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Nomura T, Muneuchi G. Comparison of Polyvinyl Alcohol Sponge and Gauze Packing for Nasal Fracture Treatment: An Efficacy and Safety Analysis. J Craniofac Surg 2024:00001665-990000000-01650. [PMID: 38819158 DOI: 10.1097/scs.0000000000010388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024] Open
Abstract
Nasal fractures are commonly treated using nasal packing as an internal splint after performing closed reduction. Although gauze and polyvinyl alcohol sponge (PVAS) are both commonly used for packing, few reports have compared their efficacy and safety in nasal fracture treatment. Therefore, in this study, the authors, aimed to retrospectively compare the efficacy and safety of gauze packing in 208 patients and PVAS packing in 225 patients who underwent closed reduction at our hospital. The proportions of patients requiring revision surgery did not differ significantly between the PVAS and gauze groups (P=0.627). However, in comparison to the gauze group, the PVAS group displayed significantly fewer instances of uncontrolled epistaxis following packing removal, as well as fewer occurrences of dropout and loss of packing (P=0.023, P=0.007, and P<0.001, respectively). The results of logistic regression analysis adjusted for confounding factors also showed that compared with the gauze group, the PVAS group was significantly less likely to experience packing dropout (odds ratio=0.13; 95% confidence interval, 0.06-0.29, P<0.001) for which younger and older age and allergic rhinitis were independent risk factors. In conclusion, both gauze and PVAS are effective packing materials as internal splints after closed reduction of nasal bone fractures. Specifically, PVAS utilization warrants consideration in pediatric and geriatric populations, individuals with allergic rhinitis, and those at elevated risk of bleeding.
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Affiliation(s)
- Takeshi Nomura
- Department of Plastic and Reconstructive Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka
- Department of Public Health, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gan Muneuchi
- Department of Plastic and Reconstructive Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka
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Tripathi PB, Majd P, Ngo T, Gu JT, Sharma GK, Badger C, Bhandarkar ND, Wong BJF. Evaluation of Safety and Efficacy for an Intranasal Airway Device in Nasal Surgery. JAMA FACIAL PLAST SU 2020; 21:38-43. [PMID: 30193353 DOI: 10.1001/jamafacial.2018.0955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Postoperative packing in nasal surgery often results in nasal obstruction and discomfort. Commercially available silicone intranasal airways (IAs) serve as dual-nasal airway tubes aimed at alleviating this process, but the safety and efficacy of these devices are unknown. Objective To evaluate the safety and efficacy of an intraoperatively placed IA device in rhinoplasty and nasal surgery. Design, Setting, and Participants In this retrospective record review, the medical records of patients undergoing nasal surgery with insertion of the IA at a single institution from 2012 to 2017 were reviewed. After review of over 200 patients, a questionnaire was developed to assess device efficacy. Exposures Use of the IA device. The IA is 12 cm long, anchored across the columella, extends distally along the nasal floor, and has a proximal external portion used for cleaning and maintaining patency. Placed intraoperatively, the device aims to support air flow postoperatively in the face of edema, hemorrhage, and packing. Results A total of 302 operations in 300 patients were analyzed, including primary and revision septorhinoplasty. A total of 24 (7.9%) patients self-removed or inadvertently dislodged the IA. Minor acute postoperative complications not unique to airway insertion included cellulitis in 4 (1.3%) participants and epistaxis in 6 (2%). Postoperatively, 1 (0.3%) patient developed dehiscence along transcolumellar incisions. A total of 59 patients (100% compliance) completed the efficacy questionnaire. The mean breathing score was between good and average (2.9 of 5), comfort scores between comfortable and average (2.9 of 5), and mean ease of irrigation score was between very easy and easy (1.96 of 5). The device was irrigated on average 3.57 times per day. A total of 43 (76%) particpiants had full patency or only partial obstruction, compared with 13 (24%) patients with total obstruction. In all patients, with or without obstruction, the effect lasted an average of 4 days. Conclusions and Relevance The device is safe and well-tolerated for maintaining patency of the nasal airway in patients undergoing rhinoplasty and nasal reconstruction without increased risk of incisional dehiscence. Level of Evidence 4.
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Affiliation(s)
- Prem B Tripathi
- Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California
| | - Pejman Majd
- Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California.,University of California Irvine School of Medicine, Irvine, California
| | - Tuan Ngo
- Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California.,University of California Irvine School of Medicine, Irvine, California
| | - Jefferey T Gu
- University of California Irvine School of Medicine, Irvine, California.,The Beckman Laser Institute and Medical Clinic, Irvine, California
| | - Giriraj K Sharma
- Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California
| | - Christopher Badger
- University of California Irvine School of Medicine, Irvine, California.,The Beckman Laser Institute and Medical Clinic, Irvine, California
| | - Naveen D Bhandarkar
- Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California
| | - Brian J F Wong
- Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California.,The Beckman Laser Institute and Medical Clinic, Irvine, California
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Zhu J, Liu J, Shen G, Zhong T, Yu X. Comparison of Efficacy Outcomes of Lidocaine Spray, Topical Lidocaine Injection, and Lidocaine General Anesthesia in Nasal Bone Fractures Surgeries: A Randomized, Controlled Trial. Med Sci Monit 2018; 24:4386-4394. [PMID: 29941861 PMCID: PMC6050998 DOI: 10.12659/msm.908468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Lidocaine is widely used as a general and local anesthetic in minor or major surgeries. The objective of the study was to compare postoperative pain relief and adverse events using different forms of lidocaine administration in patients following closed nasal bone reduction surgery. Material/Methods A total of 381 patients with a solitary nasal fracture that could be managed with closed reduction were included in this study and divided into 3 groups of 127 patients in each group. Patients had received 1% lidocaine HCl with epinephrine (LL group), inserted a mesh impregnated with lidocaine spray (TL group), or 1 mg/kg/h lidocaine infusion (GL group) before surgeries. Patients also received morphine when the pain was not controlled. The postoperative pain was assessed at 6 hours and 48 hours after surgery. Postoperative vomiting and nausea were evaluated. Repeated ANOVA/Tukey-Kramer multiple comparisons test was performed at 95% confidence level. Results At 6 hours after surgery, patients in the general lidocaine (GL) group reported decreased postoperative pain compared with those in the topical lidocaine (TL) group (P<0.001, q=6.633) and LL group (P<0.001, q=8.056). The morphine consumption within 48 hours was least in GL group than TL group (P<0.001, q=172.9) and LL group (P<0.001, q=226.42). Lidocaine infusion caused nausea (P<0.001, q=6.742) and vomiting (P<0.001, q=4.306). Conclusions Topical lidocaine anesthesia had the same postoperative pain relief and the least adverse events as local and general lidocaine anesthesia.
