Previous Nasal Surgery Research Articles

Revision of the Overresected Nasal Tip Complex

Tip deformities resulting from previous nasal surgery range from mild to profound. For the mild deformity, morbidity is low and successful correction is usually achieved with a modest and targeted surgical adjustment. However, for the profound deformity, overt cosmetic deformities and corresponding functional impairment are the byproducts of severe derangements in skeletal architecture. Hence, for the severely damaged nasal tip, a complex surgical revision in which the decimated nasal tip framework is reconstructed with autologous cartilage grafts is essential. However, rebuilding the decimated nasal tip is a challenging and risky procedure that is best left to the seasoned rhinoplasty specialist. Careful assessment of the previously operated tissues, combined with an accurate cosmetic analysis, must be juxtaposed with the patient's cosmetic desires to derive an individualized and effective treatment plan. Atraumatic soft tissue technique, combined with a strategic yet balanced and judicious application of graft material, often culminate in satisfactory surgical outcomes. Proper assessment, technical skill, and sound clinical judgment are all critical ingredients in successful restoration of the surgically compromise nasal tip.

Atypical Presentation of Primary Giant Nasal Septal Mucopyocele

Mucoceles are expansile, encapsulated, benign cystic lesions with the potential for adjacent bony remodeling and resorption. Previous nasal surgery, recurrent infections, allergies, and facial traumas are all possible causes of mucoceles involving mainly paranasal sinuses. When the mucocele is infected, it is referred to as mucopyocele. Nasal septal mucoceles seen in only very seldom cases might develop from pneumatized and infected nasal septa. In the current article, we present an interesting primary giant septal mucopyocele that destroys all paranasal cells as a tumoral lesion. The perpendicular plate of ethmoidal bone, vomer, and bilateral anterior and posterior ethmoidal cells were destroyed by mucopyocele. The nasal cavity was totally obstructed by lesions on both sides. On the left side, the lesion also eroded the left lateral nasal wall causing external swelling at the medial canthal region. This is the first case of a giant septal mucopyocele of its kind in the literature. Although nasal septal mucocele is very rare, it should be considered in differential diagnosis of intranasal masses.

Allergic rhinitis, chronic rhinosinusitis, and symptom severity: a population‐based study

Approximately 20% of the U.S. population suffers from allergic rhinitis (AR), and chronic rhinosinusitis (CRS) is estimated to affect 12.5% of the population. Frequently, many patients suffer from both disorders. In this study, we evaluated the relationship between AR and chronic rhinosinusitis as far as impact on nasal symptoms in a community-based case-control study of adult nonsmokers. In Washington County, MD, 200 subjects were recruited and interviewed from the same community. Subjects were divided into 4 study groups: AR without CRS, CRS without AR, AR with CRS, and a control group without AR or CRS. A validated questionnaire was used to assess upper respiratory symptoms, and disease-specific quality of life. Upper respiratory symptoms were significantly more severe for the affected subjects when compared to controls. Symptom severity was greatest for the CRS groups with or without AR, followed by AR without CRS, and controls least symptomatic. Subjects with AR plus CRS were most likely to have had previous nasal surgery, and use nasal decongestants when compared to the other groups. While both AR and CRS are common in the United States, it appears that patients who suffer from both disorders have more severe symptoms and are more likely to have undergone nasal surgery than if they have only 1 of these disease states.

Use of Silicone Sizers in Implantation of Porous Polyethylene Nasal Dorsal Implants in Asians

Introduction. A new technique of implantation of high-density porous polyethylene nasal dorsal implants in Asians is described in this paper. Silicone sizers, which have smooth surfaces, were used to facilitate implantation of porous polyethylene implants in Asian patients. Materials and Methods. Twenty-three patients of Asian descent underwent dorsal augmentation rhinoplasty with open technique using high-density porous polyethylene implants. In all cases, silicone sizers were used to facilitate implantations of high-density porous polyethylene nasal dorsal implants. Patient selection criteria exclude patients with history of cocaine use, history of nasal or sinus disorders, previous nasal surgery, deviated septum, poor cartilage support, and thin skin. Results. No bleeding, infection, rejection, displacement, or extrusion was noted. One implant was removed because of a patient's dissatisfaction with the resulting tip height. Conclusion. The use of silicone sizers to facilitate implantations of high-density porous polyethylene nasal dorsal implants was safe and efficacious.

