Nasal Bone Research Articles

Expression of the HIF-1α/VEGF pathway is upregulated to protect alveolar bone density reduction in nasal-obstructed rats.

Hypoxia and mouth breathing are closely related to maxillofacial bone metabolism and are characteristic of obstructive sleep apnea-hypopnea syndrome (OSAHS). Being key factors in the hypoxia response, hypoxia-inducible factor 1α (HIF-1α) and HIF-responsive gene vascular endothelial growth factor (VEGF) are essential for bone remodeling. This study focuses on the role of the HIF-1α/VEGF pathway in alveolar bone metabolism during OSAHS. 36 three-week-old male Wistar rats were divided into three groups: twelve control rats, twelve bilateral nasal obstructed (BNO) rats, twelve BNO rats treated with intraperitoneal injection of Dimethyloxalylglycine (DMOG). After two weeks, the microstructure and bone mineral density (BMD) of alveolar bone were evaluated using micro-computed tomography (micro-CT). The expressions of HIF-1α and VEGF in the alveolar bone were then assessed via immunohistochemistry staining, quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. Alkaline phosphatase (ALP) staining and Alizarin red S staining were performed to evaluate osteogenesis of bone marrow-derived mesenchymal stem cells (BMSCs). Significant reductions in alveolar bone density were noted in BNO rats. Bilateral nasal obstruction increased the expressions of HIF-1α and VEGF in alveolar bone. With upregulation of HIF-1α/VEGF via DMOG, alveolar bone density of BNO rats increased. Furthermore, DMOG promoted the osteogenic differentiation of BMSCs by stabilizing the HIF-1α protein and increasing the expression of VEGF. Bilateral nasal obstruction changes alveolar bone structure and leads to a reduction in alveolar bone density. Moreover, the expression of the HIF-1α/VEGF signaling pathway increases to protect alveolar bone density reduction in BNO rats.

Changing of nasal fracture patterns in maxillofacial trauma consultation-impact of the covid-19 pandemic.

In 2020, the coronavirus SARS-CoV-2 led to a pandemic that had a major impact on the global health care systems. The aim of this study was to analyze the impact of the Covid-19 pandemic on nasal bone (NB) fracture patterns/distributions and circumstances in a German cranio-maxillofacial trauma center. This retrospective study compared the nasal fracture patterns of patients in the PreCovid (PC) era (February 2019 - January 2020) with patients in the IntraCovid (IC) era (February 2020 - January 2021). In addition to baseline characteristics, the type of NB fractures, the circumstances leading to NB fracture and hospital admissions/treatments were analyzed. The present study showed a significant decrease in the total number of NB fractures during the Covid-19 pandemic. In the IC period, a significant increase in falls and virus-/flu associated syncopes leading to NB fractures was detected. At the same time, a significant decrease in sports accidents, road traffic accidents and interpersonal violence leading to NB fractures was observed in the IC period. Under the influence of the Covid-19 pandemic, a significant increase in accidents at home, accidents during the weekdays and closed reductions under local anesthesia was detected when being compared to the PC period. The daytime of trauma leading to NB fractures also changed significantly from night-time (PC) to morning-time (IC). The Covid-19 pandemic had a significant impact on the NB fracture circumstances and treatment modalities. Therefore, the results of this study can serve as a baseline for further studies of the impact of the Covid-19 pandemic on NB fracture patterns among different countries.

Changes in peripheral blood IL-9, Th9, and BAFF levels in patients with allergic rhinitis and their clinical implications.

