phenylephrine-hydrochloride and Pain--Postoperative

Throat packs are placed around the airway in patients undergoing upper airway surgical procedures under general anaesthetic to prevent aspiration or ingestion of blood, and consequent chest infections or postoperative nausea and vomiting (PONV). There is no definitive evidence for this, and each time a pack is placed, it risks being retained and obstructing the upper airway. This study aimed to determine whether throat packs are of benefit to patients undergoing upper airway surgical procedures.. Medline, Embase and Central were searched from conception to 15th January 2018 using individualised search strategies. A systematic search of multiple databases was undertaken using custom strategies to identify all relevant randomised controlled trials. Screening, risk of bias assessment and data extraction were undertaken independently by two authors. Primary outcomes included throat pain and PONV. Secondary outcomes included any adverse event documented.. Thirteen papers were eligible for inclusion. No studies reported any instances of retained throat packs. Ten studies assessed the effect of throat packs on post-operative throat pain, with four papers showing a significantly higher incidence of pain when throat packs were used. One study showed throat pain to be slightly, but significantly, worse 24 hours post-surgery when a pack was not used. No paper showed throat packs to be of benefit in preventing PONV.. The study was limited by methodological flaws of included trials, overall relatively low numbers of patients and difficulty in contacting authors to clarify information and obtain raw data. However, this systematic review found no evidence to support the use of throat packs. This supports the proposal that there is no indication for the routine use of throat packs in ENT, maxillofacial and dental procedures.

Topics: Anesthesia; Humans; Nose; Oral Surgical Procedures; Pain, Postoperative; Pharynx; Postoperative Nausea and Vomiting

Because of the complexity and variety of tip deformities encountered by the rhinoplasty surgeon,no single stylized approach or technique will suffice to satisfactorily correct the myriad anatomic configurations that present [21]. Thus, a graduated anatomic approach to nasal tip surgery is recommended, which equips the surgeon to correct more modest deformities with conservative approaches and techniques,reserving more aggressive approaches and techniques for more profoundly abnormal tip deformities. Pre-serving an undivided, complete residual strip in the majority of patients is entirely possible and eminently desirable for the control of long-term healing. Mastering a wide variety of tip sculpture techniques,employed as dictated by the presenting anatomy [22],equips the surgeon with the tools to correct the astonishing variety of nasal tip deformities encountered.

Topics: Esthetics; Female; Humans; Male; Nasal Septum; Nose; Pain, Postoperative; Patient Satisfaction; Rhinoplasty; Suture Techniques; Treatment Outcome

An algorithm for an endonasal approach to most aesthetic problems of the nasal tip is presented. Endonasal surgery in this manner has been successful in the management of many thousands of cases through the years and effective for most variations of tip anatomy and appearance. Every attempt is made to maintain the pleasing, natural, and individual aesthetic elements of the tip while eliminating the offending features through minimally invasive techniques.

Topics: Esthetics; Female; Humans; Male; Nasal Septum; Nose; Pain, Postoperative; Patient Satisfaction; Rhinoplasty; Suture Techniques; Treatment Outcome

Pain is the major determinant factor which affects the quality of recovery and postoperative agitation following nasal surgery with the patient under general anesthesia. Our objectives were to test the hypothesis that an external nasal nerve block will decrease pain intensity, decrease drug consumption, decrease the incidence of postoperative emergence agitation and improve quality of recovery.. In this study 100 adult patients who were scheduled for elective external nasal surgery with the patient under general anesthesia and nasal packing on each side, received external nasal nerve blocks postoperatively for 24 h with saline (group I) or 2% xylocaine (group II) with 1:200,000 epinephrine. Postoperative pain was measured at the postanesthesia care unit (PACU) utilizing a visual analog scale (VAS). Narcotics consumption was also measured. Emergence agitation and quality of recovery were also assessed.. Pain scores were statistically significant between both groups. Requirements of equivalent morphine doses in the PACU were lower in group II (block) than group I (control) with a significant P value <0.001. Group II (block) patients required significantly less intraoperative fentanyl than group I (control) patients (p = 0.001). Group II (block) showed higher scores in pain dimension of QoR-40 in comparison with group I (P <0.001). The incidence of emergence agitation was lower in group II (block) than in group I (control, 24% vs. 48%, P = 0.012).. External nasal nerve block is an effective technique for reducing postoperative pain, drug consumption and quality of recovery. It also reduces emergence agitation. The effects are mainly due to profound analgesia and effective pain control that lead to decreased drug usage and reduced discomfort.

Topics: Adult; Analgesics, Opioid; Anesthesia, General; Double-Blind Method; Female; Fentanyl; Humans; Male; Middle Aged; Morphine; Nasal Surgical Procedures; Nerve Block; Nose; Pain Management; Pain Measurement; Pain, Postoperative; Postoperative Complications; Psychomotor Agitation; Young Adult

To evaluate the preemptive analgesia effects of both the parecoxib sodium and the pentazocine in patients undergoing nasal endoscopic surgery.. In the randomized, double blind, controlled study, 120 patients undergoing septoplasty were divided into 3 groups (n = 40): group A received parecoxib 40 mg by muscle injection 30 min before the operation; group B received pentazocine 30 mg; group C received an equal volume of saline. The preemptive analgesia effect was evaluated with VAS scores which recorded at different time points. The proportion of participants using rescue analgesia after the operation were recorded as additional measures of preemptive analgesia.. Intra-operative as well as the postoperative pain scores were less in the group A and group B than in the control group. Fewer participants required rescue medication after operation with parecoxib as well as pentazocine than placebo. However there were no difference in the preemptive effects between the group A and group B.. Administration of both the parecoxib and pentazocine before the nasal endoscopic surgery can provide preemptive analgesia without serious adverse side effects that deserves popularization in the clinic.

Topics: Analgesia; Analgesics; Double-Blind Method; Endoscopy; Humans; Isoxazoles; Nasal Surgical Procedures; Nose; Pain; Pain, Postoperative; Pentazocine

We aimed to decrease the postseptoplasty morbidities depending on nasal packing by using Merocel within glove finger moistened with tetracaine 0.25% solution.. The study was designed as a randomized prospective study.. A university hospital in Turkey.. Our study consisted of 80 patients who underwent septoplasty. The Merocel nasal tampon within glove finger was inserted after surgery in the study group and removed after 24 or 48 hours. Merocel was moistened with tetracaine 0.25% solution after insertion into the nasal cavity and just before removal. The morbidities and normal breathing time were recorded and compared with those of the control group.. The postseptoplasty morbidities were significantly decreased in the study group compared with those in the control group. The morbidities were also improved after removal of tampons after 24 hours compared with 48 hours. However, the normal breathing time was prolonged when the nasal tampons were removed after 24 hours.. The glove finger provides comfortable removal of nasal packing. The Merocel tampons might be safely removed just after 24 hours postoperatively without any complication.

