Nasal Trauma Research Articles

Challenges and complications of prolonged nasogastric intubation in equine patients

SummaryManaging equine patients that require prolonged periods of nasogastric intubation can be difficult and may require the use of repeated intubation or use of an in‐dwelling nasogastric tube. Both approaches present potential risks for complications from nasal, pharyngeal and oesophageal trauma. Diagnosis and treatment of cranial oesophageal lesions can be particularly challenging due to the anatomy of this region.

Psychopathologic Evaluation in Patients With Nasal Bone Fractures.

Background: Nasal bone fractures are pretty common. The most common causes include interpersonal violence, traffic accidents, sports injuries, and falls. This study aimed to assess patients presenting with nasal bone fractures not only for nasal trauma but also for personality disorders, impulsivity, and attention-deficit/hyperactivity disorder (ADHD) using psychiatric questionnaires. Methods: The study included 41 patients, and the control group consisted of 43 volunteers without nasal bone fracture; neither the patients nor the volunteers had previously been diagnosed with or treated for psychiatric disorders. The psychiatric questionnaires administered were the Eysenck Personality Questionnaire Revised-Short Form (EPQR-S), the Barratt Impulsivity Scale-Short Form (BIS-11-SF), and Turgay's Adult ADD/ADHD DSM-IV-based Scale. Results: The most common cause of nasal bone fractures in our study was violence (41.5%), followed by traffic accidents (29.3%), falls (17%), and sports injuries (12.2%). In the EPQR-S assessment, the nasal bone fracture (NBF) group had significantly-higher total scores than the control group (CG) (P < .001). In the subscales of the questionnaire, extroversion, psychoticism, and lie subscale scores were higher in the NBF group than in the CG. In the BIS-11-SF assessment, the NBF group had higher total scores than the CG (P < .001). Assessment using Turgay's adult ADD/ADHD DSM IV-based diagnostic screening and rating scale revealed no statistically-significant difference between the NBF group and the CG in terms of attention deficit and hyperactivity. Conclusion: We found that psychoticism patterns and impulsivity were more prevalent in the patient group, whereas ADD/ADHD was not. The results of our study suggest that performing a psychiatric assessment may be the right decision in patients presenting with NBFs caused by violence, whether they are the aggressor or the victim.

Comparison of nasal masks or binasal prongs for delivering continuous positive airway pressure in preterm neonates of gestational age less than 32 weeks

Background: Aim was to compare the efficacy and safety of continuous positive airway pressure (CPAP) delivered by nasal masks vs binasal prongs. Methods: This was observational trial where preterm infants less than 32 weeks of gestation with respiratory distress were enrolled after parental consent. Participants: 145 neonates less than 32 weeks gestation requiring nasal CPAP (NCPAP) as a primary mode for respiratory distress, who were treated with either nasal mask (n=45) or nasal prongs (n=99) as interface. Primary outcome: Was the incidence of CPAP failure (need for mechanical ventilation at less than 72 hours). Results: Failure rate in nasal mask group was 13% vs nasal prongs group was 39.4% and the difference was statistically significant. Secondary outcomes were mean FiO2 requirement at 6 hours, duration of CPAP therapy, hospital stay and nasal trauma. There was 3.7±5.78% reduction in oxygen requirement at 6 hours of CPAP initiation with nasal mask as compared to nasal prongs and the difference was statistically significant (p&lt;0.05). the CPAP duration in nasal mask group was 3.4± 4.04 days vs nasal prongs group was 4.5±3.52 days and duration of hospital stay in nasal mask group was 15.4±14.19 vs in nasal prongs group was 20.2±13.86 and the both differences were also statistically significant(p&lt;0.05). Nasal mask had no nasal injury (0%) as compared to infants on nasal prongs (23.2%) and the difference was statistically significant (p&lt;0.05). Conclusions: NCPAP with mask as interface is as effective as prongs but causes less nasal trauma and less CPAP duration and hospital stay.

RAM Cannula versus Short Binasal Prongs for Non-invasive Ventilation in Preterm Infants: An Updated Systematic Review and Meta-analysis.

