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Lin JS, Won P, Lin ME, Ayo-Ajibola O, Luu NN, Markarian A, Moayer R. Factors Associated With Head and Neck Polytrauma Presentation and Admissions at Emergency Departments of Varying Sizes. J Craniofac Surg 2024:00001665-990000000-01667. [PMID: 38830051 DOI: 10.1097/scs.0000000000010371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/04/2024] [Indexed: 06/05/2024] Open
Abstract
Timely diagnosis of acute head and neck polytrauma presenting to emergency departments (EDs) optimizes outcomes. Since ED capacity influences triage and admission, the authors utilized the National Electronic Injury Surveillance System database to understand how ED size and trauma characteristics affect head and neck polytrauma presentation and admissions. Demographics and injury characteristics from the National Electronic Injury Surveillance System database from 2018 to 2021 were analyzed to delineate factors contributing to polytrauma presence and admission through multivariable logistic regressions. The authors' 207,951-patient cohort was primarily females (48.6%), non-Hispanic (62.4%), and white (51.4%) people who averaged 57.2 years old. Nonspecific head injuries were predominant (59.7%), followed by facial trauma (22.6%) with rare substance involvement (alcohol, 6.3%; drugs, 4.1%) presenting to high-volume EDs (48.5%). Of the patients, 20% were admitted, whereas 31.1% sustained polytrauma. Substance use [alcohol, odds ratio (OR) = 4.44; drugs, OR = 2.90] increased polytrauma likelihood; neck (OR = 1.35), face (OR = 1.14), and eye (OR = 1.26) associated with polytrauma more than head injuries. Burns (OR = 1.38) increased polytrauma likelihood more than internal organ injuries. Black patients sustained higher polytrauma when presented to non-small EDs (OR = 1.41-1.90) than white patients showed to small EDs. Admissions were higher for males (OR = 1.51). Relative to small EDs, large EDs demonstrated a higher increase in admissions (OR = 2.42). Neck traumas were more likely admitted than head traumas (OR = 1.71). Fractures (OR = 2.21) and burns (OR = 2.71) demonstrated an increased admission likelihood than internal organ injuries. Polytrauma presence and admissions likelihood are site, injury, and substance dependent. Understanding the impact of factors influencing polytrauma presence or admission will enhance triage to optimize outcomes.
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Affiliation(s)
- Joshua S Lin
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California
| | - Paul Won
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Matthew E Lin
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Neil N Luu
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California
| | - Alexander Markarian
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California
| | - Roxana Moayer
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California
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Xu T, Yi X, Xia S, Wu S. Comparison of outcomes for general and local anesthesia in the management of nasal bone fractures: a meta-analysis. Eur J Med Res 2024; 29:306. [PMID: 38825676 PMCID: PMC11145784 DOI: 10.1186/s40001-024-01896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND This meta-analysis aimed to perform a head-to-head comparison of the role of general anesthesia (GA) and local anesthesia (LA) in the management of patients with nasal bone fractures (NBFs). METHODS PubMed, Embase, and Web of Science were comprehensively searched. Studies investigating the clinical outcomes of GA and LA in the management of NBFs were included. Pooled odds ratios (OR) with the respective 95% confidence intervals (CIs) were calculated. Heterogeneity between the included studies was evaluated. The risk of bias in the included studies was assessed. RESULTS Eight studies were included in this meta-analysis. The pooled ORs for cosmetic results, residual septal deformity, the need for further surgery, patients' satisfaction with the anesthesia procedure, and patients' satisfaction with the surgery results were 0.70 (95% CI 0.18, 2.64; z = - 0.53, p = 0.5957), 1.11 (95% CI 0.37, 3.30; z = 0.18, p = 0.8558), 1.19 (95% CI 0.65, 2.20; z = 0.56, p = 0.5760), 1.57 (95% CI 0.92, 2.69; z = 1.65, p = 0.0982), and 1.00 (95% CI 0.55, 1.80; z = - 0.00, p = 0.9974). CONCLUSIONS Insignificant difference on clinical outcomes was observed between GA and LA in the manipulation of patients with NBFs, and the choice of anesthetic approach should be based on the tolerability of the methods and the severity of nasal fractures.
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Affiliation(s)
- Ting Xu
- Department of Otolaryngology Head and Neck Surgery, Wuxi Clinical College, Nantong University, No. 68 Zhongshan Road, Liangxi District, Wuxi, 214002, Jiangsu, China.
- Department of Otolaryngology Head and Neck Surgery, The Second People's Hospital of Wuxi, Wuxi, China.
| | - Xinsheng Yi
- Department of Otolaryngology Head and Neck Surgery, The Second People's Hospital of Wuxi, Wuxi, China
| | - Shitong Xia
- Department of Otolaryngology Head and Neck Surgery, The Second People's Hospital of Wuxi, Wuxi, China
| | - Sihai Wu
- Department of Otolaryngology Head and Neck Surgery, The Second People's Hospital of Wuxi, Wuxi, China
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Rüttgers M, Waldmann M, Vogt K, Ilgner J, Schröder W, Lintermann A. Automated surgery planning for an obstructed nose by combining computational fluid dynamics with reinforcement learning. Comput Biol Med 2024; 173:108383. [PMID: 38555704 DOI: 10.1016/j.compbiomed.2024.108383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/26/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Septoplasty and turbinectomy are among the most common interventions in the field of rhinology. Their constantly debated success rates and the lack of quantitative flow data of the entire nasal airway for planning the surgery necessitate methodological improvement. Thus, physics-based surgery planning is highly desirable. In this work, a novel and accurate method is developed to enhance surgery planning by physical aspects of respiration, i.e., to plan anti-obstructive surgery, for the first time a reinforcement learning algorithm is combined with large-scale computational fluid dynamics simulations. The method is integrated into an automated pipeline based on computed tomography imaging. The proposed surgical intervention is compared to a surgeon's initial plan, or the maximum possible intervention, which allows the quantitative evaluation of the intended surgery. Two criteria are considered: (i) the capability to supply the nasal airway with air expressed by the pressure loss and (ii) the capability to heat incoming air represented by the temperature increase. For a test patient suffering from a deviated septum near the nostrils and a bony spur further downstream, the method recommends surgical interventions exactly at these locations. For equal weights on the two criteria (i) and (ii), the algorithm proposes a slightly weaker correction of the deviated septum at the first location, compared to the surgeon's plan. At the second location, the algorithm proposes to keep the bony spur. For a larger weight on criterion (i), the algorithm tends to widen the nasal passage by removing the bony spur. For a larger weight on criterion (ii), the algorithm's suggestion approaches the pre-surgical state with narrowed channels that favor heat transfer. A second patient is investigated that suffers from enlarged turbinates in the left nasal passage. For equal weights on the two criteria (i) and (ii), the algorithm proposes a nearly complete removal of the inferior turbinate, and a moderate reduction of the middle turbinate. An increased weight on criterion (i) leads to an additional reduction of the middle turbinate, and a larger weight on criterion (ii) yields a solution with only slight reductions of both turbinates, i.e., focusing on a sufficient heat exchange between incoming air and the air-nose interface. The proposed method has the potential to improve the success rates of the aforementioned surgeries and can be extended to further biomedical flows.
