External Nasal Deformity Research Articles

Predictors of Nasal Obstruction: Quantification and Assessment Using Multiple Grading Scales.

Objective. To evaluate the association between nasal obstruction and (1) demographic factors, (2) medical history, (3) physical tests, and (4) nasal exam findings. Study Design. Case series. Methods. Chart review at a tertiary medical center. Results. Two hundred-forty consecutive patients (52.1 ± 17.5 years old, with a Nasal Obstruction Symptom Evaluation (NOSE) score of 32.0 ± 24.1) were included. Demographic factors and inferior turbinate sizes were not associated with NOSE score or Nasal Obstruction Visual Analog Scale (NO-VAS). A significant association was found between higher NOSE score on univariate analysis and positive history of nasal trauma (p = 0.0136), allergic rhinitis (p < 0.0001), use of nasal steroids (p = 0.0108), higher grade of external nasal deformity (p = 0.0149), higher internal nasal septal deviation grade (p = 0.0024), and narrow internal nasal valve angle (p < 0.0001). Multivariate analysis identified the following as independent predictors of high NOSE score: NO-VAS: ≥50 (Odds Ratio (OR) = 17.6 (95% CI 5.83–61.6), p < 0.0001), external nasal deformity: grades 2–4 (OR = 4.63 (95% CI 1.14–19.9), p = 0.0339), and allergic rhinitis: yes (OR = 5.5 (95% CI 1.77–18.7), p = 0.0041). Conclusion. Allergic rhinitis, NO-VAS score ≥ 50, and external nasal deformity (grades 2–4) were statistically significant independent predictors of high NOSE scores on multivariate analysis. Inferior turbinate size was not associated with NOSE scores or NO-VAS.

Nasal sequelae of Treacher Collins syndrome

This study aimed to determine external and endonasal deformity, and satisfaction with nasal functioning and appearance, in Treacher Collins syndrome. A cross-sectional cohort study was conducted. Eleven adult patients with Treacher Collins syndrome were compared with 151 controls in terms of satisfaction with nasal functioning and appearance by means of the Nasal Appearance and Function Evaluation Questionnaire. In all patients with Treacher Collins syndrome, external nasal deformities were scored on standardized digital photographs of the nose as rated independently by three experienced physicians. Endonasal deformity was determined by standardized nasal endoscopy. The patients were relatively satisfied with the various esthetic nasal subunits. The most significant functional problems were snoring (P=0.001) and quality of phonation (P=0.003). The main external nasal deformities were the dorsal hump (73%), external deviation (≤55%), the bifid or bulbous nasal tip (55%), and columellar septal luxation (55%). In 82% of the patients, a septal deviation was found, often associated with spurs. Satisfaction with esthetics of the nose was fair, but these patients suffer from the functional problems of snoring and impaired quality of phonation. A structured nasal ENT physical examination with nasal endoscopy might determine aspects requiring more attention during treatment. Septorhinoplasty can be performed at an adult age if there is a considerable esthetic wish of the patient and/or nasal obstruction combined with septal deviation. Attention should be paid to dorsal hump reduction, correction of the deviated external osseous framework, septoplasty, and correction of the nasal tip shape. 2b.

Effect of Septorhinoplasty on Olfactory Function: Assessment Using the Brief Smell Identification Test.

Septorhinoplasty (SRP), one of the most commonly performed rhinologic surgery procedures, can affect olfactory function; however, the findings of studies investigating smell following SRP are controversial. We used a culturally adapted modified Brief Smell Identification Test (B-SIT) to investigate the long- and short-term effects of SRP on olfactory function. We enrolled 59 patients admitted to the Ear-Nose-Throat Clinic, who were complaining of external nasal deformity and nasal obstruction. Functional SRP was performed on all cases. The B-SIT was administered prior to surgery and at 4 and 12 weeks post-surgery. The smell identification score (SIS) reflected the number of correct answers. In addition, we investigated the effects of gender and smoking on olfactory function and whether the SRP procedure changed these associations. The mean preoperative, 4-week, and 12-week postoperative SISs were 10.15±1.30, 10.21±1.52, and 10.92±0.95, respectively. The difference between the preoperative and 4-week postoperative SISs was not statistically significant; however, the 12-week postoperative score was significantly different from the preoperative and 4-week postoperative scores. Furthermore, the repeated measures analysis according to gender and smoking habit revealed a significant difference between the 4-and 12-week postoperative SISs. One patient developed postoperative anosmia; however, the patient recovered in the 12-week postoperative period. SRP surgery is a safe procedure in terms of olfactory function. In addition, olfactory function may increase following surgery as a result of improved nasal airflow.