To compare the efficacy and safety of RAM cannula with short binasal prongs (SBPs) as nasal interfaces in preterm infants requiring nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV). The authors searched electronic databases (Medline, Embase, and Web of Science) and trial registries from inception until March 15, 2024, for randomized controlled trials (RCTs) comparing the RAM cannula with SBP for delivering nCPAP/NIPPV. They performed a random-effects meta-analysis using RevMan 5.4 software. The primary outcome was failure of nCPAP/NIPPV. Secondary outcomes included nasal injury, mechanical ventilation, air leaks, and mortality. Five RCTs (825 participants) were included. There was no significant difference in nCPAP/NIPPV failure (RR: 1.04; 95%CI: 0.58 to 1.87) or the need for invasive mechanical ventilation (RR: 1.23; 95%CI: 0.75 to 2.01) between the RAM cannula and SBP groups (low to very low certainty). Compared with infants in the SBP group, those in the RAM cannula group had a significantly lower incidence of moderate to severe nasal injury [(5 RCTs, 825 participants; RR: 0.34; 95%CI: 0.18 to 0.66); low certainty] and any nasal injury [(RR: 0.44; 95%CI: 0.26 to 0.76; very low certainty)]. There was no significant difference in the other clinical outcomes. In comparison to SBP, the RAM cannula may have little to no effect on nCPAP/NIPPV failure, but the evidence is very uncertain. Low-certainty evidence suggests that the use of RAM cannula possibly results in reduction in moderate to severe nasal trauma in preterm infants receiving nCPAP/NIPPV.

EFFECT OF BEVEL DIRECTION OF THE ENDOTRACHEAL TUBE ON THE PROPORTION OF CASES DEVELOPING EPISTAXIS DURING NASOTRACHEAL INTUBATION-A RANDOMIZED CONTROLLED INTERVENTIONAL STUDY

Objective: Nasotracheal intubation is associated with a number of complications, most commonly nasal trauma or epistaxis. The aim of the study is to determine the effect of conventional versus cephalad direction of the bevel of endotracheal tube on the development of epistaxis during nasotracheal intubation. Methods: A total of 74 adults aged 18 to 50 y posted for surgeries requiring nasotracheal intubation were randomly divided into group A (Conventional) and group B (Interventional). After induction of anesthesia, in group a bevel direction of thermo softened PVC endotracheal tube was towards the nasal septum in the nasal passage and cephalad in group B, later nasotracheal intubation was completed with direct laryngoscopy and Magill forceps. After five minutes direct laryngoscopy was done to check for presence of epistaxis and its severity. Degree of resistance, nasal passage time, intubation time and haemodynamic parameters (heart rate, blood pressures) were also assessed and compared. Results: The incidence of epistaxis was significantly lower in group B (Interventional) than group A (Conventional) [15 vs 27; p-value = 0.005], severity of epistaxis [0/1/2] were also significantly lower in group B [22/12/3] than group A [10/15/12] [p value = 0.001]. There was significant difference in haemodynamic parameters between both groups at 1 min till 7 min post intubation. There was no significant difference in degree of resistance, nasal passage time and mean intubation time. Conclusion: The cephalad direction of the bevel of endotracheal tube in nasal passage during nasotracheal intubation decreases the chances of developing epistaxis and its severity. Hemodynamic parameters are also more stable in cephalad direction.

Are More Medically Complex Patients Who Undergo Complex Septorhinoplasty at an Increased Risk for Surgical Site Infection?