Impact of Baseline Nasal Polyp Size and Previous Surgery on Efficacy of Fluticasone Delivered with a Novel Device: A Subgroup Analysis

Little information exists on the impact of baseline polyp size and previous nasal surgery on the efficacy of intranasal steroids. This study was designed to investigate whether baseline polyp size and previous nasal surgery influence the efficacy of an intranasal steroid delivered with a novel device. A post hoc analysis of recently published results with intranasal administration using a novel bidirectional delivery device containing fluticasone propionate (Opt-FP) was performed in 109 patients with mild-to-moderate bilateral polyposis. Patients were allocated to subgroups based on summed polyp score at baseline (2, 3, or 4) and on their history of previous sinus surgery. A highly significant and progressive reduction in summed polyp size was observed for Opt-FP versus placebo in all three polyp size subgroups (p < 0.001). A greater relative reduction in polyp size (p < 0.05) and an increase in peak nasal inspiratory flow (p < 0.001) were observed for Opt-FP at 12 weeks in the 28 patients with a baseline summed score of 3 and 4 compared with the 27 with a summed score of 2. Nevertheless, in patients with small polyps at baseline, the polyps were completely resolved on both sides in 7 of 27 patients. Previous sinus surgery had no impact on efficacy. The highly significant progressive treatment effect of Opt-FP was observed regardless of baseline polyps score. Coupled with the complete removal of polyps in many patients with small polyps, this suggests that improved deposition to target sites achieved with the bidirectional delivery device may translate into true clinical benefits and reduced need for surgery.

Predictive factors for the outcome of nasal septal perforation repair

Objectives The aim of this study was to determine the important predictive factors for successful repair of nasal septal perforation. Materials and methods In this study, we examined 35 symptomatic patients (27 males and 8 females, aged from 16 to 76 years) with a nasal septal perforation. In order to correlate pre- and intra-operative factors to the respective results, preoperative symptoms, etiologies, size of the perforation, operation methods and postoperative results from the patients were reviewed and analyzed using logistic regression. Results Nasal obstruction, crust and epistaxis were common preoperative symptoms. In most cases, perforations were observed to evolve after the patients’ trauma caused from their previous nasal surgery experience. The overall reperforation rate was 48% and turned out to be associated with both large perforation size and unilateral mucosal flap coverage. However, we found no strong evidence that other factors such as graft materials and medical conditions were related with surgical failure. The surgical operations for our examinees resulted in complete healing of epistaxis and whistling, whereas nasal obstruction and crusting persisted after the surgeries. In addition, symptom improvement was negatively correlated with large perforation size and nasal trauma history including previous nasal surgeries. Conclusion Precise and complete coverage with bilateral flaps might be the most important factor for successful closure in a septal perforation. Moreover, both trauma history and large perforation size might be at risk for persistent symptoms after septal perforation repair.

Prevalence of the uncinate process, agger nasi cell and their relationship in a Taiwanese population

The uncinate process (UP) and the agger nasi (AN) cell are both important anatomical landmarks in endoscopic sinus surgery. The superior attachment of the UP and the prevalence of the AN cell show great anatomical variability and affect the anatomy of the frontal recess. The aim of this study was to investigate the superior attachment types of the UP, the presence of the AN cell, and the relationship between the two. Two hundred sixty-four sides of 132 patients with identifiable superior attachments of the UP were selected from our 2007-08 computed tomography (CT) scan records. Exclusion criteria were previous nasal or paranasal sinus surgery, neoplastic disease, and a history of nasal trauma. The superior attachment type of the UP and the prevalence of the AN cell were evaluated. Three case series from the English-language literature were selected for racial comparison. Single insertion of the UP into the lamina papyracea was the most common type (70.4%). The other types of UP superior attachment were found to have the following distribution: 10.2% into the middle turbinate; 7.6% into the lamina papyracea and the skull base; 6.1% into the skull base, 4.9% into the lamina papyracea and the middle turbinate; and 0.8% into the middle turbinate and the skull base. The distribution of the UP insertion types with respect to ethnicity was statistically significant (P < 0.01). The AN cell was found in 216 (81.8%) of 264 sides. The AN cell was present bilaterally in 95.3% of the cases (206 sides, 103 patients) and unilaterally in 4.7% (10 sides). The prevalence of the AN cell according to superior attachment of the UP types was not statistically significant (chi(2) = 8.6, p = 0.126). The nasofrontal anatomy did show some variations among different races. The single superior attachment of the UP into the lamina papyracea had the highest prevalence. The AN cell was found to be present in 81.8% of cases. The relationship between the presence of the AN cell and the superior attachment types of the UP was not statistically significant.

