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The emergency of esophageal button batteries is recognized. Foreign bodies in the ear or nose are treated as comparatively nonemergent. We present the case of a child who presented with suspected pen-nib in the nostril to highlight the importance of investigation and intervention in unwitnessed nasal foreign body and review the literature regarding X-rays in these cases. Fifteen papers were identified as per search parameters; 3 papers recommend the use of plain radiographs for nasal foreign bodies. We propose that in unwitnessed pediatric nasal foreign body insertion, a facial X-ray should be considered, especially if suspecting a metallic foreign body. [ABSTRACT FROM AUTHOR]

Injections of botulinum toxin for the treatment of face wrinkles are the most popular cosmetic operation both internationally as well as in Turkey. The U.S. Food and Drug Administration has approved the treatment of frown lines, crow's feet, and horizontal forehead lines as aesthetic purposes. This procedure produces predictable results, with a few side effects, and is linked to high patient satisfaction. A potent neurotoxin, botulinum toxin prevents acetylcholine from being released at the neuromuscular junction. Compared to static wrinkles, which are evident at rest, dynamic wrinkles, are seen during muscular contraction and produce more striking results. In this evaluation, only uses for aesthetics and hyperhidrosis will be investigated thorougly. [ABSTRACT FROM AUTHOR]

Introduction: Preterm neonates require Non-invasive Respiratory Support (NiRS) because of underdeveloped lungs to administer pressurized oxygen for a long duration. The interface used to deliver NiRS can cause pressure injury at the nasal surface, septum, and bridge. Preterm neonates are more vulnerable to such injuries due to immature skin and septum. It is the responsibility of Health Care Professionals (HCPs) to prevent nasal injury through the implementation of evidence-based practices and innovative techniques to secure nasal interfaces. Objectives: (1) To find out the barriers and facilitators related to nasal injury among preterm neonates in selected neonatal units of a Tertiary Care Centre, in North India. (2) To seek the remedial measures suggested by HCPs to prevent nasal injury. Methodology: After obtaining permission from the head of the department of neonatology, covert participatory observations related to existing practices were made using an observation checklist. Focused Group Discussions (FGDs) were conducted with HCPs (Nursing Officers-43 and Physicians-10) and audio-recorded. Out of the total of eight FGDs, three were conducted with physicians in a group of 2–4 members and the remaining five with nursing officers in a group of 8–9 members, each of 15–20 min duration. FGD guide was used as a tool to guide the discussion. The qualitative data were analyzed by using Van Manen's approach. Result: The barriers identified were related to supplies, staff, and administration. Supplies include limited hospital supply of RAM cannula, reuse of hard ethylene oxide sterilized RAM cannula, lack of adequate size head caps; staff includes lack of awareness regarding the implications and effect of nasal injury among healthcare professionals, variable documentation of nasal injury; administration: no standard guidelines and lack of regular audits to prevent nasal injury. The facilitator suggested were motivated healthcare professionals. Suggested remedial measures were the availability of appropriate size RAM cannula, stockinette head caps, self-motivation, frequent inspection and early identification of nasal injury, staff education, and standard protocol of measures for nasal injury prevention. Conclusion: There are concrete barriers and limited facilitators. There is a need to incorporate the suggested remedial measures to address barriers to preventing nasal injury among preterm neonates. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to compare the duration of oxygen therapy by using two methods of weaning from nasal continuous positive airway pressure (nCPAP) in very preterm babies. Study Design Between April 2014 and December 2016, 90 preterm <32 weeks and birthweight >1,000 g who, after at least 7 days on nCPAP, were clinically stable on <6 cm H 2 O and FiO 2 <30% were randomly assigned to weaning directly from nCPAP or with nasal high flow therapy (nHFT). In the nCPAP group, pressure was gradually reduced until the infant was stable on 4 cm H 2 O and then discontinued. In the nHFT group, flow rate was reduced until the infant was stable at 3.l pm and then discontinued. Results Eighty-four infants completed the study. There were no differences between the groups for the primary outcome, duration of oxygen therapy (median 33 [14–48] versus 28 [15–37] days; p = 0.17). The incidence of moderate-to-severe bronchopulmonary dysplasia was similar. Weaning time was shorter in the nCPAP group (p = 0.02), but the failure rate was slightly higher although non-significant. In the nHFT group, we observed better perception of patient comfort and a lower incidence of severe nasal injury. Conclusion Weaning by nHFT compared with weaning directly off nCPAP does not prolong duration of oxygen therapy. Rather, it is associated with better perceptions of infant comfort among parents and lower rates of severe nasal injury. Key Points Nasal high-flow therapy is commonly used in most neonatal intensive care unit for nCPAP weaning. Weaning by nHFT does not increase the duration of oxygen therapy. nHFT use improves the perception of infant comfort among parents. [ABSTRACT FROM AUTHOR]

The purpose of this study was to prevent nasal bridge pressure injury among fit‐tested employees, secondary to long‐term wear of the N95 mask during working hours. A prospective, single‐blinded, experimental cohort design. Participants were enrolled using the convenience sampling methods and randomisation was utilised for group assignment. Eligibility was determined by a COVID Anxiety Scale score and non‐COVID clinical assignment. Participants with a history of previous skin injury or related condition were excluded. The experimental group was assigned Mepilex Lite® and the control group used Band‐ Aid®. Formal skin evaluations were done by Nurse Specialists who are certified in wound and ostomy care by the Wound, Ostomy, Continence, Nursing Certification Board (WOCNCB®). Fit test logs were provided to participants to measure subjective user feedback regarding mask fit and level of comfort. The results of this feasibility trial are promising in supporting the use of a thin polyurethane foam dressing as a safe and effective dressing to apply beneath the N95 mask. Additional research is needed to validate results due to limited data on efficacy and safety of the various barrier dressings as a potential intervention to prevent skin breakdown to the nasal bridge. [ABSTRACT FROM AUTHOR]