Allergic Rhinitis (AR), a prevalent condition in otorhinolaryngology, is mediated by Type 1 hypersensitivity through IgE, characterized by Type 2 inflammatory response and eosinophil infiltration in the nasal mucosa. Since AR disease exhibits significant heterogeneity in symptom severity, an objective assessment of AR severity may facilitate better individualized treatment. To explore the changes in peripheral blood IL-9, Th9, and BAFF levels of allergic rhinitis (AR) in patients and the clinical significance associated with it. A retrospective study selected 80 AR patients admitted from January 2022 to October 2022 as the case group, dividing them into mild and moderate-to-severe groups based on symptom scores. Concurrently, 50 patients without AR, who were treated for nasal bone fractures or underwent septoplasty, were selected as the group for comparison. Alterations in the expression levels of peripheral blood IL-9, Th9, and BAFF were analyzed and compared among the different groups. The diagnostic value of serum BAFF for the severity of AR was analyzed using the receiver operating characteristic (ROC) curve. Noticeable variations were observed in clinical variables among the three groups such as, total IgE levels, peripheral blood eosinophil count and proportion, TNSS, and VAS (P< 0.05), while no statistically significant differences were observed in other variables (P> 0.05). The comparison of IL-9, Th9, and BAFF among the three groups revealed statistically significant differences (P< 0.05). Analysis using multivariate logistic regression revealed that IL-9 (OR = 2.365), Th9 (OR = 2.186), BAFF (OR = 2.307) were influencing factors of moderate-to-severe AR (P< 0.05). The ROC curve indicated that the AUC for the diagnosis of moderate-to-severe AR by IL-9, Th9, BAFF were 0.770, 0.734, 0.761, respectively, and the combined detection AUC was 0.888, an area under the curve higher than individual testing. Changes in peripheral blood IL-9, Th9, and BAFF levels in AR patients may function as indicators to assess the level of severity in diagnostic procedures.

Clinical Examination and Diagnosis of Nasal Bone Fracture; Is There Really a Need for X-ray Nasal Bone?

Objective: To evaluate the role of clinical examination in diagnosing nasal bone fracture. Methodology: This Prospective Observational study was carried out in the departments of Otolaryngology-Head and Neck Surgery and Radiology at the Pakistan Institute of Medical Sciences, Islamabad, from Jan 2022 to Dec 2023. About 1000 patients of nose trauma patients coming to ENT emergency were evaluated clinically by thorough nose examination by ENT surgeon and radiologically by X-ray nasal bone both lateral and anteroposterior view. Based on examination if nasal bone fracture was suspected patient was referred to radiology department for X-ray nasal bone which was reported by radiologist if the bone is fractured or not. The clinical findings were correlated with X-ray reports to find out if there really is a need for X-ray nasal bone for diagnosing nasal bone fracture. The diagnostic accuracy of clinical examination was calculated. Results: When clinical and radiological findings were compared regarding the diagnosis of nasal bone fracture a statistically significant association was found between the two (p=&lt;0.001) showing patients with clinical suspicion of fracture actually had fracture on X-ray. The diagnostic accuracy of clinical examination was very high with Positive Predictive Value, Negative Predictive Value, Sensitivity, Specificity, False Negative Rate and False Positive Rate being 96.1%, 93%, 88.5%, 97.7%, 11.5% and 2.3% respectively. Conclusion: We concluded that almost all patients with suspected nasal bone fracture actually had fractures on X-ray. Fractured nasal bone can correctly be diagnosed clinically by ENT surgeon and there is no real need for X-ray nasal bone just for diagnosing nasal bone fracture.

Epidemiology of maxillofacial trauma in elderly patients receiving oral anticoagulant or antithrombotic medication; a Swiss retrospective study

BackgroundThe percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. As newer agents are introduced, each comes with its own advantages and precautions. Our study covered elderly patients admitted to the ED with maxillofacial trauma while on anticoagulation (AC) or antiplatelet therapy (APT). We aimed to investigate the demographic characteristics, causes, and types of maxillofacial trauma, along with concomitant injuries, duration of hospitalisation, haemorrhagic complications, and the overall costs of care in the emergency department (ED).MethodsData were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients over 65 of age were included, who presented at our ED with maxillofacial trauma between 2013 and 2019 while undergoing treatment with therapeutic AC/APT.ResultsThe study involved 188 patients with a median age of 81 years (IQR: 81 [74; 87]), of whom 55.3% (n=104) were male. More than half (54.8%, n=103) were aged 80 years or older. Cardiovascular diseases were present in 69.7% (n=131) of the patients, with the most common indications for AC/APT use being previous thromboembolic events (41.5%, n=78) and atrial fibrillation (25.5%, n=48). The predominant cause of facial injury was falls, accounting for 83.5% (n=157) of cases, followed by bicycle accidents (6.9%, n=13) and road-traffic accidents (5.3%, n=10). The most common primary injuries were fractures of the orbital floor and/or medial/lateral wall (60.1%, n=113), zygomatic bone (30.3%, n=57), followed by isolated orbital floor fractures (23.4%, n=44) and nasal bone fractures (19.1%, n=36). Fractures of the mandible occurred in 14.9% (n=28). Facial hematomas occurred in 68.6% of patients (129 cases), primarily in the midface area. Relevant facial bleeding complications were intracerebral haemorrhage being the most frequent (28.2%, n=53), followed by epistaxis (12.2%, n=23) and retrobulbar/intraorbital hematoma (9%, n=17). Sixteen patients (8.5%) experienced heavy bleeding that required emergency treatment. The in-hospital mortality rate was 2.1% (4 cases).ConclusionsThis study indicates that falls are the leading cause of maxillofacial trauma in the elderly, with the most common diagnoses being orbital, zygomatic, and nasal fractures. Haemorrhagic complications primarily involve facial hematomas, especially in the middle third of the face, with intracerebral haemorrhage being the second most frequent. Surgical intervention for bleeding was required in 8.5% of cases. Given the aging population, it is essential to improve prevention strategies and update safety protocols, particularly for patients on anticoagulant/antiplatelet therapy (AC/APT). This can ensure rapid diagnostic imaging and prompt treatment in emergencies.

