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Erdal A, Özdemir D, Özdemir Ş, Bakırtaş M, Ağrı İ. The Effect of Rosmarinic Acid on Wound Healing of Nasal Mucosa in the Rats. Am J Rhinol Allergy 2024; 38:133-139. [PMID: 37994027 DOI: 10.1177/19458924231216656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND The nose can be damaged by environmental pollutants and foreign bodies, as well as a result of trauma, infection or surgical interventions. Proper healing of the damaged nasal mucosa is important for health. OBJECTIVE There is no study in the literature investigating the effects of rosmarinic acid on mucosal healing. The aim of this study was to investigate the effect of rosmarinic acid on nasal mucosal healing. METHODS 21 male, adult Spraque Dawley albino rats were divided into three groups as the control group, the local treatment group in which rosmarinic acid was applied locally to the nasal mucosa, and the systemic treatment group in which rosmarinic acid was injected intraperitoneally. The wound area was obtained by creating a trauma area by inserting a 10 mm interdental brush through the right nasal nostril into the right nasal cavities of all animals. For the following 15 days, the treatment agent was applied as indicated once a day and on the 15th day the animals were decapitated and tissue samples taken from the nasal mucosa were prepared for histopathological examination. The preparations were examined in terms of cellular hyperplasia, goblet cell hypertrophy and degeneration, leukocyte infiltration, cilia loss and degeneration, edema and vascular dilatation, and they have been classified into four categories as mild (+), moderate (++), severe (+++) and very severe (++++). RESULTS There was a significant difference between the groups in terms of all parameters evaluated, and there is a decrease in the intensity of the parameters with transition from the control group to the local group and from there to the systemic group. CONCLUSION Systemic rosmarinic acid administration showed an enhancing effect on the healing of experimentally induced nasal mucosal injury due to its possible anti-inflammatory effect.
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Affiliation(s)
- Arzu Erdal
- Department of Pharmacology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Doğukan Özdemir
- Department of Otorhinolaryngology, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Şule Özdemir
- Department of Public Health, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Mustafa Bakırtaş
- Department of Pathology, Samsun Training and Research Hospital, Samsun, Turkey
| | - İbrahim Ağrı
- Department of Otorhinolaryngology, Samsun Training and Research Hospital, Samsun, Turkey
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Zores C, Zana-Taïeb E, Caeymaex L, Fumeaux CF, Kuhn P. French Neonatal Society issues recommendations on preventing nasal injuries in preterm newborn infants during non-invasive respiratory support. Acta Paediatr 2023; 112:1849-1859. [PMID: 37222380 DOI: 10.1111/apa.16857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 05/25/2023]
Abstract
AIM To issue practical recommendations regarding the optimal care of nasal skin when non-invasive ventilation support is used. METHODS We performed a systematic search of PubMed to identify relevant papers published in English or French through December 2019. Different grades of evidence were evaluated. RESULTS Forty-eight eligible studies. The incidence in preterm infants was high. The lesions were more frequent for preterm infants born under 30 weeks of gestational age and/or below 1500 g. The lesion was most often located on the skin of the nose but could also be found on the intranasal mucous membranes or elsewhere on the face. Nasal injuries appear early after the beginning of non-invasive ventilation at a mean of 2-3 days for cutaneous lesions and eight or nine for intranasal lesions. The most effective strategies to prevent trauma are the use of a hydrocolloid at the beginning of the support ventilation, the preferential use of a mask and the rotation of ventilation interfaces. CONCLUSION Nasal injuries with continuous positive airway pressure treatment in preterm newborn infants were frequent and can induce pain, discomfort and sequelae. The immature skin of preterm newborn infants needs specific attention from trained caregivers and awareness by parents.