Unilateral Choanal Atresia Diagnosed During Operation: Case Report [Peroperatif Tani Konulan Unilateral Koanal Atrezi: Olgu Sunumu

Choanal atresia is the unilateral or bilateral obstruction of the passage between nasal cavity and nasopharynx. Transnasal surgery of choanal atresia in a patient with unilateral choanal atresia diagnosed accidentally during operation of septorinoplasti for septal deviation and external nasal deformity in Plastic Surgery Clinic is presented. A 25-year-old female referred to plastic surgery clinic with external nasal deformity and difficulty in breathing through nose. Although concha bullosa at middle concha and polipoid degeneration at lower concha are observed in computerized tomography of paranasal sinus, the patient referred to our clinic. In physical examination, due to advanced septal deviation, endoscopic examination of left nasal cavity could not be established. It was planned to examine the left nasal cavity in operating room after septoplasty. In the endoscopic examination after septoplasty, choanal atresia at left nasal cavity observed. Atresia was repaired with transnasal approach. At follow-up period, the choanal opening was intact. Unilateral choanal atresia is a disorder which can reach at the adolesant ages without diagnosis. Although the symptoms of the disease can be interfere in lots of diseases, the diagnosis is simple with nasal endoscopic examination. If nasal endoscopic examination is difficult because of nasal septal deviation, it must be performed in operating room before ending the operation to reveal the additional disorders.

Effect of septoplasty with a caudal septal batten graft on changes in nasal shape.

This study aimed to determine frequency of external nasal deformities in patients with deviated septa and the effect of endonasalseptoplasty with batten grafting on the external nasal appearance. The 52 patients who underwent endonasalseptoplasty with a batten graft for the correction of caudal septal deviations were included in the study. The preoperative and postoperative photographs of 52 patients were reviewed retrospectively. Gross changes (nasal deviation, dorsal middle vault height, tip height change, and nostril asymmetry) were assessed. Anthropometric measurements (dorsal height, nasal tip projection, nasolabial angle, nasofrontal angle, and deviation angle) were performed. Preoperative assessment showed that 71% of the 52 patients had deformities, including nasal deviation (n=28), hump nose (n=19), saddle nose (n=3), and nostril asymmetry (n=15). On postoperative analysis, favorable changes in dorsal deviations were seen in 61% of patients. There were no aesthetic changes for hump or saddle nose deformities, whereas nostril asymmetry was corrected in 20% of patients. Anthropometric measurements also showed that dorsal deviation angles were corrected after surgery (P<.05), whereas other parameters showed no significant changes. In selected cases, deviated noses can be corrected to some extent by septoplasty with caudal septal batten grafting.