BackgroundProphylactic antibiotics are routinely prescribed by surgeons for their patients who undergo septorhinoplasty. However, the literature to support this remains controversial, especially in complex cases, those that require grafts, revision cases, extended surgical time, and an American Society of Anesthesiology (ASA) value greater than or equal to 3. PurposeThe study purpose was to evaluate for a potential association between increased anesthetic complexity and the risk for surgical site infection (SSI) following complex septorhinoplasty. Study DesignRetrospective cohort study of patients who underwent a complex septorhinoplasty between 2005 and 2022 at the Dallas Veterans Affairs Medical Center. Patients were excluded if they did receive a septorhinoplasty, did not follow up, or had insufficient records. Independent VariableAll patients were assigned an ASA value prior to surgery, with an ASA value of 3 serving as this study’s independent variable. Main Outcome VariableThe main outcome variable of interest was the development of a postoperative SSI, defined as findings consistent with cellulitis, purulence, or fistula development necessitating antibiotic treatment. CovariatesThe demographic covariates included patient age and sex. Clinical covariates included diabetes status, history of nasal trauma or surgery, and smoking status. The operative covariates were surgical duration, perioperative antibiotic, intraoperative complication, and type of cartilage graft used. AnalysesChi square analysis and t-tests were used for calculations with p-values < .05 being considered significant. ResultsA total of 182 patients were included in this study, 81 (45%) with an ASA ≤2 and 101 (55%) with an ASA of 3. A patient’s age (P <.01), male sex (P<.01), and a diagnosis of diabetes (P<.01) were associated with an ASA value of 3. In total there were 6 (3.3%) SSIs, with 2 (1%) occurring in those with an ASA of 3. An ASA value of 3 (P = .27, Relative Risk (RR) of .40) was not shown to be associated with an increased risk of SSI. ConclusionsOur results suggest that an ASA of 3 is not significant with regards to postoperative infection in patients who undergo a complex nasal septorhinoplasty and prophylactic postoperative antibiotics are not warranted.

144 Title: A Repeat Cycle Closed Loop Audit Reviewing Emergency Department Referrals for Nasal Trauma to a Major ENT Centre; Practice Standards for Safe Care

144 Title: A Repeat Cycle Closed Loop Audit Reviewing Emergency Department Referrals for Nasal Trauma to a Major ENT Centre; Practice Standards for Safe Care

Atraumatic Infected Septal Hematoma in a Pediatric Patient.

We present a case of a 10-year-old male who developed an atraumatic, nasal septal hematoma with abscess following several days of rhinorrhea and cough. His chief complaint to the emergency department was a two-day history of nasal swelling and discomfort, associated with difficulty breathing through his nose. The patient was well-appearing with swelling and tenderness along the external nasal ridge and nasal septal swelling that occluded both nares. Contrast-enhanced maxillofacial computed tomography revealed a rim-enhancing, fluid-filled collection to the anterior nasal septum. The patient underwent successful incision and drainage by otolaryngology. Infected septal hematomas are rare but important to recognize as they can result in septal deformity and potentially life-threatening sequelae, such as intracranial infections. Most are secondary to nasal trauma in adult patients. This case highlights a unique presentation of atraumatic septal hematoma with abscess formation in an immunocompetent pediatric patient.

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.

Facial Trauma Affects the Radiological Diagnosis of Nasal Bone Fractures.

Timely and accurate diagnosis of nasal bone fractures (NBFs) is crucial for preserving the cosmetic and functional aspects of the nose. This study aims to identify factors influencing radiographic and computed tomography (CT) diagnosis of NBF in patients with nasal trauma. Two hundred six patients with acute nasal trauma underwent both conventional radiography and facial bone CT. An experienced otorhinolaryngologist independently interpreted images. Results were categorized into "Concordance" or "Discrepancy" groups, with demographic and clinical data compared. The study classified 167 patients into "Concordance" and 39 into "Discrepancy" groups based on radiography and CT interpretations. The "discrepancy group" showed higher rates of previous nasal bone fractures (P=0.044), rhinoplasty history (P=0.044), and concomitant facial bone fractures (P=0.001). Adjusted odds ratios revealed significant associations between discrepancies and a history of nasal bone fracture (OR=5.197, 95% CI 1.165-23.171), rhinoplasty (OR=6.114, 95% CI 1.393-26.847), and concomitant facial bone fractures (OR=3.765, 95% CI 1.663-8.523). This study highlights the impact of facial trauma, including rhinoplasty, on the radiological diagnosis of NBF. Consequently, in the presence of signs of concurrent facial trauma, previous nasal trauma, or rhinoplasty history, a prompt CT scan and comprehensive evaluation are recommended for accurate diagnosis and timely treatment, ultimately improving the patient's prognosis.