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Affiliation(s)
- Claire Zores
- Médecine et Réanimation du Nouveau - né, Service de Pédiatrie 2, Pôle Medico - Chirurgical Pédiatrique Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
- INCI, UPR 3212, CNRS and University of Strasbourg, Strasbourg, France
| | - Elodie Zana-Taïeb
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, Paris, France
- U955 INSERM, Université de Paris, Créteil, France
| | - Laurence Caeymaex
- Neonatal Intensive Care Unit Centre Hospitalier Intercommunal Creteil, Creteil, France
- Faculty of Health, University Paris East Creteil, Val de Marne, Creteil, France
| | - Céline Fischer Fumeaux
- Department of Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
- Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierre Kuhn
- Médecine et Réanimation du Nouveau - né, Service de Pédiatrie 2, Pôle Medico - Chirurgical Pédiatrique Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
- INCI, UPR 3212, CNRS and University of Strasbourg, Strasbourg, France
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Manninen IK, Mäkinen LK, Laukka P, Klockars T, Blomgren K. Effect of head impacts and chemical irritation on elite athletes' olfaction. Eur J Sport Sci 2023; 23:278-283. [PMID: 34839784 DOI: 10.1080/17461391.2021.2008014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Limited research exists on athletes' olfaction. As diet is an elementary part of an athlete's lifestyle and training, it is important to know whether the sport discipline itself carries a risk for olfactory impairment. The aim of this study was to evaluate whether elite swimmers (chemical irritation), boxers (head impact) or soccer players (head impact) are at risk for impaired olfaction. Elite-level male swimmers (n = 30), boxers (n = 35) and soccer players (n = 30) aged 18-40 years were recruited from Finnish sport clubs. Floorball players (n = 30) were recruited as a control group. All participants filled in a questionnaire about their training history, nasal and sinonasal diseases, asthma, nasal operations and traumas, smoking and self-evaluation of olfaction and taste function. Sniffin' Sticks odour identification test with 12 different odorants and anterior rhinoscopy were performed on all participants. The mean score from the smelling test did not differ between the sport groups. Sinonasal diseases and bronchial asthma were more common among swimmers than among the other athletes. Rhinitis symptoms were common among all athletes. Boxing, soccer or swimming does not seem to affect sense of smell. The majority of our participating elite athletes had normal olfaction, even if they had had a long history of active sports.Highlights Boxing, soccer or swimming does not seem to affect sense of smell.Rhinitis symptoms were prevalent among all elite athlete groups in our study.Athletes with hyposmia can perceive their own decreased olfaction.Swimmers have more bronchial asthma and sinus diseases than other athlete groups.
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Affiliation(s)
- Iida-Kaisa Manninen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Laura K Mäkinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Tuomas Klockars
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Karin Blomgren
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Bartholomew RA, Mohan S, Keamy DG. Infected Septal Hematoma. J Pediatr 2022; 241:260-261. [PMID: 34560094 DOI: 10.1016/j.jpeds.2021.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ryan A Bartholomew
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Suresh Mohan
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Donald G Keamy
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Alolayet D, Alobaid F, Ahmed ME, Waheed K. Multiple Sclerosis Masquerading as Post Septorhinoplasty Complication: A Case Report. Cureus 2021; 13:e19591. [PMID: 34956744 PMCID: PMC8675578 DOI: 10.7759/cureus.19591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 11/10/2022] Open
Abstract
This is a case report of a young woman, who after a successful septorhinoplasty procedure, sustained repeated nasal trauma with a subsequent diagnosis of multiple sclerosis (MS) at a large tertiary hospital in Riyadh, Saudi Arabia. A 24-year-old woman with a history of childhood trauma presented with difficulty in breathing and dissatisfaction with her nasal appearance. After a successful and uneventful septorhinoplasty, she required numerous hospital admissions due to multiple episodes of blunt nasal trauma, culminating in clear nasal discharge and neurological symptoms, including dizziness, right-sided paresthesia and difficulty walking. Cerebrospinal fluid (CSF) leak was ruled out by CT brain; however, magnetic resonance imaging (MRI) of the brain and spinal cord showed demyelinating areas in the brain and cervical region of the spinal cord. CSF examination revealed the presence of oligoclonal bands. A neurologist confirmed the diagnosis of MS and initiated treatment, which was well tolerated. The patient is in remission with mild paresthesia in the right hand. Despite the repeated nasal trauma, the septorhinoplasty procedure had an excellent outcome. In conclusion, repeated nasal trauma, especially in the early postoperative period, in addition to procedure failure, may also point to the presence of an uncommon underlying neurological disorder, hitherto undiagnosed. It is therefore important to have an open mind when it comes to the differential diagnosis in such unusual scenarios. In addition, while investigating recurrent nasal trauma, it is extremely important to keep in mind rare neurological conditions, especially in younger patients.