A Study of Aesthetic Outcomes of Primary Rhinoplasty in Crooked Nose Deformity

Objectives: (1) Rhinoplasty is the treatment of choice for patients with crooked nose deformity. (2) Objective assessment of nasal and facial profile using digital photographs and computer software is an integral part of management. (3) Recognize that subjective evaluation of patient satisfaction regarding aesthetic improvement is an important aspect of rhinoplasty. Methods: A prospective study from January 2011 to September 2012. Crooked nose deformity in 20 cases of either sex in the age group of 18 to 40 years. Setting: Pt. BDS Post graduate Institute Medical Sciences Rohtak, India, a tertiary care center. Rhinoplasty was performed through the external approach, and aesthetic improvement was evaluated through photographic analysis. Patient satisfaction was also assessed using a visual analog scale of 1 to 100. Independent Variables: Age, sex, external nasal deformity, and nasal septum deviation. Results: Statistical analysis was done using IBM SPSS v.20 software by paired “t” test. The preoperative nasal deviation alignment angle was 13.76° ± 5.21° while in the postoperative period it was 3.07° ± 2.08° ( P &lt; .001). Subjective assessment using visual analog scale showed an improvement from preoperative score of 47.6 ± 7.27 to 81.5 ± 10.69 postoperatively ( P &lt; .001). Conclusions: Objective assessment and documentation of nasal deformities is an integral part of rhinoplasty. Subjective evaluation, on the other hand, is a useful tool to assess the degree of patient satisfaction.

Non-surgical aesthetic nasal enhancement: indications, contraindications and anatomy

The non-surgical facial aesthetics arena is rapidly evolving and there has been a high demand over recent years for the correction of mild-to-moderate external nasal deformities. The minimally invasive rhinoplasty combines the adjuvant use of botulinum toxin type A and dermal fillers to rectify or improve a range of perceived or actual nasal defects (e.g. drooping tip, depressed areas). The procedure takes place in an outpatient setting and involves virtually no discomfort, little associated downtime, and is considered very safe and efficient, yielding high patient satisfaction rates. This article will explore the history of the procedure, describe the ideal nasal proportions, outline the anatomy of the external nose and cover the indications and contraindications for the procedure. A second article will look at the products used and provide readers with a treatment protocol. Both articles are reflective of the author's experience.

Criteria for Defining ‘Severe Septal Deviation’

ABSTRACTObjectiveCriteria for defining ‘severe septal deviation’ and to describe the clinical profile of the same.StudyRetrospective study.Materials and methodsHundred patients who were diagnosed with severe DNS and treated with extracorporeal septoplasty (ECSP) from September 2010 to December 2012, were retrospectively evaluated for this study. A review of their clinical charts formed the basis of this study.ResultsIn this study, majority of patients (96%) had nasal obstruction as their prime symptom followed by postnasal discharge in 60% cases, headache in 40% cases and anterior nasal discharge in 30% cases. External nasal deformity was reported by 22 patients. Snoring was seen in 24% of patients with same percentage complaining of altered sense of smell and throat discomfort. Epistaxis, sneezing and facial pain were seen in 14% patients. Epiphora was complained by only 8% of patients.In this study, nasal endoscopy/anterior rhinoscopy was used to type the septal deformity. The commonest septal deviation was C-shaped cephalocaudal (48%), followed by S-shaped cephalocaudal (18%), C-shaped AP (16%), S-shaped AP (12%) and sharp septal deviation/angulation in 6% cases.All but three patients (6%) had deviated nasal septum involving multiple Cottle's areas. These three patients had sharp septal angulation involving Cottle's area 2 only.In this study, most common region involving DNS was area 1 + 2 + 3 (48%) followed by area 2 + 4 + 5 (28%) and 1 + 2 + 3 + 4 (18%).Area 2 was invariably involved in 100% of cases.NOSE (nasal obstruction symptom evaluation) scores.Preoperatively, mean NOSE score was 67.60 ± 5.26 (65.34-72.86).NSS (nasal symptoms score):– Preoperatively, mean NSS was –5.08 ± 0.38 (–5.46-–4.70).ConclusionA septal deviation is regarded as ‘severe’ if patient satisfies all of the below-mentioned criteria:– Preoperatively, mean NOSE score should be 65.34 or more.Preoperatively, mean NSS should be –4.70 or more negative.The septal deviation must cause significant obstruction to Cottle's area 2 or nasal valve area.Patients of severe septal deviation report significantly higher rates of snoring (24% in our study) and PND (60% in our study) when compared with mild/moderate cases.All severe septal deviations display significant obstruction of Cottle's area 2/nasal valve area and it is thus concluded that a severe septal deviation must cause significant obstruction of area 2/nasal valve.How to cite this articleMattoo O, Muzaffar R, Khurshid RS, Islam S. Criteria for Defining ‘Severe Septal Deviation’. Int J Head Neck Surg 2014;5(1):6-8.

