Denizhan Dizdar

Association of Autologous Costal Cartilage Harvesting Technique With Donor-Site Pain in Patients Undergoing Rhinoplasty

Importance Postoperative pain at the donor site is a common morbidity following autologous costal cartilage grafting. Objective To evaluate postoperative pain at the donor site after the use of a muscle-sparing costal cartilage harvesting technique compared with a muscle-cutting technique using electrocautery. Design, Setting, and Participants Designed as a controlled trial without randomization, this prospective, comparative cohort study was conducted between January 1, 2016, and March 31, 2017. Participants included 20 patients who underwent rhinoplasty for various cosmetic and functional complaints from January 1, 2016, to February 28, 2017. Of the 20 patients, 1 was excluded owing to an infection that developed on postoperative day (POD) 7. Patients were grouped by the rib harvesting technique used that was either a muscle-sparing technique (n = 11) or a muscle-cutting technique (n = 8). Skin incisions for both groups were carried out with a blade. Transection of muscle fascia and muscle fibers was performed with monopolar electrocautery in the muscle-cutting technique group. Blunt dissection with a hemostat was performed in the muscle-sparing technique group. All other surgical techniques were identical. Main Outcomes and Measures Postoperative pain was assessed with visual analog scale scores for resting pain and movement pain. Eight pain measurements were noted at the sixth postoperative hour and on PODs 1, 2, 3, 7, 15, 30, and 45. During the hospital stay, the postoperative need for analgesics was recorded daily as the number of analgesic infusion vials used. Results The 19 patients in the study included 11 women and 8 men whose mean age (SD) was 33.2 (10.3) years The mean (SD) visual pain analog scale scores for resting pain and movement pain were consistently higher in the muscle-cutting technique group than in the muscle-sparing technique group. This difference was statistically significant on PODs 2, 3, and 15 for resting pain and on PODs 2, 3, 7, 15, 30, and 45 for movement pain. The mean postoperative need for analgesic infusion vials during hospital stay was higher in the muscle-cutting technique group, and the difference was statistically significant on POD 2 (1.9 [0.6] vials vs 1.0 [0.9] vials; P = .02). Conclusions and Relevance Both resting and movement pain at the donor site was significantly reduced in the muscle-sparing technique group during the postoperative period, findings that align with anecdotal reports in the literature. Routine use of the muscle-sparing technique in autologous costal cartilage harvesting is recommended to reduce postoperative pain. Level of Evidence 2.

Intraoperative Visual Documentation Using Smart Mobile Devices: A Simple Solution for Facial Plastic Surgeons.

Perioperative visual documentation is essential for facial plastic surgery. Before-and-after documentation with high standards is a routine of our daily practice,1,2 but intraoperative visual documentation (IVD) can be a hassle. Intraoperative visual documentation can be used as a useful addition to written operationnotes.3,4 Intraoperativevisual documentation is necessary not only for personal archiving and self-progress but also for sharing the surgical pearls through scientific meetings and literature. Practical and inexpensive ways of intraoperative photodocumentation have been described in the literature.5,6 Video documentation is another essential part of this process, and many professional systems are commercially available, but these require specific costly equipment, and unfortunately they are not a routine part of every facial plastic surgeon’s practice. An ideal IVD solution should be easy to set up, easy to control, enable stable and steady recording from various angles, should not interfere with the surgery, and be affordable. Smart mobile devices (SMDs) are readily available and provide high-definition (HD) photography (12 megapixels) and video recording (HD [1920 × 1080 and even 4K [3840 × 2160] video recording). Although footage recorded with these devices has been used for scientific purposes in the past,7 they are not suitable for intraoperative documentation purposes as is, mainly owing to particular shortcomings. These devices need to be held steadily by someone at a good recording angle. This is not always possible without interfering with the surgery, and can result in shaky and unsteady recordings that are poor in quality. Either the surgeon gets in the way, or the visual field or sterility and/or surgery is compromised. In addition, it is a hassle for the “sterile” surgical team to ensure ideal positioning of the camera and (start/pause) recording while operating. We wanted to share our simple and affordable IVD solution using SMDs (Video 1). A device holder and a Bluetooth remote shutter is required for this solution (Figure 1). Various device holders are commercially available under the name of “car mounts” and are available on the internet for less than

Does iron deficiency anemia affect olfactory function

15. Bluetooth remote shutters are also available for less than

Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients

10. In total, this setup costs less than

Response to comment: An objective assessment of halitosis in children with adenoid vegetation during the pre- and postoperative periods