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Affiliation(s)
- Dana Alolayet
- Otolaryngology - Head and Neck Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Fahad Alobaid
- Otolaryngology - Head and Neck Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | | | - Khurram Waheed
- Otolaryngology - Head and Neck Surgery, King Abdulaziz Medical City, Riyadh, SAU
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Bastianpillai J, Khan S, Acharya V, Tanna R, Pal S. How COVID-19 Changed Our Management of Nasal Bone Fractures and Its Impact on Patient Outcomes-A Retrospective Study. Ear Nose Throat J 2020; 101:671-676. [PMID: 33302744 DOI: 10.1177/0145561320981439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Nasal bone fractures are a common presentation to the Ear, Nose and Throat (ENT) surgeon. Simple, closed fractures are assessed and considered for closed manipulation under anesthesia (MUA #nasal bones). Most departments perform this under general anesthesia (GA). Our protocol changed in the face of COVID-19, where procedures were alternatively performed under local anesthesia (LA) in the clinic, to cope with lack of elective theater capacity during the pandemic, while still allowing a nasal fracture service to take place. We present postoperative patient outcomes on breathing and shape, comparing GA versus LA. METHODS Patient records retrospectively analyzed (January 2020-August 2020), and patients undergoing MUA #nasal bones interviewed by telephone after one month. Exclusion criteria were open injuries or depressed nasal bones requiring elevation. Breathing and shape scores were evaluated subjectively using a Likert scale (1 = very unsatisfied, 5 = very satisfied). RESULTS Two hundred five nasal injury referrals were made (21 MUA #nasal bones under GA and 27 under LA). Manipulation under anesthesia #nasal bones significantly improved both breathing satisfaction scores (GA; 2.88 ± 0.24 to 4.06 ± 0.23, P < 0.05; LA; 2.86 ± 0.22 to 3.77 ± 0.27, P < 0.05) and aesthetic scores (GA; 2.00 ± 0.21 to 3.94 ± 0.23, P < 0.05; LA; 1.64 ± 0.19 to 3.59 ± 0.28, P < 0.05) in both GA and LA groups. There was no statistically significant difference between LA and GA in postoperative outcomes. There was a trend toward greater satisfaction for GA, though this was not statistically significant and may be impacted by the rate of cartilaginous deformity in the LA group. Both techniques were well tolerated and most patients would repeat the procedure in hindsight. CONCLUSIONS Local anesthesia could provide a safer, cheaper, and satisfactory alternative for performing MUA #nasal bones in the clinic for selected patients, particularly with reduction of elective theater capacity in the event of further COVID-19 surges. We recommend training junior ENT surgeons to perform this procedure under supervision with adequate protective measures.