Primary Frontal Sinus Carcinoma: A Case Report

Primary frontal sinus carcinoma is rare, with an incidence of 0.3-1% of all paranasal sinus carcinomas. We present an 84-year-old woman who, about a month ago, developed erythema and edema of the skin of the upper eyelids and glabella, accompanied by eye discharge and slight tenderness to touch. We performed an X-ray and CT examination of paranasal cavities that found no pathological changes. The patient underwent several consultations and treatments from different specialists without any effect. Due to the growth of edema and the formation of a dense lesion at the base of the nose and frontal sinus, a repeat CT examination of the paranasal cavities was performed, which established the presence of a soft tissue oval lesion frontally in the area of the glabella with dimensions of 38/36/40 mm, which infiltrates and lyses the upper part of the right nasal bone, anterior ethmoid cells, medial wall of the right orbit, and anterior wall of the frontal sinus. The patient was referred to an otorhinolaryngology clinic, where a diagnosis of low-differentiated squamous cell carcinoma was made with the help of a biopsy and immunohistochemical examination. Due to the judgment of inoperability, definitive large-fractionated percutaneous radiotherapy was performed. The presented case illustrates the need for broad differential-diagnostic thinking in cases with edema in the head region.

Mutagenicity evaluation of methyl tertiary- butyl ether in multiple tissues of transgenic rats following whole body inhalation exposure.

Methyl tertiary-butyl ether (MTBE) is used as a component of motor vehicle fuel to enhance combustion efficiency and to reduce emissions of carbon monoxide and nitrogen oxides. Although MTBE was largely negative in the in vitro and in vivo genotoxicity studies, isolated reports of positive findings along with the observation of tumors in the rat cancer bioassays raised concern for its in vivo mutagenic potential. To investigate this, transgenic male Big Blue Fischer 344 rats were exposed to 0 (negative control), 400, 1000, and 3000 ppm MTBE via whole body inhalation for 28 consecutive days, 6 h/day. Mutant frequencies (MF) at the cII locus of the transgene in the nasal epithelium (portal of entry tissue), liver (site of primary metabolism), bone marrow (rapidly proliferating tissue), and kidney (tumor target) were analyzed (5 rats/exposure group) following a 3-day post-exposure manifestation period. MTBE did not induce a mutagenic response in any of the tissues investigated. The adequacy of the experimental conditions to detect induced mutations was confirmed by utilizing tissue samples from animals treated with the known mutagen ethyl nitrosourea. These data provide support to the conclusion that MTBE is not an in vivo mutagen and male rat kidney tumors are not likely the result of a mutagenic mode of action.

ОСОБЕННОСТИ СТРОЕНИЯ СКЕЛЕТА ГОЛОВЫ АЗИАТСКОГО (БЕЛОХВОСТОГО) ДИКОБРАЗА (HYSTRICIDAE LEVICURA)

