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Background: Indian noses are broader and lack projection as compared to other populations, hence very often need augmentation, that too by large volume. Costal cartilage remains the material of choice in large volume augmentations and repair of complex primary and secondary nasal deformities. One major disadvantage of costal cartilage grafts (CCG) which offsets all other advantages is the tendency to warp and become distorted over a period of time. We propose a simple technique to overcome this menace of warping. Materials and Methods: We present the data of 51 patients of rhinoplasty done using CCG with counterbalancing technique over a period of 4 years. Results: No evidence of warping was found in any patient up to a maximum follow-up period of 4 years. Conclusion: Counterbalancing is a useful technique to overcome the problem of warping. It gives liberty to utilize even unbalanced cartilage safely to provide desired shape and use the cartilage without any wastage. [ABSTRACT FROM AUTHOR]

Introduction. In trauma, injuries to face, head and neck are relatively frequents; the nose is the most prominent part of the face and has little protection and support. It is romper easier facial bone and not uncommon to be most frequent in present fracture by some traumatism, however jaw fractures are the second pathology more frequent in connection with facial trauma, and the main cancellations of attention by the maxillofacial surgeon. Objective. To know the frequency of patients diagnosed with fracture or fractures of mandible, in the service of surgery Maxillofacial of the Central Military Hospital, in the period from January 2009 to November 20, 2012. Material and methods. This study was developed in the maxillofacial surgery outpatient facilities and file clinician of the military Central Hospital. Records of patients who presented as main diagnostic fracture of mandible, served by service surgery Maxillofacial of the Central Military Hospital in the period from January 2009 to November 20, 2012 were reviewed. Results. Based on data obtained from the electronic clinical record available to the Central Military Hospital, reviewed the records of 90 patients who were diagnosed with fracture of mandible with key international S02.6, same treaties with different behavior that treating, depended on the characteristics of the fracture and the service experience of which 55 (61.1%) were assessed and treated by maxillofacial surgery service. [ABSTRACT FROM AUTHOR]

Aim Ear, nose and throat ( ENT) foreign body ( FB) injuries represent an emerging problem in the paediatric population because of their human and social costs. The aim of the study is the site-specific evaluation of FB injuries in the paediatric population referred to the emergency department of the Pediatric Hospital of Turin. Methods This retrospective analysis was carried out sifting medical reports between 2002 and 2011. We collected information about 338 patients' FB characteristics, complications and hospitalisation. Results The mean age was 4.2 ± 2.9 years. Nose and ear are the most involved anatomical sites, followed by pharynx, oesophagus and trachea-bronchi. The most common FBs are balls, beads and toys parts (29.6%), followed by fishbones (13.6%). A lower mean age is observed in tracheo-bronchial and oesophageal FBs. The 9.2% of cases reported complications. Conclusions A quick and proper diagnosis followed by an effective treatment of FB injuries and their complication is mandatory. Surveillance registries have a key role in prevention and management of FB injuries; useful information can be obtained also for nurse and ENT specialist training in order to create professionals ready to recognise and manage FB injuries in the most effective way. [ABSTRACT FROM AUTHOR]

Aim: Nasal bone is the most common broken bone of the face. Incorrect assessments of nasal trauma are frequently encountered in forensic evaluations. Here, we aimed to determine the reasons and frequency of erroneous assessments of nasal trauma in emergency department (ED). Methods: This is a cross-sectional multicentric study analyzing the Forensic Medical Department archive retrospectively. Epidemiologic features, type of fracture (depressed or non-depressed), and specialty of the doctor examining the cases in ED were studied. Forensic evaluation was reported by analyzing all radiologic examinations (CT and X-ray), medical records, and after repeated physical examination of nasal trauma by the forensic council, consisting of a forensic expert, a radiologist and an otolaryngologist. Nasal fracture was diagnosed when at least two of three physicians agreed. Results: A total of 535 cases (mean age 31.7 ± 14.4, 87.1 % males) were analyzed. The most common causes of injuries were assault (81.8 %), followed by traffic accident (15.3 %) and falls from a height (2.1 %). There were misdiagnoses in ten patients (1.9 %) and overdiagnosis in 135 (24.5 %). The possibility of fracture overdiagnosis was 13.5 times higher than missing it. General practitioners and emergency physicians have 19.7 times (95 % CI 5.5-22. 3) and 3.4 times (95 % CI 1.5-7.8) the tendency to report soft tissue nasal injuries as non-depressed fractures, respectively. Conclusion: We found that nasal fractures are rarely missed while the overdiagnosis was very common. Examination of patients by a general practitioner or an emergency physician without consultation with a specialist and using only plain radiographs were found to be independent parameters affecting overdiagnosis. [ABSTRACT FROM AUTHOR]