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Affiliation(s)
| | - Shaharyar Khan
- ENT Department, Northwick Park Hospital, London, United Kingdom
| | - Vikas Acharya
- ENT Department, Northwick Park Hospital, London, United Kingdom
| | - Ravina Tanna
- ENT Department, Lister Hospital, Stevenage, United Kingdom
| | - Surojit Pal
- ENT Department, Northwick Park Hospital, London, United Kingdom
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Hung KC, Chen JY, Ho CN, Sun CK. Use of sphenopalatine ganglion block in patients with postdural puncture headache: a pilot meta-analysis. Br J Anaesth 2020; 126:e25-e27. [PMID: 33131755 DOI: 10.1016/j.bja.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan; College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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Andrades P, Pereira N, Rodriguez D, Borel C, Hernández R, Villalobos R. A Five-Year Retrospective Cohort Study Analyzing Factors Influencing Complications after Nasal Trauma. Craniomaxillofac Trauma Reconstr 2019; 12:175-182. [PMID: 31428241 PMCID: PMC6697473 DOI: 10.1055/s-0038-1641713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/24/2017] [Indexed: 10/17/2022] Open
Abstract
The purpose of this study was to assess the outcomes of patients with nasal trauma during a long period of time and determine factors predisposing to complications after nasal trauma treatment. A retrospective cohort study was conducted that included all patients who were attended for a nasal trauma between January and December 2010. In 2015, the charts were retrospectively reviewed and the patients were prospectively followed up looking for outcomes after treatment of nasal trauma. A univariate analysis between complications and risk factors was performed and a logistic regression model was used to explore the prognostic role of the variables considered to have clinical relevance and to estimate the odds ratio for the occurrence of postoperative complications. A total of 220 consecutive patients with nasal trauma were included in the study. The mean follow-up was 44.3 ± 10.3 months (3-67) with 10% of lost patients. The most important factors determining complications after nasal trauma treatment were male gender, acute septal injury, chronic septal deviation, displaced or comminuted fractures in the radiologic study, and late nasal reduction surgery. A decision-making algorithm is proposed based on the fact that nasal bone fracture is not a minor problem and that closed nasal bone reduction is not the treatment of choice for all patients with nasal trauma.
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Affiliation(s)
- Patricio Andrades
- Division of Maxillofacial Surgery, Hospital del Trabajador de Santiago, Santiago, Chile
- Division of Plastic Surgery, Department of Surgery, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Nicolas Pereira
- Division of Plastic Surgery, Department of Surgery, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Diego Rodriguez
- Division of Maxillofacial Surgery, Hospital del Trabajador de Santiago, Santiago, Chile
| | - Claudio Borel
- Division of Maxillofacial Surgery, Hospital del Trabajador de Santiago, Santiago, Chile
| | - Rodrigo Hernández
- Division of Maxillofacial Surgery, Hospital del Trabajador de Santiago, Santiago, Chile
| | - Rodrigo Villalobos
- Division of Maxillofacial Surgery, Hospital del Trabajador de Santiago, Santiago, Chile
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Abstract
Background Dacryocystorhinostomy (DCR) refers to the surgical procedure that is used to relieve the chronic obstruction of the nasolacrimal duct obstruction (NLDO). In a maxillofacial setting, NLDO may arise subsequent to a facial trauma or orthognathic surgery. There is a dearth of literature from this part of the world. This article intends to provide a single maxillofacial center experience in DCR. Materials and Methods This is a retrospective, noncomparative, noninterventional, record audit type of study of all consecutive patients fulfilling inclusion and exclusion criteria. All patients with epiphora and diagnosed with lacrimal apparatus damage between 1 January 2008 and 31 December 2017 requiring DCR were considered for the study. Details of demographics, phase of treatment (primary/retreatment), types of bones involved, age, complications, period suffering from epiphora, and follow-up were obtained. All data were entered and analyzed using the Statistical Package for the Social Service (version 16; IBM). Descriptive statistics of the frequency and mean ± standard deviation (SD) as appropriate were presented. Chi-square test and one-way analysis of variance were used appropriately. P ≤ 0.05 was taken to be statistically significant. Results In all, 83 patients fulfilled the inclusion and exclusion criteria. It is more common in males (n = 56, 67.47%) with a mean ± SD of 32.24 ± 10.80 (18-59 years) with 27 (32.53%) of them presenting primarily after fractures. Fracture was the most common pathology seen in 81.93% (n = 68) of cases, while the rest were as a result of orthognathic cases. Le Fort II and III set of bones contributed to 59% of cases, while the orbitonasal complex contributed to only three cases. NLD obstruction was seen in 68 (81.9%) of cases. On an average, the patients suffered for 9.3 ± 6.74 months (range 0.5-22 months) before seeking treatment and the average follow-up was 31.07 ± 11.69 months (range 15-54 months). Discussion and Conclusion Fractures and surgeries involving nasal bones carry an innate risk of damaging the NLD system. The pattern of need for DCR and occurrence of NLDO in this part of the world have been described. The extent of the anatomical variations and need for proper surgical planning are highlighted.