The purpose of research is to study the structural features of the head skeleton of the Asian (white-tailed) porcupine. The object of the study is the skeleton of the head of an Asian (white-tailed) porcupine at the age of 12 years. To make the porcupine skeleton, a biological method of processing the material was used. The study of the bones was accompanied by measuring their length and width using an electronic caliper with an accuracy of 0.1 mm, describing and photographing. The head skeleton of the Asian (white-tailed) porcupine is divided into cerebral and facial sections, the size of which is related to the size of the brain and the development of the masticatory apparatus. The brain region is represented by unpaired (occipital, sphenoid, interparietal, ethmoid) and paired (temporal, frontal, parietal, alar) bones. The facial region is represented by the maxillary, incisive, palatine, zygomatic, lacrimal and nasal bones. The rostral edge of the orbit serves as the boundary between the facial and brain regions. The facial section reaches the greatest development, occupying 59.8 % of the length of the brain. The configuration of the skull and the presence of a large number of processes make it possible to attach well-developed masticatory muscles to it. The caudal part of the skull is represented by the occipital bone, and the cranial part by the ethmoid bones. The body of the occipital bone is connected to the sphenoid bone, which participates in the formation of the foramen lacerum. The body of the sphenoid bone is trapezoidal in shape, from which the orbital and temporal wings branch. There are six foramina on the orbital wing: optic, orbital fissure, round, caudal alar, oval and carotid. The temporal wing is involved in the formation of the foramen lacerum with the oval, spinous and carotid notches. On the facial surface of the maxillary bone there is a facial ridge; between its facial and nasal surfaces there is an extensive maxillary sinus. The mandibular bone is paired, represented by two bones connected to each other by a ligament. The massive, triangular-shaped lower jaw has two processes: the condylar and the coronoid. The condylar process is convex, oval-elongated. The coronoid process is low with a bifurcated apex. The pterygoid and chewing fossae are deep and triangular in shape.

Treatment of fracture of the nose bonés proper by closed reduction: Case report

The nasal bones are the most commonly fractured bones in the face due to their anatomical location and thin thickness, even with low-intensity traumas. Because of their high incidence, clinical and imaging diagnosis is important for proper case management, considering their complexity. Given their frequency, clinical criteria are established and must be carefully evaluated, along with different treatment approaches based on the complexity of each case. The article in question reports on closed reduction of a nasal fracture under general anesthesia. The patient, a victim of physical assault, presented with clinical signs including epistaxis, crepitus, nasal obstruction, and rhinoescoliosis. This article aims to describe the clinical case of nasal fracture from diagnosis to clinical management, comparing observed and performed actions with current literature. It was concluded that closed reduction technique for nasal fractures proves to be an effective and safe approach, with benefits including not only restoration of nasal aesthetic and functional aspects but also minimization of postoperative complications. The patient is currently under follow-up with the team, showing no signs of aesthetic or functional compromise.

Columella fistula: A case report

Cysts and fistulas located on the dorsum of the nose are rare occurrences. These malformations are strictly confined to the midline, extending from the columella to the glabella. In some cases, they may extend deeply, potentially reaching the leptomeningeal spaces. Imaging studies are crucial for determining the depth of extension and the relationship between the malformation and surrounding structures, such as the cribriform plate and meninges. Detection of frontal and/or nasal bone defects on computed tomography scans or the presence of a transosseous canal with or without a cyst on magnetic resonance imaging should raise suspicion of a dermal sinus cyst prompt surgical excision is indicated to mitigate the risk of the most concerning complication: Neuro-meningeal superinfection. Preferably, surgical excision should be carried out before the age of 1 year to minimize the risk of infection. If communication with meningeal spaces is suspected, neurosurgical intervention becomes necessary. Herein, we present the case of a 4-year-old male child with a history of neonatal distress, psychomotor delays, and epileptic seizures. The patient presented a fistula at the columella level, accompanied by pus discharge, within the context of dysmorphic syndrome. Consequently, the patient was scheduled for fistula excision.

Objective Parameters for Evaluating Internal Nasal Valve Compromise: Beyond the Angle Perspective.

Nasal valve surgery for internal nasal valve (INV) compromise has become increasingly popular. However, this rise in popularity has sparked debates regarding its indications and disputes over insurance coverage, primarily due to the lack of a gold-standard evaluation method. Therefore, we aimed to identify objective parameters for the INV compromise. We analyzed 186 INVs in 93 patients who underwent nasal valve surgery. The data comprised facial computed tomography (CT) images, acoustic rhinometry, the modified Cottle test, and symptom scores. Patients were categorized based on their symptoms and the. of the modified Cottle test. We measured the INV angle, area, volume, lateral wall thickness, septal angle, and nasal bone area using CT. The compromised INV group, characterized by nasal obstruction with a positive modified Cottle test, exhibited smaller INV areas in both coronal and axial views, reduced INV volume in the axial view, and a thinner lateral wall in the coronal view (all P<0.05). Acoustic rhinometry indicated a smaller minimal cross-sectional area and volume in the compromised INV group (both P<0.001). Regression analysis demonstrated significant associations between a compromised INV and reduced INV area on the axial view, as well as the minimal cross-sectional area measured by acoustic rhinometry. Relying solely on the INV angle in CT scans has limitations in assessing compromised INV. Alternatively, the INV area on axial CT scans and the minimal cross-sectional area measured by acoustic rhinometry may serve as objective parameters for evaluating INV compromise.

