phenylephrine-hydrochloride and Nasal-Septal-Perforation

The aim of this study was to review and describe the main innovative surgical techniques for nasal septal perforation (NSP) repair that have been published in recent years.. Several techniques for NSP repair have been developed recently. The anterior ethmoidal artery (AEA) flap is a versatile technique for middle-size perforations in different locations. The greater palatine artery (GPA) flap is an excellent option for anterior-most NSPs. The lateral nasal wall flap and the pericranial flap are the most appropriate techniques for large perforations. The advent of these techniques has changed the management and has expanded the therapeutic arsenal to treat all types of NSPs according to the size, location, and osteo-cartilaginous support. However, no technique has been accepted as the gold standard. Extensive knowledge of different techniques is important to individualize the treatment, selecting the most appropriate in each case.

Topics: Endoscopy; Humans; Nasal Septal Perforation; Nose; Surgical Flaps

Concern for illicit and restricted drug use in otolaryngology is similar to other surgical specialties with a few notable exceptions. Many illicit drugs are consumed transnasally. Repeated nasal exposure to stimulants or narcotics can cause local tissue destruction that can present as chronic rhinosinusitis or nasoseptal perforation. Further, the Food and Drug Administration has taken a stance against codeine for pediatric patients undergoing adenotonsillectomy. They have identified an increased risk of death postoperatively with these medications. Because codeine has been the most commonly prescribed narcotic, this has shifted the standard practice.

Topics: Analgesics, Opioid; Codeine; Drug Overdose; Humans; Illicit Drugs; Narcotics; Nasal Septal Perforation; Nose; Osteonecrosis; Otolaryngology; Substance-Related Disorders

Nasal septal perforations can be managed with a septal button prosthesis. While they do not restore the physiological function of the septal mucosa, they are able to improve laminar nasal airflow. With the development of septal buttons sized specifically to perforations, accurate measurement of perforations has become more important for patient satisfaction and comfort. This task can be difficult to accomplish in the clinical setting. In this study, 2 new instruments developed to measure septal perforations were evaluated for accuracy and ease of use.. Two types of measuring devices ("sizers") were created via 3D printing. One type included six serial, progressively sized instruments (serial sizers) and the other included two instruments with several size gradations (graded sizers). Septal perforations of varying sizes were surgically created in five fresh-frozen cadaver heads. Using a headlight and nasal speculum, 15 otolaryngology trainees and consultants were asked to measure the perforations (length × height) via four different methods: "eyeball" estimation, a ruler, the serial sizers, and the graded sizers. They were also asked to evaluate the methods themselves. An accurate measurement was defined as ± 1 mm of the true measurement. A combination of Chi-square analysis and ANOVA was used to assess the accuracy and ease of use of the four methods.. Chi-square analysis showed that the sizers were more accurate than the two traditional methods (eyeball and ruler) for measuring perforation length (73% vs. 44%, p = 4.8 × 10. The two novel sizers studied here were significantly more accurate and easier to use than traditional methods for measuring nasal septal perforations. With broader implementation and study of these devices, there is potential to improve patient care surrounding septal perforations.

Topics: Humans; Nasal Septal Perforation; Nasal Septum; Nose; Otolaryngology; Printing, Three-Dimensional; Prostheses and Implants

Nasal septal perforations (NSPs) often cause bleeding, crusting, obstruction, and/or whistling. The objective was to analyze the impact of anterior NSP size and shape on nasal physiology using computational fluid dynamics (CFD).. A 3-dimensional model of the nasal cavity was constructed from a radiologically normal CT scan using imaging software. Anterior NSPs (ovoid (ONSP): 0.5, 1, 2, and 3 cm long anterior-to-posteriorly and round (RNSP, 0.5 and 1 cm)) were virtually created in the model and divided into ventral, dorsal, anterior, and posterior regions. Steady-state inspiratory airflow, heat, and water vapor transport were simulated using Fluent CFD software. Air crossover through the perforation, wall shear, heat flux, water vapor flux, resistance, and humidification were analyzed.. Air crossover and wall shear increased with perforation size. Regionally, wall shear and heat and water vapor flux were highest posteriorly and lowest anteriorly, generally increasing with size in those regions. RNSPs had greater heat and water vapor flux compared to corresponding size ONSPs. Resistance decreased by 10% or more from normal only in the 3 cm ONSP. Maximum water content was achieved more posteriorly in larger NSP nasal cavities.. High wall shear and heat and water vapor flux in posterior perforation regions may explain the crusting most commonly noted on posterior NSP edges. This preliminary study suggests that larger NSPs have a greater effect on nasal resistance and water content. Decrease in resistance with larger NSP size may be implicated in reported symptomatic improvement following enlargement of NSPs for treatment.