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Affiliation(s)
- S M Balaji
- Department of Oral and Maxillofacial Surgery, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India
| | - Preetha Balaji
- Department of Oral and Maxillofacial Surgery, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India
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Sharma D, Kaur A, Farahbakhsh N, Agarwal S. To compare nasal mask with binasal prongs in delivering continuous positive airway pressure for reducing need of invasive ventilation: randomized controlled trial. J Matern Fetal Neonatal Med 2019; 34:1890-1896. [PMID: 31394955 DOI: 10.1080/14767058.2019.1651272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS To compare nasal mask with binasal prongs in delivering bubble continuous positive airway pressure (CPAP) for reducing need of invasive ventilation in VLBW infants: randomized controlled trial. METHODS In this randomized control trial 178 infants were enrolled, 90 were randomized to nasal mask group and 88 to nasal prong group for delivering bubble CPAP. Preterm neonates between 26 and 32 weeks of gestational age requiring CPAP for respiratory distress within 6 h of life were assessed for eligibility and were included if neonates had spontaneous respiratory efforts with respiratory distress in the form of tachypnea (respiratory rate >60/min), intercostal/subcostal retractions, grunting (audible with/without stethoscope), Silverman Anderson score ≥3, increased respiratory efforts or cyanosis. Infants received either nasal mask or binasal prongs for delivery of bubble CPAP. The primary outcome was the need for mechanical ventilation in first 72 h of life. RESULTS Baseline characteristics were comparable between the two groups. There was significant reduction in incidence of CPAP failure [15 (16.6%) versus 26 (29.5%); RR 0.47 (95% CI 0.23-0.97), p = .04]; nasal trauma (any grade) [14 (15.9%) versus 38 (43.2%); RR 0.26 (95% CI 0.12-0.52), p = .0002]; nasal trauma grade I [12 (13.3%) versus 23 (26.1%); RR 0.43 (95% CI 0.20-0.94), p = .03]; nasal trauma grade II [1 (1.1%) versus 10 (11.3%); RR 0.08 (95% CI 0.01-0.70), p = .02]; nasal trauma severe grade (II and III) [2 (2.2%) versus 15 (17.0%);RR 0.11 (95% CI 0.02-0.49), p = .004] and bronchopulmonary dysplasia [4 (4.4%) versus 12 (13.6%); RR 0.30 (95% CI 0.10-0.95), p = .04] in nasal mask group when compared to nasal prong group. CONCLUSION Nasal mask leads to significant reduction in need for mechanical ventilation in initial 72 h.