A single-stage technique for reconstruction of the medial nasal ala with a nasolabial flap and an inferiorly based remnant alar flap is presented in this article. The technique has been used in four cases. All the flaps healed uneventfully with aesthetically pleasing results using the one-stage technique. The subcutaneous nasolabial island flap and alar remnant flap have become the method of choice in the author's clinic for partial medial nasal ala reconstruction. It allows one-stage reconstruction with very similar tissue and a concealed scar in the natural groove. The remnant ala as an inferiorly based flap has been used by the author to cover the subcutaneous pedicle of the nasolabial flap to provide better shape to the alar base without its lateral drift during healing. Level of Evidence: Level V, therapeutic study. [ABSTRACT FROM AUTHOR]

BACKGROUND: Continuous positive airway pressure (CPAP) with nasal devices (nCPAP) is widely used in the respiratory management of newborns. The present study aimed to compare the incidence of nasal trauma secondary to nasal continuous positive airway pressure (nCPAP) protected with or without hydrocolloid dressing in preterm infants. METHODS: This prospective controlled study was performed in the neonatal intensive care unit (NICU) of the Children's Hospital of Hunan Province from March 1, 2010 to June 31, 2010. A total of 65 infants, 46 males and 19 females, were recruited in this study. Their average gestational age was 32.6 weeks (range 28-37 weeks). The infants were randomly divided into clinical trial group (group A, n=33) and control group (group B, n=32). Paraffin oil was smeared around the nostrils before inserting prongs in group B; the infants in group A were covered on the infant's nostrils surface with hydrocolloid dressing (hydrocolloid dressing, 1.8 mm thick, 90029T, 3M Company, Minnesota, USA) with a size of 2-3 cm cutting two holes adapted to the nose and nostrils. The nostrils of those infants were inspected daily during nCPAP support until they were weaned off nCPAP. RESULTS: Nine infants (2 in group A and 7 in group B) developed nasal injury during nCPAP support. The Chi-square test revealed that there was a statistically significant difference (P=0.01) in the incidence of nasal injury between groups A and B. CONCLUSION: The study demonstrated that hydrocolloid dressing significantly decreased the incidence and the severity of nasal injury. [ABSTRACT FROM AUTHOR]

Abstract: Background: Severe craniofacial injury may cause intractable oronasal bleeding, a rare but life-threatening surgical emergency that may occur in the Emergency Department (ED). Uncontrolled massive bleeding is the major cause of mortality. This kind of trauma is usually associated with the transfer of high kinetic energy such as a motor vehicle collision. Objective: We report an unusual case of intractable oronasal bleeding diagnosed by angiography. Case Report: A 43-year-old man was brought to the ED after being in a high-energy motor vehicle collision. He had suffered severe craniofacial trauma, including intracranial hemorrhage and intractable oronasal bleeding; he later developed a large pseudoaneurysm arising from the right internal maxillary artery. In the ED, the patient successfully underwent endovascular treatment (EVT) using angiography with transarterial embolization (TAE) therapy to control the bleeding. Conclusion: EVT by TAE for intractable oronasal bleeding was an effective treatment in this life-threatening situation. [Copyright &y& Elsevier]

Graft selection remains the greatest challenge for surgeons performing rhinoplasty. The preferred choice thus far for nasal reconstruction would be autograft compared to allograft due to its lower rate of infection and extrusion as it does not induce an immune response. We have evaluated 26 patients who underwent open structured rhinoplasty at our center and compared our experience regarding the operative technique, graft availability, indications, and limitations. The racial distribution was 18 Indians, 5 Chinese, and 3 Malays with a mean age, hospitalization, and followup of 30.5 years, 16.9 months, and 4.4 days, respectively. Majority of the patients (57.6%) presented with twisted nose and 30.7% of the patients presented with history of nasal trauma. All the patients had deviated septum of varying severity. The most common graft used was quadrangular cartilage graft and the common complications noted were ala deformity and tip anaesthesia in 7.6% patients respectively. [ABSTRACT FROM AUTHOR]

Copyright of Children's Nurses: Italian Journal of Pediatric Nursing Science / Infermieri dei Bambini: Giornale Italiano di Scienze Infermieristiche Pediatriche is the property of Societa Italiana di Scienze Infermieristiche Pediatriche and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Facial trauma commonly includes injury to the nose and perinasal area. In this review, we will focus on the sequelae of severe nasal trauma and provide examples of correction of the severely deviated nose, the severely collapsed nose, and revision of a traumatic deformity after prior rhinoplasty. We will then discuss coexistent deformities of perinasal regions in addition to functional and posttraumatic nasal correction, including posttraumatic periorbital deformities. [ABSTRACT FROM AUTHOR]

The nose contributes greatly to the facial aesthetic. Derangements in nasal cosmesis, whether from surgery, trauma, or natural causes, have a plethora of implications for the emotional well-being of the individual. Rhinoplasty and revision rhinoplasty are both facial cosmetic operations that have potentially profound cosmetic, and therefore psychological, implications for the patient. Althoughmany revision rhinoplasty patients have hopeful yet realistic surgical expectations, there is a subset of revision rhinoplasty patients having underlying psychological disturbances that may negatively affect the surgical outcome, no matter how favorable the surgical improvement. In this article, the various psychological disorders impacting revision rhinoplasty patients will be dis- cussed. In addition, this article will familiarize the revision rhinoplasty surgeon with many of the hallmark characteristics of psychopathology, as well as the typical emotional presentation of the well-adjusted revision rhinoplasty patient, to facilitate differentiation between these seemingly similar, but distinctly different patient groups. [ABSTRACT FROM AUTHOR]