Topics: Adolescent; Adult; Anesthetics, Local; Epistaxis; Female; Follow-Up Studies; Formaldehyde; Gloves, Surgical; Headache; Hemostatics; Humans; Male; Middle Aged; Nasal Cavity; Nasal Septum; Nose; Pain, Postoperative; Polyvinyl Alcohol; Postoperative Complications; Postoperative Hemorrhage; Prospective Studies; Respiration; Rhinoplasty; Tampons, Surgical; Tetracaine; Tissue Adhesions; Young Adult

Nasal packing is used to control postoperative bleeding and wound healing, and it also exerts a very strong influence on the comfort of the patient. Sorbsan(®) (calcium alginate) is an absorbent packing that shows a potent hemostatic effect and is able to maintain wound surfaces in a moist environment by absorbing and gelling the wound exudate. The aim of this study was to evaluate the early symptoms and QOL with Sorbsan(®) versus Beschitin-F(®) (chitin-coated gauze) for middle meatus packing after endoscopic sinus surgery (ESS).. We performed a cohort study of 40 patients who underwent ESS. Following ESS, the patients were randomly allocated into two groups of 20 patients each who underwent insertion of either Sorbsan(®) or Beschitin-F(®) into the middle meatus. A daily diary was used to record the symptoms and QOL, measured using visual analogue scales, before the ESS and on each day thereafter. Postoperative bleeding and local infection were also recorded.. The scores for each of the symptoms of nasal pain, headache, nasal bleeding and postnasal drip were statistically significantly lower in the Sorbsan(®) group. The scores for each of the QOL parameters, including the effect on their stay in the hospital and sleep disturbance, were also significantly lower in the Sorbsan(®) group. There were no findings of postoperative hemorrhage or local infection in either group.. Sorbsan(®) packing did not cause any major complications and has the potential to reduce nasal pain and suffering in post ESS patients compared with gauze packing.

Topics: Adult; Alginates; Chitin; Cohort Studies; Epistaxis; Female; Hemostatics; Humans; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Pain, Postoperative; Paranasal Sinuses; Postoperative Hemorrhage; Quality of Life; Surgical Wound Infection; Treatment Outcome

To determine whether premedication with 45 mg of oral dextromethorphan (DM) given 90 minutes prior to nasal surgery decreases postoperative pain and consequently reduces opioid administration and also, if it reduces the pain of pack removal.. This was a prospective, double blind, randomized, controlled study carried out from January 2007 to March 2008 at Al-Moosa General Hospital, Al-Ahsa, Saudi Arabia, in which 38 patients received oral DM (age 28 +/- 11 years), and 38 patients received placebos (age 26 +/- 10 years). Postoperative pain was assessed using a visual analog scale, and a pain score of > or -5 was treated by a rescue bolus dose of morphine sulfate 2 mg every 10 minutes in the post-anesthesia care unit (PACU) and by one gm of paracetamol in the surgical ward until the score became <5. Pain was also assessed during pack removal.. The placebo group had a higher pain score in the PACU, and hence a higher morphine consumption than the DM group (7.3 mg +/- 2.6 versus 4.6 mg +/- 1.2, p=0.03). Pain score in the surgical ward was also higher in the placebo group at 4, 8, 12, and 24 hours, but this was insignificant, and was insignificantly lower only at 18 hours (p=0.26). The placebo group had a higher pain score at pack removal than the DM group (7.8 +/- 11 versus 3.5 +/- 15, p=0.004).. Preemptive medication with DM reduces opioid administration in the early postoperative period and during pack removal.

Topics: Administration, Oral; Adult; Dextromethorphan; Double-Blind Method; Female; Humans; Male; Nose; Pain, Postoperative; Premedication; Prospective Studies

To demonstrate the technique and efficacy of powered assisted adenoidectomy using nasal endoscopy.. Between 2002 and 2003, forty children (age ranged from 3 to 17 years) with symptoms and signs suggestive of snoring and/or obstructive sleep apnea and choanal adenoids were randomly selected and distributed in two groups. Group A underwent transnasal endoscopic powered adenoidectomy (TEPA) and group B underwent curettage adenoidectomy (CA). Both groups underwent pre- and postoperative nasal endoscopy. Direct comparisons between the two groups were made with regards to operative time, amount of blood loss, postoperative morbidity, complications, and resolution of symptoms.. Male to female distribution was equal 1:1. The mean age of both groups was 8 years. In group A, the mean blood loss was 8.2 ml compared to 22.1 ml in group B (p<0.05). The operative time in group A was 6.1 min vs 12.3 min in group B (p<0.05). There were no operative or postoperative complications in both groups. Postoperative follow up and nasal endoscopy showed no recurrence of symptoms or adenoid remnants.. Using TEPA for removing choanal adenoids is an adequate and safe method. The TEPA technique can be added to the armamentarium of techniques used by pediatric otolaryngologists.

Topics: Adenoidectomy; Adenoids; Adolescent; Child; Child, Preschool; Choanal Atresia; Endoscopy; Female; Follow-Up Studies; Humans; Hypertrophy; Length of Stay; Male; Minimally Invasive Surgical Procedures; Nose; Pain, Postoperative; Postoperative Care; Preoperative Care; Prospective Studies; Risk Assessment; Treatment Outcome

In this study, we compared the use of preincisional lidocaine 2% with epinephrine (LA) and levobupivacaine 0.25% plain (LB) for postoperative analgesia and vasoconstriction in patients undergoing nasal surgery.. Sixty patients were randomly assigned to receive preincisional local infiltration under general anesthesia. Group LB received levobupivacaine 0.25%, and group LA received epinephrine plus lidocaine 2% (add volume injected). Intraoperative hemodynamic changes, pre- and postoperative hemoglobin and hematocrit values were recorded. Visual analog scale values 30 min and 1, 2, 8, 12, and 24 h postoperatively and the need for rescue analgesic treatment in the first 24 h of all patients was recorded.. At 30 min and 1, 2, 8, and 12 h postoperatively, visual analog scale values were lower in group LB than in group LA (P < 0.0001, P = 0.002, P = 0.023, P < 0.0001, and P = 0.011, respectively). The analgesic requirement was significantly lower in group LB when compared with that in group LA (P = 0.038). Group LB had significant differences between preoperative and postoperative hemoglobin and hematocrit values (P = 0.014 and 0.025). Group LA had significant differences between preoperative and postoperative hemoglobin and hematocrit values (P = 0.031 and 0.024).. We conclude that postoperative analgesia in nasal surgery with local infiltration of levobupivacaine was significantly more potent and longer lasting than that achieved by lidocaine plus epinephrine.