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Affiliation(s)
- Mario Rüttgers
- Jülich Supercomputing Centre, Forschungszentrum Jülich GmbH, Wilhelm-Johnen-Straße, 52425 Jülich, Germany; Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Wüllnerstraße 5a, 52062 Aachen, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany.
| | - Moritz Waldmann
- Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Wüllnerstraße 5a, 52062 Aachen, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany
| | - Klaus Vogt
- Faculty of Medicine, Center of Experimental Surgery, University of Latvia, 1586 Riga, Latvia
| | - Justus Ilgner
- Department of Otorhinolaryngology, Head and Neck Surgery, Uniklinik RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Wolfgang Schröder
- Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Wüllnerstraße 5a, 52062 Aachen, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany
| | - Andreas Lintermann
- Jülich Supercomputing Centre, Forschungszentrum Jülich GmbH, Wilhelm-Johnen-Straße, 52425 Jülich, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany
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Vishwanath N, Rhee B, Sobti N, Beqiri D, Xi K, Lerner J, Woo AS. The Role of Antibiotics in Nasal Fractures after Closed Reduction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4886. [PMID: 37038410 PMCID: PMC10082294 DOI: 10.1097/gox.0000000000004886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/17/2023] [Indexed: 04/12/2023]
Abstract
Nasal fractures represent the most common fracture in facial trauma. The role of prophylactic antibiotics in these injuries is debated, given low infection rates and demonstrated risks of antibiotics. We studied the isolated effect of prophylactic antibiotics on infection rate in patients with nasal fracture after closed reduction. Methods Retrospective cohort study of a prospectively maintained facial trauma database was conducted. Demographics, comorbidities, fracture classifications, and management of patients who received antibiotics at the time of closed nasal reduction were compared against those who did not receive antibiotics. Infection rates between groups were analyzed. Multivariate analysis was conducted to control for confounding variables. Qualitative analysis was performed for patients who experienced infection following nasal fracture. Results A total of 282 patients met inclusion criteria (n = 144, antibiotic; n = 138, nonantibiotic). Six patients experienced infection. There was no difference in infection rate between antibiotic and nonantibiotic groups (2.0% versus 2.2%; P = 0.90). On multivariate regression, antibiotics did not significantly decrease odds of infection (OR 1.7 [0.17-13.6]; P = 0.64). Moreover, patients with open nasal fractures did not have significantly higher odds of infection (OR 1.9 [0.08-20.8]; P = 0.64). Similarly, increasing severity of injury based on Rohrich classification did not significantly impact odds of infection (OR 0.68 [0.23-1.9]; P = 0.46). All six infections were managed at the bedside, with zero infections following operating room management (P = 0.32). Conclusions Prophylactic antibiotics do not decrease infection rates following nasal fractures managed by closed reduction. Bedside management may be a risk factor for the development of infection; however, this finding requires further evaluation.
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Affiliation(s)
- Neel Vishwanath
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Ben Rhee
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Nikhil Sobti
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Dardan Beqiri
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Kevin Xi
- Brown University School of Public Health, Providence, R.I
| | - Julia Lerner
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Albert S Woo
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
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Kumar M, Panneerselvam E, Prabhu K, Ganesh SK, Vb KKR. Prospective cohort study on short-term evaluation of septoplasty as early management of naso-septal fractures - A correlation of clinical outcomes with computational fluid dynamic parameters. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:639-644. [PMID: 35853555 DOI: 10.1016/j.jormas.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/12/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Post-traumatic deviated nasal septum (PTDNS) leads to impaired breathing and poor esthetics. The aim of this study was to assess treatment outcomes of early septoplasty for correction of PTDNS and correlate it with computational fluid dynamic (CFD) parameters. METHODS This prospective cohort study included patients who underwent early septoplasty for PTDNS. Outcome variables were clinical (pain, nasal symmetry, and nasal obstruction) and computational (velocity, pressure, wall shear stress and Reynold's number). The cohort consisted of two groups: patients with history of closed reduction for nasal fractures (CR) and patients without (NCR). The primary outcome measure was response to treatment. Correlation between clinical and computational parameters, and influence of closed reduction on septoplasty outcomes were the secondary and tertiary outcomes, respectively. Descriptive and inferential statistics were performed to analyze data. Level of significance was fixed at 5% (α = 0.05). RESULTS The sample included 12 patients, of which 5 underwent CFD analysis. Pain score reduced from a pre-operative mean of 7.3 to 0.5 post-operatively (p<0.001). All patients demonstrated reduction of nasal obstruction (p<0.001) and deviation (p<0.001) post-operatively. CFD analysis revealed post-operative reduction of velocity (p = 0.005) and Reynold's number (p = 0.007), with positive correlation between nasal obstruction and CFD parameters. Though patients in the CR group demonstrated reduced nasal deviation and obstruction before septoplasty, as compared to the NCR group, their outcomes were comparable following septoplasty. CONCLUSION Early septoplasty improves functional and esthetic outcomes in patients with PTDNS. CFD simulation is a predictable method to objectively evaluate nasal function.