25. Connecting the SMD to the operative lights with a “vacuumed mobile device holder” ensures stabilization and ease of recording from various angles (Figure 2). It works in a fashion similar to that of professional cameras embedded to operative light handles that record bird’s eye views. When the Bluetooth remote shutter is paired to the mobile device, it works as a shutter in photography mode, and when the device is in video recording mode, clicking the button will start or stop recording. The small remote shutter can be inserted in a sterile nylon bag for the control of the surgical team. A sterile handle attached to the operative lights will enable the surgeon to easily control the positioning and angle of the camera as required. This solution enables both intraoperative photography and video recording. The easy setup (it takes <2 minutes) makes it practical to use, and the only requirement is the presence of operating theater lights. Easy synchronization/backup of IVD footage using the cloud system is another pro of this solution. This setup may be useful for facial plastic surgeons looking for an affordable and practical IVD system. Surgical techniques, interesting and new surgical cases, and unsuspected findings can be documented with this approach. Although there are more professional systems that provide superior results, this is a simple solution that makes use of the technology readily available in facial plastic surgeons’ pockets. Video at jamafacialplasticsurgery.com

A Simple Technique to Avoid Restenosis for Dacryocystorhinostomy.

Abstract Conclusion This study found a negative effect of IDA on olfactory function. IDA leads to a reduction in olfactory function, and decreases in hemoglobin levels result in further reduction in olfactory function. Objective This study examined the effects of iron-deficiency anemia (IDA) on olfactory function. Method The study enrolled 50 IDA patients and 50 healthy subjects. Olfactory function was evaluated using the Sniffin’ Sticks olfactory test. The diagnosis of IDA was made according to World Health Organization (WHO) criteria. Results Patients with IDA had a significantly lower threshold, discrimination, and identification (TDI) value, and a lower threshold compared with the control group. However, there were no significant differences between the groups in terms of smell selectivity values.

Osmophobia and olfactory functions in patients with migraine

INTRODUCTION The most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those. OBJECTIVE In this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization. METHODS This retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0±12.4 years, range 17-61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography. RESULTS The transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p=0.004). In both groups the lower turbinate volumes were significantly decreased (p=0.002, p<0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p=0.033). CONCLUSION Both turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization.

An objective assessment of halitosis in children with adenoid vegetation during pre- and post-operative period

We greatly appreciate the readers valuable comment. We completely agree with the reviewer that the diagnosis of allergic rhinitis (AR) is based on history, physical examination, and allergy tests. However, in many cases, especially in children, we tend to prefer noninvasive procedures. Therefore, in our study, patients with suspicious AR history or suspicious AR findings on endoscopic examination were excluded. As we mentioned in the Discussion section, one of the limitations of our study was the small sample size. Although adenoid hypertrophy is a common childhood disease, few potential participants met all the criteria. Therefore, the adenoid hypertrophy group included only 40 patients. A detailed history was obtained, and nasal endoscopy was performed with a rigid pediatric nasal endoscope in all subjects to visualize all anatomic details, differentiate nasal pathologies, and assess estimated adenoid size. Recently, a significant relationship was reported between endoscopic findings and the perception of nasal symptoms in children with AR [1]. AR is a common chronic disorder characterized by typical symptoms, including itchy nose, sneezing, rhinorrhea, and nasal obstruction. The nasal mucosa is particularly exposed to allergens and represents the site of local inflammation in AR. Nasal inflammation induces the occurrence of anatomic changes that may be easily observed during endoscopy. The typical endoscopic picture in children with AR is characterized by hypertrophic turbinates with relevant edema of the inferior turbinate head. This edema is usually localized and sectorial and may cause contact between the inferior turbinate and the lateral wall. In addition, pale turbinates are considered by most physicians to be a sign of AR [2]. It also does not seem possible that allergic inflammation is capable of causing adenoid hypertrophy without causing any nasal anatomic changes that may be observed by endoscopic examination. Because of the invasive nature of allergy tests, Ameli et al. investigated whether the diagnosis of allergic rhinitis in children could be made by anamnesis and endoscopic examination. They reported that endoscopic features associated with clinical symptoms could precede the classical AR diagnosis based on allergy tests in children. Furthermore, they reported that about 20% of children with suspected AR were negative on the skin prick test despite both clinical and endoscopic suspicions. In other words, localized edema might

Effects of Spreader Grafts on Olfactory Function in Septorhinoplasty

The most common reason for failure in dacryocystorhinostomy has been proven to be the granuloma or membranous obstruction of scar tissue formation on lacrimal opening in the nasal cavity during the healing process. In this article, the authors suggest an easy maneuver to avoid the risk of scarring and collapsing of the knot in bony window by using a piece of an aspiration catheter. Using this easy maneuver, the authors can manage to reduce the risk of scarring and stenosis, and when the authors take out the tubes after 2 months, removing the silicone tube was easier with our technique. Moreover with the present technique the authors observed there was no embedding of the knot in the scar.