Nasal Congestion, Postnasal Drip, and Aural Fullness

A54-year-oldmanpresentedwith a3-monthhistory ofworsening right-sidednasalcongestion,postnasaldrip,andaural fullness.Hedeniedepistaxisbutcomplainedofheadachesandfacialpainoverhisright frontalandmaxillarysinuses.Hehadcompleted2coursesoferythromycin,acourseofmethylprednisolone,andatrialofalbuterol,allwith partial relief.He reportedahistoryofallergic rhinitis and recurrent sinusitiswithaural fullnessbutdeniedsmokingorenvironmentalexposures. Therewas no external nasal deformity. Rigid nasal endoscopy revealedapale,multilobulatedmasshigh in the rightnasal cavityand medial to themiddle turbinate (Figure, A). The lesionobstructed the middlemeatusbymasseffectandlateralizationofthemiddleturbinate withsecondaryobstructionofthemaxillaryostiumandfrontal recess. Thenasal septumwasmidlinewithoutdisease in the left nasal cavity. Unenhanced computed tomographic (CT) imaging showed a 34 × 15-mm lesion in the superior aspect of the right nasal cavity with extension to the cribriform plate and ethmoid sinuses. There was opacification of the right frontal sinus but no evidence of bony erosion of the cribriform plate or lateral invasion into the orbit or nasal septum. Representative coronal T1-, T2-, and postcontrast T1-weighted MRI images are shown in the Figure, B-D, respectively. Findings from the examinationwere otherwise unremarkable. At surgery, the lesionwas found tohaveeroded through themiddle turbinate and to be attached to the skull base near the anterior attachment of themiddle turbinate. What is your diagnosis? A

Deviated nose attenuates the degree of patient satisfaction and quality of life in rhinoplasty: a prospective controlled study

To analyse and compare the patient satisfaction and quality of life in patients with and without deviated nose deformity who underwent rhinoplasty. Prospective, before-after trial. Tertiary referral centre. A total of 191 patients who underwent primary rhinoplasty between 2006 and 2009 were included. The study population was separated into two groups: non-deviated (patients with an external nasal deformity of less than 5(0)) and deviated nose (patients with an external nasal deformity of more than 5(0)). The angles of deviations were measured from the pre- and postoperative photographs by an image analysis software program. Patient satisfaction and quality of life were measured by Rhinoplasty outcome evaluation and European Quality of Life-5 Dimension questionnaires before and after surgery. Eighty-one cases had deviated nose deformity; on the other hand, 110 cases had nasal deformities other than deviated nose deformity. The objective analysis of surgical outcome demonstrated a statistically significant improvement in the favour of postoperative results in both non-deviated (P = 0.0004) and deviated (P = 0.0002) nose groups. In addition, Rhinoplasty outcome evaluation and European Quality of Life-5 Dimension questionnaires demonstrated remarkable improvement in both non-deviated and deviated nose groups after rhinoplasty. However, the comparison of pre- and postoperative change between non-deviated and deviated nose groups demonstrated statistically significant differences in almost all questions (except family and friends' satisfaction with appearance P = 0.069) and total score (P < 0.001) of Rhinoplasty outcome evaluation questionnaire, European Quality of Life-5 Dimension index (P < 0.001), European Quality of Life-5 Dimension visual analogue scale (P = 0.036) and living quality index (P < 0.001) with lower scores in deviated nose group. Rhinoplasty can provide an objective improvement, high satisfaction and positive impact on quality of life. However, the degree of satisfaction and improvement in quality of life in patients with deviated nose deformity are less than patients with non-deviated nose deformity.