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Affiliation(s)
- Deepak Sharma
- Department of Neonatology, National Institute of Medical Sciences, Jaipur, India
| | - Amandeep Kaur
- Department of Pediatrics, National Institute of Medical Sciences, Jaipur, India
| | - Nazanin Farahbakhsh
- Department of Pulmonology, Pediatric Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sunil Agarwal
- Helping Hand Polyclinic, Vaishali Nagar, Jaipur, India
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Arnold MA, Yanik SC, Suryadevara AC. Septal fractures predict poor outcomes after closed nasal reduction: Retrospective review and survey. Laryngoscope 2018; 129:1784-1790. [PMID: 30593703 DOI: 10.1002/lary.27781] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/19/2018] [Accepted: 12/10/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine outcomes of patients with displaced nasal bone fractures after closed nasal reduction (CNR). STUDY DESIGN Retrospective patient review. METHODS Review of all patients presenting to the emergency department of a tertiary-care, level 1 trauma hospital with a nasal bone fracture over a 2-year period, followed by telephone survey after CNR. RESULTS Six hundred seven patients presented to the emergency department in 2015 and 2016 with a diagnosis of nasal bone fracture. Of these, 134 patients met inclusion criteria and underwent CNR without septal reduction. Those with sports-related injuries and those with a septal fracture identified on computed tomography imaging were significantly more likely to undergo CNR. Ninety-one patients completed the post-CNR telephone survey. Over 90% of patients were satisfied with the procedure. However, patients with septal fractures reported worse outcomes, as 53.6% versus 24.1% (P = .0025) disagreed that CNR improved nasal breathing. Of all patients, 11 (2%) eventually underwent septorhinoplasty, with the presence of septal fracture on imaging a significant risk factor. CONCLUSIONS Nasal bone fractures are a common injury, often managed initially with CNR. Patients with septal fractures should be counseled on the high risk of posttraumatic nasal deformity and obstruction despite CNR. In addition, addressing a septal fracture found on imaging may be warranted with either closed septal reduction or early aggressive management given the poorer outcomes seen in the present study. Although these patients are more likely to have definitive treatment, many forego later intervention despite persistent symptoms, emphasizing the need for early intervention or close follow-up. LEVEL OF EVIDENCE 3 Laryngoscope, 129:1784-1790, 2019.
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Affiliation(s)
- Mark A Arnold
- Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University, Syracuse, New York, U.S.A
| | - Susan C Yanik
- Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University, Syracuse, New York, U.S.A
| | - Amar C Suryadevara
- Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University, Syracuse, New York, U.S.A
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Chen CY, Chou AK, Chen YL, Chou HC, Tsao PN, Hsieh WS. Quality Improvement of Nasal Continuous Positive Airway Pressure Therapy in Neonatal Intensive Care Unit. Pediatr Neonatol 2017; 58:229-235. [PMID: 27666491 DOI: 10.1016/j.pedneo.2016.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/13/2016] [Accepted: 04/25/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Nasal continuous positive airway pressure (NCPAP) therapy is widely used in neonates, but the clinical practice varies. However, nursing practice differs among individuals, and an inappropriate application method may delay the respiratory therapy, influence the beneficial effect of NCPAP, and increase complications. We introduced a quality improvement project to expedite the application of NCPAP therapy and decrease the incidence of nasal trauma. METHODS A new strategy of mobile NCPAP cart with prepacked fixation kits and a written protocol was implemented from April 2006. All medical staff answered a questionnaire to assess their basic knowledge before and after intensive training. The records of the patients who were treated with NCPAP from October 2005 to November 2006 were reviewed. RESULTS Fifty-nine medical staff were involved in the project, and their mean score for the questionnaire improved from 69.2 points to 98.3 points after training. From October 2005 to November 2006, 113 infants were recruited in total and 82 of them were admitted after the protocol was implemented. The NCPAP cart dramatically shortened the preparation time (from 520 seconds to 72 seconds) and the application time (from 468 seconds to 200 seconds). The use of the nursing protocol significantly decreased the incidence of nasal trauma in the study population (45.2% vs. 19.6%, p = 0.006), but not in infants with a birth weight of < 1000 g. Risk factors for nasal skin trauma included lower gestational age and birth weight, longer duration of NCPAP use, and lack of standardized nursing care. CONCLUSION The mobile NCPAP cart with prepacked fixation kits is a practical way of expediting the initiation of NCPAP therapy. The written nursing protocol decreased the incidence of nasal trauma in infants, except for those with an extremely low birth weight.
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Affiliation(s)
- Chien-Yi Chen
- Department of Pediatrics, National Taiwan University Children Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - An-Kuo Chou
- Department of Pediatrics, National Taiwan University Hospital, Hsin-Chu Branch, Taipei, Taiwan
| | - Yu-Lien Chen
- Department of Nursing, National Taiwan University Children Hospital, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Children Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Children Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Children Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.