Free-living amoebic encephalitis - Case series.

Free-living amoeba is ubiquitous in fresh water, mud, and moist soil; although seldom pathogenic to humans, Naegleria fowleri, Acanthamoeba spp., and Balamuthia spp. are known to cause infections of the central nervous system. We report two interesting cases, both of which presented with a rapid-onset and fulminant course. The first case details a 36-year-old male with a history of surgically corrected nasal bone fracture 15 years back, who presented with acute onset of fever, headache and convulsions. Direct smears of cerebrospinal fluid (CSF) revealed motile trophozoites resembling N. fowleri and were later confirmed by molecular diagnosis (polymerase chain reaction [PCR]). Subsequently, the source was identified as water used for religious purposes. Unfortunately, the patient succumbed to cardiac arrest. The second case is that of a 4-year-old boy from Palakkad district, Kerala, who presented with sudden onset of nasal discharge, fever, headache, vomiting, seizures and altered sensorium. His CSF smear examination showed motile trophozoites resembling Acanthamoeba spp. While undergoing treatment, he seized thrice before going into cardiac arrest. Despite extensive resuscitation measures, the child could not be revived and passed away. The postmortem CSF sample sent for molecular analysis confirmed infection by Acanthamoeba spp. Rapid progression and lack of definite treatment options make this a highly fatal condition. Although clinical presentations of both patients were indicative of pyogenic meningitis, parasitic infection was suspected when the CSF was found turbid with no bacteria, high protein, and low sugar. High index of suspicion helped us to get an early preliminary diagnosis from direct microscopy.

Ash1 l loss-of-function results in structural birth defects and altered cortical development

Abstract The histone methyltransferase ASH1L plays a crucial role in regulating gene expression across various organ systems during development, yet its role in brain development remains largely unexplored. Over 130 individuals with autism harbour heterozygous loss-of-function ASH1L variants, and population studies confirm it as a high-risk autism gene. Previous studies on Ash1 l deficient mice have reported autistic-like behaviours and provided insights into the underlying neuropathophysiology. In this study, we used mice with a cre-inducible deletion of Ash1 l exon 4, which results in a frame shift and premature stop codon (p.V1693Afs*2). Our investigation evaluated the impact of Ash1 l loss-of-function on survival and craniofacial skeletal development. Using a tamoxifen-inducible cre strain, we targeted Ash1 l knockout early in cortical development (Emx1-Cre-ERT2; e10.5). Immunohistochemistry was utilized to assess cortical lamination, while EdU incorporation aided in birthdating cortical neurons. Additionally, single-cell RNA sequencing was employed to compare cortical cell populations and identify genes with differential expression. At e18.5, the proportion of homozygous Ash1 l germline knockout embryos appeared normal; however, no live Ash1 l null pups were present at birth (e18.5: n = 77, P = 0.90; p0: n = 41, P = 0.00095). Notably, Ash1l-/- exhibited shortened nasal bones (n = 31, P = 0.017). In the cortical-specific knockout model, SATB2 neurons showed increased numbers (n = 6/genotype, P = 0.0001) and were distributed through the cortical plate. Birthdating revealed generation of ectopically placed deep layer neurons that express SATB2 (e13.5 injection: n = 4/genotype, P = 0.0126). Single cell RNA sequencing revealed significant differences in gene expression between control and mutant upper layer neurons, leading to distinct clustering. Pseudotime analysis indicated that the mutant cluster followed an altered cell differentiation trajectory. This study underscores the essential role of Ash1 l in postnatal survival and normal craniofacial development. In the cortex, ASH1L exerts broad effects on gene expression and is indispensable for determining the fate of upper layer cortical neurons. These findings provide valuable insights into the potential mechanisms of ASH1L neuropathology, shedding light on its significance in neurodevelopmental disorders like autism.

