Hong-Ryul Jin

Endoscopic versus external repair of orbital blowout fractures

OBJECTIVES: This study evaluates the usefulness of endoscopic repair compared to external repair in the treatment of blowout fracture (BOF) of the orbit. STUDY DESIGN AND SETTING: This retrospective study comprised 100 patients who had had surgical repair of orbital BOF since 1992. Forty-eight of the 100 had undergone endoscopic repair, 48 patients had had external repair, and four patients underwent surgery that combined the two approaches. The two basic approaches were evaluated and compared with respect to technique, results and complications. RESULTS: Endoscopically, transnasal and transantral approaches had been used for reduction and support of fractured medial and inferior walls, respectively. In the external approach, various transorbital incisions were made and the fractured wall was repaired with alloplastic or autologous materials. Complete or partial resolution of preoperative diplopia was achieved in 94% of the endoscopic group and 83% of the external group (NS). Enophthalmos was improved in 89% of the endoscopic group and 76% of the external group (NS). Though the endoscopic group had no significant complications, the external group had ectropions, significant facial scars, extrusion of inserted Medpor, and intra-orbital hematoma. CONCLUSIONS: Endoscopic repair appears to be a safe and effective technique for the treatment of BOF of the orbit.

Endoscopic Dacryocystorhinostomy: Creation of a Large Marsupialized Lacrimal Sac

This retrospective study describes and evaluates the effectiveness of a modified technique of conventional endoscopic dacryocystorhinostomy (DCR) that minimizes the obstruction of a neo-ostium by creating an enlarged marsupialized lacrimal sac using mucosal flaps. Forty-two patients who had undergone 46 endoscopic DCR at a tertiary medical center, from 2002 to 2004, for correction of lacrimal system obstruction were investigated. The surgical technique involves elevation of a nasal mucosal flap, full sac exposure using a power drill, and shaping of the mucosal flap to cover denuded bone and juxtapose exposed sac mucosa. Postoperative symptoms and endoscopic findings of the neo-ostium were evaluated. Mean duration of follow-up was 5.9 months. An eighty-three percent primary success rate was observed, without any serious complications. Obstruction of the neo-ostium with granulation tissue was observed in eight cases, among which six underwent revision with success in all cases. Overall, 44 (96%) of 46 cases experienced surgical successes. Endoscopic DCR, a procedure in which a large marsupialized lacrimal sac is created from mucosal flaps, yields a very satisfactory success rate with straightforward and highly successful revision available for those in whom the primary procedure yields a substandard result.

A multicenter evaluation of the safety of Gore-Tex as an implant in Asian rhinoplasty.

Background A retrospective multicenter study examined the safety of Gore-Tex as a nasal implant in rhinoplasty. Methods This study involved 853 patients (656 primary surgeries and 197 secondary surgeries) who had undergone rhinoplasty and used Gore-Tex either at the dorsum or at the nasal tip. Data were extracted from the medical records by surgeons and entered on a standard form. Data included the information about the demographics and history of the patient, method and results of surgery, complications, follow-up, and various factors believed to predispose to complications. Results The average follow-up period was 18 months. Overall complication rate associated with Gore-Tex was 2.5% (21 cases). Infection was the most common complication (18 cases; 2.1%) followed by two cases of seroma and one case of persistent nasal swelling. Among the 21 suffering complications, 19 patients (91%) needed graft removal. Nine cases of infection developed in primary surgeries (1.4%) and nine cases developed in secondary surgeries (4.6%), which represented a statistically higher complication rate in those undergoing secondary surgery (p = 0.0062). Infections developed within 1 month in five cases and nine cases developed infection >6 months postoperatively. Other complications including esthetic problems were identified in 16 cases (1.9%). Conclusion Gore-Tex should be used judiciously in rhinoplasty because of a 2.1% infection rate, a risk that is higher still after secondary surgery; moreover, once infected, Gore-Tex implants usually require removal.

Inverted papilloma of the nasal cavity and paranasal sinuses: A Korean multicenter study

The study group for sinonasal tumors at the Korean Rhinologic Society analyzed the results of the Korean multicenter experience for sinonasal inverted papilloma (IP) surgeries.

No packing versus packing after endoscopic sinus surgery: pursuit of patients' comfort after surgery.

