Alpen Nacar

Update on the Medical Treatment of Allergic Rhinitis

Allergic rhinitis is a global health problem affecting at least 10 to 25 % of the population. So far, numerous classifications and treatment modalities have been described. In the treatment of allergic disorders Pharmacotherapy is the most used therapeutic modality, especially in allergic rhinitis. The first step to successful management is the accurate diagnosis of the type of AR (intermittent or persistent) and assessment of its severity (mild or moderate to severe). Although objective measurements of the nasal airway have great value to evaluate and follow up the cases, in most centers they are not done in routine clinical practice. Allergen avoidance should be the initial step in the management of AR. Oral antihistamines are the first-line therapy for mild to moderate intermittent and mild persistent rhinitis. They are also recommended for moderate/severe persistent rhinitis cases which are uncontrolled on topical intranasal corticosteroids alone. Corticosteroids are well known for their antiinflammatory and anti allergic effects. Topical usage provides topical efficacy while avoiding systemic side effects. Meta-analysis shows that intranasal corticosteroids are superior to antihistamines. They act by suppression of inflammation at multiple points in the inflammatory cascade and reduce all symptoms of rhinitis. A meta-analysis demonstrated that Montelukast was better than placebo, as effective as antihistamines, but less effective than nasal corticosteroids in improving symptoms and QOL in patients with SAR. Good results were reported with subcutaneous and sublingual immunotherapy. Further investigations are promising.

Secondary Improvement in Static Facial Reanimation Surgeries: Increase of Nasal Function.

Objective:The aim of this study was to measure the effect of the static reanimation operation administered to patients with facial paralysis on nasal function area by comparing patients’ preoperative and postoperative subjective perception of the nasal airflow. Materials and Method:We applied the Nasal Obstruction Symptom Evaluation (NOSE) scale to 13 patients who underwent static reanimation because of facial palsies, both preoperatively and postoperatively, and results were compared statistically. The changes in nasal base angulation were recorded and compared based on the photographs of patients taken before and after the surgery. Results:Following the static reanimation operation, 76% (10/13) of the patients reported a subjective improvement in the nasal airflow, whereas 24% (3/13) did not report any change. Mean preoperative and postoperative NOSE scale scores were 66.92 ± 9.90 and 36.15 ± 9.61, respectively. The change in mean NOSE scale score was statistically significant (P < 0.001). In the preoperative and postoperative comparison of the photographs taken from the front view of the patients, a decreased nasal base angulation compared with preoperative period was detected in 8 (61.6%) patients. Conclusions:A statistically significant increase in subjective perception about nasal function was observed after the static facial reanimation; however, it is not certain whether this effect can be considered persistent. Long-term studies conducted on a larger patient population will provide beneficial results.

A novel method for nasal dorsal reconstruction: permanent fixation using Kirschner wire-guided hidden sutures.

Background:In this study, we aimed to present a novel application and use of Kirschner wire–guided suturing that is less invasive and allows permanent fixation for nasal dorsal reconstruction. Methods:A total of 23 patients, who underwent surgery between 2009 and 2013, were included in this study: 19 with saddle nose deformity and 4 patients with keystone area damage, or collapse of the dorsal nasal support during primary septoplasty or rhinoplasty. The patients were asked to fill out a nasal obstruction symptom evaluation (NOSE) scale preoperatively and at the postoperative sixth month to assess breathing quality. The patients were followed up for complications such as nasal dorsal contour irregularity, dorsal collapse, as well as graft malposition and infections. The results of the surgeries were assessed on the basis of preoperative and postoperative examinations, septal support test, NOSE scale results, and photographic comparison. Results:The mean (SD) NOSE scales were 78.91 (10.09) and 30.48 (10.71) in the preoperative and postoperative periods, respectively. The difference of mean NOSE scale was statistically significant (P < 0.001). None of the patients experienced nasal dorsal collapse or graft malposition. Two patients had nasal dorsal irregularity complaints owing to inadequate costal cartilage edge beveling. None of the patients had complications of suture reaction, suture visibility, or suture extrusion. All of the patients stated that they were happy with the cosmetic outcome. Conclusions:Permanent sutures introduced through channels made with the Kirschner wire provide a less invasive, cosmetically pleasing, and functional solution, promising more reliable results in the long term.

An Unexpected Otoplasty Complication: Temporal Nerve Paresis

Abstract Otoplasty, for prominent ear correction, is the most common aesthetic surgery procedure done in children. While the outcome often has a positive impact on the psychological state of the patient, the procedure itself does have associated complications that must be considered. Common complications include hematomas, infection, necrosis, outer ear canal stenosis, extrusion of sutures, insufficient correction, overcorrection, keloids, and hypertrophic scars. This is the first case report of facial nerve palsy as a complication following otoplasty. Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

A Novel Method for Smooth Contouring of Nasal Tip: Camouflaging Alar Tip Graft.

AbstractThe aim of this article is to define a tip graft that provides camouflage for a smoothly contoured, natural-looking tip and that prevents long-term graft visibility. When traditional grafts are used to substantially increase tip projection, there is a possibility for thinning of the skin and subsequent graft visibility. To avoid such unwanted results, the authors have developed a novel graft: the camouflaging alar tip (CAT) graft. In this study, the authors provide a retrospective analysis of the long-term follow-up of 742 patients from 2003 to 2013 in whom a CAT graft was placed. This article is a synopsis of the authors’ 10 years experience in nasal tip surgery.

An Update of the Classification and Treatment of Birthmarks in the Head and Neck Region

Birthmarks are present in 8-10% of the population. In the United States, of the 400,000 newborns who have a birthmark each year, 70% are misdiagnosed.1 Unfortunately most are diagnosed as hemangioma due to the clinical characteristics, findings, and varied physical appearances; as such, in this respect, patients are misinformed and misguided. Another issue is the use of incorrect terminology due to physicians not following updates in both nomenclature and class/grading schemes. In this review, we consider the misconceptions and confusing aspects of commonly occurring birthmarks and take into consideration the advances in updates to present this topic in a way that will be of use to most specialties.