.; Podczervinski, Sara; Kuypers, Jane; Campbell, Angela P.; Boeckh, Michael; Pergam, Steven A.; Casper, Crey

2014-01-01

Background Respiratory syncytial virus (RSV) outbreaks in inpatient settings are associated with poor outcomes in cancer patients. The use of molecular epidemiology to document RSV transmission in the outpatient setting has not been well described. Methods We performed a retrospective cohort study of two nosocomial outbreaks of RSV at the Seattle Cancer Care Alliance (SCCA). Subjects included patients seen at the SCCA with RSV detected in two outbreaks in 2007-2008 and 2012, and all employees with respiratory viruses detected in the 2007-2008 outbreak. A subset of samples was sequenced using semi-nested polymerase chain reaction targeting the RSV attachment glycoprotein coding region. Results Fifty-one cases of RSV were identified in 2007-2008. Clustering of identical viral strains was detected in 10 (67%) of 15 patients with RSV sequenced from 2007-2008. As part of a multimodal infection control strategy implemented as a response to the outbreak, symptomatic employees had nasal washes collected. Of 254 employee samples, 91 (34%) tested positive for a respiratory virus, including 14 with RSV. In another RSV outbreak in 2012, 24 cases of RSV were identified; nine (90%) of 10 patients had the same viral strain, and 1 (10%) had another viral strain. Conclusions We document spread of clonal strains within an outpatient cancer care setting. Infection control interventions should be implemented in outpatient, as well as inpatient, settings to reduce person-to-person transmission and limit progression of RSV outbreaks. PMID:24607551

Nasal Drug Delivery in Traditional Persian Medicine

PubMed Central

Zarshenas, Mohammad Mehdi; Zargaran, Arman; Müller, Johannes; Mohagheghzadeh, Abdolali

2013-01-01

Background Over one hundred different pharmaceutical dosage forms have been recorded in literatures of Traditional Persian Medicine among which nasal forms are considerable. Objectives This study designed to derive the most often applied nasal dosage forms together with those brief clinical administrations. Materials and Methods In the current study remaining pharmaceutical manuscripts of Persia during 9th to 18th century AD have been studied and different dosage forms related to nasal application of herbal medicines and their therapeutic effects were derived. Results By searching through pharmaceutical manuscripts of medieval Persia, different nasal dosage forms involving eleven types related to three main groups are found. These types could be derived from powder, solution or liquid and gaseous forms. Gaseous form were classified into fumigation (Bakhoor), vapor bath (Enkebab), inhalation (Lakhlakheh), aroma agents (Ghalieh) and olfaction or smell (Shomoom). Nasal solutions were as drops (Ghatoor), nasal snuffing drops (Saoot) and liquid snuff formulations (Noshoogh). Powders were as nasal insufflation or snorting agents (Nofookh) and errhine or sternutator medicine (Otoos). Nasal forms were not applied only for local purposes. Rather systemic disorders and specially CNS complications were said to be a target for these dosage forms. Discussion While this novel type of drug delivery is known as a suitable substitute for oral and parenteral administration, it was well accepted and extensively mentioned in Persian medical and pharmaceutical manuscripts and other traditional systems of medicine as well. Accordingly, medieval pharmaceutical standpoints on nasal dosage forms could still be an interesting subject of study. Therefore, the current work can briefly show the pharmaceutical knowledge on nasal formulations in medieval Persia and clarify a part of history of traditional Persian pharmacy. PMID:24624204

Impact of endoscopic sinus surgery on olfaction and use of alternative components in odor threshold measurement.

PubMed

Gupta, Divya; Gulati, Achal; Singh, Ishwar; Tekur, Uma

2015-01-01

One of the major causes of olfactory disturbances is chronic rhinosinusitis (CRS), and the main surgical modality to treat CRS is functional endoscopic sinus surgery (FESS). It, therefore, is essential to assess the effect of this surgery on olfaction. Also, it is necessary to find new ways of measuring olfaction so as to reduce dependability on standard tests available. To study the prevalence of olfactory impairment in patients with CRS and to evaluate the impact of FESS on olfaction. The study also aims at investigating the use of other odorants in place of butanol-1 in the Connecticut Chemosensory Clinical Research Center test. Forty patients of CRS without nasal polyposis were included in the study to analyze the prevalence of olfactory dysfunction and examine the influence of FESS at 1 and 3 months after surgery. Computed tomography scores (Lund Mackay scores) were calculated preoperatively, whereas other tests, viz., visual analog scale scoring, nasal endoscopy (Lund Kennedy scoring), and composite olfactory testing with odor thresholds of butanol-1, peppermint, lemon, clove, and ethyl acetate were carried out before surgery and after surgery at 1 and 3 months. Of 40 patients, 70% had symptoms of hyposmia or of anosmia before surgery, which dropped to 22.5% at 1 month after surgery and to 10% at 3 months after surgery. Nasal endoscopy and visual analog scale scores improved significantly. Odor threshold and odor identification scores also improved compared with the preoperative levels. A significant positive correlation was found between the threshold scores of butanol-1 and other odorants, both before and after surgery. Significant improvement was observed in olfaction after FESS, both in patient responses and in objective testing. The olfactory results with peppermint, lemon, clove, and ethyl acetate were close to those with butanol-1, and, hence, these other odorants can be used in place of butanol-1 in measuring the odor threshold.