Association of inferior turbinate enlargement, concha bullosa and nasal valve collapse with the convexity of septal deviation

Conclusion: Inferior turbinate enlargement (ITE), nasal valve collapse (NVC) and concha bullosa (CB) are nasal anatomic problems that may accompany septal deviation (SD). Establishment of a causal relationship between these variations and SD is doubtful. In patients complaining of nasal obstruction, all nasal structures that may contribute to the symptom must be separately and carefully assessed for setting an appropriate treatment plan and thereby minimizing the failure rate of surgery. Objective: To investigate if the convexity of SD is associated with the occurences of ITE, CB and NVC. Patients and methods: This retrospective study was performed on 109 patients who had been operated due to anterior C-shaped SDs. ITE, CB and NVC were encountered in 65 (59.6%), 27 (24.8%) and 55 (50.5%) patients, respectively. Patients with other forms of SD, allergic rhinitis, non-allergic rhinitis with eosinophilia, acute and chronic sinusitis, nasal polyposis, antrochoanal polyps, those who had recently used systemic or topical decongestants and patients with a history of previous nasal surgery were excluded from the study group. Assessment of the patients was based on data derived from the history, physical examination findings and paranasal sinus CT imaging records. Results: No significant correlation was found between the convexity of the SD and occurrence of ITE, CB and NVC (p = 0.098, 0.717 and 0.171, respectively).

Chemosensory function in Wegener’s granulomatosis: a preliminary report

Despite the fact that Wegener's granulomatosis affects the nasal and paranasal cavities and the cranial nerves regularly, chemosensory impairments have not been reported. The objective of this study is to test the three chemosensory systems, olfaction, taste, and intranasal trigeminal function in Wegener disease patients. We tested olfactory, gustatory, and intranasal trigeminal function in nine patients (5 women, 4 men, mean age 57 years) with confirmed Wegener's granulomatosis. Olfaction was tested with the Sniffin'Sticks, gustatory function with the "Taste strips" and intranasal trigeminal function with a lateralization task. One patient had anosmia (11%), four patients had hyposmia (44%) and four patients were normosmic (45%). Gustatory testing function showed pathological taste strip results in five patients (55%) and normal results in three patients (33%). One patient did not undergo taste testing. Intranasal trigeminal function was lowered in five patients (56%) and normal in four patients (44%). Neither previous nasal surgery status nor endoscopic status was associated to a higher frequency in pathological scores for any of the three chemical senses. In conclusion, these preliminary results suggest a consistent affection in chemosensory functions in Wegener's granulomatosis patients.

Infección rinosinusal por Scedosporium apiospermum en un hospedero inmunocompetente

Scedosporium species can cause colonization, superficial and deep localized infection or systemic disease, especially in immunocompromised hosts. We report a case of localized infection due to Scedosporium apiospermum in a 47 year old woman, with previous nasal surgery. She consulted for recurrent mucopurulent post-nasal discharge not responding to antibiotics. Computed tomography showed opacification of right maxillary sinus. Surgery was performed to removed abnormal tissue from sinus; biopsy revealed chronic sinusitis with aggregate of tightly packed hyphae suggestive of filamentous fungi. The microbiology fungal culture reported Scedosporium apiospermum.