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Affiliation(s)
- Muthu Kumar
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Elavenil Panneerselvam
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India.
| | - Komagan Prabhu
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Sriraam Kasi Ganesh
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Krishna Kumar Raja Vb
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
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AlWatban ZH, Alhussaini MK, AlTuwaijri A, Alabdulqader AA. Alar Cartilage Hematoma: Case Report and Literature Review. Indian J Otolaryngol Head Neck Surg 2022; 74:1514-1517. [PMID: 36452528 PMCID: PMC9701955 DOI: 10.1007/s12070-021-02642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022] Open
Abstract
Nasal hematomas can occur after nasal trauma. It can involve the septal, alar, or all levels, with the septum being the most commonly affected site. We present a case of alar hematoma in a five-year-old boy after nasal trauma. The patient came to the emergency room complaining of nasal pain, epistaxis, and nasal deformity. A complete ear, nose, and throat examination was performed, and X-ray and computed tomography imaging of the facial bone were done to confirm the presence of a nasal alar hematoma. The alar hematoma was successfully treated via surgical evacuation. Alar cartilage hematoma is a rare entity that can lead to undesirable complications when missed.
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Affiliation(s)
- Zaki H. AlWatban
- College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Ahmed AlTuwaijri
- Otorhinolaryngology, Head and Neck Surgery Fellow, Security Force Hospital, Riyadh, Saudi Arabia
| | - Abdullah A. Alabdulqader
- Otorhinolaryngology Department, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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7
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Gupta KK, Gupta VK, Sanghera RS, Jolly K, McClleland L. The Effect of COVID on Nasal Fracture Management in ENT Emergency Clinics. Craniomaxillofac Trauma Reconstr 2022; 15:98-103. [DOI: 10.1177/19433875211015036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study design: Retrospective cohort study. Objective: Management of nasal fractures is usually in ENT emergency clinics, with our center aiming to assess patients within 10-days. During 2020, there have been numerous lockdowns and social distancing measures implemented in the UK as a result of the coronavirus pandemic (COVID). This study aimed to assess the effect of COVID on nasal fracture management in ENT emergency clinics in terms of number of patients seen, time to follow up and their management strategies. Methods: All patients with suspected or confirmed nasal bone fractures presenting to the emergency department (ED) between January 1, 2019 and December 31, 2020 at our major trauma center were analyzed in 2 groups depending on the year they were seen (2019 vs. 2020). Results: There was a total of 104 patients analyzed, with 51.4% decrease in the number of patients seen in 2020 versus 2019. The mean days to follow up in 2019 was 8.09 days and 7.65 days in 2020 ( P = .37). There was no statistically significant difference in the number of patients seen within the 10-day target between years (2019 = 65.7% vs. 2020 = 76.5%, P = .35). The majority of patients were managed with manipulation under anesthesia (MUA) in 2019 (n = 32, 45.7%) vs. discharge from clinic in 2020 (n = 21, 61.8%). Conclusions: Our study shows a drastic reduction in the number of patients seen in ENT emergency clinic from 2019 to 2020. This is in-keeping with other studies that have shown a reduction in ED attendances, trauma admissions and admissions across other specialties all around the world.
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Khojastepour L, Dokohaki S, Paknahad M. Are of Osteomeatal Complex Variations Related to Nasolacrimal Canal Morphometry. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2022; 34:17-26. [PMID: 35145932 PMCID: PMC8801008 DOI: 10.22038/ijorl.2021.52612.2784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/08/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Due to the close anatomic relationship between paranasal structures and NLC, the morphometric measure of the nasolacrimal canal (NLC) could be affected by the osteomeatal complex (OMC) anatomical variations. The present study aimed to assess the effect of OMC variations on the NLC morphometric features using cone-beam computed tomography (CBCT). MATERIALS AND METHODS This cross-sectional study consisted of CBCT images of 150 subjects in the case group with at least one OMC variation and 40 cases in the control group without any OMC variation within the age range of 18-50 years. The presence of the OMC variations, including agger nasi, nasal septum deviation, concha bullosa, Haller cells, paradoxical middle turbinate, and pneumatization of the uncinate process, was evaluated in each patient. The NLC morphometric measurements were performed and compared between the case and control groups. RESULTS The middle anteroposterior diameter and middle sectional area of NCL were significantly higher in patients with OMC variations, as compared to that in the control group. The NLC volume was significantly higher in patients with agger nasi, nasal septum deviation, concha bullosa, and pneumatization of the uncinate process, as compared to that in the control group. Nonetheless, no significant difference in NLC angulation with the nasal floor or Frankfurt horizontal plane was observed in the presence of each OMC variation. CONCLUSIONS As evidenced by the obtained results, a higher volume of the canal was revealed in the presence of some of the OMC variations. Therefore, it can be suggested that OMC variations cannot be a predisposing factor in cases with primary acquired nasolacrimal duct obstruction.
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Affiliation(s)
- Leila Khojastepour
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Sonia Dokohaki
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Iran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Department of Oral and Maxillofacial Radiology, Shiraz Dental School, Ghasrodasht Street, Shiraz 7144833586, Iran. E-mail:
| | - Maryam Paknahad
- Oral and Dental Disease Research Center, Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
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Abstract
This article outlines current methods in the evaluation and management of nasal fractures including clinical workup, imaging, and treatment.
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Affiliation(s)
- Kelly C Landeen
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave S7 South, Nashville, TN 37232, USA
| | - Kyle Kimura
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave S7 South, Nashville, TN 37232, USA
| | - Scott J Stephan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave S7 South, Nashville, TN 37232, USA.