Pediatric patients frequently present to emergency departments with complaint of foreign bodies in the ear and/or nose. Emergency nurse practitioners need the knowledge base to safely and effectively manage ear and nose foreign bodies in urgent and emergent care settings. The purpose of this article is to teach the common anatomical sites where foreign bodies are placed, the make-up of foreign body material, procedural technique of removal, and specific circumstances that require specialty referral. [ABSTRACT FROM AUTHOR]

Background and Aim: Physical injuries affect the psychological dimension of human beings. This study aimed to investigate the impact of physical injuries on the psychological dimension of people. Methods: This is a cross-sectional descriptive study that was conducted on traffic police staff who were referred to Valiasr hospital in Tehran, Iran due to injuries between April 2015 and November 2021. The required information was collected from the database using medical documents and registered files of injured employees. After coding data, SPSS version 26 software was used for statistical analysis. Results: Among the 120 injured people, the highest average score evaluated by the GHQ questionnaire was obtained by the ear, nose, and throat group (22%), upper limb (20%), eye (19%), lower limb (17%), and digestion (14%), which shows that in some cases (physical scale, anxiety and sleep disorder, symptoms of social action, symptoms of depression) are exposed to damage. The urology-affected group got the lowest score among the different groups with 8%, which indicates that this group is in a very favorable state in terms of mental health. Conclusion: The results of this study showed that the most type of physical injury that affected the psychological dimension of people was the ear, nose, and throat injury, and the least injury was related to urology. [ABSTRACT FROM AUTHOR]

Introduction: Fishing can be problematic for the novice fisherman when the fishing hook sinks into the fisherman's body. The hook can often not be removed easily because of its specific structure. Case report: A 12-year-old boy had a fishing hook sunk into his nose after it was thrown towards his face; it inserted into the septum and right lower lateral cartilage of the nose due to inexperience in handling it by the victim. Discussion: The hook was extracted through the 'push through and cut off' method with no damage caused to the lower lateral cartilage, septum and the nasal skin. Deep insertion of the hook in the sensitive areas such cartilage of the nose can cause an irreversible complication if erroneously manipulated. Conclusion: This is the first report of technique of removed fishing hook with extra teeth from the nasal cartilage. Surgeon knowledge about the hook type and techniques of hook removal can help successful removal from the body without irreversible complication. [ABSTRACT FROM AUTHOR]

Background: Clinicians are exploring alternative treatments for nasal septum perforation since surgical treatment is challenging. Objective: The effects of topical carvacrol on the healing of nasal septal perforation were investigated in an animal model. Method: Twenty-one male New Zealand rabbits were randomly divided into three equal groups. A 5-mm circular biopsy punch was used to perforate the nasal septum behind the columella. For 14 days, bilateral gelatin sponges impregnated with carvacrol in olive oil in group 1, and only olive oil in group 2 were placed. Perforation only was performed in the control group. Animals were then sacrificed, and their nasal septums were removed. The closure of the perforation was measured, and samples were examined histopathologically. MMP-9 reactivity was evaluated using the immunoperoxidase technique. Histopathologic parameters were scored as 0 = none, 1 = mild, 2 = moderate, and 3 = strong. Results: The septum perforation closure in the carvacrol group was statistically significant compared with the other groups (p < 0.001). Cartilage regeneration, connective tissue density, and MMP-9 immunoreactivity were significantly higher in the carvacrol group (p = 0.020, p = 0.009, and p = 0.008, respectively). Conclusion: Topically administered carvacrol enhances wound healing in rabbit nasal septum perforation. It accelerated perforation closure by increasing cartilage regeneration, connective tissue, and MMP-9 expression. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants. Methods: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries. Results: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01). The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying = 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04). Conclusion: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 is an international pandemic. One of the cardinal features is acute respiratory distress syndrome, and proning has been identified as beneficial for a subset of patients. However, proning is associated with pressure-related side effects, including injury to the nose and face. Method: This paper describes a pressure-relieving technique using surgical scrub sponges. This technique was derived based on previous methods used in patients following rhinectomy. Conclusion: The increased use of prone ventilation has resulted in a number of referrals to the ENT team with concerns regarding nasal pressure damage. The described technique, which is straightforward and uses readily available materials, has proven effective in relieving pressure in a small number of patients. [ABSTRACT FROM AUTHOR]

Background: Homeless individuals frequently experience poor access to healthcare, delayed clinical presentation, and higher disease burden. Providing subspecialty otolaryngology care to this population can be challenging. We previously reported on the prevalence of hearing impairment in Toronto's homeless community. As a secondary objective of this study, we sought to define otolaryngology specific need for this population. Methods: One hundred adult homeless individuals were recruited across ten homeless shelters in Toronto, Canada using a stratified random sampling technique. An audiometric evaluation and head and neck physical examination were performed by an audiologist and otolaryngology resident, respectively. Basic demographic and clinical information was captured through verbal administration of a survey. Descriptive statistics were used to estimate frequency of otolaryngology specific diseases for this population. Results: Of the 132 individuals who were initially approached to participant, 100 (76%) agreed. There were 64 males, with median age of 46 years (IQR 37–58 years). The median life duration of homelessness was 24 months (IQR 6–72 months). Participants had a wide range of medical comorbidities, with the most common being current tobacco smoking (67%), depression (36%), alcohol abuse (32%), and other substance abuse (32%). There were 22 patients with otolaryngology needs as demonstrated by one or more abnormal findings on head and neck examination. The most common finding was nasal fracture with significant nasal obstruction (6%). Eleven patients required referral to a staff otolaryngologist based on concerning or suspicious findings, including two head and neck masses, 6 were later seen in follow-up. Conclusion: There were substantial otolaryngology needs amongst a homeless population within a universal healthcare system. Future research should focus on further elucidating head and neck related issues in this population and expanding the role of the otolaryngologist in providing care to homeless individuals. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyse the common presentations and treatment outcomes in cases involving nasal foreign bodies. Methods: A retrospective study was carried out over three years, from January 2014 to December 2017. Patient biodata, clinical presentation, nasal foreign body type and management outcome data were obtained from the medical records and analysed. Results: A total of 341 cases were analysed. The average patient age was 3.7 ± 1.2 years (range, 1–19 years).Of the nine cases involving button batteries, septal perforation was initially seen in four cases and three cases had subsequent septal perforation. Conclusion: Only button battery nasal foreign bodies were associated with increased septal perforation. Use of physiological seawater nasal spray was found to reduce the likelihood of septal perforation. Most nasal foreign bodies could be removed under local anaesthesia. [ABSTRACT FROM AUTHOR]