Prevention and Correction of Airway Compromise in Rhinoplasty

Recognition of patients who are at high risk for developing postrhinoplasty airway obstruction is essential. These patients may be at risk because of certain anatomic characteristics or may have a preexisting degree of airway obstruction from previous nasal surgery. Every surgeon who performs esthetic or reconstructive rhinoplasty procedures should be familiar with anatomic variants predisposing to airway obstruction and surgical techniques for airway improvement. The author presents case examples illustrating these principles and his methodology for recognizing and correcting airway compromise in primary and secondary rhinoplasty procedures. The use of spreader grafts, columellar graft, batten grafts, and piriform aperture widening are discussed. The author advocates incorporating these techniques to enhance nasal esthetics and function.

Endoscopic sinus surgery as day-case procedure

Functional endoscopic sinus surgery is the mainstay of surgical treatment for chronic sinusitis. Day-case surgery has the advantage over in-patient surgery of being cost-effective and resource sparing. The objectives of this study were to assess our results for day-case functional endoscopic sinus surgery. This was a retrospective case note review of day-case functional endoscopic sinus surgery procedures performed at Leeds General Infirmary from February 2004 to February 2007. We recorded patients' demographic data, operative details, post-operative course and follow-up results. A total of 105 day-case functional endoscopic sinus surgery procedures were included in the study. Patients' ages ranged from 16 to 93 years; 44 (41.9 per cent) were female and 61 (58.1 per cent) were male. Of these patients, 39 (37.1 per cent) had chronic sinusitis and the rest (66; 62.8 per cent) had nasal polyposis and sinusitis. Sixty-one patients (58.1 per cent) underwent surgery on the morning operating list, while the rest (44; 41.9 per cent) underwent surgery in the afternoon. Of the 105 patients, 24 (22.8 per cent) had undergone previous nasal surgery. The majority of patients (90/105; 85.7 per cent) were discharged on the same day as surgery. The only complication recorded in this study was bleeding, noted in seven patients (6.7 per cent). At the follow-up appointment, 90/105 (85.7 per cent) patients were satisfied with their post-operative results. Day-case endoscopic sinus surgery can be performed safely as a day-case procedure. The most important factors for a successful outcome are correct patient selection, in terms of general health and social circumstances, and a dedicated day-case team.

Management of the Short Nose Deformity in Revision Rhinoplasty

The short nose is a complex and frustrating problem that many rhinoplasty surgeons face in their practice. It can be seen in both the hereditary nasal deformity patient as well as in patients having undergone previous nasal surgery. In the revision rhinoplasty patient, the short nose can result from overresection of the nasal dorsum, a deficiency in the middle third causing a saddle nose and tip retraction, and from structural loss in the lobule. Several methods have been described regarding the treatment of this deformity. They range from simple tip grafting in the mildly affected patient to complete nasal reconstruction in the patient with severe structural loss and skin retraction. We will discuss the anatomy of the short nose and describe our techniques for addressing specific deficiencies.

Surgical Treatment Using an Allograft Dermal Matrix for Nasal Septal Perforation

PurposeNumerous methods have been utilized to repair nasal septal perforation with varying degrees of success; however, no consensus has been reached on nasoseptal perforation repair. Here, the authors describe a surgical method based on human dermal allograft (Surederm™, Hans Biomed Corp. Korea) for the repair of nasal septal perforations.Materials and MethodsEleven patients with a nasal septal perforation were included in this study. The causes of these septal perforations included previous nasal surgery, trauma, foreign body (button battery), and idiopathy. There were several sites of perforation: 9 in the central area, 1 in the posterior-central area, and 1 in the anterior area. An interpositional graft incorporating Surederm™ was positioned between bilateral mucoperichondrial flaps using an intranasal approach. A silastic sheet was then left in the nasal septum bilaterally until complete healing had occurred through new nasal mucosa, which took a mean duration of 6 weeks.ResultsOutcomes in ten of the eleven patients were successful, with complete septal perforation closure. The remaining perforation, which was caused by a button battery, closed incompletely; however, its initial size of 2 cm was reduced to 5 mm.ConclusionThe described technique has a high success rate and can be performed under local anesthesia without external scarring. In the absence of donor site morbidity, this technique can also be utilized to repair posterior or multiple septal perforations without difficulty.