Background This study was designed to evaluate the necessity of postoperative nasal packing and to find factors relevant in determining if nasal packing was required after endoscopic sinus surgery (ESS). Methods From January 2007 through June 2007, 64 consecutive patients who underwent ESS were evaluated. The decision whether or not to perform nasal packing depended on the surgeons judgment of the bleeding after surgery. Demographic characteristics, medical history, disease extent, surgical procedures, and subjective and objective amount of intraoperative bleeding were analyzed. Postoperative symptoms and endoscopic findings were evaluated also. Results Forty-eight (75%) of the 64 patients included in this study did not have nasal packing after ESS. One patient from the no-packing group needed nasal packing postoperatively because of persistent nasal bleeding. Symptom scores of nasal obstruction and postnasal drip on the 1st postoperative day were lower in the no-packing group. In unilateral ESS cases, subjectively estimated blood loss and mucosal inflammation scores were lower in the no-packing group. It was observed that preoperative steroid use was more frequent in the packing group. All other parameters did not show significant differences between the two groups. Conclusion Nasal packing can be safely used less frequently to help the patients experience less discomfort after ESS. The need for nasal packing after ESS can be decided by judicious estimation of bleeding during and after the surgery.

Complications Associated With Autologous Rib Cartilage Use in Rhinoplasty: A Meta-analysis

IMPORTANCE Although autologous rib cartilage is a preferred source of graft material in rhinoplasty, rib cartilage for dorsal augmentation has been continuously criticized for its tendency to warp and for high donor-site morbidities. However, no meta-analysis or systemic review on complications associated with autologous rib cartilage use in rhinoplasty has been conducted. OBJECTIVE To carry out a systematic review and a meta-analysis of available literature to evaluate complications regarding autologous rib cartilage in rhinoplasty. DATA SOURCES The studies reporting complications associated with the autologous rib cartilage use in rhinoplasty were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for sources published from 1946 through June 2013. STUDY SELECTION The selected articles included clinical studies conducted with at least 10 patients and at least 1 postoperative long-term complication or donor-site morbidity in rhinoplasty. Excluded were nonhuman studies; review articles; case reports; abstracts; and reports of nasal reconstruction as indication for surgery, use of homologous rib cartilage, and diced or laminated methods. DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed all studies and extracted the data using a standardized form. A meta-analysis was performed using a random-effects model. MAIN OUTCOMES AND MEASURES Number of patients; follow-up duration; and rates of complication, donor-site morbidity, and revision surgery. Also noted were study authors and year of publication. RESULTS Ten studies involving a total 491 patients were identified. Mean follow-up across all studies was 33.3 months. In meta-analysis, the combined rates were 3.08% (95% confidence interval [CI], 0%-10.15%) for warping, 0.22% (95% CI, 0%-1.25%) for resorption, 0.56% (95% CI, 0%-2.61%) for infection, 0.39% (95% CI, 0%-1.97%) for displacement, 5.45% (95% CI, 0.68%-13.24%) for hypertrophic chest scarring, 0% (95% CI, 0%-0.32%) for pneumothorax, and 14.07% (95% CI, 6.19%-24.20%) for revision surgery. CONCLUSIONS AND RELEVANCE The overall long-term complications and donor-site morbidity rates associated with autologous rib cartilage use in rhinoplasty were low. Warping and hypertrophic chest scarring showed relatively higher rates, warranting a surgeons attention. Because a limited number of studies and patients were eligible, and consistent definitions of complications were lacking in this meta-analysis, future studies with a larger series of patients and objective outcome measurements are needed to obtain more reliable results. LEVEL OF EVIDENCE 4.

Nasal tip augmentation in Asians using autogenous cartilage.

Objectives: To present surgical techniques and results of nasal tip augmentation in Asian noses and suggest a surgical algorithm for a successful outcome. Study Design: A case series at a tertiary hospital. Subjects and Methods: One hundred and seven patients who had undergone nasal tip augmentation using autogenous cartilages from January 2005 to December 2006 were enrolled in the study. Medical records, graphic operation records, and standardized patient photographs were retrospectively reviewed. Initial diagnoses, techniques for tip augmentation, combined tip surgery techniques, surgical results, and complications were analyzed. Results: Initial diagnoses included deviated nose, hump nose, saddle nose, low-profile nose, and short nose. An external approach was used in 74 percent and intranasal approach in 26 percent. For augmentation of the tip projection, onlay grafts with or without columellar strut (59%) and septal extension grafts with or without onlay grafts (25%) were the most commonly used techniques. Ninety-three percent of the patients were satisfied with the results. Complications included tip deviation and visible tip graft. Conclusion: Augmentation of nasal tip projection in Asians can be effectively performed using autogenous cartilage. Onlay graft and septal extension graft are two important techniques for a successful outcome.