Injuries to the nose and perinasal region are common. Although the nasal fractures are commonly recognized and properly addressed, injuries to adjacent structures such as the orbit,medial canthus, andmidface skeleton can bemissed ormisdiagnosed, leading to improper primary treatment and subsequent secondary deformities. In this discussion, three common injuries will be discussed, including nasomaxillary fractures, limited naso-orbital-ethmoid fractures, and severe central facial injuries with naso-orbital-ethmoid fractures. For instructional purposes, a case example of inadequate primary diagnosis and subsequent delayed or secondarymanagement will be followed by a case example of proper initial diagnosis and proper primary management. [ABSTRACT FROM AUTHOR]

PURPOSE: To explore the method and effect of degloving approach in the treatment of nasal-orbital-ethmoid (NOE) complex fracture surgery. METHODS: Eleven eases of unilateral nasal-orbital-ethmoid fracture (NOE) were selected from Medical Center of Stomatology, Foshan Hospital of Traditional Chinese Medicine. 6 were orbital fracture, 5 were nasal fracture. All the patients were treated open reduction and rigid internal fixation or rhinoplasty via midfacial degloving approach. RESULTS: Eleven patients were followed up for 3 to 12 months, all patients had transient nasal crusting and bleeding, 1 case had traumatic epiphora, 4 eases had infraorbital temporary numbness, 1 ease of crooked nose. CONCLUSIONS: The degloving approach can achieve the advantages of a widely exposed field for operation, no facial sear, and no complications such as nasal vestibular stenosis. It is worthy of wide clinical application. [ABSTRACT FROM AUTHOR]

Background Nasal pyramid fractures accompanied by saddle nose deformities are not easily corrected by closed reduction. We used an absorbable plate as a perpendicular strut to support the collapsed "keystone area" and obtained good results. Methods Between September 2008 and June 2011, 18 patients who had nasal pyramid fractures with saddle nose deformities underwent surgery. Pre- and postoperative facial computed tomographic images and photographs were taken to estimate outcomes. The operative technique included the mucoperichondrial dissection of the nasal septum, insertion of an absorbable plate prepared to an appropriate length to support the "keystone area", and fixation of the absorbable plate strut to the cartilaginous septum. Results Functional and esthetic outcomes were satisfactory in all patients. Eleven patients assessed the postoperative appearance of the external nose as 'markedly improved' and 7 patients as 'improved'. The 5 surgeons scored the results as a mean of 4.5 on a 5-point scale. Conclusions The use of an absorbable plate as a perpendicular strut requires no additional procedures because the plate is gradually absorbed. The mechanical strength provided by a buttress between the "keystone area" and the maxillary crest lasts for a long time before the strut is absorbed. [ABSTRACT FROM AUTHOR]

Background: This study was designed to evaluate the extent of restenosis that occurs after an endoscopic frontal sinus drainage Draf type III (Draf III; modified Lothrop procedure) using a modified technique with reconstruction of the frontal sinus drainage pathway with mucosal transplants, in combination with occlusive postoperative care. Methods: Retrospective case series was performed with 24 consecutive patients undergoing Draf III drainage between 2005 and 2010 using the modified technique of covering the bare bone with mucosal transplants from the nasal septum. To ensure optimal moist wound healing, occlusion of the nose was realized by taping the nose for 2 weeks postoperatively. Frontal ostium measurements were done intraoperatively and at follow-up visits for a minimum of 12 months. Data on patient history, demographics, comorbidities, and computed tomography scans were collected. Results: Mean follow-up was 25.6 months. Eight patients were lost to follow-up. Ninety-four percent of frontal sinus neo-ostia remained open. One patient needed revision surgery using an osteoplastic flap with obliteration. The frontal neo-ostium narrowed by an average of 36.9% from 20.5 × 12.5 to 15 × 9.6 mm. On average, three visits were needed for postoperative care. The patients did not experience significant pain throughout the postoperative healing time. Conclusion: The modified Lothrop procedure is a well-established technique in endoscopic sinus surgery to handle difficult frontal sinus drainage pathways or revision surgeries. The modified technique provides good results in combination with minimized postoperative care and morbidity. A comparative study would be necessary to show superiority to the standard method of Draf III. [ABSTRACT FROM AUTHOR]

Although serious trauma injuries are uncommon in the pediatric population, nasal injuries are a more common problem. In this population, many physicians are uncomfortable managing these injuries. The evaluation and treatment of nasal trauma differ considerably in children compared with adult nasal fractures. Poor patient cooperation during the physical exam coupled with significant anatomic differences can present the nasal surgeon with a difficult diagnostic dilemma. The surgical management of pediatric nasoseptal injuries is not without controversy, as disturbing the nasal growth centers can have significant effect on future nasal and midfacial development. This article reviews the diagnostic and therapeutic challenges presented by these injuries for children and provides recommendations to successfully manage nasal injuries in this population. [ABSTRACT FROM AUTHOR]

