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Background: The workhorse for endonasal reconstruction of skull base defects is the posteriorly-based nasoseptal flap (NSF). Postoperative nasal deformities and decreased olfaction are potential complications of NSF. The reverse septal flap (RSF) minimizes the donor site morbidity of the NSF by covering the exposed cartilage of the anterior septum. Currently, there are minimal data examining its effect on outcomes including nasal dorsum collapse and olfaction. Objective: Our study aims to clarify whether the RSF should be utilized when the option exists. Methods: Adult patients undergoing endoscopic endonasal approach (EEA) surgery of the skull base (transsellar/transplanum/transclival approaches) with NSF reconstruction were identified. Data from 2 separate cohorts, one retrospective and one prospective, were collected. Follow-up was at least 6 months. Patients were photographed preoperatively and postoperatively using standard rhinoplastic nasal views. Patients completed the University of Pennsylvania Smell Identification Test (UPSIT) and the 22-item Sino-Nasal Outcome Test (SNOT-22) preoperatively and postoperatively and were also queried regarding subjective changes in nasal appearance and plans for cosmetic surgery following EEA. Results: There were no statistically significant differences in the change in UPSIT and SNOT-22 scores between patients receiving RSF and other reconstructive groups (either NSF without RSF or no NSF). One of 25 patients who were reconstructed with an NSF with RSF reported a change in nasal appearance; none were considering reconstructive surgery. The proportion of patients reporting changes in appearance was significantly lower in the NSF with RSF group as compared to the NSF without RSF group (P =.012). Conclusion: The use of an RSF to limit donor site morbidity of the NSF was shown to significantly decrease the proportion of patients who reported nasal deformities and did not show a significant difference in patient-reported sinonasal outcomes. Given these findings, RSF should be considered whenever an NSF is used for reconstruction. [ABSTRACT FROM AUTHOR]

Objective The endoscopic endonasal approach (EEA) is commonly employed in skull base surgery for neoplasm resection. While nasal deformity following EEA is described, this study aimed to perform a detailed qualitative and quantitative assessment of the associated saddle nose deformity (SND) in particular. Setting/Participants This is a retrospective review of 20 adult patients with SND after EEA for resection of skull base tumors over a 5-year period at the University of Pittsburgh Medical Center. Main Outcome Measures Fifteen measurements related to SND were obtained on pre- and postoperative imaging. Statistical analyses were performed to evaluate differences between pre- and postoperative anatomies. Results The most common EEA was transsellar. Reconstruction techniques included nine free mucosal grafts alone, eight vascularized nasoseptal flaps (NSFs), one combined free mucosal graft/abdominal fat graft, and one combined NSF/fascia lata graft. Imaging analysis showed a trend toward loss of mean nasal height, nasal tip projection, and nasolabial angle postoperatively. Subgroup analysis showed that patients with NSF reconstruction had a significantly decreased nasal tip projection (1.2 mm, p = 0.039) and increased alar base width (1.2 mm, p = 0.046) postoperatively. Patients without functional pituitary microadenomas demonstrated significantly increased nasofrontal angle and decreased nasal tip projection on postoperative imaging, in contrast to those with functional adenomas who had no measurable significant changes. Conclusion Clinically evident SND does not always lead to significant radiographic changes. This analysis suggests that patients who undergo surgery for indications other than functional pituitary microadenomas or who receive NSF reconstruction develop more marked SND on standard imaging tests. [ABSTRACT FROM AUTHOR]