Topics: Adult; Analgesics; Anesthetics, Local; Blood Loss, Surgical; Bupivacaine; Double-Blind Method; Drug Therapy, Combination; Endoscopy; Epinephrine; Female; Hematocrit; Hemoglobins; Humans; Levobupivacaine; Lidocaine; Male; Middle Aged; Nose; Otorhinolaryngologic Surgical Procedures; Pain Measurement; Pain, Postoperative; Prospective Studies; Rhinoplasty; Time Factors; Vasoconstriction; Vasoconstrictor Agents

The aim of this prospective, randomized, double-blind study was to compare the efficacy of parecoxibfor postoperative analgesia after endoscopic turbinate and sinus surgery, with the non-selective non-steroid anti-inflammatory drug (NSAID), ketorolac.. A total of 50 patients with an ASA physical status I-II, receiving functional endoscopic sinus surgery (FESS) and endoscopic turbinectomy after local infiltration with 1% mepivacaine, were randomly assigned to receive intravenous administration of either 40 mg parecoxib (N.=25) or 30 mg ketorolac (N.=25), 15 min before the discontinuation of anaesthesia and then every 8 h postoperatively. A blinded observer recorded the incidence and severity of pain upon admission to the postanesthesia care unit (PACU), as well as 10, 20, and 30 min after PACU admission. Thereafter, observations continued every 1 h for the first 6 h, and then 12 h and 24 h after surgery.. The area under the curve of the visual analogue scale (AUCVAS) calculated during the study period was 635 (26-1 413) in the Parecoxib group and 669 (28-1 901) in the Ketorolac group (P=0.54). Rescue morphine analgesia was required by 12 patients (48%) in the Parecoxib group and 11 patients (44%) in the Ketorolac group (P<0.05); while mean morphine consumption was 5 +/- 2.5 mg and 5 +/- 2.0 mg in Ketorolac and Parecoxib groups, respectively (P<0.05). No differences in the incidence of side effects were recorded between the two groups. Patient satisfaction was similarly high in both groups, and all patients were discharged uneventfully 24 h after surgery.. In patients undergoing endoscopic nasal surgery and local infiltration with 1% mepivacaine, parecoxib administered before discontinuing general anesthesia is as effective in treating early postoperative pain as ketorolac.

Topics: Adolescent; Adult; Aged; Analgesia; Anti-Inflammatory Agents, Non-Steroidal; Cyclooxygenase Inhibitors; Double-Blind Method; Humans; Isoxazoles; Ketorolac; Middle Aged; Nose; Pain, Postoperative; Postoperative Care; Prospective Studies; Time Factors; Young Adult

The efficacy of pharyngeal packing in the prevention of postoperative nausea and vomiting (PONV) in patients undergoing nasal surgery was evaluated in a prospective randomised controlled study. The effect of the presence of the pharyngeal pack on the incidence of postoperative sore throat was also assessed. One hundred patients were randomly allocated to one of two groups; the first had packing and the second received no packing. The placement of a pharyngeal pack was found to have no effect on the incidence of PONV but was associated with a significantly increased incidence of sore throat. The absence of a pharyngeal pack was not associated with an increase in postoperative aspiration or vomiting. We conclude that the routine placement of pharyngeal packs during uncomplicated nasal surgery has no effect on the incidence of PONV and will increase the incidence of postoperative sore throat.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Intraoperative Care; Male; Middle Aged; Nose; Pain Measurement; Pain, Postoperative; Pharyngitis; Pharynx; Postoperative Nausea and Vomiting; Prospective Studies; Tampons, Surgical

To ascertain whether local anaesthetic use is of clinical benefit in nasal surgery, a prospective double-blind randomized controlled trial of topical bupivacaine on post-operative pain in patients packed after bilateral nasal surgery was carried out. Each patient received a bupivacaine-soaked and a saline-soaked Merocel pack, thereby acting as their own control. Power analysis ascertained the number of patients required to enter the trial to detect a statistically significant difference in pain. Fifty-seven patients completed the trial. Visual analogue scales determined the level of post-operative pain at different time points in each nostril. Less pain was demonstrated in nostrils containing bupivacaine-soaked packs compared with saline-soaked packs at two hours (p < 0.0001), four hours (p = 0.0183) and six hours (p = 0.0476) post-operatively. Although not statistically significant, less pain was noted on pack removal on the local anaesthetic sides. These results provide clinical-based evidence for the use of bupivacaine as a local anaesthetic in reducing pain following nasal surgery with packing.

Topics: Adolescent; Adult; Aged; Anesthetics, Local; Bupivacaine; Double-Blind Method; Humans; Middle Aged; Nose; Pain Measurement; Pain, Postoperative; Postoperative Care; Prospective Studies; Tampons, Surgical

The objective of this study was to assess the efficacy of topical lignocaine in reducing the pain of pack removal after nasal surgery. Fifty-eight patients with Merocel nasal packs in situ after nasal surgery were randomized to receive 10 ml of either 2 per cent lignocaine or 0.9 per cent saline on the packs 10 minutes prior to their removal and the pain experienced on their removal was recorded on a visual analogue scale. The median pain score was 3.4 in the lignocaine group and 2.9 in the saline group with no statistical evidence of a difference between the two groups. There was no statistical evidence of an association between the group and the operation performed, the use of intra-operative Moffat's solution or the use of post-operative oral analgesia. We conclude that lignocaine used in this way does not reduce the pain of pack removal after nasal surgery.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anesthetics, Local; Double-Blind Method; Female; Humans; Lidocaine; Male; Middle Aged; Nose; Pain Measurement; Pain, Postoperative; Postoperative Care; Prospective Studies; Tampons, Surgical

The prevalence of unrelieved postoperative pain is high and may lead to adverse effects including prolonged hospitalization and delayed recovery. Distraction may be an effective pain-relieving strategy, and can be implemented by several means including affective imaging, games, and possibly music. The aim of this study was to explore the effect of music therapy on postoperative pain. Fifty-seven patients (24 females, 33 males; mean +/- SD age 39.9 +/- 14.35 years [range 15 to 69 years] were matched for age and sex and then nonselectively assigned to either an experimental (n = 27) or a control (n = 30) group. Music was played intermittently to members of the experimental group during the first 24 hour postoperative period. Pain intensity was measured using the Pain Verbal Rating Scales (VRS). Significant decreases in pain intensity over time were found in the experimental group compared to the control group (p < 0.0001). In addition, the experimental group had a lower systolic blood pressure and heart rate, and took fewer oral analgesics for pain. These findings suggest that music therapy is an effective nonpharmacologic approach for postoperative pain management.