Nasal septal perforation is a common complication of many nasal diseases such as congenital, infectious, trauma, and iatrogenic, and rarely may occur as a complication of systemic diseases, etc. The symptoms of uncorrected nasal septal perforations include crusting, epistaxis, difficulty in breathing, nasal twang in speech, postnasal discharge, foul-smelling, rhinorrhea, and hyposmia. Large nasal defects cannot be closed by hard acrylic resin nasal septal obturators because of the problems in access and path of insertion. However, obturation can be achieved by fabrication of a nasal stent that engages one of the nasal cavities. This clinical report describes prosthetic management of a patient with large nasal septal defect following septal surgery complication with an intranasal heat-processed acrylic resin stent. The stent is rendered patent for comfortable breathing, improves speech, is esthetically acceptable, dense and hygienic. These nasal stents indirectly separate the two nasal cavities with effective obturation of large nasal septal defects. [ABSTRACT FROM AUTHOR]

Nasal injuries are among the most common sports injuries. We conducted a prospective, observational study of 91 patients, aged 7 to 60 years (mean: 18.3), who had sustained a nasal injury while engaging in a sport, exercise, or other recreational physical activity. We found that a substantial proportion of these injuries occurred in females (29.7% of cases). A high percentage of injuries (86.8%) occurred in those who had been participating in a noncontact sport; the sport most often implicated was basketball (26.4%). Also, injuries were more common during organized competition as opposed to recreational play (59.3 vs. 40.7%). Of the 91 nasal injuries, 59 (64.8%) were fractures, most of which were treated with a closed reduction. Almost all of the patients in this study (92.3%) were able to return to their sport. We conclude that most sports-related nasal fractures are not preventable. [ABSTRACT FROM AUTHOR]

The nose is the most prominent feature of the face and as such is the most likely to be traumatized. Fractured nose is a common condition with awareness and interest of it dates back to time of ancient Egypt (3000 BC). Although these injuries often do not seem to be severe, undertreatment of nasal trauma could lead to significant functional and esthetic problems. The aim of this study is to describe the demographic characteristics of the fractured nose in Basrah governorate and to improve our experience in the management of fractured nose. Materials and methods: A prospectively collected data of individuals attending AL- Basrah General Hospital in AL- Basrah city/Iraq during the period from the 1st of July 1997 to the 30th of June 1998. Data matching the diagnosis fractured nose were analyzed. Results: The highest incidence was personal accidents 85 (51.2%) as a cause of nasal trauma in our patients. And frontal direction found in more than half of the cases (n= 85). 61.45%(n =102) of patients was class 1 fractured nose. 92.07% of X-rayed patients showed positive correlation with the clinical diagnosis of nasal bone fracture. Out of 166 patients, 52 (31.3%) patients, closed reduction was done for them, three quarter of cases with class 1 showed good result, while 7 (87.5%) patients with class 2 showed poor results after closed reduction (P value= 0.000) . The percentage of good results decrease from 100% if the reduction within 6 hours to 43% if the reduction was done after 14 days from the time of the injury (P value< 0.001). 80% of patients who did for them reduction under LA showed good results, while 61.7% showed good results when the reduction was done under GA Conclusions: although fractured nose is a common problem, the overall result of its closed reduction remain unsatisfactory. However, the study showed a statistically significant in the results of closed reduction regarding the time and the class of fractured nose. [ABSTRACT FROM AUTHOR]

Purpose. In breast cancer patients, Mailliez and others described that 5 of 70 patients (7%) developed a bevacizumab-induced nasal septal perforation. However, to date, no studies have reported such rates in colorectal cancer patients, who derive a survival advantage with this drug. Methods. This study examined the incidence of bevacizumab-induced, clinically symptomatic, otolaryngology specialist-confirmed nasal septal perforation among 100 patients who had been consecutively-treated for metastatic colorectal cancer. Results. The incidence of nasal septal perforation was 1% (95% confidence intervals: −−0.95% to 2.95%). This single adverse event was successfully managed conservatively. Within the whole group, 94 had been treated with bevacizumab at 5 mg/kg every two weeks, except for four patients treated at higher doses. The median number of bevacizumab doses (range) was seven (1--96). Concomitant chemotherapy had been prescribed to all patients, consisting of oxaliplatin, 5-fluorouracil, leucovorin, as per one of the FOLFOX regimens (44 patients); irinotecan, 5-fluorouracil, leucovorin, as per the FOLFIRI regimen (13 patients); both these regimens and no other (five patients); or a different regimen (38 patients). Conclusion. Nasal septal perforation from bevacizumab occurs infrequently among colorectal cancer patients. [ABSTRACT FROM AUTHOR]