Objectives: "Young adulthood" is a term used to define individuals falling within the 18- to 22-year-old age range. Injuries account for more than a third of emergency department visits in this population. A particular area of concern is accidents that lead to injuries of the facial bones because they can have long-term functional, aesthetic, and psychosocial impacts. As many as 30 million young adults participate in some sort of sport in the United States per year, and facial injuries from these activities are not uncommon and thus require further exploration. Methods: The National Electronic Injury Surveillance System was used to conduct a retrospective review to explore patterns of maxillofacial fractures in young adult patients between the ages of 18 and 22 years from 2004 through 2017. The data analyzed yielded information about patient demographics, diagnoses, and associated products. Results: A total of 3486 emergency department visits were included in the study. The most common facial fractures were nasal fractures (64.4%), mandible fractures (12.3%), and orbital fractures (6.1%). The most common causes of fractures were sports (55.48%), fixed structures (6.39%), and stairs or steps (5.60%). The top 3 sports associated with facial fractures were basketball (25.4%), baseball (11.6%), and football (10.4%). Conclusions: For young adult individuals, some sort of sporting activity is common outside of the National Collegiate Athletic Association. The overwhelming majority of facial fractures in this population were caused by sports, and the authors believe this issue warrants further exploration and discussion. According to the Centers for Disease Control and Prevention, an estimated 8.6 million sports- and recreation-related injuries occurred per year between 2011 and 2014. Despite ever growing research and guidelines into sports injury incidence and prevention, it is clear that sports are the cause of a large portion of maxillofacial fractures in the United States. [ABSTRACT FROM AUTHOR]

Background: With increasing use of nCPAP, the safety and comfort associated with nCPAP have come into the forefront. The reported incidence of nasal injuries associated with the use of nCPAP is 20% to 60%. A recent meta-analysis concluded that the use of nasal masks significantly decreases CPAP failure and the incidence of moderate to severe nasal injury and stress the need for a well powered RCT to confirm their findings. Methods: In this Open label, 3 arms, sequential, stratified randomized controlled trial, we evaluated the incidence and severity of nasal injury at removal of nCPAP when using two different nasal interfaces and in three groups (i.e. rotation group, mask continue group, prong continue group). Preterm infants with gestation ≤ 30 weeks and respiratory distress within the first 6 hours of birth and in need of CPAP were eligible for the study. Results: Among the 175 newborns included in the study, incidence of nasal injury in mask continue group [n = 19/57 (33.3%)] was significantly less as compared to prong continue group [n = 55/60 (91.6%)] and rotation group [33/ 58 (56.9%), p value <0.0001]. Median maximum nasal injury score was significantly less in Mask continue group as compared to Prong continue group and Rotation group [Injury Score 0 (IQR 0–1) vs. Injury Score 3 (IQR 2–5) vs. Injury Score 1 (IQR 0–2), p value = <0.0001] respectively. The proportion of infants failing nCPAP was similar across the three groups. Conclusion: nCPAP with nasal masks significantly reduces nasal injury in comparison with nasal prongs or rotation of nasal prongs and nasal masks. However, the type of interface did not affect the nCPAP failure rates. [ABSTRACT FROM AUTHOR]

In a medical setting, such as the treatment of post-operative nosebleeds, nasal packing, including the use of nasal packs, nasal plugs or nasal tampons (NTs), is widely used to temporarily control anterior epistaxis. Although some literature has documented the use of NTs as a quick, easy and temporary solution to deal with anterior epistaxis in sports-induced nasal injuries, additional research is needed to appreciate on-field versus off-field efficacy, as well as the efficiency of different brands of NTs and packing materials. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine the relationship between a foreign body in the nose of a child and the dominant hand, the educational level of the parents and the habits of the mother in cleaning the nose with tissues or tweezers etc. Objectives: There is a lack of evidence about the foreign body in the nose in children and association among dominant hand, parental behaviour and education level. Methods: A retrospective examination was made of the records of 136 patients (78 male, 58 female) diagnosed with a foreign body in the nose in the period January 2014 - January 2017. A record was made of age, gender, the type of foreign body, treatment and complications, etc. Patients with a psychosomatic disorder were excluded from the study. Results: The vast majority of the patients were children aged 2-5 years (N = 124, 91.17%). The most common foreign bodies were a bead, a part of a plastic toy, a button, a safety pin, paper and paper tissues. The foreign body was removed from the same side as the dominant hand in 116 (85.29%) cases. The incidence of nasal foreign body was found to be statistically significantly higher in those with a parental level of education of primary school (P < 0.026). Conclusions: There was a statistically significant relationship between the localisation of a nasal foreign body and the dominant hand, so the patient's relatives must be asked about the side of the dominant hand. Taking into consideration that complications are greatly reduced with clinical experience, it is recommended that intervention for a nasal foreign body is made by an ear, nose and throat specialist. [ABSTRACT FROM AUTHOR]