Comparison of two nasoalveolar molding techniques in unilateral complete cleft lip patients: a randomized, prospective, single-blind trial to compare nasal outcomes.

PubMed

Chang, Chun-Shin; Wallace, Christopher Glenn; Pai, Betty Chien-Jung; Chiu, Yu-Ting; Hsieh, Yuh-Jia; Chen, I-Ju; Liao, Yu-Fang; Liou, Eric Jen-Wein; Chen, Philip Kuo-Ting

2014-08-01

Nasoalveolar molding became increasingly popular in the 1990s as a means of easing surgery and improving nasal outcomes for cleft lip repairs. In the late 1990s, three orthodontists from our center underwent nasoalveolar molding training: two at the Rush Craniofacial Center, in Chicago; and one at New York University Craniofacial Center. They brought two different nasoalveolar molding techniques back to Chang Gung Craniofacial Center: the modified Figueroa and the modified Grayson techniques. Outcomes following use of these techniques have not previously been compared prospectively. Between May of 2010 and March of 2013, a randomized, prospective, single-blind trial was conducted to compare the number of clinical visits, total costs, complications, and nasal symmetry between the two nasoalveolar molding techniques in 30 patients with unilateral complete cleft lip. There were no differences between nasoalveolar molding techniques in the number of clinical visits, total costs, nostril height, or nostril area ratio. Preoperatively but after nasoalveolar molding, the nostril width ratio was wider for the Figueroa group than for the Grayson group. Six months after surgical correction, there were no differences in nostril height, nostril width, nasal sill height, or nostril area ratio between nasoalveolar molding methods. Alveolar ulceration occurred more frequently in the Grayson group. The modified Grayson technique reduced nostril width more efficiently, but alveolar ulceration was more frequent and no differences in nostril width were found following surgery. Overall, the two nasoalveolar molding techniques produced similar nasal outcomes. Therapeutic, II.

Accumulation of CD69+ tissue‑resident memory T cells in the nasal polyps of patients with chronic rhinosinusitis.

PubMed

Ickrath, Pascal; Kleinsasser, Norbert; Ding, Xin; Ginzkey, Christian; Beyersdorf, Niklas; Hagen, Rudolf; Kerkau, Thomas; Hackenberg, Stephan

2018-08-01

In patients with chronic rhinosinusitis with nasal polyps (CRSwNP), a relative accumulation of cluster of differentiation (CD)8+ T cells over CD4+ T cells occurs in nasal polyps compared with the peripheral blood. Nasal CD8+ T cells and CD4+ T cells predominantly present an effector memory phenotype. Immunological studies have reported that memory T cells recirculate from the tissues to the peripheral blood and a high percentage of these T cells persist within the tissue. The aim of the present study was to characterize CD69+ sphingosine‑1‑phosphate receptor 1 (S1PR1)‑ tissue resident memory T cells (Trm) in the polyps of patients with CRSwNP. Tissue and blood samples were collected from 10 patients undergoing nasal sinus surgery. Expression of specific extra‑ and intracellular molecules were analyzed using multicolor flow cytometry. A significantly higher level of CD8+ T cells than CD4+ T cells was present in nasal polyps, while significantly more CD4+ T cells than CD8+ T cells were detected in the peripheral blood of patients with CRSwNP. The frequency of CD69+ T cells was significantly higher in CD8+ and CD4+ T cells in nasal polyps compared with the peripheral blood. The frequency of CD69+ S1PR1‑ Trm was also significantly higher in CD4+ and CD8+ T cells from nasal polyps compared with the peripheral blood. Within polyps, the frequency of CD69+ S1PR1‑ Trm was again significantly higher in CD8+ compared with CD4+ T cells. In summary, a significantly higher frequency of CD69+ S1PR1‑ T cells was observed in the nasal polyps compared with the peripheral blood in patients with CRSwNP. The results of the present study suggest that local regulation of the immune response occurs within nasal polyps. As such, Trm should be considered a potential stimulus in the pathogenesis of nasal polyps. However, the role of Trm in nasal polyps as a pathogenic trigger of the local inflammatory reaction requires further investigation.

A new approach to the treatment of nasal bone fracture: radiologic classification of nasal bone fractures and its clinical application.