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Affiliation(s)
- Jihong Zhu
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Jian Liu
- Department of General Surgery, Wuyi Traditional Chinese Medical Hospital, Jinhua, Zhejiang, China (mainland)
| | - Guoying Shen
- Our-Patient Department, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Taidi Zhong
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Xin Yu
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
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Abstract
BACKGROUND It has been advocated that reduction of nasal bone fractures should be followed by internal packing and/or external splinting. Despite the ample literature concerning the advantages and limitations of various splint types, the necessity and effectiveness of external splinting has not been well documented. OBJECTIVE To present the authors' experience and review the literature on treatment of nasal bone fractures, focusing on the indications and effectiveness of external splinting following closed reduction. STUDY DESIGN Retrospective analysis and literature review. PATIENTS AND METHODS Medical records of all patients, treated at the Department of Oral and Maxillofacial Surgery of the "KAT" General Hospital of Attica between January 2010 and December 2016 for facial trauma including nasal bone fractures, were retrospectively reviewed. Patient demographic data, fracture type, applied treatment, complications, and final outcome were registered. RESULTS A total of 77 patients (58 males; 19 females) were included in the study. The age range was 18 to 65 years (mean, 37.8). Closed reduction without external splinting was performed in 63 patients and open reduction with internal fixation in 6; 8 severely comminuted fractures were treated with closed reduction and external splinting. The mean follow-up was 4.8 months. All severely comminuted fractures presented complications. CONCLUSIONS External splinting following closed reduction of nasal bone fractures should not be used routinely but only in selected patients with severe comminution. Since the pertinent literature is inconclusive on the indications and effectiveness of external splinting, randomized controlled studies are warranted to fully elucidate the issue.
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Bequignon E, Vérillaud B, Robard L, Michel J, Prulière Escabasse V, Crampette L, Malard O, Malard O, Crampette L, Achache M, Alaoui Lamrani Y, Ardillon L, Babin E, Bal Dit Sollier C, Bequignon E, Borsik M, Castillo L, Coste A, Debry C, Dessi P, Drouet L, Dufour X, Dupuis-Girod S, Faure F, Gallet P, Guldman R, Houdart E, Jankowski R, Jegoux F, Leble S, Michel J, Mortuaire G, Mouchon E, Page C, Prulière Escabasse V, Robard L, Roux A, Saint Maurice J, Sarlon G, Strunski V, Trevillot V, Vérillaud B, Vironneau P. Guidelines of the French Society of Otorhinolaryngology (SFORL). First-line treatment of epistaxis in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:185-189. [DOI: 10.1016/j.anorl.2016.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shahi RG, Tanaka T, Towns S, Forrest A, Blanchard SB. Novel Approach for Lateral Window Sinus Membrane Elevation Using Medical Grade Polyurethane Sponges: Case Report. Clin Adv Periodontics 2017. [DOI: 10.1902/cap.2017.160014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rana G. Shahi
- Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry, Indianapolis, IN
| | - Tsuyoshi Tanaka
- Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry, Indianapolis, IN
| | - Stephen Towns
- Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry, Indianapolis, IN
- Private practice, Indianapolis, IN
| | | | - Steven B. Blanchard
- Department of Periodontics and Allied Dental Programs, Indiana University School of Dentistry, Indianapolis, IN
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Identifying preoperative factors associated with the postoperative nasal synechia in patients undergoing closed reduction of the nasal bone fracture. J Craniofac Surg 2016; 26:849-52. [PMID: 25901673 DOI: 10.1097/scs.0000000000001577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We conducted this study to identify preoperative factors that are associated with the postoperative nasal synechiae in patients with nasal bone fracture who underwent closed reduction.In the current single-center, retrospective study, we evaluated the fracture type, septal deviation angle (SDA), synechia scores (SSs) and visual analog scale (VAS) scores through a retrospective review of the medical records and computed tomography scans of 42 patients (n = 42) who had undergone closed reduction for nasal bone fracture at our medical institution during a period ranging from April to August 2013.The mean SS was significantly lower in the plane I group (n = 25) as compared with the plane II group (n = 17) (1.28 ± 1.77 vs 2.76 ± 1.89, P = 0.013). There was a significant positive correlation between the SDA and the SS with a formula of SS = 0.216SDA - 0.322 (r(2) = 0.532, P < 0.001) and between the SS and the VAS with a formula of VAS = 1.280SS + 0.612 (r(2) = 0.648, P < 0.001). Both the SS and VAS were significantly higher on the convex side as compared with the concave side of the nasal cavity.Our results indicate that patients with higher SDA or combined septal fractures might be at increased risks of developing the postoperative synechiae. Further large-scale, prospective studies are warranted to establish our results.
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