A 14-years-old boy came with chief complaint of epiphora and history of globe rupture repair surgery due to facial trauma one year ago. Patient got complications from the trauma, including nasolacrimal duct obstruction, phthisis bulbi, enophthalmos, facial deformities, and ptosis. Multidisciplinary approach was performed simultaneously in one session surgery which included oral mucosal graft for non-irritative phthisis bulbi, silicone block implant for blowout fracture, external dacrycystorhinostomy for obstructed nasolacrimal duct, fascia lata brow suspension/frontalis sling for ptosis, and septorhinoplasty for nasal augmentation. After the surgery, symptoms of epiphora had resolved and aesthetical improvement of facial deformities was also prominent. Management of old orbital fracture poses additional challenges due to the complications that have occurred over time. Loss of functionality may seem impractical to manage because no function can be pertained. Nevertheless, it is important to still perform surgical repair for aesthetic purposes due to the psychological effect on their daily lives. [ABSTRACT FROM AUTHOR]

Objective: Binasal prongs are the most commonly used interface for the delivery of nasal positive airway pressure (CPAP) to preterm infants. However, they are associated with pressure-related nasal injury, which causes pain and discomfort. Nasal injury may necessitate a change in interface and occasionally damage is severe enough to require surgical repair. We aim to determine the incidence and risk factors for nasal injury in preterm infants, and to provide clinicians with strategies to effectively prevent and treat it.Design: We conducted a systematic search of databases including MEDLINE (PubMed including the Cochrane Library), EMBASE, CINAHL and Scopus. Included studies enrolled human preterm infants and were published prior to 20 February 2017.Results: Forty-five studies were identified, including 14 ra ndomised controlled trials, 10 observational studies, two cohort studies, eight case reports and 11 reviews. The incidence of nasal injury in preterm infants ranged from 20-100%. Infants born <30 weeks' gestation are at highest risk. Strategies shown to reduce nasal injury included: nasal barrier dressings (2 studies, n=244, risk ratio (RD) -0.12, 95%, CI - 0.20 to -0.04), nasal high flow therapy as an alternative to binasal prong CPAP (7 studies, n=1570, risk difference (RD) -0.14, 95% CI -0.17 to -0.10), and nasal masks rather than binasal prongs (5 studies, n=544, RR 0.80, 95% CI 0.64 to 1.00).Conclusions and Relevance: Nasal injury is common in preterm infants born <30 weeks' gestational age receiving CPAP via binasal prongs. Larger randomised trials are required to fully evaluate strategies to reduce nasal injury. [ABSTRACT FROM AUTHOR]

Nasal injuries with use of nasal continuous positive airway pressure (CPAP) range from blanching of nasal tip to septal necrosis and septal drop. This analysis was done in preterm neonates of < 34-week gestation, who received nasal CPAP as primary support as part of a randomized trial comparing Jet device with Bubble device for delivery of CPAP, both through nasal prongs of different structure, make and fixation methods. Nasal injury was assessed using a validated nasal injury score. Out of 170 neonates enrolled, 103 (61%) had nasal injuries; moderate and severe injuries were observed in 18 (11%) and 8 (5%) infants, respectively. Septum was the most common site injured. The incidence and severity of nasal injury were significantly lesser in Jet group compared to Bubble group [RR 0.6 (95% C.I. 0.5-0.8); p < 0.001]. Similarly, neonates in Jet group had lesser average [median (IQR): 3 (3,4) vs. 4 [8, 14]; p = 0.04] as well as peak N-PASS pain scores [median (IQR): 4 [8, 14] vs. 5 [13, 16]; p = 0.01] in comparison to Bubble group. However, Jet group neonates had significantly more common prong displacements.Conclusion: Bubble CPAP device with its nasal interface had higher and more serious incidence of nasal injuries in comparison to Jet CPAP device. What is known: • Nasal injuries are becoming increasingly common with use of nasal CPAP low gestational age, low birth weight, longer use of CPAP and longer NICU stay are risk factors for such injuries • Validated nasal injury scores have been created for assessment of nasal trauma in neonates What is new: • Bubble device with its interface had higher and more serious incidence of nasal injuries in comparison to Jet device • Even though pain assessed by N-PASS was less with Jet device, prong displacements were more frequent with its system. [ABSTRACT FROM AUTHOR]

Key Clinical Message This study reports a case of an 8-year-old boy who suffered from a dog bite injury to the nose. The amputated nasal tissue measured approximately 1.0 × 1.5 cm and included part of the tip, alar, and soft triangle subunits. Both ends of an artery of less than 0.5 mm were found, and replantation was performed. Chemical leeching was performed postoperatively. At 5-year follow-up, a good aesthetic result was achieved. [ABSTRACT FROM AUTHOR]

Orofacial injuries are common in sports activities and may vary in complexity and the tissues involved. Most sports-related trauma occurs when a player hits another player, an object or the ground. This report presents a case of an injury caused by a punchlike blow to the face during a handball college team practice session. The patient suffered a traumatic blow to the left side of the nose and mouth and promptly attended a dentist. After a clinical examination and a CBCT scan, the following injuries were diagnosed: upper lip laceration, upper left lateral incisor subluxation and anterior nasal spine fracture. More severe teeth injuries were likely prevented because the patient was wearing a mouthguard. [ABSTRACT FROM AUTHOR]

Loss of nasal skin as well as loss of both lateral alar cartilages and vestibular lining with exposure of septum presents a grotesque deformity by itself, with further danger of loss of nasal bones and other cartilaginous structures leading to total loss of nose. The Goal of the treatment is to restore the skin cover as well as lining and cartilage support, restoring nose while avoiding the deformity. In an elderly patient with Spiritual restrictions, with diabetes and Hypertension, the treatment was needed to be carried out under local anesthesia as a daycare procedure. Forehead flap was pre-Laminated on forehead before the transfer to have all the three layers of nasal covering. Next the flap was transferred, customizing to recipient site. Finally pedicle was divided retaining the supratrochlear vessels, ensuring the vascularity of the reconstruction and retaining the ability to debulk/manipulate the flap later. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic nasal septal collapse results in flat, broad, non-projecting nose due to mid-vault collapse. These patients may have airway obstruction due to poorly supported internal valve. Traditional techniques like 'cantilever graft technique' or conventional 'L-graft technique' produce a rigid lobule as the single unit framework extends to the tip. These grafts also lack in internal valve support. Materials and Methods: Twelve patients with post-traumatic nasal septal collapse were treated with three component cartilage framework technique in the past 3 years. The framework was reconstructed in three components-septal, columellar and dorsal onlay; using costal cartilage. If needed, upper lateral cartilage support grafts were also provided. Results: At 6 months' follow-up, all 12 patients were satisfied with the outcome. The nasal projection and dorsal definition were aesthetically pleasing, and there was free natural movement of the lobular part of the nose. One graft was revised for further improvement in outcome. Airway obstruction, when present was also relieved. Conclusion: This technique has distinct advantages over the conventional techniques as the framework of separate components maintains pliability of the lobule, supports the internal valve and offers good control of aesthetic needs. [ABSTRACT FROM AUTHOR]