Objective: We aim to discuss the demographics, symptoms, bacteriology, treatment, and sequelae associated with nasal septal hematoma/nasal septal abscess (NSH/NSA)., Data Sources: CINAHL, PubMed, and Scopus were searched from inception until October 15, 2023., Review Methods: Preferred Reporting Items for Systematic Reviews and Meta-analysis 2020 guidelines were followed. Inclusion criteria included patients who were diagnosed with a traumatic NSH/NSA. NSH/NSA due to surgical procedures was excluded. Demographics included N of patients, patient age, and gender. Symptoms, antibiotics given, bacteriology, and sequelae were analyzed. Meta-analysis of continuous measures (mean, median), and proportions (%) with a 95% confidence interval (CI) was conducted., Results: Thirty studies (N = 598) were included. In total, 72.1% were males (95% CI: 67-78). The total mean age was 21.6 years (range: 0.2-85, 95% CI: 17.2-26.1). The mean time from trauma to diagnosis was 8.2 days. Common symptoms at presentation included nasal obstruction/congestion at 60.3% (95% CI: 37.1-81.4), nasal pain at 30.0% (17.2-44.6), swelling at 20.4% (8.7-35.5), headache at 15.5% (7.3-26.0), and fever at 13.9% (7.3-22.2). The most common pathogens isolated included Staphylococcus   aureus at 56.5% (49.0-63.8), Streptococcus species at 8.9% (5.2-14.0), and Klebsiella pneumoniae at 6.3% (3.2-10.8). Antibiotics given included amoxicillin-clavulanate at 10.3% (4.5-18.2), metronidazole at 9.5% (1.1-24.9), ampicillin-sulbactam at 8.9% (0.4-26.5), and unspecified antibiotics at 39.7% (13.8-69.2). The most common sequelae were nasal septal deformity/cartilage destruction at 14.3% (7.7-22.6)., Conclusion: NSA/NSH has an 8-day delay in diagnosis from the time of trauma. First-line practitioners should be made aware of the signs and symptoms of this condition to minimize the risk of morbidity., Competing Interests: All authors (Douglas P. Nanu, Daniel Adelsberg, Shaun A. Nguyen, Nicholas P. Radulovich, Michele M. Carr) report no financial support or funding., (© 2024 The Author(s). OTO Open published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Abstract Background Granulomatosis with polyangiitis (GPA) causes a recurring inflammation in nose and paranasal sinuses that clinically resembles chronic rhinosinusitis (CRS) of other aetiologies. While sinonasal inflammation is not among the life-threatening features of GPA, patients report it to have major negative impact on quality of life. A relatively large proportion of GPA patients have severe CRS with extensive damage to nose and sinus structures evident by CT, but risk factors for severe CRS development remain largely unknown. In this study, we aimed to identify clinical and radiological predictors of CRS-related damage in GPA. Methods We included GPA patients who had clinical data sets from time of diagnosis, and two or more paranasal sinus CT scans obtained ≥12 months apart available for analysis. We defined time from first to last CT as the study observation period, and evaluated CRS development across this period using CT scores for inflammatory sinus bone thickening (osteitis), bone destructions, and sinus opacifications (here defined as mucosal disease). In logistic regression, we applied osteitis as main outcome measure for CRS-related damage. Results We evaluated 697 CT scans obtained over median 5 years observation from 116 GPA patients. We found that 39% (45/116) of the GPA patients remained free from CRS damage across the study observation period, while 33% (38/116) had progressive damage. By end of observation, 32% (37/116) of the GPA patients had developed severe osteitis. We identified mucosal disease at baseline as a predictor for osteitis (odds ratio 1.33), and we found that renal involvement at baseline was less common in patients with severe osteitis at last CT (41%, 15/37) than in patients with no osteitis (60%, 27/45). Conclusions In this largely unselected GPA patient cohort, baseline sinus mucosal disease associated with CRS-related damage, as measured by osteitis at the end of follow-up. We found no significant association with clinical factors, but the data set indicated an inverse relationship between renal involvement and severe sinonasal affliction.

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Objective: Saddle nose deformity is a well‐described condition that most commonly results from trauma or prior surgery. For larger saddle nose deformity defects, bone grafts are a reconstructive option that provide adequate structure for repair. One new technique for repair of these deformities is a vomerian bone onlay graft. We aim to provide a review of literature on autogenous repair of saddle nose deformities, as well as introduce a new technique in which the vomer bone is used as an onlay bone graft. Methods: Literature review and case series. Five cases in which vomer onlay grafts were used for repair of saddle nose deformity were reviewed between January 2013 and December 2015. Aesthetic outcomes and postoperative complications were evaluated at subsequent follow‐up visits in clinic. Results: In all cases where vomer bone was harvested, the vomer onlay graft provided adequate structure to traverse the saddle nose deformity. No postoperative complications were observed in an 18 month follow‐up period. Conclusion: Vomerian bone onlay grafts are a reconstructive option for saddle nose deformity and nasal dorsum defects. While septal cartilage is commonly used, and ethmoidal bone has been previously described as an option for composite graft reconstruction, vomer bone onlay grafting has not been well described in the literature. This method may be of use when previous nasal surgery has been performed and standard septal cartilage is not possible to harvest. The aesthetic outcomes following nasal dorsum reconstruction using onlay grafts are favorable, but long‐term outcomes of these grafts require further study. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