A new protocol for making an immediate provisional eyeglasses-supported nasal prosthesis is presented that uses laser scanning, computer-aided design/computer-aided manufacturing procedures, and rapid prototyping techniques, reducing time and costs while increasing the quality of the final product. With this protocol, the eyeglasses were digitized, and the relative position of the nasal prosthesis was planned and evaluated in a virtual environment without any try-in appointment. This innovative method saves time, reduces costs, and restores the patient's aesthetic appearance after a disfiguration caused by ablation of the nasal pyramid better than conventional restoration methods. Moreover, the digital model of the designed nasal epithesis can be used to develop a definitive prosthesis anchored to osseointegrated craniofacial implants. [ABSTRACT FROM AUTHOR]

Nasal fractures are the most common facial fractures and displaced fractures may cause considerable cosmetic concern. Traditionally, displaced nasal fractures have been manipulated under general anaesthesia (GA) performed within 2 weeks of the injury. Despite evidence for the benefit of local anaesthesia (LA), nasal fractures are still most commonly reduced under GA. We have presented a method of reduction of simple nasal fractures under LA in an outpatient setting. This has the advantage of being painless, simple to attempt and cost-effective. If reduction is inadequate then a general anaesthetic reduction is still possible. A recent comprehensive systematic review of all the available evidence did not show any significant difference (in terms of cosmesis, pain or nasal obstruction) between using LA and GA methods and highlighted the evidence base to support LA. We describe our method of assessment and treatment of displaced nasal fractures and provide an online tutorial ( ). It is important to keep in mind that any concerns should be referred to an otolaryngology specialist for further management and that practitioners attempting this technique should first receive training from an otolaryngologist. [ABSTRACT FROM AUTHOR]

Copyright of Revue de Stomatologie & de Chirurgie Maxillo-Faciale is the property of Masson SPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To identify the patterns and optimum management of nasal trauma during close combat training in military training institutions. Study Design: Descriptive study. Place and Duration of Study: The study was conducted in ENT department, Combined Military Hospital Abbottabad from August 2007 to July 2010. Material and Methods: All patients who reported with nasal trauma during the training were included in the study. A total of 200 cases were studied. They were all males and their ages were between 16 to 24 years. Results: The most common presentation of nasal trauma was epistaxis (92.5 %) while 7.5 % of cases were having no nasal bleed. Nineteen percent cases had external deviation of nasal axis while only 17% revealed inferior turbinate injury after initial treatment. Septal hematoma was present in 15% and was drained immediately in all cases. Nasal bone fracture was present in 36.5%. Anterior nasal packing was sufficient to stop nasal bleed in 80% cases of episatxis while 20% cases of nasal bleed required post nasal packing. Conclusion: The close combat techniques in army training institutions have increased the risk of nasal trauma and many different patterns of this trauma have been identified. Addressing the epistaxis, septal heamatoma and fracture nasal bone reduces the chances of complications. [ABSTRACT FROM AUTHOR]

The article presents a study of tissue conserving technique for reconstruction of nasal lining defects. The technique uses split-thickness skin grafts (STSG) from a second site to repair the nasal mucosal lining, and the area was anesthesized using buffered lidocaine with epinephrine. The surgery also involves graft sutured into place to recreate the nasal lining, with the dermal side facing up and epidermal side facing down toward nasal cavity.

AbstractObjectives:This study aimed to compare an experienced ENT treatment room nurse's ability to assess nasal injuries with that of junior doctors.Design:One hundred consecutive patients with nasal injuries were assessed prospectively in two phases, followed by a telephone survey.Main outcome measures:Comparison of nasal injury assessment, advice, and outcomes regarding cosmesis, airway obstruction and patient satisfaction.Results:In the first phase, there was almost perfect agreement between doctor and nurse assessments regarding the management of nasal fractures (p?

Nasal injuries are commonly assessed in the accident and emergency (A&E) departments. Where swelling precludes assessment of deformity, patients are often referred to the ear, nose and throat (ENT) outpatients once the swelling has subsided. However, not all of these pateints require referral. Patients with no deformity, or those in whom there is no deformity after any swelling has subsided, do not need further assessment. The purpose of this audit was to assess the impact of a nasal injury management guideline on nasal injury referrals to the ENT department. An audit was made of nasal injury referrals seen in ENT outpatients, before and after the introduction of a guideline. The proportion of patients seen in ENT outpatients not requiring any ENT treatment after the introduction of the guideline was reduced. We suggest that our guideline can reduce unnecessary ENT outpatient appointments for patients with nasal injuries and may prevent delayed ENT input for those with new onset nasal deformity. [ABSTRACT FROM AUTHOR]

During delivery the delicate structures of the face are predominantly exposed to external force effects and hence deformities on the nose can emerge as a birth-related trauma in newborns. As self-straightening of the nasal septum commonly occurs, a conservative therapy is recommended for most cases. We report on a case where a birth-related trauma of the nose leaded to acute breathing problems in a newborn with insufficient oxygenation. An overview about the available literature is given. A cautious reposition of the nose proved to be an appropriate management for short- and long-term development. [ABSTRACT FROM AUTHOR]