The second to fourth digit ratio (2D:4D) is claimed to be a biomarker of prenatal sex steroids. This study compared 2D:4D and waist–hip ratio (WHR) in men and women with nose deformity caused by injuries suggesting risky behaviour with those of unaffected controls. This kind of facial trauma was accepted as an indicator of risk-taking behaviour. The study involved 100 patients (50 women aged 30.74±8.09 years and 50 men aged 30.98±10.86 years) who underwent rhinoplasty due to nose trauma in a hospital in Łódź, Poland, in 2015. For comparison purposes, a control sample of 70 women (aged 23.03±3.36 years) and 70 men (aged 22.87±3.46 years) was recruited. In both groups the following measurements were taken: body height, waist and hip circumferences, II and IV digit lengths and body weight. The results showed that women and men who had suffered nose injury had significantly higher values of WHR than controls. The 2D:4D in women with post-traumatic nose deformity was significantly different than the ratio in control women (p<0.0001) and presented the male pattern. It is concluded that in women risky behaviours seem to be associated with prenatal sex hormone influence, while differences in WHR suggest that this tendency is also related to postnatal hormonal factors. Risky behaviours in men should be linked to postnatal hormonal changes rather than to increased prenatal androgen exposure. [ABSTRACT FROM PUBLISHER]

This research provides a cautionary example when evaluating changes in behavioral end points with respect to postulated pharmacologic activity. Various small molecule substrate mimetic protein tyrosine phosphatase 1B (PTP1B) inhibitors were investigated as pharmacologic agents for decreasing food consumption using intranasal (IN) dosing as a means for direct nose-to-brain delivery along the olfactory/trigeminal nerve pathways. Although food consumption was decreased in diet-induced obese (DIO) mice, nasal discharge was observed. Studies were conducted to investigate local effects on the nasal airway and to develop structure–activity relationships. Intranasal administration of PTP1B inhibitors at ≥0.03 mg/d to DIO mice produced dose-dependent injury to various cell types of the nasal epithelia. Protein tyrosine phosphatase 1B inhibitors with calculated log octanol >3.0 were the most toxic. Whereas a pharmacologically inactive analog of a PTP1B inhibitor produced nasal injury, along with decreased food consumption, the marketed IN drug ketorolac produced no lesions at the same dose of 0.3 mg/d and only minor changes at 3 mg/d. Rat skin fibroblast cells were exposed in vitro to PTP1B inhibitors, ketorolac, paraquat, and the detergent sodium dodecylbenzene sulfonate (NDS) followed by measures of cytotoxicity. The most potent PTP1B inhibitors were similar to NDS, whereas ketorolac was the least toxic compound. Cytotoxic potency in vitro was similar to in vivo. In conclusion, PTP1B inhibitors injured nasal epithelium through a mechanism independent of PTP1B inhibition and likely due to nonspecific cytotoxicity such as disruption of the cell membrane. Decreased food consumption in DIO mice was due to toxicity rather than a pharmacologic mode of action. [ABSTRACT FROM AUTHOR]

This paper investigates mutilation of the nose and ears in New Kingdom Egypt (c. 1550-1070BCE). The topic is first contextualised within cross-cultural mutilation research, before discussion shifts to focus more closely on Egypt. The threat of mutilation in oaths is considered, as is the possibility of mutilation not being enforced if such oaths were broken. The paper then investigates the lived experience of mutilation, encompassing both physiological and social impairments. Finally, a ‘supra-practical’ aspect is proposed, considering the esoteric connotations of mutilation, this latter understood as a set of practices including but not confined to actual physical dismemberment. [ABSTRACT FROM AUTHOR]

Fracture of the nasal septum is a common injury. Fracture reduction using Ash forceps is the standard treatment for non-severely comminuted cases. In this study, septoplasty was compared to Ash forceps reduction of nasal septum fractures with regard to the quality of life outcome of patient breathing. Thirty consecutive patients with non-comminuted septal fractures were divided randomly into two groups. In group I, fractures were managed by closed reduction (using Ash forceps), while in group II, fractures were managed by septoplasty surgery. Each patient completed a validated quality of life scale for breathing (Nasal Obstruction Symptom Evaluation, NOSE) preoperatively and at 3 months postoperative. In group I, the mean difference between postoperative and preoperative NOSE scores was −28.33 (range −40 to −15), while in group II the mean difference was −44.33 (range −70 to −30). There was a significant improvement in nasal breathing quality of life in group II compared with group I ( t -test, P = 0.001). The results of this study showed a significant improvement in quality of life outcome with the use of septoplasty compared to closed reduction for acute septal fractures. Septoplasty could be recommended for patients with acute nasoseptal fractures to ensure better nasal breathing outcomes. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the association between nasal obstruction and (1) demographic factors, (2) medical history, (3) physical tests, and (4) nasal exam findings. Study Design. Case series. Methods. Chart review at a tertiary medical center. Results. Two hundred-forty consecutive patients (52.1±17.5 years old, with a Nasal Obstruction Symptom Evaluation (NOSE) score of 32.0±24.1) were included. Demographic factors and inferior turbinate sizes were not associated with NOSE score or Nasal Obstruction Visual Analog Scale (NO-VAS). A significant association was found between higher NOSE score on univariate analysis and positive history of nasal trauma (p=0.0136), allergic rhinitis (p<0.0001), use of nasal steroids (p=0.0108), higher grade of external nasal deformity (p=0.0149), higher internal nasal septal deviation grade (p=0.0024), and narrow internal nasal valve angle (p<0.0001). Multivariate analysis identified the following as independent predictors of high NOSE score: NO-VAS: ≥50 (Odds Ratio (OR) = 17.6 (95% CI 5.83–61.6), p<0.0001), external nasal deformity: grades 2–4 (OR = 4.63 (95% CI 1.14–19.9), p=0.0339), and allergic rhinitis: yes (OR = 5.5 (95% CI 1.77–18.7), p=0.0041). Conclusion. Allergic rhinitis, NO-VAS score ≥ 50, and external nasal deformity (grades 2–4) were statistically significant independent predictors of high NOSE scores on multivariate analysis. Inferior turbinate size was not associated with NOSE scores or NO-VAS. [ABSTRACT FROM AUTHOR]