Crowdsourced Assessment of Aesthetic Outcomes of Dorsal Preservation Rhinoplasty

Abstract Goals/Purpose The inherent subjectivity in evaluating aesthetic outcomes presents a unique challenge in assessing rhinoplasty. Crowdsourcing has provided a new metric for objective analysis. The authors designed a study to compare the aesthetic outcomes of dorsal preservation rhinoplasty versus structural rhinoplasty using a reliable and valid crowdsourcing platform. We aim to objectively quantify the relative aesthetic advantages of performing a dorsal preservation technique. Additionally, we aim to demonstrate the efficacy of using crowdsourcing as an efficient and reliable method for evaluating any plastic surgery aesthetic outcome. Methods/Technique This retrospective observational study was approved by the IRB at UCLA. A total of 64 patients who had previously undergone rhinoplasty performed by the senior author were included. All surgeries were performed at the UCLA Ronald Reagan Medical Center. Patients with prior nasal surgery or trauma were excluded. All subjects were photographed using standard rhinoplasty views during the pre-and postoperative visits. Frontal and right profile photographs were then cropped in a standardized fashion (Photos, Version 8.0, Apple Inc.) and used for evaluation. All evaluations and ratings were collected using the HIPPA compliant and encrypted software via a secure online platform (LoveMyDelta, Inc., Philadelphia, PA). All crowd workers were recruited and vetted through this platform, with internal fidelity checks performed. Each crowd worker was shown a profile and frontal view of a patient and asked to score the overall appearance of the nose, the nasal dorsum profile, the symmetry of the dorsal aesthetic lines, and the dorsal contour using a visual analog scale. Scoring was performed using a provided validated visual assessment guide. They were asked whether they believed the subject had undergone rhinoplasty and asked to provide a level of confidence in their guess. Crowdworkers’ responses were aggregated to allow for high-powered intra-rater analysis. Intra-rater reliability and confidence intervals were calculated. Aggregate data from all raters were used to generate an absolute value of aesthetic state for each cohort. A "delta" was then obtained for each value by comparing the preoperative to the postoperative state to obtain a representative value of the improvement after undergoing surgery. Raters were asked if the patient appeared to have had surgery, and each correct and incorrect response was proportionally weighted based on the raters' confidence in their answer. The delta (difference in preoperative to postoperative aesthetic state) for each parameter for the dorsal and non-dorsal preservation cohorts was calculated using non-paired T-tests to determine significance. Results/Complications A total of 64 patients were included for evaluation. The structural rhinoplasty cohort consisted of 34 patients. The dorsal preservation cohort included 30 patients. Both dorsal preservation and non-dorsal preservation rhinoplasty cohorts were associated with improved overall crowdsourced aesthetic outcomes and improved outcomes across all subparameters. Overall, delta (d) improved in both dorsal preservation (0.300, 95% CI +/- 0.047) and structural (0.377, 95% CI +/- 0.055) cohorts. When raters were asked to predict whether a patient had surgery, the correlation coefficient between the confidence in the prediction and that prediction being correct was 0.74 (95% CI +/- 0.47 in the structural group, suggesting that a crowd worker was likely to be correct in identifying whether a patient had structural rhinoplasty. However, the correlation coefficient was -0.0554 (95% CI +/- 0.058) in the dorsal preservation group. This suggests the raters were unable to consistently identify which patients had dorsal preservation rhinoplasty with any confidence. Conclusion In the ongoing challenge to achieve better aesthetic outcomes in plastic surgery, crowdsourcing is a valuable tool for helping to measure these outcomes. We compared the aesthetic outcomes of dorsal preservation rhinoplasty versus structural rhinoplasty using a reliable and valid crowdsourcing platform. We found that significant improvements in overall aesthetic outcomes were achieved with both techniques, while a more natural “unoperated” outcome was achieved when performing a dorsal preservation technique. With this type of study and assessment tool, we helped to demonstrate the efficacy of using crowdsourcing as an efficient and reliable method for evaluating any plastic surgery aesthetic outcome.