The main purpose of this article is to present an alternative technique for the reconstruction of saddle nose deformity in patients with severely scarred or contracted soft tissue envelopes. In this single surgeon case series, the authors present a two-staged reconstruction performed on four adult patients with saddle nose deformities and contracted soft tissue envelope stemming from a variety of etiologic factors including vasculitis, sarcoidosis, and trauma. Stage one involved placement of a 1 × 4 cm tissue expander along the nasal dorsum through anterior scalp and endonasal incisions. The tissue expander port was positioned under the anterior scalp and injected with saline over 3 weeks in-office. Stage two involved removal of the tissue expander and rhinoplasty using osteocartilaginous rib grafts. All four patients had successful expansion of the contracted soft tissue envelope, creating adequate space for the newly reconstructed nasal framework. One patient developed exposure of the tissue expander through the endonasal incision, which did not lead to any adverse outcome. All patients in this series tolerated expansion well, without complaints of pain or external skin breakdown. The use of soft tissue expanders along the nasal dorsum can successfully expand contracted and scarred soft tissue envelopes prior to reconstructive rhinoplasty. This technique may be an effective alternative to the use of interpolated flaps in treating these patients. [ABSTRACT FROM AUTHOR]

Introduction: Correction of Saddle nose deformity is one of the most challenging issues in facial plastic surgery. Materials and Methods: In this study, a single structure in the form of L-strut was attempted to be created by using one 0.035" Kirschner wire and an autologous costal graft out of the 10th and 11th ribs. This study involved 13 cases, most of whom were traumatic. The corrective surgical techniques used in this study will be described in detail. Results: There was no warping, no rejection, and no infection in the created L-strut and patients’ satisfaction was very good during the follow up period. Conclusion: Surgical correction of a saddle-shaped nose using the described technique seems to be an acceptable and uncomplicated technique, and the cosmetic result is totally acceptable.

Pyoderma gangrenosum is a rare ulcerative condition associated with various systemic diseases. Lesions on the lower extremities and the trunk are common, but lesions on the nose are rare. Here we report a case of pyoderma gangrenosum on the nose. A 33-year-old woman presented with fever, nasal obstruction, and painful swelling on the nasal bridge. Physical examination revealed swellings on the nasal septal mucosa bilaterally. Computed tomography showed a septal abscess and a subcutaneous abscess on the nasal bridge. The lesions worsened despite treatment with intravenous antibiotics and abscess drainage. Meanwhile, the patient also complained of bloody stools and was diagnosed with ulcerative colitis. Therefore, pyoderma gangrenosum on the nose was suspected, and was diagnosed by exclusion of other diseases. Treatment with systemic corticosteroids was started and the nasal lesions improved rapidly. However, saddle nose deformity occurred. A review of the literature reveals that pyoderma gangrenosum on the nose can cause ulcerations, septal abscess, and sinusitis. Further, there is a high likelihood of nasal complications, including saddle nose deformity, septal perforation, and skin defects. Pyoderma gangrenosum should be included in the differential diagnosis when nasal ulceration, abscesses, and sinusitis do not improve with antibiotics and drainage. [ABSTRACT FROM AUTHOR]

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes granulomatous inflammation in the mucous membrane of the intestinal tract, especially in the colon. Additionally, UC can be accompanied by extraintestinal manifestation (EIM). EIM of UC includes cutaneous lesions such as pyoderma gangrenosum, and rarely, systemically occurring aseptic abscesses (AA) have been reported in a few cases. Nasal involvement of UC as an extraintestinal manifestation of IBD is rare, and few reports of nasal mucosa and septal cartilage involvement have been documented in the literature. However, aseptic nasal abscess involving septal cartilage associated with UC and pyoderma gangrenosum resulting in saddle nose deformity have not been reported. The author presents a case of a 52 year-old woman with UC and pyoderma gangrenosum and an aseptic abscess in the nasal septal cartilage resulting in saddle nose deformity, which was corrected by augmentation rhinoplasty. [ABSTRACT FROM AUTHOR]