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Xie LF, Zhu L, Lu ZY, Liu C, Xu CY, Nian FH. [Efficacy analysis of endoscopic stage Ⅰ reconstruction of nasal contour and function]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:1275-1279. [PMID: 29797969 DOI: 10.13201/j.issn.1001-1781.2016.16.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Indexed: 11/12/2022]
Abstract
Objective:The aim of this study is to assess the effectiveness of endoscopic stage Ⅰ reconstruction of nasal contour and function.Method:Twenty subjects with severe nasal trauma,nasal bone fracture and deviation of nasal septum were selected.The surgeries of stage Ⅰ reconstruction of nasal contour and function were proceeded on 7 to 30 days after trauma.Result:The VAS scores of deformity of nasal contour and severity of nasal blockage assessed by patients decreased significantly after operation.Deflection distance of nasal dorsum measured by 3D imaging decreased significantly.In patients with abnormal nasal ventilation,the volume and the minimal cross-section area of abnormal nasal cavity increased significantly(P<0.05).Conclusion:The effectiveness of endoscopic stage Ⅰ reconstruction of nasal contour and function was excellent.The patients were satisfied with improvement of nasal contour and ventilation.
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Affiliation(s)
- L F Xie
- Department of Otolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing,100191,China
| | - L Zhu
- Department of Otolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing,100191,China
| | - Z Y Lu
- Department of Otolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing,100191,China
| | - C Liu
- Department of Otolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing,100191,China
| | - C Y Xu
- Department of Otolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing,100191,China
| | - F H Nian
- Department of Plastic Surgery,Peking University Third Hospital
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Younes A, Elzayat S. The role of septoplasty in the management of nasal septum fracture: a randomized quality of life study. Int J Oral Maxillofac Surg 2016; 45:1430-4. [PMID: 27338674 DOI: 10.1016/j.ijom.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/09/2016] [Accepted: 06/02/2016] [Indexed: 11/23/2022]
Abstract
Fracture of the nasal septum is a common injury. Fracture reduction using Ash forceps is the standard treatment for non-severely comminuted cases. In this study, septoplasty was compared to Ash forceps reduction of nasal septum fractures with regard to the quality of life outcome of patient breathing. Thirty consecutive patients with non-comminuted septal fractures were divided randomly into two groups. In group I, fractures were managed by closed reduction (using Ash forceps), while in group II, fractures were managed by septoplasty surgery. Each patient completed a validated quality of life scale for breathing (Nasal Obstruction Symptom Evaluation, NOSE) preoperatively and at 3 months postoperative. In group I, the mean difference between postoperative and preoperative NOSE scores was -28.33 (range -40 to -15), while in group II the mean difference was -44.33 (range -70 to -30). There was a significant improvement in nasal breathing quality of life in group II compared with group I (t-test, P=0.001). The results of this study showed a significant improvement in quality of life outcome with the use of septoplasty compared to closed reduction for acute septal fractures. Septoplasty could be recommended for patients with acute nasoseptal fractures to ensure better nasal breathing outcomes.
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Lopez A, Tang S, Kacker A, Scognamiglio T. Demographics and etiologic factors of nasal pyogenic granuloma. Int Forum Allergy Rhinol 2016; 6:1094-1097. [PMID: 27122134 DOI: 10.1002/alr.21781] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 02/22/2016] [Accepted: 03/08/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Nasal pyogenic granuloma (lobular capillary hemangioma) is a rare benign tumor of unclear etiology. This study describes the clinical characteristics and possible etiologic factors in a series of patients with pyogenic granuloma. METHODS All adult patients with a histologic diagnosis of pyogenic granuloma of the nasal cavity were identified between January 2005 and May 2015. A total of 128 charts were reviewed retrospectively for age, gender, clinical presentation, location of lesion, and medical history. RESULTS Thirty-eight patients were identified including 13 (34%) men and 25 (66%) women with a mean age of 45 years (range, 18-80 years). The majority (92%) presented with epistaxis and 76% had the lesion located on the septum. All patients had the lesion surgically excised with final pathology confirming pyogenic granuloma. Out of 38 patients, 15 (40%) had a concurrent history of altered hormonal activity (due to hormone therapy, pregnancy, or tumor), and 7 (18%) had prior injury to the nasal cavity. CONCLUSION This study is 1 of the largest case series of nasal pyogenic granuloma to be reported. In this series, this disease process was seen in approximately twice as many women as compared to men. Our data further supports prior studies, suggesting that altered hormonal activity and nasal injury may increase the risk of developing nasal pyogenic granuloma.