Analysis of Facial Deformities in Korean Leprosy

ObjectivesThe clinical features of various facial deformities in Korean leprosy patients were evaluated according to the type of leprosy.MethodsOne hundred ninety six patients with leprosy were examined for various facial deformities using a nasal speculum, endoscope, and digital camera. The frequency and severity of external nasal deformities and septal perforations were evaluated according to the type of leprosy. Eye deformities, ear deformities, and facial palsy were also assessed.ResultsSeventy-one patients (36.2%) displayed external nasal deformities: 28 minimal contractures, three cartilage contractures, two bony-cartilage contractures, and 38 skin defects. The external nasal deformity and severe form deformity in lepromatous types were more frequent compared to other types (P<0.05 for each variable). Twenty-three patients (9%) displayed septal perforations, among whom 11 had cartilaginous perforations and 12 had bony-cartilaginous perforations. The frequency of septal and bony-cartilaginous perforations did not differ significantly between the types of leprosy (P>0.05 for each variable). Sixty-one patients (31.1%) had eye deformities and 19 patients (9.7%) had facial nerve palsy, common in the borderline type. No cases of ear deformities were observed.ConclusionKorean patients had characteristic deformities according to the type of leprosy. They were different from those seen in the prior analyses of Caucasian populations.

Criteria for Defining Severe Septal Deviation

Objective: Criteria for defi ning ‘severe septal deviation’ and to describe the clinical profi le of the same. Study: Retrospective study. Materials and methods: Hundred patients who were diagnosed with severe DNS and treated with extracorporeal septoplasty (ECSP) from September 2010 to December 2012, were retrospectively evaluated for this study. A review of their clinical charts formed the basis of this study. Results • In this study, majority of patients (96%) had nasal obstruction as their prime symptom followed by postnasal discharge in 60% cases, headache in 40% cases and anterior nasal discharge in 30% cases. External nasal deformity was reported by 22 patients. Snoring was seen in 24% of patients with same percentage complaining of altered sense of smell and throat discomfort. Epistaxis, sneezing and facial pain were seen in 14% patients. Epiphora was complained by only 8% of patients. • In this study, nasal endoscopy/anterior rhinoscopy was used to type the septal deformity. The commonest septal deviation was C-shaped cephalocaudal (48%), followed by S-shaped cephalocaudal (18%), C-shaped AP (16%), S-shaped AP (12%) and sharp septal deviation/angulation in 6% cases. • All but three patients (6%) had deviated nasal septum involving multiple Cottle’s areas. These three patients had sharp septal angulation involving Cottle’s area 2 only. • In this study, most common region involving DNS was area 1 + 2 + 3 (48%) followed by area 2 + 4 + 5 (28%) and 1 + 2 + 3 + 4 (18%). • Area 2 was invariably involved in 100% of cases. • NOSE (nasal obstruction symptom evaluation) scores. • Preoperatively, mean NOSE score was 67.60 ± 5.26 (65.34

A prospective study of an effect of septorhinoplasty/rhinoplasty on deviated external nasal pyramid in Kashmiri population

Most studies show that objective measures to quantify and determine surgical success in the treatment of External nasal deformity with/without nasal obstruction do not correlate with subjective improvement as reported by patients.

Comparison of the quality of life before and after septorhinoplasty

Objective: The aim of our study is to assess the impact of septorhinoplasty on quality of life (QOL) using general health and disease-specific quality scales and to identify the effect of age, gender and education on the change process of the patient's quality of life. Methods: The study included patients with septal deviation and external nasal deformity. Short Form 36 and Esthetic Functional Nasal Assessment Form (EFBDF) were used as QOL instruments; and rhinomanometry to measure airway resistance. Tests were conducted just before surgery and three months and one year after surgery. Results: Forty-one patients (22 males, 19 females, mean age 29.9) undergoing nasal surgery were studied prospectively. Compared to preoperative scores, we found significant improvements in general health, mental health, energy, pain, physical and social function scores of SF-36 subscales conducted in the third month and first year after the surgery. There was no difference in physical role and emotional role subscales. Nasal surgery specific EFBDF scores were significantly improved in two measurement periods following surgery compared to preoperative values. The pre/post-operative rhinomanometric measurements showed an improvement and the difference was also significant. There was no correlation between QOL instruments with sex, age and educational status. Conclusion: Our study has shown that general and nasal specific QOL was improved with SRP patients assuming that correct indication for surgery is given and correct surgical method is chosen. Also SRP patients were able to breathe more efficiently through their noses after surgery.