DESCRIPTIVE OSTEOLOGY OF THE BOVINE SKULL

The bovine skull performs vital functions, protecting the brain and sensory organs, as well as providing structure and support for the head. Composed of various bones, such as the frontal, parietal, occipital, temporal, maxillary, and mandibular bones, each has a specific role. The frontal bone, for instance, forms the forehead and part of the orbital cavities, while the occipital bone protects the posterior part of the brain and articulates with the vertebral column. The mandible, essential for mastication, is one of the most robust bones, supporting the molar and premolar teeth, which are fundamental for grinding fibrous foods. The nasal and maxillary bones form the structure of the snout and house the incisor teeth, important for grasping food. Studying the osteology of the bovine skull is crucial for understanding the functional anatomy and health of the animals. Detailed knowledge of the bone structure aids veterinarians and animal scientists in identifying anomalies, fractures, and bone diseases, as well as being fundamental for surgical procedures and imaging diagnostics. These detailed anatomical informations are generally found in specialized books, not in scientific articles. Therefore, this article aims to describe the osteology of the bovine skull, providing an accessible and practical reference for students and professionals in the field. A deep understanding of bovine cranial anatomy is essential to ensure the well-being and productivity of the animals, directly reflecting the efficiency of agricultural practices.

Detecting Mandible Fractures in CBCT Scans Using a 3-Stage Neural Network.

After nasal bone fractures, fractures of the mandible are the most frequently encountered injuries of the facial skeleton. Accurate identification of fracture locations is critical for effectively managing these injuries. To address this need, JawFracNet, an innovative artificial intelligence method, has been developed to enable automated detection of mandibular fractures in cone-beam computed tomography (CBCT) scans. JawFracNet employs a 3-stage neural network model that processes 3-dimensional patches from a CBCT scan. Stage 1 predicts a segmentation mask of the mandible in a patch, which is subsequently used in stage 2 to predict a segmentation of the fractures and in stage 3 to classify whether the patch contains any fracture. The final output of JawFracNet is the fracture segmentation of the entire scan, obtained by aggregating and unifying voxel-level and patch-level predictions. A total of 164 CBCT scans without mandibular fractures and 171 CBCT scans with mandibular fractures were included in this study. Evaluation of JawFracNet demonstrated a precision of 0.978 and a sensitivity of 0.956 in detecting mandibular fractures. The current study proposes the first benchmark for mandibular fracture detection in CBCT scans. Straightforward replication is promoted by publicly sharing the code and providing access to JawFracNet on grand-challenge.org.

Three-dimensional prediction of the nose for facial reconstruction: A preliminary study on North Indian adults

Forensic facial reconstruction is the last recourse to establish the identity of an unknown skull. The facial soft-tissue thickness (FSTT) is required to reconstruct various facial features on a skull. Unlike other facial features, the nose is made of cartilaginous tissue except for a small nasal bone. A large cavity (pyriform aperture) exists on the skull in place of the nose, which makes it a challenging job for reconstruction. The nose is a vital feature for the recognition of a face. Any change in the shape or size of the nose can alter the original aesthetic of the face. The present study proposes angles and regression functions on the bony structure to predict the various parts of the soft nose. A sample of computed tomography (CT) images of 100 males and 100 females aged between 18 and 45 years were included in the study. Apart from measuring fourteen linear parameters with three angles, simple linear regression models were derived for five pairs of parameters. Pearson's correlation coefficients for most of the parameters ranging between 0.221 and 0.872 were found to be significant at p ≤ 0.05 level. FSTT at three anatomical landmarks of the nose was also measured. A morphological observation study was undertaken to find the most frequent direction of the bony anterior nasal spine (ans) and its relation with the position of the pronasale (prn) on the soft nose. The devised parameters proposed in the study may also prove useful for reconstructing the nose in other populations.

Title Isolated Absent or Hypoplastic Nasal Bone during Second Trimester Scan- Should it be Considered a Major Soft Marker?