Nasal Valve Suspension Revisited

Nasal valve suspension (NVS) is a simple technique to correct nasal valve obstruction or collapse by providing a lateral vector of pull on the nasal sidewall. The purpose of this research was to review our experience with NVS in a cohort of patients with nasal valve collapse, including a subset of patients with facial paralysis. The objectives were to determine patient satisfaction and complication rates after NVS. A retrospective review of patients 18 years and older who had NVS from 2003 to 2006 with a follow-up of at least 1 month was performed. Data were collected on diagnosis, surgical outcomes, complications, and treatments required. Complications included adverse outcomes, infections, and the need for repeat surgery or treatments. In 17 charts reviewed, 9 patients (53%) had nasal valve collapse as a result of facial paralysis, and 8 (47%) had previous nasal surgery. Follow-up ranged from 1 to 30 months, with a mean of 16.5. Moderate to complete resolution of obstruction was reported by 82% of patients, or for 88% of procedures. Sustained relief was observed in two of eight patients who had previous nasal surgery and six of nine who had no previous nasal surgery (P = .1). Infection occurred in four (24%) patients and five (21%) total suspensions and ranged from 1.5 to 7 months. Six (35%) patients experienced a loss of suspension at 6 to 22 months. NVS is a technically straightforward, relatively reversible procedure particularly useful in the patient with facial paralysis. The efficacy is excellent in the short term yet appears to diminish with time.

A Review of 25-Year Experience of Nasal Septal Perforation Repair

To report the long-term follow-up of 25 years of experience in 100 consecutive cases of septal perforation (SP) repair using the technique of the senior author (F.P.). From 1981 to 2006, a total of 100 consecutive patients were surgically treated and followed up for 1 to 10 years. The medical records of 68 of the patients were retrospectively examined. Outcomes were assessed based on comparison of the results of preoperative and last follow-up assessment of SP size and symptoms. The SP repair technique consists of subperichondrial/periosteal dissection, rotation of nasal mucosa for tension-free closure, with no mucosa incision if possible, and a multilayer closure with interposition graft. The most common symptoms were nasal obstruction (72%), crusts (50%), and epistaxis (31%). Previous nasal surgery was the pathogenetic factor in 39 cases (57%). Fifty-two patients (76%) presented with SPs measuring 1.0 to 3.0 cm in diameter. The internal approach was used in 54 cases (79%), and temporal muscle fascia and conchal cartilage were concomitantly used in 45 cases (66%). The great majority of patients (40 [59%]) received more than 5 years of follow-up. The success rate of closure was 97%. Two patients (3%) presented with reperforation measuring less than 1.0 cm in diameter. The senior author's SP repair technique is easily accomplished, provides good visualization, and is low in cost. Also, in our experience, the success rate of closure has been 97%.

Functional Endoscopic Sinus Surgery: Review Of 266 Patients

Introduction: Functional Endoscopic Sinus Surgery is a method used with success in the treatment of chronic or recurrent sinusitis & nasal polyps. Objective: This study was conducted to assess the treatment results in patients undergoing Functional Endoscopic Sinus Surgery for chronic sinusitis, with evaluation of prognostic indicators of success and failure. Method: This study includes 266 patients who underwent Endoscopic Sinus Surgery for chronic sinusitis over a period of 7 years (from Feb.1995 to Feb.2002). The diagnosis of chronic sinusitis was based on ongoing symptomatology for greater than 3 months and the presence of mucosal disease on radiological examination. A retrospective analysis was done looking at patient data, presenting symptoms, CT findings, operative details and outcome at 6 and 12 months follow up. Results: The most common presenting complaints were olfactory disturbance followed by nasal obstruction and postnasal discharge. There was a positive history of asthma in 25.4 %, allergies in 13% and ASA triad in 3.3 % patients. 41.7% patients had previous nasal surgeries in the past. Positive outcome was obtained in 81.9% at 3 months and 84.7% at 6 months. Revision operations were required in 7.9% patients. Minor complications were seen in 10.5% and major complications in 0.75%. These results are comparable to those in the literature. Factors affecting outcome included asthma, polyposis & pansinusitis. Complications: Functional Endoscopic Sinus Surgery has good results and little morbidity. Extent of diseases as reflected by polyposis and pan sinusitis are the most important determinants of the outcome. Study conducted at: Staffordshire General Hospital, Stafford, UK Paper presented at: Section of Rhinology, Royal Society of Medicine, May 2004