Nasal Septal Deviation and External Nasal Deformity: A Correlative Study of 100 Cases

A prospective study of 100 consecutive patients of deviated nasal septum to analyze association of septal deviation with external nasal deformity was undertaken at Acharya Vinoba Bhave rural Hospital of Jawaharlal Nehru Medical College, Sawangi (Meghe) Wardha from January 2009 to September 2010. Nasal septal deviations were evaluated by clinical examination and diagnostic nasal endoscopy while external nasal deformities, after evaluating, were documented using high resolution photography Nasal septal deviations were classified in seven types from I to VII by using Mladina's classification modified by Janardhan et al. Jang classification was employed to classify external nasal deformities. 66% of the patients with deviated nasal septum were symptomatic while 34 lacked symptoms. Nasal obstruction was the most frequent symptom in 64% followed by nasal discharge in 33% Type VII was the most common type of deviation in 29%. Study revealed that 67% of the patients with deviated nasal septum had external nasal deformity and of the 67 patients with external deformity, Type I deformity was most frequent (26%). Remarkable feature of our study was Type I, III, V septal deviations were not associated with external deviation Type II septal deviations were commonly associated with Type III external deformity (7%) and Type IV septal deviation were closely associated with Type I external deformity (12%).

Oronasal complications in patients after transsphenoidal hypophyseal surgery

Transsphenoidal surgery is the most commonly used surgical procedure to handle the hypophyseal region, sometimes associated with oronasal complications. MATERIAL AND METHODS/AIM: To evaluate prospectively (specific questionnaire, clinical evaluation) undiagnosed chronic oronasal complications in patients submitted to conventional transsphenoidal adenomectomy surgery, operated at different neurosurgery services more than 6 months ago. RESULTS: 49 patients were evaluated, 37/45 presented macroadenoma. 28,5% were submitted to more than one intervention, 2/5 transsphenoidally. Transsphenoidal approach 92.8% through sublabial route. No patient had spontaneous complaint. With the specific questionnaire 63.2% presented complaints. One patient presented an oronasal fistula, 1 stenosis of the nasal valve area with external nasal deformity. Rhinoscopy detected alterations in 77.5%, nasal endoscopy in 87.7%. Septal perforation was present in 10/12 patients with scabs and 2 with purulent secretion. All 4 patients submitted to 2 transsphenoidal approaches presented septal perforation and nasal synechiae. In the endonasal, synechiae (2), alteration in medium meatus (1) and stenosis of the nasal valve area (1) were observed. Only two patients presented normal evaluation. CONCLUSION: A high incidence of nasal complications after conventional transsphenoidal surgery observed through examination and not reported spontaneously point to the need of otorhinolaryngological investigation complemented by nasal endoscopy in patients submitted to procedures through this route.

Oronasal complications in patients after transsphenoidal hypophyseal surgery

SummaryTranssphenoidal surgery is the most commonly used surgical procedure to handle the hypophyseal region, sometimes associated with oronasal complications.Material and methods/aimTo evaluate prospectively (specific questionnaire, clinical evaluation) undiagnosed chronic oronasal complications in patients submitted to conventional transsphenoidal adenomectomy surgery, operated at different neurosurgery services more than 6 months ago.Results49 patients were evaluated, 37/45 presented macroadenoma. 28,5% were submitted to more than one intervention, 2/5 transsphenoidally. Transsphenoidal approach 92.8% through sublabial route. No patient had spontaneous complaint. With the specific questionnaire 63.2% presented complaints. One patient presented an oronasal fistula, 1 stenosis of the nasal valve area with external nasal deformity. Rhinoscopy detected alterations in 77.5%, nasal endoscopy in 87.7%. Septal perforation was present in 10/12 patients with scabs and 2 with purulent secretion. All 4 patients submitted to 2 transsphenoidal approaches presented septal perforation and nasal synechiae. In the endonasal, synechiae (2), alteration in medium meatus (1) and stenosis of the nasal valve area (1) were observed. Only two patients presented normal evaluation.ConclusionA high incidence of nasal complications after conventional transsphenoidal surgery observed through examination and not reported spontaneously point to the need of otorhinolaryngological investigation complemented by nasal endoscopy in patients submitted to procedures through this route.

