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

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.

Evaluation of the efficacy of salmon calcitonin nasal spray on bone healing following open reduction and internal fixation of mandibular fractures - A randomized controlled trial

The objective of this study was to assess the efficacy of calcitonin spray on bone healing following open reduction internal fixation (ORIF) of mandibular fractures. Fourteen patients were subdivided into a study group and a control group. A standardized surgical protocol for ORIF was followed. Postoperatively, salmon calcitonin nasal spray was administered to only the study group. The outcome parameters assessed were serum osteocalcin, pain, and radiographic bone healing. Serum osteocalcin was assessed pre- and postoperatively. Postoperative pain was documented using a visual analogue scale (VAS) on the 7th, 14th, 23rd, and 30th days. An orthopantomogram was used to score fracture healing at four time intervals, as follows: 1 - absence of callus; 2 - presence of minimal callus; 3 - considerable callus; and 4 - complete fusion of fracture. Pain scores were lower for the study group, with no pain from the fifth day, while the control group produced a mean score for day 5 of 2.43 ± 0.98 (p = 0.001). Mean postoperative serum osteocalcin levels were higher for the study group (67.82 ± 8.89) compared with the control group (57.69 ± 6.22; p = 0.029). Bone healing at 12 weeks postoperatively was level 4 for 28.6% of patients in the study group and level 3 for 71.4%. In comparison, 85.7% in the control group demonstrated level 3 healing, while 14.3% remained at level 2 (p = 0.462). Within the limitations of the study, it can be concluded that intranasal salmon calcitonin spray reduces postoperative pain and facilitates fracture healing, although its economic efficiency is still to be proven.

Use of knotless barbed sutures for closure of intraoral incisions for maxillofacial trauma: a randomised controlled trial

The objective of this study was to assess the efficacy of knotless barbed sutures in intraoral wound closure for maxillofacial trauma in comparison with conventional (vicryl) sutures. This was a randomised controlled clinical trial involving 40 patients with isolated mandibular angle fractures who required intraoral incisions for open reduction and internal fixation (ORIF). The sample was randomised into the study group (20 patients) and control group (20 patients). Following fracture fixation by a standardised surgical protocol, the wound closure was done with bidirectional knotless barbed suture and vicryl for the study and control groups, respectively. The wounds were closed in layers (periosteum and mucosa). All operations were performed by a single surgeon. Outcome parameters measured were intraoperative wound closure time and wound healing using 'Landry's wound healing index' on the first, third, and seventh postoperative days. Statistically significant difference in suturing time was noted between the study and control group (p value <0.001). The study group demonstrated a mean (SD) suturing time of 9.46 (2.01) minutes, compared with the 17.61 (2.57) minutes in the control group. Wound healing was found to be better and statistically significant in the study group than the control group (p value<0.001). Knotless barbed suture is a promising alternative to vicryl for intraoral wound closure.

The Use of a Novel CAD-CAM Splint to Simplify Open Reduction and Internal Fixation of Mandibular Angle Fracture: A Technical Note

Mandibular angle fractures are frequently encountered as they constitute an area of weakness. Complications after open reduction and internal fixation (ORIF) of angle fractures commonly arise due to improper reduction and fixation methods that fail to counteract the dynamic muscle forces present in this region. Conventional reduction methods such as digital manipulation, intermaxillary fixation, towel clip traction, and wiring are associated with various limitations. This technical note highlights the fabrication and use of a computer-aided designing/computer-aided manufacturing-generated splint for ORIF of a superiorly displaced mandibular angle fracture. The splint consisted of 2 components: (1) a distal tooth-borne component to guide the teeth into maximum intercuspation and (2) a proximal bone-borne component to reduce the angle fracture. This composite splint facilitates simultaneous restoration of occlusion as well as reduction of mandibular angle fractures. The advantages of this technique include the following: (1) easy fabrication of splint, (2) easy and precise anatomical reduction of angle fracture, and (3) less operative time.

Analysis of 87 cases with Vogt-Koyanagi-Harada disease

PURPOSE

Vogt-Koyanagi-Harada (VKH) disease is known to have varied manifestations in different ethnic groups. In order to analyze the clinical profile of VKH cases in the Indian population, we studied 87 consecutive cases of VKH disease treated in an uveitis clinic in South India between 1985 and 1996.

METHODS

Retrospective analysis and review of charts of consecutive new VKH cases diagnosed in a referral clinic.

RESULTS

VKH disease comprised 2.2% of all uveitis referrals. Extraocular symptoms or signs were seen in 64% of cases at the time of presentation. Most common was meningism (95.9%). However, subsequently all patients developed extraocular manifestations. Panuveitis (92%) was the commonest presentation. Systemic corticosteroid was the usual form of therapy (50.3%) followed by immunosuppressive therapy (39%); surgical treatment was needed in 8% of the cases. Complicated cataract (33%) and glaucoma (24%) were major complications. Final vision was between 6/60 and 6/18 in 88% of the cases and 6/18 and better in 15.4%; there was no improvement in 11% of the cases.