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Affiliation(s)
- Alexis Lopez
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Columbia University Medical Center New York, NY.,School of Medicine, University of California, San Diego, La Jolla, CA
| | - Shan Tang
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Columbia University Medical Center New York, NY.,Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY
| | - Ashutosh Kacker
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY.
| | - Theresa Scognamiglio
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY
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Newnam KM, McGrath JM, Estes T, Jallo N, Salyer J, Bass WT. An integrative review of skin breakdown in the preterm infant associated with nasal continuous positive airway pressure. J Obstet Gynecol Neonatal Nurs 2013; 42:508-16. [PMID: 24020476 DOI: 10.1111/1552-6909.12233] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To identify factors associated with skin injury during nasal continuous positive airway pressure (NCPAP) and describe differences in frequency, severity, and type of skin injuries when comparing nasal interfaces used during NCPAP in the preterm infant. DATA SOURCES Scientific databases were searched using provided key terms and yielded 113 articles. STUDY SELECTION Forty-six articles were included in this integrative review: six case studies, 22 with identified aim of examining skin and nasal injury during NCPAP; 18 included skin care considerations during NCPAP. DATA EXTRACTION Studies were categorized into four themes: types of nasal injuries; associated risk factors that increase incidence of injury; differences between NCPAP devices and/or nasal interface and corresponding rate and severity of nasal injury; and recommended prevention strategies to reduce iatrogenic cutaneous injury. DATA SYNTHESIS Skin injury was a common theme during neonatal NCPAP with skin breakdown rates of 20% to 60%. Increased skin injury risk was associated with smaller infant size, gestational age, and duration of therapy. Nursing care strategies to improve skin integrity during NCPAP had little supportive evidence. Nursing practice is varied with reportedly little standardized care during NCPAP therapy. Recommendations for specific care strategies to reduce skin injury during NCPAP were supported by limited experimental studies. CONCLUSIONS Risk factors during NCPAP include nasal injury and trauma secondary to tight-fitting nasal interfaces necessary to provide continuous distending pressure for respiratory stability. Identifying strategies to reduce skin breakdown will support noninvasive treatment success, reduce reintubation rates, reduce sepsis, reduce patient discomfort, and improve developmental outcomes during NCPAP use.
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Anastassov GE, Payami A, Manji Z. External fixation of unstable, "flail" nasal fractures. Craniomaxillofac Trauma Reconstr 2013; 5:99-106. [PMID: 23730426 DOI: 10.1055/s-0032-1313359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 02/07/2011] [Indexed: 10/28/2022] Open
Abstract
Nasal bone fractures are the most common among facial fractures. Usually these are adequately treated with closed reduction and internal and/or external stabilization with splints. However, there are clinical situations where the nasal bones are severely displaced, the nasal septum fractured and displaced, or there are external drape lacerations which preclude the use of nasal splints. If the nasal bones are reducible but unstable we consider them "flail" and in this case transmucosal, endonasal Kirschner wires are used for dorsal support until sufficient healing occurs. The technique is simple, quick, and predictable and causes minimal discomfort to the patients.
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Affiliation(s)
- George E Anastassov
- Maxillofacial Surgery, Elmhurst Hospital Center and Maxillofacial Surgery Services
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