Background: Comminuted and compound fractures of the nose pose a surgical dilemma for the treating surgeon. There is a general belief that in such cases, a secondary septorhinoplasty is often required after a closed reduction and so there is a bias towards adopting an open or modified open reduction technique in the first instance. We, however, believe that a change in the splinting strategy after a closed reduction can make use of the innate advantages of the nasal structure and avoid a lot of major surgeries and consequent discomfort and expenses. Methods: Thirty-six patients with comminuted/compound fractures of the nose were enlisted in the study after due informed consent. After standard closed reduction, a new splintage technique developed by us, the 'Tripod suspension and stabilisation technique' was employed and kept for up to 3 weeks. The patients were then interviewed a minimum 8 weeks post splint removal to assess their levels of satisfaction regarding aesthetics and function of the nose post reduction on a visual analog scale. Results: Thirty-six patients having comminuted or compound fracture nasal bone were splinted by this technique after closed reduction and followed up for subjective assessment at least 2 months later. While 95 % were quite satisfied with the aesthetic outcome and 97 % with the nasal function, only one felt the need for (and subsequently underwent) a septorhinoplasty. Conclusions: Tripod suspension and stabilisation is an effective and rational technique for splintage following closed reduction of comminuted/compound fractures of nasal bones. It is convenient for patients as they can breathe through their noses and do not restrict any activity while the splints are on. It is very stable and versatile and reduces hospitalisation as no packs are required and has shown excellent long-term functional and aesthetic results thereby reducing the need for open procedures. Level of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Background According to European and US protocols, two nasal potential difference (NPD) measurement methods are considered acceptable, although they have not been formally compared: subcutaneous agar-filled needle with calomel (Ndl) and dermal abrasion with conducting cream and Ag/AgCl electrodes (Abr). We compared both in CF and healthy volunteers (HV), assessing their discriminative value and subject's preference. Methods Twelve classic CF and 17 HV underwent both NPD methods, performed by one operator in random order. A written questionnaire, assessing preference, was completed after each test. Tracings were coded, scored in a semi-blinded fashion and categorised as CF/non-CF. Results 110 tracings (56 Ndl/54 Abr) were collected: 42/110 scored CF and 68/110 non-CF, showing a good correlation. No significant preference for either method was reported. Conclusion Both NPD methods are similar in terms of discriminative value and subject's preference, comparing classical CF and HV. For diagnosing CF, the operator's preferred NPD-method may be used. [ABSTRACT FROM AUTHOR]

The article presents a study on complex medial cheek and lateral nasal ala defect in a female patient presented for treatment of a basal cell carcinoma on the upper lateral aspect of her right nasal ala and alar crease. The authors presented a single-stage combination sliding advancement and transposition flap to repair the defects of the lateral ala, and on paranasal cheek and nasal sidewall.

The presence of age, sex and regional features, the variety of fractures of the bones of the nose and its septum are shown. As a result, in the forensic medical examination of the FNB, the nature and extent of lesions, features of the anatomical structure of the nose bones, possible anomalies in their development, concomitant diseases, possible complications and consequences of trauma are taken into account. [ABSTRACT FROM AUTHOR]

A review of the article "Nasal packing in sphenopalatine artery bleeding: therapeutic or harmful?'' by Sireci et al. which appeared in the periodical on October 9, 2017.

The Nasal Obstruction Symptom Evaluation (NOSE) scale is a reliable and valid instrument used widely in otorhinolaryngology to evaluate nasal obstruction symptoms in patients with nasal disorders. The purpose of this study was to assess nasal obstruction symptoms prospectively in patients undergoing surgically assisted rapid maxillary expansion (SARME) using the NOSE scale. Sixteen patients were studied (mean age 31 ± 7.7 years), 10 women and six men, all with a transverse maxillary deficiency and an indication for SARME. Hyrax type devices were placed preoperatively and SARME was performed using Kraut's technique. The NOSE scale was applied prospectively to assess nasal obstruction symptoms. The results were recorded for each score on a scale ranging from 0 to 4, and these scores were multiplied by 5, generating a balanced scale from 0 to 100. Data were stratified according to NOSE scores, and nasal obstruction was categorized as mild (0–25), moderate (26–50), or severe (>50). The questionnaire was administered twice, first preoperatively and then at 6 months after surgery, and the results compared. Data were analyzed statistically using SAS statistical package software and showed that patients experienced a subjective improvement or did not have a worsening of nasal obstruction symptoms after SARME. [ABSTRACT FROM AUTHOR]