Introduction: This is a diagnostic study that investigates the clinical significance between patients with short and long nasal bones and the variation in upper septal composition that would delineate propensity for middle vault collapse. Methods: Computed tomographic scans of 16 female patients undergoing evaluation with sinus films were analyzed. Two measurements were taken from each scout image: nasal bone length and total nasal length. Patient scans were separated into 2 groups; patients whose nasal bone length was less than one-half their total nasal length were defined as patients with "short nasal bone" (n = 8), and those with nasal bones longer than one-half the length of their noses were defined as patients with "long nasal bone" (n = 8). Results: Key differences were identified between patients with short and long nasal bones. Total septal area in the upper vault was decreased in the short nasal bone group relative to that of the long nasal bone group (5.7 ± 0.6 cm2 vs 8.1 ± 1.0 cm2, P = .002). This was mainly the result of the decreased ethmoid bone component in the short nasal bone group when compared with the long nasal bone group (1.6 ± 0.6 cm² vs 3.2 ± 0.8 cm², P = .007). [ABSTRACT FROM AUTHOR]

Centralmidface fractures should be treated early due to their propensity for secondary devastating and disfiguring consequences. For example, the expected sequelae to inadequately repaired naso-orbital ethmoid (NOE) injuries include shortened retruded nose, altered palpebral fissures, telecanthus, enophthalmos, and ocular dystopia, to name a few. Secondary repair of NOE fractures is indicated when primary surgical repair is not possible and for any of the aforementioned sequelae. When secondary repair of NOE fractures is necessary, these should be planned carefully while focusing on restoring facial function and aesthetics. Specific attention should focus on midface projection and intercanthal relationship. Virtual surgical planning as intraoperative navigation can be helpful for complex secondary reconstructions. [ABSTRACT FROM AUTHOR]

Introduction: Correction of Saddle nose deformity is one of the most challenging issues in facial plastic surgery. Materials and Methods: In this study, a single structure in the form of L-strut was attempted to be created by using one 0.035" Kirschner wire and an autologous costal graft out of the 10th and 11th ribs. This study involved 13 cases, most of whom were traumatic. The corrective surgical techniques used in this study will be described in detail. Results: There was no warping, no rejection, and no infection in the created L-strut and patients' satisfaction was very good during the follow up period. Conclusion: Surgical correction of a saddle-shaped nose using the described technique seems to be an acceptable and uncomplicated technique, and the cosmetic result is totally acceptable. [ABSTRACT FROM AUTHOR]

The subdorsal cantilever graft (SDCG) is a costal cartilage graft that is positioned below the nasal dorsum to control the position of the nasal bones and middle nasal vault. SDCG type A is used to raise the middle nasal vault and caudal nasal bones to correct the saddle nose deformity. SDCG type B can be used to raise the entire dorsum of the nose (radix, bony vault, and middle vault) in the ethnic augmentation rhinoplasty patient. This article will discuss the indications and technique of the SDCG in dorsal preservation rhinoplasty., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Subtotal septal reconstruction is a surgical technique used to reconstruct severe septal deviations that are not easily repaired using less invasive methods. Patients with identifiable septal fractures across the caudal or dorsal segments of the L-strut are good candidates. These patients may present with deformities such as the deviated nose or saddle nose. Adequate autologous cartilage is needed to reconstruct the septum. The deviated segments of the nasal septum are removed and then reconstructed by replacing the caudal septum with a straight piece of septal cartilage fixated to the nasal spine. The bilateral extended spreader grafts fixated to the remnant dorsal strut is then fixed to the caudal septal replacement graft to reconstitute the L-strut. In some cases, the dorsal strut may overlap the caudal portion of the L-strut to complete the repair. Care must be taken in setting nasal length, projection, rotation, and supratip break. If these parameters are not set very carefully deformity may ensue. Other potential complications include change in the upper lip smile or a crease forming in the upper lip when the patient smiles. This is a complex technique and must be performed with special care to avoid deformity. [ABSTRACT FROM AUTHOR]