AbstractObjective:To determine the most effective local anaesthetic method for manipulation of nasal fractures, and to compare the efficacy of local anaesthesia with that of general anaesthesia.Method:Systematic review and meta-analysis.Databases:Medline, Embase, Cochrane Library, National Research Register and metaRegister of Controlled Trials.Included studies:We included randomised, controlled trials comparing general anaesthesia with local anaesthesia or comparing different local anaesthetic techniques. Non-randomised studies were also systematically reviewed and appraised. No language restrictions were applied.Results:Five randomised, controlled trials were included, three comparing general anaesthesia versus local anaesthesia and two comparing different local anaesthetic methods. No significant differences were found between local anaesthesia and general anaesthesia as regards pain, cosmesis or nasal patency. The least painful local anaesthetic method was topical tetracaine gel applied to the nasal dorsum together with topical intranasal cocaine solution. Minimal adverse events were reported with local anaesthesia.Conclusions:Local anaesthesia appears to be a safe and effective alternative to general anaesthesia for pain relief during nasal fracture manipulation, with no evidence of inferior outcomes. The least uncomfortable local anaesthetic method included topical tetracaine gel. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether or not patients receiving rhinoplasties following nasal trauma sought intervention for a functional or cosmetic reason and look at underlying psychosocial influences. Methods: A cross-sectional questionnaire study was performed in the setting of otorhinolaryngology outpatient clinics in the Cambridge University Hospitals. New patients referred to the clinic with nasal deformities secondary to recent trauma were included. To provide a control group, new patients attending for nonrhinological reasons were also asked to complete 2 questionnaires (a study specific one and the SF36). The age range of patients was 21 to 66 years in the control group and 17 to 67 years in the rhinoplasty group. Results: Patients attending for rhinoplasty were more likely to be male (79% vs 37%, P = .008) and have had previous nasal trauma (relative risk = 2.14, P = .0086) They neither had significantly higher scores for the SF36 or higher alcohol consumption nor were more likely to participate in contact sports than the control group nor did they differ significantly in terms of social class. Conclusion: This study did not find evidence that posttrauma rhinoplasty patients are anymore introspective and depressed than the normal control population and that function was the predominant concern over cosmesis. [ABSTRACT FROM AUTHOR]

Objective: Nasoseptal injuries have traditionally been treated via closed reduction. Historically, the high incidence of postreduction deformities has led some surgeons to consider alternative approaches to obtain superior results. Here we compare simple closed reduction versus primary open repair of the nasoseptal fracture. Study Design: This was a prospective study of 40 consecutive patients treated with simple closed reduction of their combined nasal bone and septal fracture versus 40 patients treated with closed reduction of their nasal bone fracture and open treatment of the septum. Group outcomes were then compared. Results: In the closed reduction group, 60% had significant postoperative septal deviation, whereas only 12.5% suffered from residual septal deformity in the open group. This resulted in a statistically significant reduction (p < .01) of patients requiring a second operation to formally address the septum. Conclusion: By addressing the septum through an open approach, a statistically significant reduction in the number of patients requiring revision rhinoplasty was achieved. [ABSTRACT FROM AUTHOR]

Summary: Nasal fractures are the most common facial fractures. The majority of nasal fractures have been discussed as minor injuries and managed by closed reduction and intranasal packing. However, in cases of a nasal fracture with open laceration on fracture site, the plates fixation may be accomplished with definite reduction through the open laceration. But, metallic reconstruction plates can sometimes produce palpable irregularity at the site of fixation in nasal bone fractures. We performed rigid fixation through open laceration wound with bioabsorbable plate and screws under local anesthesia. Satisfactory result was obtained in both functional and aesthetic aspect. Open reduction through external laceration and bioabsorbable fixation under local anesthesia is a reliable and useful method for the treatment of extensive and comminuted nasal fractures. [Copyright &y& Elsevier]

The article discusses the reconstruction of the defects in the tip of the nose using the dorsal nasal flap. Dorsal nasal flap utilizes nasal skin with defects of the distal third of the nose having a distance of 5 millimeter away from the alar rim. It involves rotation advancement of dorsal nasal skin from the upper two-thirds of the nose and glabella to the lower nose.

The article presents a case study of 35-year-old male intensivist with a painful swollen red area in the contact point of an NP95 face mask and the nose during the coronavirus disease 2019 (COVID-19) outbreak in Italy. It states that nasal pressure injuries (NPI) result from intense and prolonged pressure on soft tissue, and that applying silicone or hydrogen foam cover or placing padded bandage between mask and skin may be useful. Also noted are regular skin checks every 3-4 hours.