This study proposes that the bony anatomy of the human nose andmasonry structure of the Gothic cathedral are geometrically similar, and have common fracture patterns. We also aim to correlate the fracture patterns observed in patients' midface structures with those seen in the Gothic cathedral using computational approach. CT scans of 33 patients with facial fractures were examined and compared with computer simulations of both the Gothic cathedral and human nose. Three similar patterns were found: (1) Cracks of the nasal arch with crumpling of the vertical buttresses akin to the damage seen during minor earthquakes; (2) lateral deviation of the central nasal arch and collapse of the vertical buttresses akin to those due to lateral forces from wind and in major earthquakes; and (3) Central arch collapse seen as a result of collapse under excessive dead weight. Interestingly, the finding of occult nasal and septal fractures in the mandible fractures with absence of direct nasal trauma highlights the possibility of transmission of forces from the foundation to the arch leading to structural failure. It was also found that the structural buttresses of the Gothic cathedral delineate the vertical buttresses in the human midface structure. These morphologic similarities between the human nose and Gothic cathedral will serve as a basis to study the biomechanics of nasal fractures. Identification of structural buttresses in a skeletal structure has important implications for reconstruction as reestablishment of structural continuity restores normal anatomy and architectural stability of the human midface structure. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: High-flow therapy is the most recent, and popular, mode of respiratory support in neonates. However, the evidence supporting its efficacy and safety has not yet been established. We conducted a systematic review and meta-analysis of clinical trials comparing efficacy and safety of high-flow therapy compared with other modes of noninvasive ventilation (NIV) in preterm infants. METHODS: Articles were indexed by using Medline, Embase, Scopus, OpenSIGLE, Health Management Information Consortium, and Cochrane Central Register of Controlled Trials. Randomized or quasi-randomized clinical trials involving preterm infants, comparing high-flow therapy with other modes of NIV, and reporting extractable data on relevant outcomes, were selected. Data on efficacy, safety, and other common neonatal outcomes were extracted on predesigned forms. RESULTS: In this analysis, we included 1112 preterm infants, participating in 9 clinical trials. High-flow therapy was similar in efficacy to other modes of NIV in preterm infants when used as primary support (odds ratio of failure of therapy, 1.02 [95% confidence interval: 0.55 to 1.88]), as well as after extubation (1.09 [0.58 to 2.02]). There were no significant differences in odds of death (0.48 [0.18 to 1.24]) between the groups. Preterm infants supported on high-flow had significantly lower odds of nasal trauma (0.13 [0.02 to 0.69]). CONCLUSIONS: High-flow therapy appears to be similar in efficacy and safety to other conventional modes of NIV in preterm infants. It is associated with significantly lower odds of nasal trauma. Caution needs to be exercised in extreme preterm infants because of the paucity of published data. [ABSTRACT FROM AUTHOR]

Background:While there is concern regarding head, face, and eye injuries in field hockey, prompting some to recommend the use of protective equipment such as goggles and helmets, little has been written about their incidence and mechanism of injury in the modern game of field hockey. The elucidation of this information will better inform the development of maximally effective injury prevention schemes to protect the athlete while maintaining the integrity of the game.Purpose:To determine the incidence and epidemiology of head, face, and eye injuries in United States collegiate women’s field hockey players from 2004-2005 to 2008-2009.Study Design:Descriptive epidemiological study.Methods:All head, face, and eye injuries reported to the National Collegiate Athletic Association Injury Surveillance System for collegiate women’s field hockey athletes from the 2004-2005 through 2008-2009 seasons were analyzed. Data regarding the event type, injury mechanism, body part injured, type of injury, outcome, and time lost were reviewed. The weighted injury incidence per 1000 athlete-exposures (AEs) was calculated using the exposure data set for the same years; 95% CIs were calculated based on a normal approximation to the Poisson distribution.Results:There were 150 reported traumatic injuries during this time period, with a weighted occurrence of 1587.3 injuries. The overall incidence of head, face, and eye injuries in collegiate women’s field hockey was 0.94 per 1000 AEs (95% CI, 0.86-1.19). Injuries to the head or face, other than the mouth, nose, and eye, accounted for 75.3% of these injuries. The incidence of eye injuries was 0.07 per 1000 AEs (95% CI, 0.03-0.12); nose injuries occurred at a rate of 0.10 per 1000 AEs (95% CI, 0.05-0.15). The rate of traumatic dental injuries was 0.06 per 1000 AEs (95% CI, 0.04-0.14). Contact with an apparatus caused 72.9% of all injuries; specifically, contact with an elevated ball accounted for 47.9% of all injuries, and contact with an elevated stick caused 21.7% of all injuries. While the majority of players suffering a head, face, or eye injury were able to return to sport that season (90.0%), the remaining athletes suffered season-ending injuries (10%). Concussions accounted for 42.8% of all head, face, and eye injuries reported (0.40 per 1000 AEs; 95% CI, 0.32-0.53).Conclusion:Head, face, and eye injuries occur regularly in women’s field hockey. This description of the injury profile and mechanisms of injury may be used to design appropriate injury prevention schemes for the sport. [ABSTRACT FROM AUTHOR]

Congenital malformations of the nose can be associated with a variety of syndromes, including solitary median maxillary central incisor syndrome, CHARGE syndrome, Bosma syndrome, median cleft face syndrome, PHACES association, Bartsocas-Papas syndrome, Binder syndrome, duplication of the pituitary gland-plus syndrome and syndromic craniosynsotosis (e.g., Apert and Crouzon syndromes) among other craniofacial syndromes. Imaging with CT and MRI plays an important role in characterizing the nasal anomalies as well as the associated brain and cerebrovascular lesions, which can be explained by the intimate developmental relationship between the face and intracranial structures, as well as certain gene mutations. These conditions have characteristic imaging findings, which are reviewed in this article. [ABSTRACT FROM AUTHOR]

Because of its prominent position on the facial skeleton, the nose is commonly injured. Though significant trauma can result in nasal obstruction, there is also considerable concern for potential cosmetic deformity. Repairing traumatic deformities is complex and can involve all aspects of the nose, including the bony and cartilaginous framework as well as the soft tissue envelope. Trauma can result in deflection, asymmetry, and deformity of the bony nasal dorsum, midvault, and nasal tip. Any serious nasal trauma places patients at risk for complications thatmay include nasal septal hematoma, septal perforation, and possible cerebral spinal fluid leak. Unrecognized or untreated septal hematomas can result in cartilaginous septal necrosis followed by saddle nose deformity. Though damage to structural scaffolding is often the cause of cosmetic deformity following nasal trauma, the nasal soft tissue envelope is also commonly affected. This can result in lacerations, avulsions, and traumatic tattooing. The following will discuss the evaluation, diagnosis, and management of these cosmetic concerns relating to nasal trauma. [ABSTRACT FROM AUTHOR]