Psychological implications in ENT diseases.

We are sometimes faced with psychic derangement or overlay in some of the ENT diseases and the link between patient's psyche and any ENT disease at times becomes signifi cant and troublesome. The conditions in the fi eld between otorhinolaryngology and psychiatry can be classifi ed as psychiatric symptoms resulting from ENT diseases or interventions and those expressing themselves as ENT symptoms due to mental ailment. The former include hearing impairment, dizziness, tinnitus, choked airway, bad oral breath, stuffy nose, traumatic interventions and external nasal deformities. The later include exaggerated and diminished pharyngeal refl ex, globus hystericus, speech disorders, vasomotor rhinitis, nose picking, choked feeling, dizziness and headache. At times diseases originate in the human mind (consciousness), causing negative thoughts like jealousy, anger, and depression due to frustration. p ]A healthy mind in a healthy body generates sound and noble thoughts. Once a healthy body-mind relationship is established, we can be reasonably sure that greater happiness and success is within our reach. Patient seeking help from ENT surgeons to change their physical appearances and or function may not understand that the ultimate goal of surgery is to bring about psychological change by modifying the physical change, which is important aspect in septorhinoplastic surgery. At times patients asking for corrective rhinoplasty for minor external nasal deformities may have underlying psychological disturbance and use even slight external nasal deformity as scapegoat for psychological upset. Males are more diffi cult patients psychologically for any facial cosmetic surgery. These days some patients read about their diseases or treatment on the Internet and get more confused and psychologically disturbed due to rare causes of their illness, rare complications and diversity of treatment available.

Nasal septal cyst: A rare phenomenon

Introduction Well-recognized complications of nasal septal surgery i.e. septoplasty or submucous resection (SMR), include septal haematoma, infection, septal perforation and external nasal deformity. Nasal septal cysts are extremely rare in rhinology. Objectives To discuss the underlying aetiological theories, management and strategies for prevention of this very rare complication of a commonly performed rhinological procedure such as SMR. Case report We describe a case of a nasal septal cyst several years after an SMR had been performed, which was excised using an open rhinoplasty approach that has not previously been described for this purpose. Conclusion Entrapment of free nasal mucosal remnants or inward folding of incised septal mucosa in the submucosal space is postulated as the cause of this phenomenon, leading to the development of this type of “inclusion” cyst. Postoperative nasal packing, especially if traumatic, may exacerbate this. We recommend that anterior nasal packing should be used only if necessary, and packs inserted with care, possibly under endoscopic guidance.

The Caudal Septum Replacement Graft

To describe a technique for reconstructing the lost tip support in cases involving caudal septal and premaxillary deficiencies. The study included 120 patients with aesthetic and functional nasal problems resulting from the loss of caudal septal and premaxillary support. An external rhinoplasty approach was performed to reconstruct the lost support using a cartilaginous caudal septum replacement graft and premaxillary augmentation with Mersilene mesh. The majority of cases (75%) involved revisions in patients who had previously undergone 1 or more nasal surgical procedures. A caudal septum replacement graft was combined with premaxillary augmentation in 93 patients (77.5%). The mean follow-up period was 3 years (range, 1-12 years). The technique succeeded in correcting the external nasal deformities in all patients and resulted in a significant improvement in breathing in 74 patients (86%) with preoperative nasal obstruction. There were no cases of infection, displacement, or extrusion. The caudal septum replacement graft proved to be very effective in restoring the lost tip support in patients with caudal septal deficiency. Combining the graft with premaxillary augmentation using Mersilene mesh helped increase support and stability over long-term follow-up.