Topics: Acetaminophen; Adolescent; Adult; Aged; Analgesia; Analgesics; Blood Pressure; Diclofenac; Female; Heart Rate; Humans; Male; Middle Aged; Music Therapy; Nose; Otorhinolaryngologic Surgical Procedures; Pain Measurement; Pain, Postoperative

Non-opioid analgesics are often used to supplement opioids for the management of perioperative pain. In this randomized, double-blinded, placebo-controlled study, we examined the effects of acetaminophen and a cyclooxygenase type-2 inhibitor, celecoxib, when administered alone or in combination, before elective otolaryngologic surgery in 112 healthy outpatients. Subjects were assigned to 1 of 4 study groups: Group 1, placebo (vitamin C, 500 mg per os [PO]); Group 2, acetaminophen 2000 mg PO; Group 3, celecoxib 200 mg PO; or Group 4, acetaminophen 2000 mg and celecoxib 200 mg PO. All patients received a standardized anesthetic technique. During the postoperative period, pain was assessed using a 10-point verbal rating scale. Recovery times, the need for rescue analgesics, side effects, and patient satisfaction scores were also recorded. The combination of acetaminophen and celecoxib was significantly more effective than placebo in reducing postoperative pain. Celecoxib, when administered alone or in combination with acetaminophen, improved patients' satisfaction with their postoperative analgesia. With the combination of acetaminophen and celecoxib, an additional expenditure of $6.16 would be required to obtain complete satisfaction with postoperative pain management in one additional patient who would not have been completely satisfied if he/she had received the placebo. However, oral celecoxib or acetaminophen alone was not significantly more effective than placebo in reducing postoperative pain when administered before surgery. We conclude that oral premedication with a combination of acetaminophen (2000 mg) and celecoxib (200 mg) was highly effective in decreasing pain and improving patient satisfaction after outpatient surgery.. Oral premedication with a combination of acetaminophen (2000 mg) and celecoxib (200 mg) was effective in decreasing pain and improving patient satisfaction after otolaryngologic surgery. However, acetaminophen (2000 mg) or celecoxib (200 mg) alone was not significantly more effective than placebo in reducing postoperative pain.

Topics: Acetaminophen; Adenoids; Adolescent; Adult; Aged; Analgesics, Non-Narcotic; Anti-Inflammatory Agents, Non-Steroidal; Celecoxib; Double-Blind Method; Drug Therapy, Combination; Humans; Middle Aged; Nose; Otologic Surgical Procedures; Pain, Postoperative; Palatine Tonsil; Premedication; Pyrazoles; Sulfonamides

In our department, nasal packs have traditionally remained in place for a period of 24 h after routine elective nasal surgery. We decided to determine whether reducing the duration of nasal packing from 24 h to 2 h would reduce postoperative pain without a concomitant increase in haemorrhagic complications. A series of 72 patients undergoing elective nasal surgery were randomised to have either nasal packs for 24 h (n = 39) or for 2 h (n = 33). Pain was assessed using a visual analogue scale with the nasal packs in place and on their removal. The incidence of haemorrhage was noted. The results showed a significant decrease in mean pain score (MPS) with the packs in place, from 3.4 (range 0.8-6.8) to 1.16 (range 0-2.5); (P < 0.001) and also on pack removal from 5.3 (range 1.2-7.9) to 2.6 (range 0-5.4); (P < 0.05). There was no postoperative haemorrhage in either group. A new standard of 2 h for routine nasal packing was set and our departmental protocols were changed accordingly. Results in a further 36 patients gave a MPS with the packs in place of 1.12 (range 0-3.2) and a MPS of 2.36 (range 0-6.7) on their removal. There was no statistical difference between these and our previous findings. We conclude that postoperative nasal packing for only 2 h rather than 24 h significantly reduces pain without a concomitant risk of haemorrhage.

Topics: Adult; Bandages; Female; Follow-Up Studies; Humans; Male; Medical Audit; Middle Aged; Nose; Pain, Postoperative; Postoperative Care; Postoperative Hemorrhage; Postoperative Period

Packing of the nasal cavity following intranasal surgery is still widely practised. The removal of this packing is invariably associated with a significant amount of pain. We designed a prospective randomised case-controlled study to look at the efficacy of 4% lignocaine solution as a potential analgesic in the removal of Merocel nasal packs. Each patient had bilateral packs and acted as his or her own control with one pack being rehydrated with lignocaine and the other with saline. We found that there was a reduction in the level of discomfort experienced on the side rehydrated with lignocaine, although this reduction did not reach significance. We emphasize the importance of rehydration of these packs prior to removal.

Topics: Anesthetics, Local; Case-Control Studies; Female; Formaldehyde; Hemostatics; Humans; Lidocaine; Male; Nose; Pain Measurement; Pain, Postoperative; Polyvinyl Alcohol; Postoperative Complications; Postoperative Hemorrhage; Prospective Studies; Tampons, Surgical