Topics: Computer Simulation; Humans; Hydrodynamics; Nasal Cavity; Nasal Septal Perforation; Nose

This case series is about four different foreign bodies lodged in different locations of the aerodigestive tract. All four cases had delayed diagnosis due to inconspicuous history. Radiology in the form of computed tomography aided the appropriate diagnosis in most of these cases. Though all four patients have been successfully managed by removal of foreign body, not all of them have identical outcomes. A brief discussion about predictive factors in the fish bone foreign body has been included. The authors also discuss certain critical aspects of the management, which may aid in reducing the morbidity. We emphasise on the high index of suspicion in peculiar cases and on the low threshold for radiological investigation in doubtful clinical scenarios.

Topics: Adult; Arachis; Child, Preschool; Foreign Bodies; Humans; Infant; Male; Middle Aged; Nasal Septal Perforation; Nose; Pharynx; Retropharyngeal Abscess; Tomography, X-Ray Computed

The nose deformity associated with cleft lip is difficult to solve in the primary and secondary surgery. In an adult patient, many techniques are used including mobilization, suspension, fixation and trimming the alar cartilages, septoplasty, nasal bones osteotomies, and dorsal bone and cartilage resection. Different types of cartilage grafts are commonly used.. A septal cartilage graft was used in 75 adult patients with mild to severe cleft lip deformities. Based on the golden ratio proportions of the columella that can be observed in the lateral view, a septal cartilage graft with a number 1 shape was created and inserted between the medial cruras in 75 patients, with unilateral or bilateral cleft lip, between 2007 and 2014. Complementary surgery was done in the nose of all the patients. A retrospective, observational, and descriptive study was made with presurgical and postsurgical photographs, throughout a 6-month follow-up period.. Excellent cosmetic and functional results were seen, especially in the lateral view. There was 1 septal perforation reported. The patients were satisfied with the aesthetic results.. The graft number 1 works in the reality; it has proven to be a stable support to the affected cartilage, projects a nice nasal tip, and is a lasting solution for adults.

Topics: Adult; Cartilage; Chile; Cleft Lip; Female; Humans; Male; Nasal Bone; Nasal Septal Perforation; Nasal Septum; Nose; Patient Satisfaction; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Rhinoplasty; Treatment Outcome

In this study, we analyze and discuss the treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms (PNs). We performed 129 endonasal transsphenoidal resections of PNs and analyzed and treated cases with nasal complications. After endonasal transsphenoidal resection of PNs, there were 26 cases of postoperative nasal complications (20.1%), including nasal hemorrhage (4.8%), cerebrospinal fluid rhinorrhea (6.9%), sphenoid sinusitis (2.3%), atrophic rhinitis (1.6%), olfactory disorder (1.6%), perforation of nasal septum (0.8%), and nasal adhesion (2.3%). All patients clinically recovered after therapy, which included treatment of the cavity through nasal endoscopy, intranasal corticosteroids, and nasal irrigation. We propose that regular nasal endoscopic review, specific nasal medications, and regular nasal irrigation can effectively clear nasal mucosal hyperemia-induced edema and nasal/nasoantral secretions, as well as promote regeneration of nasal mucosa, prevent nasal adhesion, maintain the sinus cavity drainage, and accelerate the recovery of the physiological function of the paranasal sinus. Timely treatment of patients with nasal complications after endonasal transsphenoidal resections of PNs could greatly relieve the clinical symptoms. Nasal cleaning is very beneficial to patients after surgery recovery.

Topics: Adolescent; Adult; Aftercare; Aged; Cerebrospinal Fluid Rhinorrhea; Child; Epistaxis; Female; Humans; Male; Middle Aged; Nasal Lavage; Nasal Mucosa; Nasal Septal Perforation; Nasal Surgical Procedures; Natural Orifice Endoscopic Surgery; Nose; Nose Diseases; Olfactory Nerve Diseases; Paranasal Sinuses; Pituitary Neoplasms; Postoperative Complications; Recovery of Function; Retrospective Studies; Rhinitis, Atrophic; Sphenoid Sinus; Sphenoid Sinusitis; Tissue Adhesions; Young Adult

Secondary nasal obstruction occurs when surgery fails to improve a patient's nasal obstruction symptoms. This may occur from failure to recognize a problem preoperatively or failure to address mucocutaneous medical ailments. Secondary obstruction may even occur despite perfect execution of the operative plan. In this article, we discuss the etiology, intraoperative pitfalls, and surgical correction of secondary obstruction after primary rhinoplasty. When managing postrhinoplasty secondary obstruction, care must be taken to correct the cause of obstruction without creating new problems.