Background: The removal of a paraffinoma over the nasal bridge may result in thinning and even loss of involved skin as well as a saddle nose deformity. For nasal reconstruction, a variety of techniques using a free graft of autogenous tissue such as fascia, dermofat, or cartilage have been used, either in immediate, single-stage or in delayed, multiphase treatment. However, such reconstructions can be challenging largely due to absorption of the grafted tissue and poor blood supply to the surrounding nasal tissue infiltrated with paraffin. This article reports the successful clinical outcomes of immediate, single-stage reconstructions by wrapping a pericraniosubgaleal flap over the nasal implant after removing a paraffinoma. Methods: Eleven patients with a paraffinoma showing a palpable lump, redness, or telangiectasia over the nasal skin were treated between November 1998 and March 2011. The mean follow-up period was 20.1 months. As much of the paraffinoma as possible was removed via a bidirectional approach (open rhinoplasty and frontal hairline incision), and the resulting deformity was reconstructed simultaneously using a pericraniosubgaleal flap and turning it over the sculpted nasal implant (ePTFE; GORE-TEX in nine cases and silicone in two cases). Results: Nine patients (81.8%) were treated successfully without complications and were satisfied with their results. However, the other two patients complained of incomplete removal of the paraffinoma requiring additional removal. Telangiectasia over the nose improved in four out of six patients after surgery. Conclusion: Nasal reconstruction using a pericraniosubgaleal flap is one of the most reliable surgical options for treating skin-involving nasal paraffinomas. The advantage of such a method is that a well-vascularized and durable flap, which is resistant to infection, is wrapped over the sculpted nasal implant in a single step. It also reinforces the thinned skin, which makes it easier to form various shapes, producing excellent cosmetic results. Finally, it can also serve as a tolerable graft bed in the case of overlying skin loss. [ABSTRACT FROM AUTHOR]

Summary: Hypohidrotic ectodermal dysplasia is a genetic disorder, which has significant manifestations in the ear, nose and throat but could escape detection or may be misdiagnosed due to the rarity of the condition. We present one such rare case of full-blown Christ–Siemens–Touraine syndrome in a female patient who presented to us for the first time with nasal and aural myiasis. When associated with myiasis, these patients are more vulnerable for the complications of both aural cholesteatoma and atrophic rhinitis. Hence the otolaryngologist needs to consider this disorder in the differential diagnosis of simultaneous aural and nasal myiasis. [Copyright &y& Elsevier]

Objective  The endoscopic endonasal approach (EEA) is commonly employed in skull base surgery for neoplasm resection. While nasal deformity following EEA is described, this study aimed to perform a detailed qualitative and quantitative assessment of the associated saddle nose deformity (SND) in particular. Setting/Participants  This is a retrospective review of 20 adult patients with SND after EEA for resection of skull base tumors over a 5-year period at the University of Pittsburgh Medical Center. Main Outcome Measures  Fifteen measurements related to SND were obtained on pre- and postoperative imaging. Statistical analyses were performed to evaluate differences between pre- and postoperative anatomies. Results  The most common EEA was transsellar. Reconstruction techniques included nine free mucosal grafts alone, eight vascularized nasoseptal flaps (NSFs), one combined free mucosal graft/abdominal fat graft, and one combined NSF/fascia lata graft. Imaging analysis showed a trend toward loss of mean nasal height, nasal tip projection, and nasolabial angle postoperatively. Subgroup analysis showed that patients with NSF reconstruction had a significantly decreased nasal tip projection (1.2 mm, p  = 0.039) and increased alar base width (1.2 mm, p  = 0.046) postoperatively. Patients without functional pituitary microadenomas demonstrated significantly increased nasofrontal angle and decreased nasal tip projection on postoperative imaging, in contrast to those with functional adenomas who had no measurable significant changes. Conclusion  Clinically evident SND does not always lead to significant radiographic changes. This analysis suggests that patients who undergo surgery for indications other than functional pituitary microadenomas or who receive NSF reconstruction develop more marked SND on standard imaging tests., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)