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10
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Khetpal S, Gowda AU, Parsaei Y, Mozaffari MA, Dinis J, Lopez J, Steinbacher D. Rhinoplasty in the Older Adult. Aesthet Surg J 2021; 41:1231-1241. [PMID: 33739380 DOI: 10.1093/asj/sjab140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rhinoplasty in older adults requires unique consideration of the aging nose. OBJECTIVES The purpose of this study was to systematically review the literature pertaining to rhinoplasty in the aging population, review the senior author's experience, and describe techniques aimed at addressing age-related features. It was hypothesized that consistent age-related nasal dysmorphology is described in the literature and standard rhinoplasty techniques may effectively address these changes. Furthermore, it was hypothesized that rhinoplasty is more commonly performed for posttraumatic and functional indications than for aesthetic reasons. METHODS A literature review including publications describing rhinoplasty in patients over 55 years old was conducted. Additionally, a retrospective review of the senior author's cases was performed. Pre- and postoperative photographs were used to compare anthropometric changes. Demographic factors, surgical indications, and operative details were collected. RESULTS Nine articles met the study criteria. Manifestations of the aging nose included soft tissue atrophy, bony fragility and resorption, tip ptosis, internal and external valve collapse, and worsening dorsal hump. Twenty-seven patients were included in this institutional review. Primary indication for rhinoplasty was posttraumatic deformity in 17 (63%) patients and nasal obstructive symptoms in 10 (37%) patients. Tip refinement and ptosis were addressed through tip grafts (70%), columellar struts (26%), and caudal septal extension grafts (67%). Nasal obstruction was relieved through septoplasty (96%), turbinate ablation (85%), and spreader grafts (70%). CONCLUSIONS This study presents a systematic review of rhinoplasty in the older adult as well as a retrospective review of the senior author's patients. Unique considerations specific to this population should be integrated into treatment planning. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Arvind U Gowda
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Yassmin Parsaei
- Division of Orthodontics, University of Connecticut, Farmington, CT, USA
| | | | - Jacob Dinis
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Joseph Lopez
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Derek Steinbacher
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
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11
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Abstract
Importance: Although nasal bones are the most common type of facial fracture given their natural projection and vulnerability to trauma, there is a paucity of data on its trends. Objective: To report on the trends and costs associated with open and closed nasal bone fractures across the United States. Methods: A retrospective analysis from 2006 to 2014 was conducted of the Nationwide Emergency Department Sample by using the International Classification of Disease, Ninth Revision codes for closed and open nasal bone fractures (802.0 and 802.1) presenting to emergency departments (ED). Trend analysis of total number and rate of visits, discharges, admissions, and associated costs were conducted. Results: Data from 1,253,399.741 records were collected. The total number of ED visits decreased by 2.05% for both open and closed nasal fractures from 2006 to 2014 whereas their associated costs increased (p < 0.001 and p < 0.05 for closed and open nasal fractures). Notably, open fractures were consistently costlier whereas closed fractures had a greater percent-increase in costs (76.65%). Conclusions and Relevance: This study identified a significant rise in nasal fracture costs, which can be reduced via use of cheaper diagnostic modalities and cost-effective endoscopic procedures.
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Affiliation(s)
- Selina X Dong
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Nishi Shah
- Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Amar Gupta
- New York University Langone Health, Otolaryngology-Head and Neck Surgery, New York, New York, USA
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12
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Nasal Cracking Leading to Septal Hematoma. J Craniofac Surg 2021; 31:1978-1980. [PMID: 32604314 DOI: 10.1097/scs.0000000000006621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nasal cracking is the habit of applying pressure to one's nose until hearing a popping noise or feeling a release of pressure. Clinicians are mostly unaware of it as it is a lesser known habit that has been popularized on social media. Most often it is harmless, however sometimes it can lead to adverse consequences such as pain, bruising, bleeding, and/or breathing problems. In this case study, a patient is evaluated and treated for nasal cracking that led to a septal hematoma.
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13
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Apaydin F, Garcia RFFP, Tas V. L-Strut Graft: A Very Versatile Graft in the Management of Crooked and Traumatic Noses. Facial Plast Surg Aesthet Med 2020; 23:110-117. [PMID: 32779941 DOI: 10.1089/fpsam.2020.0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Importance: Numerous techniques have been described on the correction of nasal septum in crooked nose or badly deviated septum. To our knowledge, no previous study has been published solely on the value of using an L-strut graft for straightening the nasal septum. Objective: To investigate the use of L-strut graft technique for septal reconstruction in patients with a crooked nose or badly deviated septum. Design: A retrospective study was performed in patients with crooked nose or badly deviated septum who underwent correction by using an L-strut graft from the 1st of January 2000 to 1st of May 2019 at a tertiary referral center and a private hospital by the senior author. Intervention: All patients with crooked noses or badly deviated septums who underwent L-strut graft repair were taken into the study group. Main Outcomes and Measures: Straightening the deviated septum was the primary outcome. Secondary outcomes were getting rid of crookedness: mean deviation angles and distances from the midline in perioperative/postoperative pictures in three main landmarks: rhinion, supratip, and tip; and resolution of presenting symptoms of nasal obstruction. Results: One hundred nineteen patients were included: 65 men and 54 women (mean age 30.7 years). Septorhinoplasty was performed in 71 and septoplasty in 48 cases. The material for L-strut graft was cartilaginous in 100, bony cartilaginous in 11, and bony in 8 patients. The pictures of 21 rhinoplasty patients (10 women and 11 men; mean age 33.48 years) were uploaded into Rhinobase 1.1 for measurements. There was a decrease in the mean and median values in all measurements from the midline between pre- and postoperative measurements. Conclusions: In selected cases of crooked and traumatic noses, the L-strut graft can be helpful to splint and correct the deviated L-strut framework and it can act as a caudal septal extension graft to support the tip.
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Affiliation(s)
- Fazil Apaydin
- Department of Otorhinolaryngology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Rodrigo Fortunato Fernández-Pellón Garcia
- Department of Otorhinolaryngology, Faculty of Medicine, Ege University, Izmir, Turkey.,International Fellow of the European Academy of Facial Plastics Surgery (EAFPS), Ege University, Izmir, Turkey
| | - Vedat Tas
- Department of Otorhinolaryngology, Faculty of Medicine, Ege University, Izmir, Turkey.,International Fellow of the European Academy of Facial Plastics Surgery (EAFPS), Ege University, Izmir, Turkey
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Abstract
Nasal fractures are the most common type of facial bone fracture. Studies conducted globally have shown that nasal fractures represent a significant liability on the health care system due to the frequency of its occurrence among most populations. This study aimed to describe the frequency, etiology, and demographics of nasal fractures in patients presenting to King Fahad General Hospital, Jeddah, Saudi Arabia.This study was a cross-sectional questionnaire-based study and included all patients with a nasal fracture who were referred from the emergency department to the ENT unit of King Fahad General Hospital over a four-month period (December 2018 to March 2019).A total of 130 patients with nasal fracture were included in the present study; most of the included patients were males (83.1%). The mean age of the patients was 28.5 years. The most frequent cause of nasal fracture was physical assault (54.6%), followed by road traffic accidents (20%). Most patients had epistaxis and presented with either active epistaxis at the time of assessment or epistaxis that spontaneously resolved after injury. Patients who had lacerations on the nose were more likely to have a displaced nasal bone (P = 0.016). Isolated nasal bone fractures were more commonly noted in victims of physical assault, whereas combined facial bone fractures were commonly noted in patients involved in road traffic accidents (P < 0.001).Most of the injuries occurred in the city, particularly among foreigners and young adults. Physical assault was reported to be the leading cause of nasal fractures.