1. Vomiting and restlessness following ENT and eye surgery are undesirable, and may be related to the emetic and analgesic effects of any analgesic given to augment anaesthesia during surgery. 2. To rationalise the choice of analgesic for routine ENT surgery we examined the intraoperative, recovery and postoperative effects following the administration of either buprenorphine (3.0 to 4.5 micrograms kg-1), diclofenac (1 mg kg-1), fentanyl (1.5 to 2.0 micrograms kg-1), morphine (0.1 to 0.15 mg kg-1), nalbuphine (0.1 to 0.15 mg kg-1), pethidine (1.0 to 1.5 mg kg-1) or saline (as control) given with the induction of anaesthesia in 374 patients. A standardised anaesthetic technique with controlled ventilation using 0.6-0.8% isoflurane in nitrous oxide and oxygen was employed. The study population constituted 7 similar groups of patients. 3. Intraoperatively, their effects on heart rate and blood pressure, airway pressure and intraocular pressure, were similar. This implies, most surprisingly, that neither their analgesic nor their histamine releasing effects were clinically evident during surgery. By prolonging the time to extubation at the end of anaesthesia, only buprenorphine, fentanyl, morphine and pethidine provided evidence of intraoperative respiratory depression. 4. Postoperatively, buprenorphine was associated with severe respiratory depression, prolonged somnolence, profound analgesia and the highest emesis rate. Diclofenac exhibited no sedative, analgesic, analgesic sparing, emetic or antipyretic effects. Fentanyl provided no sedative or analgesic effects, but was mildly emetic. Morphine provided poor sedation and analgesia, delayed the requirement for re-medication and was highly emetic. Nalbuphine and pethidine produced sedation with analgesia during recovery, a prolonged time to re-medication and a mild emetic effect. None provided evidence, from analysis of postoperative re-medication times and analgesic consumption, of any pre-emptive analgesic effect. 5. We conclude that nalbuphine (mean dose 0.13 mg kg-1) and pethidine (mean dose 1.35 mg kg-1), given individually as a single i.v. bolus during induction of anaesthesia, are the most efficacious analgesics for routine in-patient ENT surgery.

Topics: Adolescent; Adult; Aged; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Child; Double-Blind Method; Ear; Fever; Humans; Injections, Intravenous; Intraoperative Period; Middle Aged; Narcotic Antagonists; Narcotics; Nose; Pain, Postoperative; Pharynx; Postoperative Complications; Prospective Studies; Vomiting

Ninety-five patients undergoing routine nasal surgery were enrolled into a randomized, prospective trial to investigate the efficacy and morbidity of nasal packing. The patients were randomized to receive a bismuth iodoform paraffin paste (BIPP) pack, a Telfa pack or no pack. Patients for septal surgery were randomized between the BIPP and Telfa groups only. They were independently randomized to receive or not receive, a silastic nasal splint for the first post-operative week. Post-operative pain levels were analysed using a visual analogue scale. Mean pain scores were increased 50 per cent by the use of nasal packs and pack removal, particularly BIPP which, was a most painful event (p < 0.001). Reactionary haemorrhage occurred in only two patients (2.1 per cent), both of whom had packs in situ. Vestibulitis was unique to the patients with a silastic splint, who were packed with BIPP, occurring in 21 per cent of them. Similarly septal perforation was unique to this group. There was no significant difference in the incidence of adhesions between the groups which received packs and those who did not. Routine nasal packing, especially with BIPP, would seen difficult to justify in view of the increased pain levels and increased complications which occur without any demonstrable benefit in the majority of patients. Therefore packing should be reserved for cases where there is concern about persistent haemorrhage. In these cases Telfa would be preferable to BIPP.

Topics: Adult; Bandages; Bismuth; Drug Combinations; Female; Humans; Hydrocarbons, Iodinated; Male; Nose; Nose Diseases; Pain, Postoperative; Prospective Studies; Splints

A controlled investigation was conducted to compare the efficacy of ketoprofen and pethidine in relief of postoperative pain after nasal surgery. Sixty patients were randomly allocated to receive intravenous ketoprofen 1.5 mg.ml-1 or pethidine 1 mg.kg-1 during induction of anaesthesia. Appearance, pain and headache were assessed 1, 2, and 4 h postoperatively, and the following morning. The use of ketoprofen was associated with a significantly faster recovery from anaesthesia (P less than 0.001), and a more rapid return to calm awakening (P less than 0.05). Patients who received ketoprofen had significantly lower pain and headache scores (P less than 0.01 and P less than 0.001, respectively), and required significantly (P less than 0.05) less postoperative analgesia. No significant difference in incidence and severity of postoperative nausea or vomiting was found between the two groups at any time. A single intravenous dose of ketoprofen during anaesthesia may offer an advantage compared to pethidine in reducing postoperative pain following nasal surgery.

Topics: Adult; Female; Headache; Humans; Infusions, Intravenous; Ketoprofen; Male; Meperidine; Nausea; Nose; Pain, Postoperative; Postoperative Complications; Vomiting

Obstructive sleep apnea (OSA) and nasal obstruction are common in the general population and frequently treated by otolaryngologists and facial plastic surgeons. Understanding the appropriate pre-, peri-, and postoperative management of OSA patients undergoing functional nasal surgery is important. OSA patients should be appropriately counseled in the preoperative period on their increased anesthetic risk. In OSA patients who are continuous positive airway pressure (CPAP) intolerant, the role of drug-induced sleep endoscopy should be discussed with the patient, and depending on the surgeon's practice may prompt referral to a sleep specialist. Should multilevel airway surgery be indicated, it can safely be performed in most OSA patients. Surgeons should communicate with the anesthesiologist regarding an airway plan given this patient population's higher propensity for having a difficult airway. Given their increased risk of postoperative respiratory depression, extended recovery time should be given to these patients and the use of opioids as well as sedatives should be minimized. During surgery, one can consider using local nerve blocks to reduce postoperative pain and analgesic use. After surgery, clinicians can consider opioid alternatives such as nonsteroidal anti-inflammatory agents. Neuropathic agents, such as gabapentin, require further research in their indications for managing postoperative pain. CPAP is typically held for a period of time after functional rhinoplasty. The decision on when to restart CPAP should be individualized to the patient based on their comorbidities, OSA severity, and surgical maneuvers performed. More research would provide further guidance in this patient population to shape more specific recommendations regarding their perioperative and intraoperative course.

Topics: Humans; Nasal Obstruction; Nose; Pain, Postoperative; Rhinoplasty; Sleep Apnea, Obstructive

This cohort study examines the extent of mismatched opioid prescribing between hospitalization and discharge after otolaryngology–head and neck surgery.