• There are various effective treatment options for refractory posterior epistaxis including endoscopic diathermy or endoscopic artery ligation.• If these treatment options are not immediately available, posterior nasal packing with Foley catheter is an effective and rapid non-surgical treatment alternative.• A systematic approach is presented. The principles and mechanisms of action of the posterior nasal packing are explained.• Nevertheless, there are morbidities involved and posterior packing can be painful and uncomfortable for the patient.• Marking and modifying the catheter will help one inflate the balloon in the correct place and avoid the problem of nasal alar pressure necrosis. [ABSTRACT FROM AUTHOR]

Objective: To compare three different systems of continuous positive airway pressure (CPAP): the naso-pharyngeal tube and two-prong systems in newborns, focusing on duration of CPAP, side effects and cost.Design: Randomized clinical study.Patients: Between July 2000 and September 2001 newborns were randomized to three different CPAP systems. Forty infants in two weight groups (>2500 g and 1250-2500 g; 20 patients in each group) were included.Results: In the group >2500 g the median duration of CPAP was 1.1 days (range 0.25-14.3 days). The median time on a naso-pharyngeal CPAP was 1 day (range 0.25-14.3 days), on Hudson prongs 1.6 days (range 0.5-3.3 days) and on the Infant Flow system 0.7 days (range 0.3-13.6 days; p>0.05 for comparison between groups, Fisher's exact test). With naso-pharyngeal CPAP, 2 patients developed moderate nasal injuries. On Hudson, 2 patients developed moderate and three mild nasal injuries. One patient on the Infant Flow showed mild and one moderate nasal injuries. In the weight group 1250-2500 g the median duration of CPAP was 1.1 days (range 0.1-7.0 days). The median time on the naso-pharyngeal tube was 0.9 days (range 0.1-7 days), on Hudson prongs 1.1 days (range 0.7-6.6 days) and on the Infant Flow system 1.3 days (range 0.25-5.9 days; p>0.05 for comparison between groups, Fisher's exact test). With a naso-pharyngeal tube, one infant developed mild and one moderate nasal injuries. On Hudson prongs, two had moderate nasal injuries. On Infant Flow, one newborn showed a severe nasal injury and two mild injuries. None of the patients developed a pneumothorax.Conclusion: The naso-pharyngeal tube is an easy, safe and economical CPAP system usable with every common ventilator. For very low birth weight newborns, a prong system may have advantages. [ABSTRACT FROM AUTHOR]

Background. The reconstruction of full-thickness alar wounds often requires multiple challenging surgical procedures. These procedures, although often functionally and aesthetically successful, are often staged, and they therefore introduce operative risks, significant investments of surgeon and patient time, and extraordinary costs. Objective. A turnover nasolabial flap can offer a one-step repair of difficult full-thickness alar wounds. A thorough explanation of the flap's design and execution is presented. An understanding of these factors is required to achieve predictably reliable operative results. Methods. A case report and review are given. Results. The turnover nasolabial flap can produce aesthetic and functional results that rival the most sophisticated pedicled flap reconstructions of the lateral ala. Conclusion. In distinction to the multiple operative procedures required to replace the missing tissues of the complicated ala, this turnover flap offers a one-step elegant repair of the nose. The flap belongs in the repertoire of any dermatologic surgeon interested in facial reconstruction. [ABSTRACT FROM AUTHOR]

We report the use of a traditional technique of rhinoplasty in the immediate assumption of responsibility of deep burn of the nasal edge which cannot be grafted. The limit of the realization of this gesture lies in the fact that it must exist nasal morphological characteristics at the patient. The two cases presented had an hypertrophic nose with osseous and/or cartilaginous bump. The reduction height of the osseo-cartilaginous frame allows closing the defect without cutaneous tension. One carries out a true excision–joining of the burn of the nasal dorsum. We note at one year of retreat, the discretion of the scar located on the centre line of the nose, the absence of after-effects as well as the cosmetic satisfaction of the patients with respect to the modifications morphological their noses. [Copyright &y& Elsevier]

Isolated fractures of the nasal pyramid are among the most common facial injuries. Nevertheless, studies of therapeutic results following closed reduction of nasal fractures are rare. We conducted a retrospective clinical review of 187 patients who were evaluated for nasal trauma (including nondislocated fractures, dislocated fractures, and contusions) at our otolaryngology department during 1997 and 1998. Of this group, 96 fractures were treated with closed reduction--either under local anesthesia (n = 68), under general anesthesia (n = 21), or with concomitant septoplasty under general anesthesia (n = 7). At follow-up, which ranged from 1 to 2 years, 91 of the 96 patients (94.8%) expressed satisfaction with their results. Prior to deciding on a course of action, the surgeon must conduct a careful physical examination because the decision as to whether treatment is required, which technique to use (open vs closed reduction), and which type of anesthesia is appropriate (local vs general) all depend on the clinical findings, such as the degree of deviation and airflow obstruction. We also suggest that all patients receive both a Waters' view and a lateral view x-ray. In our opinion, closed reduction is a safe procedure for isolated nasal fractures and can be performed with local anesthesia in most adult patients. Morbidity is minimal in the hands of an experienced ENT surgeon. [ABSTRACT FROM AUTHOR]

Presents an algorithm devised for using titanium mesh to repair severely comminuted frontal sinus fractures. Effect of a delay or improper management of the fracture; Materials and methods; Characteristics of the patients; Repair of the anterior frontal sinus wall with titanium mesh.