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15
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Li L, Zang H, Han D, Yang B, Desai SC, London NR. Nasal Bone Fractures: Analysis of 1193 Cases with an Emphasis on Coincident Adjacent Fractures. Facial Plast Surg Aesthet Med 2020; 22:249-254. [PMID: 32250646 DOI: 10.1089/fpsam.2020.0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Importance: The nasal bone is one of the most commonly fractured bones of the midface. However, the frequency of coincident fractures of adjacent bones such as the frontal process of the maxillary bone, nasal septum, and medial or inferior orbital walls has not been fully evaluated. Objective: The purpose of this study was to investigate the incidence of fractures of adjacent structures in the setting of a nasal bone fracture. Second, we propose a new classification system of nasal bone fractures with involvement of adjacent bony structures. Design, Setting, and Participants: One thousand, one hundred ninety-three patients with midfacial fractures were retrospectively reviewed. The characteristics of fractures of the nasal bone and the incidence of coincident fractures of the frontal process of maxilla, bony nasal septum, medial, or inferior orbital walls were analyzed. Exposure: All patients included in the study presented with nasal trauma. Main Outcomes and Measures: The coincident fractures of adjacent midfacial structures were assessed, and a new classification of midfacial fractures based on computed tomography (CT) scan images was proposed. Results: Among the 1193 cases, bilateral fractures of the nasal bone were most common (69.24%), and coexistent fracture of the frontal process of the maxilla and bony nasal septum was 66.89% and 42.25%, respectively. Coincident fracture of the orbital walls was observed in 16.51% of cases. The major etiology of fracture for the younger and elderly groups was falls, compared with assault as the most common etiology in the adult group. A classification scheme was generated in which fractures of the nasal bone were divided into five types depending on coexisting fractures of adjacent structures. Conclusions and Relevance: External force applied to the nasal bone can also lead to coexistent fracture of adjacent bony structures including the frontal process of the maxilla, nasal septum, and orbital walls. The proposed classification of nasal fracture based on CT imaging helps to incorporate coincident disruption of adjacent structures.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Hongrui Zang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Demin Han
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Bentao Yang
- Department of Radiology, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Shaun C Desai
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland, USA
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16
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Elsayed M, Alosaimy RA, Ali NY, Alshareef MA, Althqafi AH, Rajab MK, Assalem AS, Khiyami AJ. Nerve Block for Septorhinoplasty: A Retrospective Observational Study of Postoperative Complications in 24 Hours. Cureus 2020; 12:e6961. [PMID: 32190509 PMCID: PMC7067574 DOI: 10.7759/cureus.6961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Septorhinoplasty is a surgical procedure that provides functional improvements and esthetic adjustments to the appearance of the nose. Pain is a common postoperative complication, and pain management is known to decrease postoperative complications and total cost. Local anesthetics can cost-effectively decrease postoperative pain scores and reduce analgesic requirements. The primary objective of this study was to assess the effect of bilateral facial nerve blocks given with general anesthesia on pain scores and the use of postoperative analgesia. The secondary objective was to compare the vital signs stability between a group given bilateral facial nerve blocks with general anesthesia and a group given general anesthesia only. We conducted a retrospective observational study among 40 patients who were divided into two groups, each containing 20 patients. The patients in the nerve block (NB) group received general anesthesia and bilateral facial blocks of the infraorbital and infratrochlear nerves via 5 ml of 0.25% levobupivacaine with 5 ml of diluted adrenaline 1:100,000. Patients in the Control group received general anesthesia only. Both groups received the same local injection of a mixture of 5 ml of 1% lidocaine and 5 ml of 1:100,000 epinephrine at the surgical site, along with the standard general anesthesia. A numerical rating scale, the visual analog scale (VAS), was used to evaluate postoperative pain at 15, 30, and 45 minutes postoperatively, and the stability of the vital signs was also assessed. The results showed that using bilateral infraorbital and infratrochlear nerve block injection with 0.25% levobupivacaine for patients who underwent septorhinoplasty under general anesthesia provided greater stability of vital signs but had no effect on the pain score or analgesia need. Further assessment should be performed in a larger number of patients to either confirm or refute these results. Additional studies could be conducted in several hospitals within the Kingdom to determine how broadly applicable nerve blockade is in reducing pain sensation.
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Affiliation(s)
- Mohammed Elsayed
- Otolaryngology Head and Neck Surgery, King Abdullah Medical City, Makkah, SAU
| | - Razan A Alosaimy
- Otolaryngology Head and Neck Surgery, Umm Al-Qura University, Makkah, SAU
| | - Nujod Y Ali
- Otolaryngology Head and Neck Surgery, Umm Al-Qura University, Makkah, SAU
| | | | - Ahmed H Althqafi
- Otolaryngology Head and Neck Surgery, King Fahad General Hospital, Jeddah, SAU
| | - Mohannad K Rajab
- Otolaryngology Head and Neck Surgery, King Fahad General Hospital, Jeddah, SAU
| | - Abdullah S Assalem
- Otolaryngology Head and Neck Surgery, Armed Force Hospital, Ministry of Defense, Taif, SAU
| | - Ahmed J Khiyami
- Otolaryngology Head and Neck Surgery, Umm Al-Qura University, Makkah, SAU
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17
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Khajuria A, Osborne MS, McClleland L, Ghosh S. Improving the quality of assessment and management of nasal trauma in a major trauma centre (MTC): Queen Elizabeth Hospital, Birmingham. BMJ Open Qual 2019; 8:e000632. [PMID: 31803851 PMCID: PMC6887497 DOI: 10.1136/bmjoq-2019-000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 11/05/2019] [Accepted: 11/09/2019] [Indexed: 11/19/2022] Open
Abstract
Background Nasal fractures present in 39% of patients with facial trauma. These patients are assessed in the emergency department followed by outpatient review in the senior house officer-led emergency ear, nose and throat (ENT) clinic. Inadequate treatment of nasal trauma can result in debilitating functional and aesthetic problems. Inexperienced junior doctors may be apprehensive in assessing nasal trauma resulting in time pressured clinics and suboptimal management. Measures A retrospective review of clinical noting over 3 months was carried out to gauge the extent of the problem. Three baseline measurements for satisfactory quality of assessments included: (1) 3/5 key symptoms elicited by the clinician (epistaxis, rhinorrhoea, nasal airway obstruction, dental malocclusion and diplopia). (2) Presence/absence of ‘septal haematoma’ (SH) and ‘deviated nasal septum’ (DNS) documented. (3) Patient follow-up within 2 weeks after the initial injury. Three Plan-Do-Study-Act (PDSA) cycles were conducted with implementation of interventions (proforma, clinic poster, patient information leaflet and training) as visualised in our ‘driver diagram’. Results The quality of nasal trauma assessments improved following each intervention. There was an increase from 86% to 100% patients being seen within 2 weeks of the injury. There was an improvement in quality of assessments following the teaching as two-thirds (PDSA cycle 2) followed by 100% (PDSA cycle 3) of clinical documentation included ‘rhinorrhoea’ and 83% (PDSA cycle 2) to 100% (PDSA cycle 3) included ‘nasal airway obstruction’. Similarly, two thirds (PDSA cycle 2) followed by 100% (PDSA cycle 3) examined and documented the presence/absence of SH and DNS. A 100% improvement in trainee confidence was reported. We are now conducting more comprehensive assessments of nasal trauma patients. Conclusion The need to provide relevant training and support to ENT junior doctors is crucial in their development, as well as to ensure delivery of high-quality patient-centred care.