Topics: Analgesics, Opioid; Humans; Nose; Otolaryngology; Pain, Postoperative; Pharynx

Nasal telangiectasias are superficial, small vessels in the ala nasi and nasolabial crease with a varying origin. They represent an unaesthetic condition, frustrating patients who frequently request their removal. Microsclerotherapy, electrosurgery, different types of laser therapy, needle-assisted electrocoagulation, and TRASER therapy have been described for treating this condition.. The aim of this study is to describe a novel technique that removes nasal telengectiasias using voltaic arc dermabrasion (VAD).. Voltaic arc dermabrasion treatment was used to remove nasal telangiectasia in 23 patients. The post-treatment condition was monitored by means of photographic records and the evaluation of erythema, pain score, patient and surgeon satisfaction, and skin temperature. The timing points were 1, 4, 6 days and 1 year after treatment.. Patients referred a moderate pain during the treatment that ceased at the end of the procedure. Moderate erythema and punctiform fine crusting were present in all patients that lasted until the 6th day after treatment. No other adverse effects were observed. After 1-year, the mean patient and surgeon satisfaction scores were 2.90 and 3.00 ± 0.3, respectively. A single treatment was effective in 85% of the patients and no recurrences were recorded for one year. The skin temperature increased about 18.2 ± 3.2°C during the treatment but returned to basal values in about 20 seconds in most of the patients.. Voltaic arc dermabrasion treatment is a viable, easy to use, and inexpensive tool for successful nasal telangiectasia removal, with minimal post-treatment discomfort.

Topics: Dermabrasion; Humans; Nose; Pain, Postoperative; Telangiectasis; Treatment Outcome

Topics: Anesthesia; Dentofacial Deformities; Humans; Intubation, Intratracheal; Nose; Orthognathic Surgical Procedures; Pain, Postoperative; Rhinoplasty

Severe dorsal deviations in crooked noses are treated by either in situ septoplasty with asymmetric spreader grafts (ISS) or extracorporeal subtotal septal reconstruction (ECS). To our knowledge, except one retrospective study, there is no other that compares the objective and subjective results of these two treatment modalities.. The aim of this study was to compare the aesthetic and functional outcomes of ECS and ISS in crooked noses.. This study was carried out on 40 patients (ISS in 20 patients and ECS in 20 patients) who underwent external rhinoplasty surgery due to crooked noses between May 2014 and January 2016. While performing rhinoplasty on the patients, the decision of whether to use the ECS or ISS technique was randomized in a sequential fashion.. Surgical outcomes were assessed and compared using the anthropometric measurement of photographs with Rhinobase software. Subjective assessments of nasal obstruction and aesthetic satisfaction were evaluated with a visual analog scale.. There was a significant difference between rhinion deviation angle, supratip deviation angle (SDA) and tip deviation angle pre- and postoperatively in the ECS group, whereas in the ISS group, except SDA, all other postoperative angles were significantly improved from preoperative values (p = 0.218). The nasal tip projection in the ECS and ISS groups was 29.48, 31.5 preoperatively and 29.78, 31.26 postoperatively. The mean postoperative nasal tip projection value (p > 0.005) did not change significantly compared to the preoperative value in both groups. The mean postoperative value of nasolabial (p = 0.226) angle did not change significantly compared to the mean preoperative one in the ECS group. However, in the ISS group, the mean postoperative value of nasolabial (p = 0.001) angle significantly improved compared to the mean preoperative value. There was significant improvement in both groups, while improvements in both functional and aesthetic outcomes were much higher in the extracorporeal group. None of the patients had postoperative nasal obstruction that required revision surgery. One patient underwent revision rhinoplasty due to an irregularity on the nasal dorsum in the ECS group.. This is the first study that compares subjective and objective aesthetic and functional outcomes of crooked nose surgery according to two common septoplasty techniques in a randomized self-controlled fashion. This study was effective in both objectively and subjectively comparing the functional and aesthetic aspect of the patients submitted to two common different techniques of treatment of nasal deviations in crooked nose patients.. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Topics: Adult; Confidence Intervals; Esthetics; Female; Follow-Up Studies; Humans; Male; Nasal Obstruction; Nasal Septum; Nose; Nose Deformities, Acquired; Odds Ratio; Pain Measurement; Pain, Postoperative; Plastic Surgery Procedures; Prospective Studies; Recovery of Function; Rhinoplasty; Risk Assessment; Tertiary Care Centers; Treatment Outcome; Turkey; Young Adult

This study aimed to assess the long-term outcome of functional endoscopic sinus surgery for Samter's triad patients using an objective visual analogue scale and nasal endoscopy.. Using a retrospective database, 33 Samter's triad patients who underwent functional endoscopic sinus surgery were evaluated pre- and post-operatively between 1987 and 2007 in Hospital of La Chaux-de-Fonds, Switzerland.. A total of 33 patients participated in the study, and the mean follow-up period was 11.6 years (range 1.2-20 years). Patients were divided into two groups based on visual analogue scale scores of the five parameters with the greatest difference in intensity of symptoms between the beginning and end of follow up. Group 1 included patients with a mean visual analogue scale score of 6 and below at the end of follow up and group 2 included patients with a mean visual analogue scale score of more than 6. The only statistically significant difference noted between the two groups was the endonasal findings: stage III-IV polyposis was present in 1 out of 24 patients (4 per cent) in group 1 and in 5 out of 9 patients (56 per cent) in group 2.. The results of our study indicate that functional endoscopic sinus surgery helps stabilise disease progression. Stage III-IV polyposis had a significant adverse effect on long-term outcome.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Asthma; Drug Hypersensitivity; Female; Follow-Up Studies; Forecasting; Humans; Male; Nasal Polyps; Natural Orifice Endoscopic Surgery; Nose; Otorhinolaryngologic Surgical Procedures; Pain Measurement; Pain, Postoperative; Retrospective Studies; Tomography, X-Ray Computed

The aim of this study was to compare the degree of nasal tip rigidity from different techniques for increasing nasal tip projection.. Retrospective records of patients who had undergone rhinoplasty were reviewed at the tertiary referral center. 81 patients who had undergone suturing of the medial crura to the extension graft or to the long septum were selected. In group A, fixation was performed at the same level compared to before surgery. In group B, tip grafting was performed to gain 3 mm or more in projection after fixation as done in group A. In group C, the same tip projection was provided by advancing the medial crura on the caudal septum or extension graft. Patients were evaluated with a visual analog scale, based on the rigidity of the nasal tip (0=very flexible, 10=very rigid).. When the preoperative and postoperative VAS scores of all groups were compared, postoperative scores were significantly higher than the preoperative scores (p<0.001). The postoperative scores of group C were higher than those of the other groups. These differences were statistically significant (p<0.001). There was no statistically significant difference between groups A and B with regard to the postoperative scores (p=0.389). However, in group C, the increase between preoperative and postoperative scores was significantly higher than in the other groups (p<0.001).. Advancing the medial crura on the caudal septum and suturing to gain 3 mm or more of tip projection may result in a more rigid nasal tip. Patients should be informed preoperatively of this potential result.. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Topics: Adolescent; Adult; Cohort Studies; Endoscopy; Esthetics; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasal Cartilages; Nasal Septum; Nasal Surgical Procedures; Nose; Operative Time; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Retrospective Studies; Rhinoplasty; Risk Assessment; Statistics, Nonparametric; Treatment Outcome; Young Adult