PubMed

Han, Daniel Seung Youl; Han, Yea Sik; Park, Jin Hyung

2011-11-01

A radiologic examination is required in the treatment of nasal bone fracture to determine the fracture condition. Thus, there is an increasing need for radiologic classification of nasal bone fractures that can be applied to clinical practice. Computed tomography was performed in 125 patients with nasal bone fractures to determine which axial view best showed the entire nasal view. The obtained axial view was then used as a reference for classification. The length from the top to the base of the nasal bone was divided into upper, middle, and lower levels, after which the fracture location was determined. If the fracture spanned the boundaries of these levels, it was classified as the total level. Subsequently, the fracture was subclassified based on the fracture direction and pattern and the concurrent fracture. Radiologic examination of patients with nasal bone fracture showed that nasal bone fracture was frequently found at the total, middle, upper, and lower levels, in that order. Nasal bone fractures at the upper level showed lower frequencies of complication and reoperation than the fractures at the other levels, whereas nasal bone fractures at the total level showed the highest frequencies of complication and reoperation. Radiologic classification can be useful for preoperative and postoperative evaluations of nasal bone fractures and can be helpful in understanding such fractures because it can efficiently predict the prognosis of a fracture. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Nasal and Oral Inspiration During Natural Speech Breathing

PubMed Central

Lester, Rosemary A.; Hoit, Jeannette D.

2015-01-01

Purpose The purpose of this study was to determine the typical pattern for inspiration during speech breathing in healthy adults, as well as the factors that might influence it. Method Ten healthy adults, 18–45 years of age, performed a variety of speaking tasks while nasal ram pressure, audio, and video recordings were obtained. Inspirations were categorized as a nasal only, oral only, simultaneous nasal and oral, or alternating nasal and oral inspiration. The method was validated using nasal airflow, oral airflow, audio, and video recordings for two participants. Results The predominant pattern was simultaneous nasal and oral inspirations for all speaking tasks. This pattern was not affected by the nature of the speaking task or by the phonetic context surrounding the inspiration. The validation procedure confirmed that nearly all inspirations during counting and paragraph reading were simultaneous nasal and oral inspirations; whereas for sentence reading, the predominant pattern was alternating nasal and oral inspirations across the three phonetic contexts. Conclusions Healthy adults inspire through both the nose and mouth during natural speech breathing. This pattern of inspiration is likely beneficial in reducing pathway resistance while preserving some of the benefits of nasal breathing. PMID:24129013

Effect of pre-operative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery.

PubMed

Reiser, M; Scherag, A; Forstner, C; Brunkhorst, F M; Harbarth, S; Doenst, T; Pletz, M W; Hagel, S

2017-02-01

To evaluate the effect of pre-operative octenidine (OCT) decolonization on surgical site infection (SSI) rates. Before-and-after cohort study. Patients undergoing an elective isolated coronary artery bypass graft (CABG) procedure: control group (1 st January to 31 st December 2013), N=475; intervention group (1 st January to 31 st December 2014), N=428. The intervention consisted of nasal application of OCT ointment three times daily, beginning on the day before surgery, and showering the night before and on the day of surgery with OCT soap. A median sternotomy was performed in 805 (89.1%) patients and a minimally invasive direct coronary artery bypass procedure was performed in 98 (10.9%) patients. Overall, there was no difference in SSI rates between the control and intervention groups (15.4% vs 13.3%, P=0.39). The rate of harvest site SSIs was significantly lower in patients in the intervention group (2.5% vs 0.5%, P=0.01). Patients who had undergone a median sternotomy in the intervention group had a significantly lower rate of organ/space sternal SSIs (1.9% vs 0.3%, P=0.04). However, there was a trend towards an increased rate of deep incisional sternal SSIs (1.2% vs 2.9%, P=0.08). Multi-variate analysis did not identify a significant protective effect of the intervention (odds ratio 0.79, 95% confidence interval 0.53-1.15, P=0.27). Pre-operative decolonization with OCT did not reduce overall SSI rates in patients undergoing an elective isolated CABG procedure, but significantly decreased harvest site and organ/space sternal SSIs. Randomized controlled trials, including controlled patient adherence to the intervention, are required to confirm these observations and to determine the clinical utility of OCT in pre-operative decolonization. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Oronasal Masks Require a Higher Pressure than Nasal and Nasal Pillow Masks for the Treatment of Obstructive Sleep Apnea

PubMed Central

Deshpande, Sheetal; Joosten, Simon; Turton, Anthony; Edwards, Bradley A.; Landry, Shane; Mansfield, Darren R.; Hamilton, Garun S.