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Affiliation(s)
- Apoorva Khajuria
- Ear, Nose & Throat (ENT) Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Max Sallis Osborne
- Ear, Nose & Throat (ENT) Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Lisha McClleland
- Ear, Nose & Throat (ENT) Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sandip Ghosh
- Diabetes and Endocrinology Department, Queen Elizabeth Hospital Birmigham, Birmingham, UK
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18
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Abstract
A nasal bone fracture is one of the most common facial injuries and is often treated by closed reduction. Typically, 2 to 3 weeks are needed for patients to return to daily life because the operation is performed after swelling around the fracture site is reduced. This study aimed to investigate that hyaluronidase injection could reduce swelling, perform early operation and return to daily life accelerated.From January 2017 to December 2017, 181 patients with nasal bone fracture were analyzed. 60 patients underwent hyaluronidase injection and massage to reduce edema, then performed surgery within 2 to 4 days. The remaining patients were treated conservatively (massage alone); they then underwent surgery. Ultrasonography was used to measure changes in skin thickness, and the treatment duration, outcome, and patient satisfaction were compared.The duration from injury to surgery was short in the early operation group, and the period of recovery and return to ordinary life was significantly shorter than in the conventional group. The difference in skin thickness after hyaluronidase injection and massage was 0.8 mm in the early operation group; there was no significant difference in the conventional group. There was no statistically significant difference in satisfaction between the 2 groups, but the mean satisfaction was higher in the early operation group.In patients with nasal bone fracture after facial trauma, hyaluronidase injection, and massage led to reduced edema. This might improve patient satisfaction by allowing earlier operation and earlier return to daily life.
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19
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Lavernia L, Brown WE, Wong BJF, Hu JC, Athanasiou KA. Toward tissue-engineering of nasal cartilages. Acta Biomater 2019; 88:42-56. [PMID: 30794988 DOI: 10.1016/j.actbio.2019.02.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/15/2019] [Accepted: 02/18/2019] [Indexed: 12/25/2022]
Abstract
Nasal cartilage pathologies are common; for example, up to 80% of people are afflicted by deviated nasal septum conditions. Because cartilage provides the supportive framework of the nose, afflicted patients suffer low quality of life. To correct pathologies, graft cartilage is often required. Grafts are currently sourced from the patient's septum, ear, or rib. However, their use yields donor site morbidity and is limited by tissue quantity and quality. Additionally, rhinoplasty revision rates exceed 15%, exacerbating the shortage of graft cartilage. Alternative grafts, such as irradiated allogeneic rib cartilage, are associated with complications. Tissue-engineered neocartilage holds promise to address the limitations of current grafts. The engineering design process may be used to create suitable graft tissues. This process begins by identifying the surgeon's needs. Second, nasal cartilages' properties must be understood to define engineering design criteria. Limited investigations have examined nasal cartilage properties; numerous additional studies need to be performed to examine topographical variations, for example. Third, tissue-engineering processes must be applied to achieve the engineering design criteria. Within the recent past, strategies have frequently utilized human septal chondrocytes. As autologous and allogeneic rib graft cartilage is used, its suitability as a cell source should also be examined. Fourth, quantitative verification of engineered neocartilage is critical to check for successful achievement of the engineering design criteria. Finally, following the FDA paradigm, engineered neocartilage must be orthotopically validated in animals. Together, these steps delineate a path to engineer functional nasal neocartilages that may, ultimately, be used to treat human patients. STATEMENT OF SIGNIFICANCE: Nasal cartilage pathologies are common and lead to greatly diminished quality of life. The ability to correct pathologies is limited by cartilage graft quality and quantity, as well as donor site morbidity and surgical complications, such as infection and resorption. Despite the significance of nasal cartilage pathologies and high rhinoplasty revision rates (15%), little characterization and tissue-engineering work has been performed compared to other cartilages, such as articular cartilage. Furthermore, most work is published in clinical journals, with little in biomedical engineering. Therefore, this review discusses what nasal cartilage properties are known, summarizes the current state of nasal cartilage tissue-engineering, and makes recommendations via the engineering design process toward engineering functional nasal neocartilage to address current limitations.
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Affiliation(s)
- Laura Lavernia
- Department of Biomedical Engineering, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA
| | - Wendy E Brown
- Department of Biomedical Engineering, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA.
| | - Brian J F Wong
- Division of Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, 1002 Health Sciences Road, Irvine, CA 92617, USA; Department of Biomedical Engineering, University of California Irvine, 1002 Health Sciences Road, Irvine, CA 92617, USA.
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA.
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA.