Background: For many years, absent or hypoplastic nasal bone during prenatal scans has been reported to be associated with increased risk of chromosomal abnormalities. We aimed to study the association of isolated absent or hypoplastic nasal bone with chromosomal abnormalities and genetic syndromes. Methods: a retrospective observational study conducted at BLK Max foetal medicine unit, in which women with absent or hypoplastic nasal bone during second trimester scan between 16-24weeks of gestation were recruited over a period of 2 years, from June 2021 to June 2023. Nasal bone was defined as absent when no calcification was seen below the skin of the nasal bridge in mid sagittal view of facial profile, while defined as hypoplastic nasal bone when nasal bone length was &lt;5th centile for gestation according to gestation corrected Indian charts. Absent or hypoplastic nasal bone was defined as isolated - when there was absence of other second trimester soft markers, no other structural abnormalities were seen on the ultrasound and biochemistry screen was low risk. Results :A total of 3008 women were scanned during this period, among these 21 (0.69%) foetuses were found to have absent or hypoplastic nasal bone during second trimester scan. Thirteen (61.9%) fetuses were defined to have isolated absent (n-9) or hypoplastic (n-4) nasal bone which were included in the final analysis. Out of 13, 11 women opted for invasive testing where fluorescence in situ hybridisation (FISH) for 5 common aneuploidies and Microarray (750K) were sent on the amniotic fluid as a unit protocol, and 2 parents opted against any further genetic testing. In all tested cases, FISH and chromosomal microarray reports were reported as normal. All pregnancies were continued in our study group and had favourable foetal outcomes.

Comparison of the efficacy of fat, cartilage, and bone grafts in traumatic and asymmetric noses

BackgroundCorrection of asymmetry and irregularity deformities with autologous grafts, without osteotomies, offers advantages to both plastic surgeons and patients with severe deviation. Various autologous tissues such as fat, bone, and cartilage grafts are viable options for this purpose. ObjectivesThis study aims to compare the efficacy of three autologous filling materials in patients with bone asymmetry. MethodsA retrospective evaluation was conducted on 297 patients seeking aesthetic nose surgery between 2015 and 2022. Only primary patients without prior surgery, those with bone asymmetry from trauma, dorsum protrusion less than 3 mm, and no osteotomy were included. Patients were divided into fat, cartilage, and bone groups. Grafts were applied to the concave side during closed rhinoplasty, and evaluations were done at 12 months post-surgery by blinded plastic surgeons and patients using established assessment tools. ResultsFat, cartilage, and bone grafts were utilized in 74, 127, and 96 patients respectively, with mean follow-up of 19 months. Mean graft volumes were 1.0 cc (bone), 1.3 cc (cartilage), and 1.6 cc (fat). Patient self-assessment scores were 75%, 84.9%, and 86.6% respectively. Asher-McDade averages were 77.2%, 86.7%, and 88.4%. Cartilage and bone graft results were statistically similar in patient self-evaluation, both significantly higher than fat grafts. Blinded assessments showed no significant difference between cartilage and bone groups. ConclusionPlacing autologous grafts on the concave side for patients with minimal nasal bone protrusion (<3 mm) yields successful results. Cartilage grafts offer advantages in volume, result estimation, and preparation time, suitable for larger patient cohorts.

Nasal Deviation and Facial Asymmetry in Patients Undergoing Rhinoplasty.

The existing literature is conflicted on whether nasal deviation is primarily attributable to trauma or the result of asymmetric facial development. The aim of this study was to establish the prevalence of nasal trauma and facial asymmetry in patients undergoing rhinoplasty, and to determine if a correlation exists between the laterality of facial asymmetry and nasal deviation. A retrospective review was undertaken of patients who had undergone primary rhinoplasty with the senior author over a 12-month period. Patient charts were reviewed and clinical photographs were analyzed. In total, 144 patients underwent rhinoplasty over the study period; 68 patients underwent revision rhinoplasty and were excluded. Of the 76 patients who underwent primary rhinoplasty, 9% reported prior nasal trauma, 68% had deviated nasal bones, 46% had deviated nasal tips, 70% had asymmetric midfaces, and 36% had deviated chins. In patients without prior trauma history, nasal bones were most commonly deviated towards the side of midface hypoplasia (53%, P = .008). The nasal tip was most commonly deviated contralateral to the side of septal deviation (59%, P = .001). There was no association between nasal bone and chin deviation. Nasal tip deviation was not associated with midface hypoplasia or chin deviation. Nasal deviation is primarily driven by asymmetric facial growth rather than being the result of nasal trauma.

Comparison of outcomes for general and local anesthesia in the management of nasal bone fractures: a meta-analysis

BackgroundThis 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).MethodsPubMed, 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.ResultsEight 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).ConclusionsInsignificant 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.