Topics: Humans; Medical Errors; Nasal Obstruction; Nasal Septal Perforation; Nose; Postoperative Complications; Reoperation; Rhinoplasty; Tissue Adhesions; Treatment Failure

Most of palatal fistula occur from poor repairation of cleft palate, leaving an abnormal channel between mouth and nose. Palatal fistula can cause a series of complications, such as voice and hearing disorder, poor oral and nasal hygiene, psychological diseases and so on. However, hard palate fistula secondary to Leukemia infection is rarely seen, it hasn't been reported yet. We report one case with hard palate fistula and nasal septum perforation after Leukemia infection.

Topics: Fistula; Humans; Infections; Leukemia; Nasal Septal Perforation; Nose; Nose Diseases; Oral Fistula; Palate, Hard; Postoperative Complications

The purpose of this study was to identify the most common deformities seen preoperatively in secondary rhinoplasty patients and the required surgical maneuvers to correct them.. A retrospective chart review of 100 consecutive secondary rhinoplasty patients was performed. Preoperative variables included demographics, prior rhinoplasty data, main aesthetic/functional concerns, and the senior author's physical examination of the nose. Details of the operative maneuvers were reviewed.. The average patient age was 39.2 years. All patients had previous rhinoplasties performed by other surgeons. The most common preoperative complaints were airway occlusion (65 percent), dorsum asymmetry (33 percent), nostril asymmetry (18 percent), and tip asymmetry (14 percent). The most common preoperative nasal deformities seen by the senior author (B.G.) were dorsal asymmetry (65 percent), wide dorsum (47 percent), nostril asymmetry (41 percent), wide alar base (38 percent), and dorsal hump (30 percent). The senior author saw significantly more nasal deformities than the patients themselves, especially in the following areas: dorsal asymmetry (65 percent versus 33 percent; p = 0.0002), wide dorsum (47 percent versus 13 percent; p < 0.0001), nostril asymmetry (41 percent versus 18 percent; p = 0.0003), wide alar base (38 percent versus 6 percent; p < 0.0001), dorsal hump (30 percent versus 9 percent; p < 0.0001), and columella protrusion (25 percent versus 6 percent; p = 0.0002). The most common revision rhinoplasty surgical maneuvers were septoplasty (71 percent), alar rim graft (67 percent), dorsal graft (63 percent), osteotomy (60 percent), and dorsal hump removal (46 percent).. The high incidence of airway concerns among secondary rhinoplasty patients is alarming and emphasizes the urgent need to pay attention to the airway during primary rhinoplasty. There is often a disparity between what the patient sees and what the surgeon observes.

Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Nasal Septal Perforation; Nasal Septum; Nose; Patient Satisfaction; Postoperative Complications; Reoperation; Retrospective Studies; Rhinoplasty; Young Adult

The most typical complaints of patients with nasal septal perforation (SP) are nasal obstruction, crusting, and recurrent epistaxis depending on the size and site of the SP mainly due to disturbed airflow patterns. The objective of the study was to determine the influence of differently localized SPs on intranasal airflow patterns during inspiration by means of numerical simulation.. An experimental setup using three dimensional computer models of a human nose was created. Four different models with three differently localized septal perforation allowed an examination of intranasal airflow changes.. Four high-resolution, realistic, bilateral computer models of the human nose with three differently localized SPs were reconstructed based on computed tomography. A numerical simulation was performed. The intranasal airflow patterns (path lines, velocity, turbulent kinetic energy) during inspiration were displayed, analyzed, and compared.. SPs cause a highly disturbed airflow in the area of the SP and behind. A spacious vortex within the perforation, including various localized vortices, was detected. The airflow in the nose was disturbed to varying degrees depending on the location of the perforation. SPs within the anterior caudal septum in area II led to increased negative turbulences and crossflow.. The numerical simulations demonstrate significantly disturbed intranasal airflow patterns due to SPs. This fact may contribute to crusting and nosebleed due to dehydration of the nasal mucosa. The location and size of the SP are crucial for the impact on disturbed airflow pattern and therefore the patients' complaints. Anterior caudal SPs seem to be the worst. Surgical closure of SPs or simply changes in the site and size of the SP if a complete closure is surgically impossible makes sense.

Topics: Airway Resistance; Computer Simulation; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Models, Anatomic; Nasal Obstruction; Nasal Septal Perforation; Nose; Respiratory Mechanics; Tomography, X-Ray Computed

Topics: Atrophy; Humans; Nasal Septal Perforation; Nasal Septum; Nose; Nose Diseases; Rhinitis; Rhinitis, Atrophic