Bystander-application of a novel nasal swab optimized for drug delivery is safe and non-traumatic for the general population

ObjectiveThe PN Naloxone Nasal Swab (Pocket Naloxone Corp., Bethesda, MD) is a swab optimized for drug delivery and intended for use by non-medical personnel for the emergency treatment of opioid overdose. The aim of this study (PNC-20–003) is to determine the safety of this nasal swab in a real-world environment. MethodsThis was a single-institution, quantitative-qualitative prospective trial performed at an outpatient clinic. Patients with normal or abnormal nasal structure were recruited. A non-medically trained individual placed the nasal (soaked in fluorescein dye) on each side of the patient’s nose. Endoscopy with recording was performed before and after swab placement. An independent reviewer rated degree of staining, mucosal bleeding, and trauma at nasal subsites. ResultsVideos from 32 nasal cavities (16 participants) were reviewed. All cavities had high intensity staining at the septum and the inferior turbinate. No patients had staining within the middle meatus, agger nasi, or olfactory regions. In patients with normal anatomy, obstructive nasal anatomy or prior nasal surgery, all cavities had staining near the nasal septum. Only 7 cavities (22 %) had minor bleeding defined as ooze that stopped in 1–2min, and 3 (9 %) had minor trauma defined as mucosal disruption less than 5mm. There were no significant differences in comparing pre- and post-swab nasal cavity, trauma, or bleeding exams. ConclusionsThese study results showed that this swab is atraumatic to the nasal mucosal membranes when administered by non-medical personnel. Analysis suggests contact with targeted sites for drug absorption regardless of anatomy.

CT comparison of the nasal airway anterior and posterior to the piriform aperture in patients with and without nasal obstruction

BackgroundNasal airway stenosis may lie anterior and/or posterior to the piriform aperture. We intended to compare the nasal airway anterior and posterior to the piriform aperture in patients with and without nasal obstruction.MethodsSegmented computed tomography cross-sectional areas of the nasal airway anterior (CT-CSAant) and posterior to the piriform aperture (at the level of the head of the inferior turbinate; CT-CSApost) were compared between patients with nasal obstruction (cases) and trauma controls. CT-CSA were approximately perpendicular to the direction of the nasal airflow. Anterior to the piriform aperture, they were tilted about 30o, 60o and 90o to the nasal floor. Posterior to the piriform aperture, they were tilted about 50o, 80o and 100o to the nasal floor. In cases, we examined the Pearson’s correlation of active anterior rhinomanometry with CT-CSAant and CT-CSApost.ResultsNarrow and bilateral CT-CSApost were similarly large between 56 cases and 56 controls (all p > 0.2). On the contrary, narrow and bilateral CT-CSAant were significantly smaller in cases than in controls (all p < 0.001). The ratio of the size of CT-CSAant−30 to that of CT-CSApost−80 was significantly lower in cases (median: 0.84; lower to upper quartile: 0.55–1.13) than in controls (1.0; 0.88–1.16; Mann-Whitney U test; p = 0.006). Bilateral CT-CSAant correlated significantly with total inspiratory flow (all p < 0.026) in contrast to bilateral CT-CSApost (all p > 0.056).ConclusionsThe nasal airway anterior to the piriform aperture was smaller in patients with nasal obstruction due to skeletal nasal stenosis than that in controls. On the contrary, the nasal airway posterior to the piriform aperture was similarly large between patients with and without nasal obstruction. Furthermore, in patients with nasal obstruction, the anterior nasal airway was narrower compared to that located posterior to it. On the contrary, control patients’ anterior nasal airway was as large as the posterior one.

Correlation of maximal nasal septal deviation with deviation at the maxillary insertion.