The Korean American Woman's Nose

To assess the differences in nasal anthropometric measurements between Korean American women and North American white women and to perform an in-depth nasal index calculation. This anthropometric survey included a volunteer sample of Korean American women (n = 72) aged 18 to 35 years with Korean parents and no previous nasal surgery or trauma to the nose. Standardized and referenced frontal, lateral, and basal photographs of the nose were taken of the subjects and 22 standard anthropometric measurements of the nose were determined. Results were compared with published standards for North American white women. In addition, 18 nasal indices were calculated and compared with the published standards for North American white women. The Korean American woman's nose did not fit the neoclassic facial canons. Compared with North American white women, 20 of 22 nasal measurements in Korean American women were found to be significantly different. Nasal indices also revealed significant differences in 16 of the 18 that were calculated. The Korean American woman's nose exhibits less rotation, has a flatter dorsum, and is more flared at the alae, with less definition of the nasal tip. The average Korean American and North American white female nasal anthropometric measurements are very different. As cosmetic surgery becomes more popular among Asian Americans, our findings bolster the need for a broader view of facial analysis and transcultural aesthetics.

Técnica de doble intubación para el tratamiento de la epífora en casos complicados

The aim of this study is to present a surgical technique used to treat epiphora secondary to difficult cases of lacrimal pathway obstruction after fractures, previous surgery or anatomic abnormalities. From January 2001 to December 2002 we treated 27 patients with complicated lacrimal pathway obstruction secondary to fractures (10 cases), previous nasal surgery (4 cases), failure of a previous ipsilateral dacryocystorhinostomy (DCR; 6 cases), or failure of a previous contralateral DCR (7 cases). A DCR through an external approach was performed by placing a double concentric intubation in the lacrimal sac and nasal fossa, with the additional introduction of an interpositional silicone structure within a third hollow tube anchored to the sac entrance. The results were evaluated according to the absence of tearing, the emptiness of the lacrimal meniscus, and the permeability of the lacrimal system after forced liquid infusion. Globally, the technique was effective in 85 percent of cases. The results were satisfactory in 90% of cases of postraumatic epiphora, in 75% of patients with previous surgery, in 83% of patients with previous ipsilateral DCR, and in 71% of patients with failed DCR in the contralateral eye. The double intubation technique is a good option in lower lacrimal system obstructions when conventional techniques have a high index of failure.

Nasal Congestion and Hyperventilation Syndrome

This article evaluates the prevalence of hyperventilation syndrome (HVS) in patients who continue to complain of ongoing nasal congestion, despite an apparently adequate surgical result and appropriate medical management. Prospective case series of 14 patients from June 2002 to October 2003 was performed. Patients, who presented complaining of nasal congestion after previous nasal surgery and who appeared to have an adequate nasal airway with no evidence of nasal valve collapse, were evaluated for HVS. When appropriate, nasal steroids and oral antihistamines also had been tested without success. Three patients had end-tidal P(CO2) levels measured and five patients underwent breathing reeducation. All patients had an elevated respiratory rate (>18 breaths/minute) with an upper thoracic breathing pattern. Twelve of the 14 patients complaining of nasal obstruction had an elevated Nijmegen score indicative of HVS. An average number of 2.5 procedures had been performed on each patient. End-tidal P(CO2) levels were < or = 35 mmHg in the three patients who had expired P(CO2) levels measured. Breathing retraining was successful in correcting the nasal congestion in two of five patients. HVS should be included in the differential diagnosis of patients presenting with nasal congestion, particularly after failed nasal surgery. One possible explanation is increased nasal resistance secondary to low arterial P(CO2) levels. Another possible explanation is reduced alae nasae muscle activity secondary to the reduced activity of serotonin-containing raphe neurons. Additional surgery may not necessarily be the answer in HVS patients complaining of nasal congestion.