Evaluation of benign paroxysmal positional vertigo following Le Fort I osteotomy

Assessment of Benign Paroxysmal Positional Vertigo (BPPV) Incidence Following Closed Sinus Lift and Ridge Splitting Surgeries: A Cohort Study

Background

With a notable increase in demand for implant placement in atrophic cases, this study aimed to evaluate the occurrence of benign paroxysmal positional vertigo (BPPV) following closed sinus lift and ridge splitting surgeries.

Materials and Methods

Healthy patients requiring posterior maxillary closed sinus lift or ridge split surgeries at Mashhad Dental School from September 2021 to September 2022 were enrolled in this cohort study. A single surgeon performed all surgeries under standard protocols. The intervention groups consisted of closed sinus lift and ridge splitting procedures. The primary outcome variable was BPPV, and the Dix-Hallpike maneuver was used before and after the operation to diagnose BPPV. The data were statistically analyzed using SPSS 23, and the significance level was set at 0.05.

Results

A total of 112 patients (51 women and 61 men) with a mean age of 48.4 ± 9.5 years participated in the study. The average BMI was 21.5 ± 2.4, and the mean duration of surgery was 31.9 ± 6.6 min. Of the patients, 10.7, 36.6, 27.7, 12.5, and 1.8% presented with hypertension, headache, dizziness, nausea, and BPPV, respectively. Two patients (3.1%) in the closed sinus lift group were diagnosed with BPPV, whereas no patients in the ridge split group were diagnosed. However, there was no significant difference (P = 0.509). No statistically significant difference in the occurrence of certain symptoms between two groups was found. There was a significant association between certain health conditions and the onset of BPPV.

Conclusion

The study suggests closed sinus lift surgery may have a higher risk of BPPV than ridge split surgery, but further studies with larger sample are needed to confirm this association.

Comparisons of Auditory and Vestibular Functions After Septorhinoplasty Performed with the Micro-compass Saw Technique and the Classical Technique

AIM

To evaluate hearing and labyrinth functions following different osteotomy types (micro-compass saw, osteotome, and no osteotomy) performed in septorhinoplasty operations.

MATERIAL AND METHOD

The study included 74 patients operated between January 2020 and March 2022, separated into 3 groups: Group 1: 24 patients (16 females and 8 males): osteotome was used for the osteotomy; Group 2: 24 patients (12 females and 12 males): micro-saw was used for osteotomy; and Group 3: 26 patients (17 females and 9 males): open technique septoplasty with no osteotomy. At 1 day before and 1 week after the operation, all the patients underwent audiological examination, tympanometry, vestibular evoked myogenic potentials (c-VEMP), video head impulse test (v-HIT), videonystagmography (VNG), and distortion product otoacoustic emission (DPOAE) tests.

RESULTS

In the c-VEMP tests, significant differences were determined between the groups in respect of N1, P1, and N1-P1 latencies and N1-P1 amplitudes before and after the operation. In the v-HIT test, the change in right-side posterior gain postoperatively was statistically significant in the micro-saw group (p<0.05). The postoperative right lateral canal values were determined to be statistically significantly increased in the micro-saw group compared to the osteotome group (p<0.05).

CONCLUSION

This is the only study in the literature to have determined vestibular effects with the evaluation of such a wide range of techniques. Previous studies in the literature have found no effect of osteotomy technique on the balance and hearing systems. The results of this study demonstrated that the preoperative and postoperative difference between the osteotomy techniques had an effect on the balance system. The change in the balance tests following an operation with classic osteotomy shows a greater predisposition to benign positional vertigo. In this sense, the micro-saw can be considered safer. Level of Evidence II 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 Risk of Benign Paroxysmal Positional Vertigo After Head Trauma

OBJECTIVES

Head trauma may cause dislodgement of otoconia and development of benign paroxysmal positional vertigo (BPPV). The risk of developing BPPV is expected to be highest shortly after the trauma, then decrease and approach the risk seen in the general population. The aim of this study was to estimate the risk-time curve of BPPV development after head trauma.

STUDY DESIGN

Prospective observational study.

METHODS

Patients with minimal, mild, or moderate head trauma treated at the Department of Neurosurgery or the Department of Orthopedic Emergency at Oslo University Hospital, were interviewed and examined for BPPV using the Dix-Hallpike and supine roll maneuvers. BPPV was diagnosed according to the International diagnostic criteria of the Bárány Society. Telephone interviews were conducted at 2, 6, and 12 weeks after the first examination.

RESULTS

Out of 117 patients, 21% developed traumatic BPPV within 3 months after the trauma. The corresponding numbers were 12% with minimal trauma, 24% with mild, and 40% with moderate trauma. The difference in prevalence between the groups was significant (P = .018). During the first 4 weeks after the trauma, it was observed 20, 3, 0, and 1 BPPV onsets, respectively. No BPPV cases were seen for the remainder of the 3-month follow-up.

CONCLUSION

The risk of developing BPPV after minimal-to-moderate head trauma is considerable and related to trauma severity. Most cases occur within few days after the trauma, but any BPPV occurring within the first 2 weeks after head trauma are likely due to the traumatic event.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021.

Potential Risk of Benign Paroxysmal Positional Vertigo Due To Traumatic Effect of Osteotomy in Septorhinoplasty Patients

PURPOSE

We investigated the effect of osteotomy on the vestibular system in septorhinoplasty patients and determined the potential risk of benign paroxysmal positional vertigo (BPPV) in these patients.

PATIENTS AND METHODS

In the present prospective study, 47 primary septorhinoplasty patients were evaluated as the study group and 50 septoplasty patients as the control group. Osteotomy was performed in all septorhinoplasty patients. No hammer and osteotomes were used in the control group. All patients underwent static balance tests (tandem stance test, 1-leg standing test, and Romberg test), dynamic balance tests (tandem walking test and Fukuda test), positional balance tests (Dix-Hallpike test and supine roll test), head impulse test, and the adult dizziness handicap inventory (ADHI) preoperatively and during the first postoperative week.

RESULTS

No significant differences were found between the 2 groups in terms of the static balance tests, dynamic balance tests, positional balance tests, or head impulse test results. The postoperative ADHI scores were significantly worse in the septorhinoplasty patient group than in the control group. Posterior semicircular canal BPPV was observed in 2 patients in the septorhinoplasty group but none in the control group.

CONCLUSIONS

BPPV is one of the possible early postoperative complications of rhinoplasty. In patients with vertigo after rhinoplasty, surgeons should evaluate the semicircular canals using the Dix-Hallpike and supine roll tests. To avoid the traumatic effect of osteotomy reflected on the inner ear, attention should be given to the applied force, and sharp osteotomes should be used.