It is unclear if septal deviation at the insertion points to the nasal cavity is associated with the overall septal deviation. This study aimed to assess septal deviation at the cribriform plate (CP) and maxillary crest (MC) using CT scans and to see if there was any correlation with overall septal deviation. All consecutive CT sinus scans between January 2020 and December 2021 were retrospectively reviewed. Patients were excluded if they had a history of head, nasal or facial trauma, or any previous nasal surgical procedure. Angles between the septum and MC and the septum and CP as well as maximal angle of septal deviation (MSD) were measured. A total of 70 scans were included in the final analysis. The mean MSD was 8.14°. The mean septal deviation was 0.89° at the CP and 2.02° at the MC. The correlation coefficient between the deviation at the CP and MSD was 0.025 and between the deviation at the MC and MSD was 0.321. Our data reveal a positive correlation between septal deviation at the floor of the nose and overall septal deviation; this was not observed at the septal deviation at the roof. This could be explained due to the inherent tilt in the cribriform plate or by earlier ossification and fixation of the septum during its development at its insertion to the roof, thereby allowing further growth and potential for deviation of the lower part of the septum and its insertion to the floor.

The Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery: Are We Screening the Troublesome Patients?

This study aims to clarify the current concept of performing rhinoplasty in patients with possible body dysmorphic disorder (BDD). The primary objective was to investigate the validity and evolution over time of the Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery (BDDQ-AS) before and after surgery. Together with the BDDQ-AS, also the Nasal Obstruction Symptom Evaluation scale, FACE-Q nose and nostrils, and Utrecht questionnaire (UQ) were used for convergent validation. In this prospective study, 187 patients completed these patient-reported outcome measures at four time points: at the preoperative consultation and postoperatively at 3, 6 and 12 months. The preoperative BDDQ-AS positivity rate was as high as 55.1%. Postoperatively, there was a highly significant decrease in the odds of scoring positive on the BDDQ-AS. At the preoperative consultation, positively screened patients were less satisfied with the esthetics of their noses with worse scores on UQ, FACE-Q nose, and visual analog scale. The preoperative differences in outcome measure ratings disappeared postoperatively, except for the FACE-Q nostrils, which surprisingly showed better values in BDDQ-AS positive patients. Younger age and absence of nasal trauma were statistically significant covariates associated with positive BDDQ-AS screening. Due to the overwhelming decrease in positive BDDQ-AS outcomes after surgery, a positive screening result on the BDDQ-AS should not be interpreted as a formal contraindication for surgery. Collaboration with psychologists or psychiatrists remains crucial to diagnose BDD conclusively.

Aesthetic Outcomes of Rhinoplasty Performed in the Early Posttrauma Period after Nasal Bone Fracture.

The optimal timing of rhinoplasty for patients with nasal bone fractures remains controversial. We investigated whether the timing of rhinoplasty after nasal trauma affects the aesthetic outcome of the procedure. A total of 41 adult patients with nasal bone fractures who underwent rhinoplasty between 2006 and 2021 were enrolled in this study. A visual analog scale (VAS) was used to indicate the assessor's satisfaction with the surgical outcome after a comparison of the pre- and postoperative facial photographs of each patient. Of the 41 patients, 28 underwent rhinoplasty within 14 days after nasal trauma (early rhinoplasty group), whereas 13 underwent rhinoplasty more than 14 days after nasal trauma (late rhinoplasty group). The rate of receiving spreader and shield graft was higher in the late rhinoplasty group (p = 0.043 and 0.018, respectively). Patients with type IV or V nasal bone fracture and patients with preoperative saddle noses had higher VAS scores than those with types I to III fractures and those without preoperative saddle nose (p = 0.003 and 0.020, respectively). There was no significant difference in overall aesthetic outcome between the early and late rhinoplasty groups. Both groups achieved significantly better radix height, dorsal height, and tip projection after rhinoplasty. The aesthetic outcome of rhinoplasty performed in the early posttrauma period is comparable with that of rhinoplasty performed more than 2 weeks after nasal bone fracture. Rhinoplasty can be considered a safe surgical treatment option for nasal bone fracture, even in the early posttrauma period. LEVEL OF EVIDENCE: : 4.