2016-01-01

Study Objectives: Oronasal masks are frequently used for continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). The aim of this study was to (1) determine if CPAP requirements are higher for oronasal masks compared to nasal mask interfaces and (2) assess whether polysomnography and patient characteristics differed among mask preference groups. Methods: Retrospective analysis of all CPAP implementation polysomnograms between July 2013 and June 2014. Prescribed CPAP level, polysomnography results and patient data were compared according to mask type (n = 358). Results: Oronasal masks were used in 46%, nasal masks in 35% and nasal pillow masks in 19%. There was no difference according to mask type for baseline apnea-hypopnea index (AHI), body mass index (BMI), waist or neck circumference. CPAP level was higher for oronasal masks, 12 (10–15.5) cm H2O compared to nasal pillow masks, 11 (8–12.5) cm H2O and nasal masks, 10 (8–12) cm H2O, p < 0.0001 (Median [interquartile range]). Oronasal mask type, AHI, age, and BMI were independent predictors of a higher CPAP pressure (p < 0.0005, adjusted R2 = 0.26.). For patients with CPAP ≥ 15 cm H2O, there was an odds ratio of 4.5 (95% CI 2.5–8.0) for having an oronasal compared to a nasal or nasal pillow mask. Residual median AHI was higher for oronasal masks (11.3 events/h) than for nasal masks (6.4 events/h) and nasal pillows (6.7 events/h), p < 0.001. Conclusions: Compared to nasal mask types, oronasal masks are associated with higher CPAP pressures (particularly pressures ≥ 15 cm H2O) and a higher residual AHI. Further evaluation with a randomized control trial is required to definitively establish the effect of mask type on pressure requirements. Commentary: A commentary on this article appears in this issue on page 1209. Citation: Deshpande S, Joosten S, Turton A, Edwards BA, Landry S, Mansfield DR, Hamilton GS. Oronasal masks require a higher pressure than nasal and

Institutional charges and disparities in outpatient brain biopsies in four US States: the State Ambulatory Database (SASD).

PubMed

Bekelis, Kimon; Missios, Symeon; Roberts, David W

2013-11-01

Several groups have demonstrated the safety of ambulatory brain biopsies, with no patients experiencing complications related to early discharge. Although they appear to be safe, the reasons factoring into the selection of patients have not been investigated. We performed a cross-sectional study involving 504 patients who underwent outpatient and 10,328 patients who underwent inpatient brain biopsies and were registered in State Ambulatory Surgery Databases and State Inpatient Databases respectively for four US States (New York, California, Florida, North Carolina). In a multivariate analysis private insurance (OR 2.45, 95 % CI, 1.85, 3.24), was significantly associated with outpatient procedures. Higher Charlson Comorbidity Index (OR 0.16, 95 % CI, 0.08, 0.32), high income (OR 0.37, 95 % CI, 0.26, 0.53), and high volume hospitals (OR 0.30, 95 % CI, 0.23, 0.39) were associated with a decreased chance of outpatient procedures. No sex, or racial disparities were observed. Institutional charges were significantly less for outpatient brain biopsies. There was no difference in the rate of 30-day postoperative readmissions among inpatient and outpatient procedures. The median charge for inpatient surgery was 51,316 as compared to 12,266 for the outpatient setting (P < 0.0001, Student's t test). Access to ambulatory brain biopsies appears to be more common for patients with private insurance and less comorbidities, in the setting of lower volume hospitals. Further investigation is needed in the direction of mapping these disparities in resource utilization.

Phenotype and function of nasal dendritic cells

PubMed Central

Lee, Haekyung; Ruane, Darren; Law, Kenneth; Ho, Yan; Garg, Aakash; Rahman, Adeeb; Esterházy, Daria; Cheong, Cheolho; Goljo, Erden; Sikora, Andrew G.; Mucida, Daniel; Chen, Benjamin; Govindraj, Satish; Breton, Gaëlle; Mehandru, Saurabh

2015-01-01

Intranasal vaccination generates immunity across local, regional and distant sites. However, nasal dendritic cells (DC), pivotal for the induction of intranasal vaccine- induced immune responses, have not been studied in detail. Here, using a variety of parameters, we define nasal DCs in mice and humans. Distinct subsets of “classical” DCs, dependent on the transcription factor zbtb46 were identified in the murine nose. The murine nasal DCs were FLT3 ligand-responsive and displayed unique phenotypic and functional characteristics including the ability to present antigen, induce an allogeneic T cell response and migrate in response to LPS or live bacterial pathogens. Importantly, in a cohort of human volunteers, BDCA-1+ DCs were observed to be the dominant nasal DC population at steady state. During chronic inflammation, the frequency of both BDCA-1+ and BDCA-3hi DCs was reduced in the nasal tissue, associating the loss of these immune sentinels with chronic nasal inflammation. The present study is the first detailed description of the phenotypic, ontogenetic and functional properties of nasal DCs and will inform the design of preventative immunization strategies as well as therapeutic modalities against chronic rhinosinusitis. PMID:25669151