The nose is frequently traumatized in facial injuries and this often results from motor vehicle accidents, sports-related injuries, and altercations. Subsequently, posttraumatic nasal deformity is one of the most common reasons that patients seek consultation in the doctor's office. Depending on the type of nasal deformities, this can result in functional impairment and aesthetic problems. Two challenging problems to be addressed in the posttraumatic nose include the crooked nose deformity and the saddle nose deformity. The numerous publications on these two topics attest to the exacting surgical expertise required in its treatment. The key features in management of these conditions are discussed further. [ABSTRACT FROM AUTHOR]

Facial trauma commonly produces trauma to the nose and perinasal area. In this review, emphasis is on the treatment of the severely deviated nose in terms of excessive shift of the bony dorsum and bony pyramid. In particular, we focus on the problemof centering the severely deviated bony dorsum and when we believe it is helpful to move the entire bony dorsum as a unit, utilizing the transverse osteotomy in addition to traditional osteotomies. [ABSTRACT FROM AUTHOR]

Injuries to the nose and perinasal region are common. Though the nasal fractures are commonly recognized and properly addressed, injuries to adjacent structures such as the orbit, medial canthus, and midface skeleton can be missed or misdiagnosed leading to improper primary treatment and subsequent secondary deformities. In this discussion, we focus on secondary deformities of themedial canthal region injuries that result from inadequate primary repair of the displaced medial canthal tendon apparatus in naso-orbital-ethmoid fractures. Emphasis is placed on the difference in complexity of the secondary pseudotelecanthus deformity relative to primary fracture treatment. Case examples are used to discuss the complexity of the correction of such deformities. [ABSTRACT FROM AUTHOR]

Acute management of complex nasal fractures in the adult nose is still frequently conducted using closed reduction techniques as first-line therapy. Treatment outcomes from closed reduction are often disappointing and secondary surgical corrections are required in a sizeable subset of patients. In response to the shortcomings of closed fracture manipulation, classic rhinoplasty techniques have been introduced to improve anatomic fracture reduction. Although these techniques improve the accuracy of skeletal reduction, they also weaken the nose, leaving it susceptible to the deformational forces of healing. To provide optimal anatomic fracture reduction and concomitant stabilization of the skeletal framework, we have been using contemporary strategies derived from open structure rhinoplasty and extracorporeal septal reconstruction for initial fracture treatment. Using wide-field exposure with open rhinoplasty, these strategies provide optimal fracture reduction and rigid stabilization of the septal Lstrut using suture-based fixation and structural grafting techniques. The result is unsurpassed contour restoration and lasting architectural stability of the nose. When combined with power-driven instruments to cut, shape, mobilize, and create osseous suture holes, open structure stabilization of the disrupted skeletal framework establishes a new benchmark in acute fracture management. [ABSTRACT FROM AUTHOR]

The prominence of the nose renders it susceptible to soft tissue trauma of multiple etiologies. In this review, we present a framework for evaluation and treatment of nasal soft tissue injuries. Initial evaluation of nasal soft tissue injuries should include a complete trauma assessment, history, and physical examination. Mechanisms described include lacerations, abrasions, bites, and thermal injuries. Finally, we discuss wound care and surgical treatment options, including local flap and free tissue transfer. Though timing of repair remains somewhat controversial, most sources indicate that immediate reconstruction should be undertaken when possible. [ABSTRACT FROM AUTHOR]

Nasal fractures are the most common of all facial skeletal injuries. Untreated, these fractures frequently lead to functional and aesthetic problems. Careful history and physical assessment are critical to determine the extent of injury and to determine proper management. Critical aspects of assessment are discussed, as is the role of imaging in management. The unique aspects of pediatric nasal fractures and their management are reviewed. Fractures are classified based on the degree of injury and the involvement of the septum. A simple treatment algorithm is provided to help guide the selection of optimal treatment techniques. A review of instrumentation and treatment techniques is provided. The goal of treatment is to restore the nose to its preinjury shape and function and to minimize the need for secondary septorhinoplasty. Unauthorized distribution is strictly prohibited. [ABSTRACT FROM AUTHOR]

This review addresses thickening of the bony pyramid of the nose, a condition that is caused by in-flight oxygen masks in otherwise healthy Royal Netherlands Air Force (RNLAF) F-16 pilots. The overlying skin may show temporary or permanent reddening, irritation, thickening and may become painful. Both in vitro and in vivo animal research has shown that mechanical stimuli are converted into a biochemical response through a process called mechanotransduction. Examination of the RNLAF F-16 pilots showed that the oxygen mask exerts pressure and friction on the nose. The biochemical response to chronic exposure to these stimuli results in the development of skin conditions and eventually exostoses of the bony pyramid of the nose. Painful skin conditions are most frequently observed, while the development of exostoses is rare. It lies at the extreme end of the spectrum of the pilots' nasal conditions. The suboptimal fit of their work gear probably contributes to the pilots' soft and bony tissue nasal conditions. Explaining the pathogenesis of the development of exostoses may aid in the development of preventive measures. Also, the obtained knowledge may be of use in similar occupational health issues that involve mechanical loading. Our conclusions are that areas containing osteocyte precursors and covered by a relatively thin cushioning layer are prone to develop a soft tissue and bony tissue response when they are chronically exposed to intermittently exerted, mechanical stimuli of sufficiently high magnitude. Modification of the suboptimally fitting oxygen mask-helmet assembly is needed to prevent symptoms associated with its use. [ABSTRACT FROM AUTHOR]