Comparison Between High- Resolution Ultrasonography and Conventional Radiography in the Diagnosis of Nasal Bone Fractures

Objectives to describe the diagnostic findings of ultrasonography in nasal bones fractures and to determine the validity of classical clinical practice assisted by radiography in the diagnosis of nasal bone fractures and compared it to the value of ultrasonograp-hy. A total sample of 53 patients (11 females and 42 males) at age range (14-40) years, with a differential diagnosis of nasal fracture based on history of nasal trauma and physical signs and symptoms of nasal bone fracture. All subjects had a true lateral soft tissue profile view of the face and high resolution ultrasonography in addition 8 patients had an occipitomental view based on physician request. The radiographs and ultrasound images of each subjects were analyzed and reports were recorded as either “positive” or “negative” according to the existence of nasal bone fracture with other details about the fracture if present (number of the fracture lines detected, the type of the fracture, its location and assessment of the soft tissue swelling and hematoma). The results were analyzed by various statistical testing methods (for sensitivity, specificity, positive and neg ative predictive value, and accuracy). The sensitivity to est ablished clinical diagnosis (based on crepitation and mobility ) in diagnosis of nasal bone fracture was 76.6% (23.4% false – v e rate). This figure is increased to 89.4% (10.6% false – ve rat e) when clinical decision is aided by radiography. Such a practice however is associated with low specificity (33.3%). Usi ng ultrasonography will increase both sensitivity and specificity to 100%. The conclusion of this study is the ultrasonography in diagnosis of nasal bone fracture is superior to radiography and it is recommended to shift the classical clinical approach from radiography to ultrasonog raphy in this context.

ПРИМЕНЕНИЕ МАЗИ ТРАУМЕЛЬ® С В КОМПЛЕКСНОЙ ТЕРАПИИ ПОСТТРАВМАТИЧЕСКОГО СОСТОЯНИЯ В ПРАКТИКЕ ОТОРИНОЛАРИНГОЛОГА

A clinical case describes the treatment of facial and nasal trauma in a child complicated by rhinosinusitis. The choice of optimal treatment tactics allows you to eliminate the adverse cosmetic and pathophysiological consequences of the injury.

Mesenchymal Stem Cell Exosome-Integrated Antibacterial Hydrogels for Nasal Mucosal Injury Treatment.

Hydrogels have emerged as appealing prospects for wound healing due to their superior biocompatible qualities. However, the integration of antibacterial active substances into hydrogels for effective wound repair remains challenging. Here, we present a novel double-network hydrogel for nasal mucosal injury repair with antibacterial and self-healing capabilities. This hydrogel is the result of mixing aldehyde polyethylene glycol (PEG) and a carboxymethyl chitosan (CMCS)-based hydrogel with a photocured methylacrylate gelatin (GelMA) hydrogel to envelop mesenchymal stem cell exosomes (MSC-Exos). CMCS is rich in amino groups and facilitates antibacterial repair. Given the dynamically reversible Schiff base connections between the amino group of chitosan and the aldehyde group of modified PEG, the hydrogel can be easily injected into the lesion site because of its excellent injection and shear thinning properties. GelMA introduces an additional network layer for the hydrogel, which enhances its strength and extends the duration of stem cell exosomes on the wound surface. On the basis of these characteristics, we provide evidence that this compound hydrogel can substantially increase cell proliferation and regeneration, inhibit scar hyperplasia, and stimulate angiogenesis in rabbit nasal septum mucosa trauma models. These results suggest that MSC exosome-loaded hydrogels (ME-Gel) have substantial clinical potential for the repair and regeneration of nasal mucosa after surgery or trauma.

Nasal Injuries and Issues in Athletes.

Nasal injuries and issues are widespread in athletic populations and can adversely affect training, performance, and overall well-being. Causes can typically be understood as cellular (allergic, nonallergic, and infectious rhinitis) or structural (static vs dynamic obstruction, trauma), and diagnosis and management differ accordingly. Upper respiratory tract infections, a subtype of infectious rhinitis, remain the most common illnesses among athletes. Here, the authors review the research surrounding the complex relationship between exercise, immunology, and susceptibility to infection. Furthermore, the authors provide an updated understanding of the current literature surrounding rhinitis and nasal trauma management and synthesize practical treatment considerations for providers caring for athletes at all levels.