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20
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Pham TT, Lester E, Grigorian A, Roditi RE, Nahmias JT. National Analysis of Risk Factors for Nasal Fractures and Associated Injuries in Trauma. Craniomaxillofac Trauma Reconstr 2019; 12:221-227. [PMID: 31428247 DOI: 10.1055/s-0039-1677724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022] Open
Abstract
Nasal fractures account for up to 58% of facial fractures. However, the literature characterizing associated injuries and risk factors for nasal fractures is sparse and is mostly composed of single-center experiences. This study sought to provide a large descriptive analysis and identify associated injuries and risk factors for nasal fractures in trauma using a national database. A retrospective analysis of the National Trauma Data Bank (NTDB) from 2007 to 2015 was performed. Patients ≥18 years of age with nasal fractures were included. A multivariable logistic regression model was used to identify predictors for nasal fracture in trauma. Of 5,494,609 trauma patients in the NTDB, 255,533 (4.6%) had a nasal fracture. Most were male (74.8%) with a mean age of 45.6 years. Blunt trauma accounted for 90.5% of fractures, with motor vehicle accident being the most common mechanism (27.5%). Closed fractures occurred in 93.0% of patients. Concomitant injuries included traumatic brain injury (TBI; 56.9%), malar/maxillary fracture (27.9%), and open wound of the face (38.6%) and nose (9.5%). Of all patients, 10.1% underwent closed or open reductions at index hospitalization. The strongest associated injuries with nasal fracture included open wound of the nose (odds ratio [OR]: 8.71, 95% confidence interval [CI]: 8.49-8.94, p < 0.001), epistaxis (OR: 5.26, 95% CI: 4.59-6.02, p < 0.001), malar/maxillary fracture (OR: 4.38, 95% CI: 4.30-4.45, p < 0.001), and orbital fracture (OR: 3.99, 95% CI: 3.91-4.06, p < 0.001). Nasal fractures are common traumatic injuries with more than 90% occurring by blunt mechanism and over half suffering from a concomitant TBI. The strongest associated injury with nasal fracture is an open wound of the nose.
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Affiliation(s)
- Tiffany T Pham
- Division of Trauma, Burn and Critical Care, Department of Surgery, University of California, Irvine School of Medicine, Orange, California
| | - Ellen Lester
- Division of Trauma, Burn and Critical Care, Department of Surgery, University of California, Irvine School of Medicine, Orange, California
| | - Areg Grigorian
- Division of Trauma, Burn and Critical Care, Department of Surgery, University of California, Irvine School of Medicine, Orange, California
| | - Rachel E Roditi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffry T Nahmias
- Division of Trauma, Burn and Critical Care, Department of Surgery, University of California, Irvine School of Medicine, Orange, California
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21
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Svider P, Arianpour K, Mutchnick S. Management of Epistaxis in Children and Adolescents: Avoiding a Chaotic Approach. Pediatr Clin North Am 2018; 65:607-621. [PMID: 29803286 DOI: 10.1016/j.pcl.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This article provides an organized foundation that facilitates the management of acute epistaxis and an understanding of features that merit further diagnostic workup. Prompt management, including measures such as holding pressure and using nasal packing, takes precedence over comprehensive diagnostic workup. Severe, recurrent, and posteriorly based bleeds should prompt consideration of alternate interventions and expert consultation.
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Affiliation(s)
- Peter Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, 4102 St. Antoine, 5E-UHC, Detroit, MI 48201, USA.
| | - Khashayar Arianpour
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, 4102 St. Antoine, 5E-UHC, Detroit, MI 48201, USA
| | - Sean Mutchnick
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, 4102 St. Antoine, 5E-UHC, Detroit, MI 48201, USA
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22
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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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23
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Lanigan A, Lospinoso J, Bowe SN, Laury AM. The Nasal Fracture Algorithm: A Case for Protocol-Driven Management to Optimize Care and Resident Work Hours. Otolaryngol Head Neck Surg 2017; 156:1041-1043. [PMID: 28118548 DOI: 10.1177/0194599816688179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since the initiation of resident duty hour restrictions, significant controversy has arisen regarding its impact on surgical resident training. We reviewed a singular facet of the otolaryngology residency experience, nasal bone fracture management, to identify if treatment standardization would improve care and efficiency. For 1 year, otolaryngology consults for isolated nasal fractures were analyzed to assess consultation trends, rate of intervention, and resident work hour utilization. Following a review of the literature, an evidence-based algorithm for management of nasal fractures was developed. Analysis revealed a potential improvement in intervention rate from 20% to 100% with utilization of the algorithm, with an 84% decrease in overall emergency room and inpatient consultations. Sixty-three hours of otherwise lost resident time would be gained. In the setting of Accreditation for Graduate Medical Education duty hour restrictions, implementation of protocol-driven management may result in a decrease in work hours and serve as a model for more efficient otolaryngology care.
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Affiliation(s)
- Alexander Lanigan
- 1 Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | | | - Sarah N Bowe
- 3 Department of Otology and Laryngology, Division of Pediatric Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Adrienne M Laury
- 1 Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
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24
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Renkonen S, Vehmanen S, Mäkitie A, Blomgren K. Nasal bone fractures are successfully managed under local anaesthesia - experience on 483 patients. Clin Otolaryngol 2016; 41:79-82. [PMID: 25943694 DOI: 10.1111/coa.12456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 12/18/2022]
Affiliation(s)
- S Renkonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Vehmanen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - K Blomgren
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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25
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Özdoğan F, Özel HE, Esen E, Altıparmak E, Genç S, Selçuk A. An often neglected area in crooked nose: middle turbinate pneumatization. Braz J Otorhinolaryngol 2016; 83:563-567. [PMID: 27472981 PMCID: PMC9444759 DOI: 10.1016/j.bjorl.2016.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/27/2016] [Accepted: 06/30/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction Crooked or deviated nose is a deviation of the nose from the straight vertical position of the face. Extensive pneumatization of the middle turbinate, also called concha bullosa or bullous middle turbinate (BMT) is known to be one of the possible etiologic factors in nasal obstruction, recurrent sinusitis, and headache. There is no study concerning a link between BMT and crooked nose. Objective To investigate the association between crooked nose and the presence of a BMT. Methods A total of 199 patients who underwent open septorhinoplasty were retrospectively analyzed. Preoperative paranasal Computerized Tomography (CT) findings, preoperative photodocumentation, and anterior rhinoscopic examination findings were documented. Of the 199 patients, 169 were found to meet the criteria and were included in the study. CT scans were examined to note the presence of BMT, inferior turbinate hypertrophy, and septum deviation (SD). SDs and crooked noses were classified. Results Ninety-four of 169 patients (56%) presented a crooked nose deformity and seventy-five of 169 patients (44%) presented a straight nose. While 49 (52%) crooked nose patients had a bulbous and extensive BMT, 20 patients with straight nose (26.6%) had a BMT. A statistically significant relationship was found between the presence of crooked nose and BMT, regardless of the side of the disease (p = 0.011). Conclusion This study revealed a link between crooked nose and BMT.