CONCLUSIONS

VKH disease occurs less frequently in India than in Japan and about as commonly as in the United States. Extraocular signs are far less common than in the Japanese population. Visual prognosis is good in patients presenting within 1 month of onset of symptoms. Immunosuppressive agents and vitreoretinal surgery are needed in advanced cases and in cases reported later. Jpn J Ophthalmol 2000;44:296-301

Evaluation of cataract surgery in intermediate uveitis

BACKGROUND AND OBJECTIVE

The authors analyzed the results of cataract surgery performed on patients with intermediate uveitis from January 1990 through January 1997.

MATERIALS AND METHODS

Fifty-two eyes of 44 patients with intermediate uveitis underwent cataract surgery during this period. These patients were evaluated with respect to duration of intermediate uveitis, treatment regimen, intraoperative complications and final visual results.

RESULTS

Visual acuity improved following surgery in 94.2% eyes and 71.2% eyes achieved a final visual acuity better than or equal to 20/60. Intraocular lens implantation accompanied the surgery in 24 eyes. Regional and systemic steroids were required for control of inflammation. The factors that limited visual recovery were severe cystoid macular edema, epiretinal membrane formation, and secondary retinal detachment. Recurrence of uveitis was noted in 6 cases.

CONCLUSION

Absolute control of inflammation, atraumatic surgery, and regular postoperative follow-up can improve the results of cataract extraction. Intraocular lens implantation in selected cases is well tolerated with good visual results.

Posterior scleritis: clinical profile and imaging characteristics

Posterior scleritis is relatively uncommon and is often misdiagnosed due to its protean manifestations. We report eight cases of posterior scleritis to analyse the clinical profile, ultrasonographic and computed tomography (CT) scan features of this rare disorder. Fundus findings included serous retinal detachment, choroidal folds, retinal folds, subretinal mass, choroidal detachment, disc edema, and macular edema. There was associated anterior scleritis and anterior uveitis in the majority of the cases. In all cases ultrasound with or without CT scan confirmed the clinical diagnosis. All patients responded to systemic steroids except one who required immunosuppressive therapy. This paper describes the clinical profile of a series of posterior scleritis cases highlighting varied clinical presentation, and the role of ultrasound and CT scan findings in the diagnosis.

Pattern of uveitis in a referral uveitis clinic in India

This report describes a retrospective study of all new patients in our uveitis clinic between January 1992 and December 1994, undertaken to identify the pattern of uveitis in the Indian subcontinent. A standard clinical protocol, and the naming-meshing system with tailored laboratory investigations were used to arrive at a final uveitic diagnosis. Uveitis comprised 1.5% of new cases seen at the centre. Out of 1,273 uveitis cases, anterior uveitis was the most common type (39.28%), followed by posterior uveitis (28.75%), intermediate uveitis (17.44%), and panuveitis (14.53%). The most commonly affected age group were patients in their forties (23.57%). Uveitis was less common in children below 10 years (3.61%) and in adults over 60 years of age (6.44%). Men (62.21%) were more commonly affected than women (37.79%). Aetiology remained undetermined in 59.31% of cases. Anterior uveitis was most commonly idiopathic (58.6%). The most common cause of posterior uveitis was toxoplasmosis (27.87%), and that of panuveitis was the Vogt-Koyanagi-Harada syndrome (21.08%). A higher incidence of microbiologically proven tubercular uveitis (5 cases), and uveitis due to live intraocular nematode (4 cases), and malaria (1 case), were seen, in contrast to other studies. Only 2 cases of AIDS with ocular lesions were seen. This paper reveals the pattern of uveitis seen at a major referral eye institute in India.

Pattern of uveitis in a referral uveitis clinic in India

The pattern of uveitis changes over time with the emergence or identification of new uveitic entities. The aim of this prospective study was to obtain a correct incidence pattern and aetiology of uveitis cases seen in a uveitis clinic. We studied all new uveitic cases seen in a-one year period. A standard clinical protocol was followed for each case. Of the 465 new uveitic cases, anterior uveitis was most commonly encountered (170 cases, 36.5%), followed by posterior uveitis (132 cases, 28.4%), intermediate uveitis (92 cases, 19.8%) and panuveitis (71 cases, 15.3%). The aetiology remained undetermined in majority of the cases (58.7%): anterior uveitis (48.8%), posterior uveitis (45.45%), panuveitis (53.52%). The most common cause was collagen disease (29.4%) in anterior uveitis; toxoplasmosis (30.3%) in posterior uveitis; and Vogt-Koyanagi Harada's disease (25.35%) in panuveitis.