The currently recommended strategies for short nose elongation were designed primarily for the Caucasian nasal framework. For Oriental patients, more elongation often is required because a hypoplastic septal cartilage requires more elongation, resulting in a higher risk of complications. This report proposes a modified technique for Oriental nose elongation, which adjusts the pressure points after nasal elongation using an L-shaped implant.. Between January 2007 and December 2009, 58 patients underwent Oriental nose elongation using an L-shaped, porous, high-density polyethylene sheet implant. Augmentation rhinoplasty and conchal cartilage shield grafts were performed depending on the nasal shape. Pre- and postoperative nasal length, height, and projection as well as columella-labial angle, columella-lobular angle, and nasal tip angle were measured and compared. A patient satisfaction survey was performed postoperatively. All occurring complications were recorded.. The postoperative nasal length was significantly elongated from 47.0±10.4 mm to 49.3±10.1 mm (p=0.003), and the nasal height increased significantly from 48.5±9.1 mm to 50.4±8.5 mm (p=0.011). The initially obtuse columella-labial angle improved significantly from 100.8°±12.1° to 92.5°±15.5° (p=0.014). No significant changes were found regarding nasal projection, nasal tip angle, or columella-lobular angle. The majority of the patients (91.3%) were highly satisfied or satisfied with the aesthetic results. A major complication in terms of implant exposure was observed in one case. The minor complications included stiffness of the nasal tip (3 patients) and tip redness (1 patient).. In Oriental nose elongation, the use of an L-shaped graft is a feasible and safe treatment option that allows for an excellent aesthetic outcome and reduces the incidence of complications.. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Topics: Adult; Asian People; Cohort Studies; Combined Modality Therapy; Esthetics; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasal Septum; Nose; Pain Measurement; Pain, Postoperative; Polyethylene; Postoperative Complications; Prostheses and Implants; Prosthesis Implantation; Retrospective Studies; Rhinoplasty; Risk Assessment; Treatment Outcome; Young Adult

The inclusion of maxillary canines is a very common condition. The intraoral approach to the canine extraction can be buccal or palatal depending on the position of the tooth. However, in some cases, the proximity to the nasal floor or the side wall of the nose makes the transoral approach rather invasive. The aim of this article was to describe a novel transnasal endoscopically assisted approach for the extraction of high palatal/paranasal impacted canines. Thirty-seven maxillary canines have been extracted in 29 patients. The surgical approaches were buccal in 5 cases, palatal in 24 cases, and transnasal endoscopically assisted in 8 cases. Patients treated with the transnasal approach required the least amount of pain killers in the postoperative period, and the average of the operative time was shorter than that of the transoral extraction. In our opinion, the transnasal endoscopically assisted approach is a safe and effective procedure for the extraction of highly impacted maxillary canines located within 2 cm from the piriform aperture.

Topics: Acetaminophen; Adolescent; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Cuspid; Endoscopy; Female; Humans; Male; Maxilla; Middle Aged; Nose; Operative Time; Pain, Postoperative; Palate; Tooth Ankylosis; Tooth Extraction; Tooth, Impacted; Young Adult

This study was designed to determine postoperative pain levels after ear, nose, and throat (ENT) surgery, and also to examine whether intraoperative fentanyl use during ENT surgery enhances the quality of postoperative pain control.. The distribution of pain scores and rescue analgesic requirements among 198 patients undergoing ENT surgery were examined. Multivariate logistic regression analysis was performed to identify independent factors associated with moderate to severe postoperative pain (maximal pain score ≥ 5 on the numerical rating scale) and postoperative nausea and vomiting (PONV).. 27.8% of patients experienced moderate to severe postoperative pain after ENT surgery. The distribution of postoperative pain levels was similar among procedures performed on different anatomical regions. Intraoperative fentanyl use was not associated with moderate to severe postoperative pain (adjusted odds ratio (95% confidence interval) :1.03 (0.51-2.13))]. On the other hand, intraoperative fentanyl use was independently associated with PONV [3.10 (1.25-8.92); P = 0.0138].. Prevalence of moderate to severe postoperative pain after ENT surgery was approximately 28%. Intraoperative fentanyl use was not associated with a decreased incidence of moderate to severe postoperative pain, but was significantly associated with PONV.

Topics: Aged; Analgesics, Opioid; Ear; Female; Fentanyl; Humans; Male; Middle Aged; Nose; Pain Measurement; Pain, Postoperative; Pharynx

The management of traumatic epistaxis is an important issue for maxillofacial trauma patients, because of their frequency and severity. We assessed a single use sterile hemostatic gel matrix (surgiflo© [SF], Floseal © [FS]) available for this indication.. Ten patients were managed between 2008 and 2012 by the same surgeon. The following data was documented for each patient: gender, age, mechanism of trauma or type of surgery, characteristics of epistaxis, the various hemostatic techniques used before using SF, and its effectiveness. The primary endpoint was SF effectiveness compared with usual techniques. The secondary endpoint was the evaluation of patient comfort compared to other hemostatic methods, using a visual analogue scale (VAS).. In nine out of ten cases, epistaxis was controlled after endonasal instillation of SF after failure of wicking, or double balloon catheter in first line treatment, or use of SF directly as first line treatment. The mean post procedure VAS was: 7/10 for wicking (eight patients), 9.3/10 for the double balloon catheter (three patients), 3.2/10 for SF (ten patients).. Our study highlights the effectiveness of hemostatic gel matrix in the management of post-traumatic epistaxis compared to usual methods. It also pointed out better patient comfort. A prospective comparative study on a larger cohort of patient would support the legitimacy of SF as first-line treatment for severe posttraumatic epistaxis.