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Affiliation(s)
- Fatih Özdoğan
- Derince Research and Training Hospital, Department of Otolaryngology, Kocaeli, Turkey.
| | - Halil Erdem Özel
- Derince Research and Training Hospital, Department of Otolaryngology, Kocaeli, Turkey
| | - Erkan Esen
- Derince Research and Training Hospital, Department of Otolaryngology, Kocaeli, Turkey
| | - Erdem Altıparmak
- Derince Research and Training Hospital, Department of Otolaryngology, Kocaeli, Turkey
| | - Selahattin Genç
- Derince Research and Training Hospital, Department of Otolaryngology, Kocaeli, Turkey
| | - Adin Selçuk
- Derince Research and Training Hospital, Department of Otolaryngology, Kocaeli, Turkey
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26
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A Comparison Between K-Wire Splinting and Intranasal Gauze Packing in Nasal Bone Fracture. J Craniofac Surg 2016; 26:1624-7. [PMID: 26163842 DOI: 10.1097/scs.0000000000001850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the outcomes between Kirschner wire (K-wire) splinting and intranasal packing. METHODS The authors performed a retrospective and comparative analysis of subjective patient discomfort and objective postoperative computed tomography (CT) imaging after closed reduction for treating type II and type III nasal bone fractures from April 2010 to April 2013 in 2 groups, 1 with K-wire splinting and 1 with intranasal packing. RESULTS Complaints of nasal obstruction, dry mouth, loss of appetite, and sleep disturbance were significantly less in K-wire group. Mean scores for concerns about aesthetics/postoperative asymmetry did not differ significantly between groups. There was no significant difference in accuracy of reduction and support provided to the reduced nasal bones between groups. CONCLUSIONS The K-wire fixation can be considered a reliable and useful immobilization method for treating type II and type III nasal bone fractures.
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Infraorbital and infratrochlear nerve blocks combined with general anaesthesia for outpatient rhinoseptoplasty: A prospective randomised, double-blind, placebo-controlled study. Anaesth Crit Care Pain Med 2015; 35:31-36. [PMID: 26549134 DOI: 10.1016/j.accpm.2015.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 06/29/2015] [Accepted: 09/03/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION We conducted a study to determine the efficacy of bilateral extraoral infraorbital and infratrochlear nerve blocks during outpatient rhinoseptoplasty under general anaesthesia. PATIENTS AND METHODS In this prospective, double-blind, randomised, controlled trial, 40 adult patients undergoing outpatient rhinoseptoplasty under general anaesthesia were assigned to receive bilateral infraorbital and infratrochlear nerve blocks with either 10mL of 0.25% levobupivacaine (Group LB) or isotonic saline (control group). Patients in Group LB received 0.1mL/kg of isotonic saline as a placebo and patients in the control group received 0.1mL/kg of morphine. The primary endpoint was total perioperative morphine consumption (intraoperative and in the post-anaesthesia care unit). The secondary endpoints were pain scores, time spent in the post-anaesthesia care unit and the outpatient ward, block-related complications and patient satisfaction. RESULTS The total dose of perioperative morphine was lower in Group LB than in the control group (2.5±2.8mg versus 9.5±3.5mg, respectively, P<0.001). The mean±SD or median [IQR] times spent in the post-anaesthesia care unit (60±10min and 78±33min, respectively, P<0.03) and in the outpatient ward (210 [178-223] min versus 275 [250-300] min, respectively, P<0.001) were lower in Group LB than in the control group. There were no differences between groups for other endpoints. CONCLUSION Bilateral extraoral infraorbital and infratrochlear nerve blocks performed with 0.25% levobupivacaine during general anaesthesia combining remifentanil and desflurane reduce the perioperative dose of morphine and the time spent in the post-anaesthesia care unit and the outpatient ward in adult patients undergoing outpatient rhinoseptoplasty.
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Park HK, Lee JY, Song JM, Kim TS, Shin SH. The Retrospective Study of Closed Reduction of Nasal Bone Fracture. Maxillofac Plast Reconstr Surg 2014; 36:266-72. [PMID: 27489845 PMCID: PMC4283532 DOI: 10.14402/jkamprs.2014.36.6.266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/08/2014] [Accepted: 11/10/2014] [Indexed: 12/03/2022] Open
Abstract
Purpose: This study was conducted in order to investigate the therapeutic effect of closed reduction according to a classification in patients with nasal bone fracture. Methods: The study was conducted retrospectively on 186 patients with a mean age of 38 years (range: 7 to 80 years). All patients were diagnosed by clinical and radiologic examination, and then classified according to Hwang’s classification by computed tomography. The patients were further classified by their age, gender, causes of fracture, operation timing after fracture, concurrent facial bone fracture, and complications. All patients underwent the same reduction and treatment protocol and were then followed up regularly for at least three months. Results: The cause of the fracture was slip down, and the highest prevalence was shown in the 20s. The mean operation timing after fracture was 4.1 days (range: 1 to 14 days), and it tended to be longer in the case of defected septal bone or more severe fracture. The most common concurrent facial bone fracture was orbital blow-out fracture, and zygomaticomaxillary complex and maxillary fracture occured frequently. The largest number of complications occurred in class III and IIBs patients, and the main complication was postoperative pain. Conclusion: Results of nasal bone closed reduction on the 186 patients showed that serious complications rarely occurred. Closed reduction is generally an effective treatment for nasal bone fracture. However, in the case of severe concurrent septal bone fracture or comminuted fracture with depression, open reduction should be considered. Further study with a larger number of patients and further classification is required.
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Affiliation(s)
- Han-Kyul Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University
| | - Jae-Yeol Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University
| | - Jae-Min Song
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University
| | - Tae-Seup Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University
| | - Sang-Hun Shin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University
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Abstract
This article reviews the importance of particular radiologic findings related to facial trauma and their implications for clinical and surgical management. An emphasis is placed on critical imaging signs that warrant immediate surgical attention.
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Affiliation(s)
- Alina Uzelac
- Department of Radiology, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, 1X55, San Francisco, CA 94110, USA.
| | - Alisa D Gean
- Department of Radiology, Brain and Spinal Injury Center (BASIC), San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, 1X55, San Francisco, CA 94110, USA
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Ferguson G, Bell PR, Hall SJ. What becomes of the broken nose? THE ULSTER MEDICAL JOURNAL 2014; 83:49-50. [PMID: 24757271 PMCID: PMC3992096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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