Residual diplopia after repair of pure orbital blowout fracture: the importance of extraocular muscle injury.

Background The aim of this study was to evaluate the incidence of and possible risk factors for residual diplopia after surgical repair of pure blowout fracture (BOF) of the orbit. Methods Sixty-three patients with pure orbital BOFs who had preoperative symptomatic diplopia were investigated. In each patient, the relationship of residual diplopia and the following factors were analyzed: (1) timing of surgery, (2) presence of enophthalmos, (3) site of fracture, (4) type of fracture, (5) extraocular muscle swelling, and (6) surgical method. Results Fifty-five (87.3%) of 63 patients experienced improvement in diplopia and 8 (12.7%) patients had residual symptomatic diplopia after surgery. Of the six factors, only swelling of extraocular muscle on computed tomography (CT) scan was significant for the development of residual diplopia after surgery (p < 0.01). Conclusion In pure BOF of the orbit, patients who have swelling of the extraocular muscles on CT scan are more likely to have residual postoperative diplopia.

Computed tomography versus nasal endoscopy for the measurement of the internal nasal valve angle in Asians.

Conclusions. The internal nasal valve (INV) angle in Asians is 21.6°±4.5° and it is significantly larger than that of Caucasians. The reconstructed CT method has better reproducibility than the endoscopic method in measuring the INV angle. Objectives. The INV is an area of interest for nasal surgeons due to its functional significance in rhinoplasty and septoplasty. This study was designed to evaluate the size of the INV angle in an Asian population by measuring the angle through reconstructed CT scans and nasal endoscopy. Patients and methods. Thirty-eight ostiomeatal unit CTs and 24 endoscopic photos of patients who had minimal or no sinonasal problems were analyzed. CT images that had been reconstructed perpendicular to the acoustic axis and endoscopic photos were used to measure the INV angle. Each method was verified as to reproducibility and the angles measured by the two methods were compared. Results. The INV angle of the Asians measured by CT scan was 21.6°±4.5°. This value was significantly larger than that of the Caucasians, which has been reported to be 11.4°±2.6° (p<0.001). The INV angle measured endoscopically was 19.3°±3.6°. Reproducibility of the reconstructed CT method was good (p<0.001), while the reproducibility of the endoscopic method was poor (p=0.093). The correlation between the two methods was also poor (p=0.107).

Key maneuvers for successful correction of a deviated nose in Asians.

Background The authors present surgical results of 64 Asian patients with deviated nose and introduce important key maneuvers used in the surgery. Methods Sixty-four consecutive patients who underwent corrective rhinoplasty because of a deviated nose were analyzed retrospectively. Approaches and techniques used for the surgery, surgical results, and complications were evaluated. A questionnaire was used to evaluate each patients functional and esthetic satisfaction. Preoperative and postoperative standardized photographs of the face were evaluated to judge objectively the esthetic outcomes of the surgery. Results An endonasal approach was used in 44 patients and an open approach was used in 20 patients. Five important key maneuvers to correct the deviation were noted, in the order of frequency: septoplasty, osteotomy, spreader graft, turbinoplasty, and camouflage graft. Additional procedures included augmentation of the dorsum, tip surgery, and hump removal. On a 5-point box scale of 0–4, the patients scored their satisfaction on functional improvements as 3.2 ± 0.79 and their esthetic satisfaction as 3.0 ± 0.8. The objective evaluation of the appearance showed complete correction in 84.4%, a minimally visible deviation in 10.9%, and a residual deviation but less than before surgery in 4.7%. Aside from residual deviations, complications included a slight depression of the middorsum after spreader graft and a malpositioning of the dorsal cartilage graft. Conclusion Deviated nose in Asians can be managed successfully by combining key maneuvers that correct specific anatomic abnormalities. Many of these key maneuvers require modifications that take into account the race-specific characteristics of the Asian nose.