Reconstruction Conundrums will accept manuscripts from prospective authors. Three high-quality photographs should be submitted of the wound to be reconstructed, an immediate post-reconstruction photograph, and two long-term follow-up photos. The follow-up photo should be no less than two months postoperatively. The cases submitted for “Reconstruction Conundrums” should have specific educational merit with regards to the reconstruction. This may include issues relating to the closure type, underlying anatomy, or the peculiarities of a particular wound site, etc. The cases need not necessarily be large defects or particularly complicated closures. Reconstructions, large or small, should have salient teaching points. The author will be required to present a discussion of the closure. This should include the author's thought process in deciding which closure type would be the best option. The author should include specific reasons for choosing the method of reconstruction as well as the reasons to consider alternative reconstructions and why they were not chosen. Salient pearls pertaining to the specific closure or to reconstruction in general add value to submissions. The case will be presented in two parts. The first part will be the presentation of the conundrum that the defect presents. A brief pertinent patient history and description of the defect will accompany the unreconstructed defect. Historical details pertinent to the reconstruction, such as anticoagulants, a history of keloid formation, and other medical history should be included. The second part of the manuscript will be the immediate post-reconstruction photograph as well as a long-term follow-up. The discussion of salient educational points will be made here. Manuscripts should be sent to' David G. Brodland, MD, 575 Coal Valley Road, Suite 360, Clarion, PA 15025. Final disposition for publication will reside with the editorial staff. [ABSTRACT FROM AUTHOR]

Introduction A foreign body (FB) is an object or substance foreign to the location where it is found. FBs in the ear, nose, and throat are a common problem frequently encountered in both children and adults. Objective To analyze FBs in terms of type, site, age, and gender distribution and method of removal. Methods A retrospective study was performed in a tertiary care hospital in the central part of Nepal. The study period was from June 2013 to May 2014. The information was obtained from hospital record books. Results A total of 134 patients had FBs in the ear, nose, or throat; 94 were males and 40 were females. Of the 134 patients, 70 (52.23%) had FB in the ear, 28 (20.89%) in the nose, and 36 (26.86%) in the throat. The FB was animate (living) in 28 (40%) patients with FB in the ear and 1 (3.5%) patient with FB in the nose, but the FB was inanimate (nonliving) in any patient with FB in the throat, in 42 (60%) patients with FB in the ear FB, and in 27 (96.4%) patients with FB of the nose. The FB was removed with or without local anaesthesia (LA) in 98 (73.13%) patients, and only 36 patients (26.86%) required general anaesthesia (GA). The most common age group affected was <10 years. Conclusion FBs in the ear and nose were found more frequently in children, and the throat was the most common site of FB in adults and elderly people. Most of the FBs can be easily removed in emergency room or outpatient department. [ABSTRACT FROM AUTHOR]

The article describes the case of a 2-year-old boy with a history of total upper lip and partial nose amputation after a dog bite which was treated using supermicrosurgical techniques without vein graft. The operation was succesful with congestion of the flap after initial surgery which was addressed by giving lidocaine and increasing drainage from a subcutaneous vein. A discussion on lip defects after traumatic amputations is presented.

The article discusses research which examined the discontinuation and non-publication of surgical randomised controlled trials. Topics covered include the reasons behind the discontinuation of trials such as poor recruitment of patients, the association of industry funding with lower odds of publication for completed trials and the non-compliance of investigators that led to the non-registration of trials.

Two cases of fibrous papule of the nose (FPN) with granular cell features are presented and discussed. Both lesions have classic architectural features of FPN; however, the main stromal cells show large cytoplasmic granules of the type seen in granular cells. We are uncertain of the significance of these findings. Our hypotheses include a perifollicular granular cell reaction and a granular degenerative change of local dermal dendrocytes. [ABSTRACT FROM AUTHOR]

Abstract. If the septal component of a nasal injury is adequately managed, usually the entire nasal injury will be well managed. Major or minor nasal trauma can cause cartilage fracture, deviation, dislocation, hematoma, or abscess formation, and the various associated sequelae, some of them life-threatening. A negative x-ray report should never be used as a substitute for a complete intranasal examination in any child with nasal trauma. Any nasal abnormality should be referred for immediate evaluation and treatment. Pediatrics 64:32-35, 1979; children, septum, trauma, nose, cartilage. [ABSTRACT FROM AUTHOR]

Provides guidelines in treating nosebleeds. Standard measures in the intervention of nosebleeding; Potential causes of nosebleeding; Medicine that increases susceptibility to nosebleeds; Information on the anterior packing inserted in the anterior portion of the nose for severe nosebleeding. INSET: WHEN STANDARD MEASURES FAIL.

Discusses the management of nasal injuries by on-site sports medicine physicians. Identification of conditions which require referral; Description of the physical examination which should be performed; Evaluation of the patient by the physician; What an intranasal exam involves; Symptoms of septal hematoma. INSET: Pinpointing and controlling epistaxis.