Topics: Adult; Epistaxis; Female; Gelatin Sponge, Absorbable; Gels; Hemostatic Techniques; Hemostatics; Humans; Male; Middle Aged; Nose; Pain, Postoperative; Patient Satisfaction; Severity of Illness Index; Young Adult

Corrective rhinoplasty for functional and aesthetic recovery relies much on the use of grafts. This may be effectively accomplished with alloplastic materials; however, certain circumstances mandate the use of autologous grafts. Septal and auricular cartilages are inadequate for dorsal augmentation of the Asian nose. Here, we present our experiences with the correction of nasal deformities using chondro-osseous rib grafts, aiming at anatomic and functional reconstruction of the nose dorsum, especially the keystone area. The deformity was the result of trauma in 16 patients, postrhinoplastic deformities in 7, and congenital deformities in 5 patients. All the patients underwent reconstructive rhinoplasty using the sixth or seventh rib complex graft. Overall, functional and aesthetic outcome was satisfactory in all patients. Rigid bony union, good nasal projection, and symmetry were obtained. Graft exposure, displacement, warping, and significant bone absorption were not observed. The seventh or sixth rib provided not only the greatest overall available length and thickness, but also less donor-site morbidity. In conclusion, using rib bone and cartilage combination graft as a single unit allowed more predictable and reliable reconstruction of the nose deformity than did the conventional dorsal grafts.

Topics: Adolescent; Adult; Asian People; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Nose; Pain, Postoperative; Rhinoplasty; Ribs; Tomography, X-Ray Computed; Transplantation, Autologous

The aim of this study was to evaluate the patient's experience of transnasal flexible laryngo-oesophagoscopy under local anaesthetic in an out-patient setting. This was a clinical observational study using a patient questionnaire and visual analogue score. Subjects were 50 patients seen in the hospital's ENT outpatient clinic between March and August 2004 in whom transnasal flexible laryngo-oesophagoscopy was performed and who completed pain discomfort questionnaires. Any patient undergoing transnasal flexible laryngo-oesophagoscopy, for either diagnostic or therapeutic purposes, was included in the study. Patients in whom transnasal flexible laryngo-oesophagoscopy was not necessary as part of their investigation or treatment were excluded. Patients completed a questionnaire, providing a simple visual analogue score for discomfort during the procedure. Any operative complications were noted by the surgeon. All patients completed transnasal flexible laryngo-oesophagoscopy, and the upper aerodigestive tract was clearly visualized. The procedure is well tolerated, with mean score of <1 out of 10 for all forms of discomfort. There was a complication rate of 2 per cent (one patient with epistaxis); no other complications occurred. Transnasal flexible laryngo-oesophagoscopy is a new diagnostic and therapeutic technique which is well tolerated by patients. It compares favourably with other flexible endoscopic techniques. This report documents for the first time a detailed description of patients' experience of this technique.

Topics: Chest Pain; Esophagoscopy; Humans; Laryngoscopy; Larynx; Nose; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Postoperative Complications; Stomach; Surveys and Questionnaires

Otorhinolaryngological surgical procedures are nowadays frequently performed as day-cases. This makes it possible to shorten the length of hospitalisation however the surgeon's responsibility connected with the treatment of peri-operative pain is greater. The experience of pain that follows some operations performed on the pharynx is most intense. The decision to discharge the patient depends mainly on his ability to control the pain using oral medication. The purpose of this study was to examine the experiences of postoperative pain in 102 patients operated for ENT (ear, nose, and throat) problems. The numerical 0 to 10 and 6-grade verbal scales were used to assess pain intensity. Character and localisation of pain were also analysed. The patients were followed-up until the end of their complaints. The scores below 5 points were noted by more than 90% of the patients after the first 24 hours and even more individuals on the second postoperative day. The pain reacted relatively well to oral painkillers and did not require prolonged hospitalisation. The pain after the majority of ENT day-case procedures is mild (scores 1 or 2 in the verbal scale). Many properly treated participants of the study did not complain of pain at all. Tonsillectomies were accompanied by most intense pain.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Analgesics, Non-Narcotic; Analgesics, Opioid; Ear; Female; Humans; Larynx; Male; Middle Aged; Nose; Otorhinolaryngologic Diseases; Otorhinolaryngologic Surgical Procedures; Pain Measurement; Pain, Postoperative; Patient Discharge

Seventy-six patients with oroantral communications after tooth extraction and chronic maxillary sinusitis were treated as follows: bacterial cultures were taken in all of them and maxillary sinuses were irrigated with an antibiotic from the cephalosporin group. Then, in 36 patients, drainage using the Caldwell Luc procedure was performed, including a naso-antral window. In all patients operations were completed by closing oroantral communications with flaps of the mucosa of the alveolar process close to the fistula. Antibiotics according to antibiogram were administered to all patients at least 10 days after surgery. Retrospective comparison between the results obtained in the first group and those in the second group 1, 3 and 6 months after operation was based on objective findings (condition of the oroantral communication, maxillary sinusitis), side effects (pain, numbness of the operated area, headache) and control radiographs (clear maxillary sinus or with mucosal thickening). The study suggests that transnasal drainage is not required in maxillary sinus surgery and in the closure of oroantral communications. Equally good results are achieved by treating with antibiotics and without drainage of the maxillary sinus into the nose.

Topics: Cephalosporins; Chronic Disease; Drainage; Follow-Up Studies; Headache; Humans; Maxillary Sinus; Maxillary Sinusitis; Mouth Mucosa; Nose; Oroantral Fistula; Pain, Postoperative; Radiography; Recurrence; Retrospective Studies; Sensation Disorders; Staphylococcal Infections; Streptococcal Infections; Surgical Flaps; Therapeutic Irrigation; Tooth Extraction

Topics: Analgesia; Humans; Medical Audit; Nose; Pain, Postoperative

We present the surgical management of 51 patients with a primary diagnosis of snoring. Patients with sleep apnoea syndrome were eliminated from the study. Four procedures were used: the classical uvulopalatopharyngoplasty, a limited uvulopalatoplasty, laser palatoplasty with tonsillectomy; and laser palatoplasty alone. Fifty-one of the 67 patients (76.1%) responded to a telephone questionnaire with a mean follow-up period of 18.2 months, 78.4% of patients reported improved or absent snoring. There was almost equal patient satisfaction between the conventional technique and the laser technique. The improvement in snoring was not influenced by the type of operation performed.

Topics: Adult; Aged; Alcohol Drinking; Body Mass Index; Female; Follow-Up Studies; Humans; Laser Therapy; Male; Middle Aged; Nose; Pain, Postoperative; Palate, Soft; Patient Satisfaction; Pharynx; Smoking; Snoring; Surveys and Questionnaires; Telephone; Tonsillectomy; Treatment Outcome; Uvula

Topics: Ear; Humans; Nasal Surgical Procedures; Nose; Otolaryngology; Otologic Surgical Procedures; Pain Management; Pain, Postoperative; Tonsillectomy