Nipun Chhabra

The Diagnosis and Management of Empty Nose Syndrome

Empty nose syndrome (ENS) is a poorly understood and rare iatrogenic disorder resulting from the destruction of normal nasal tissue. In severe forms, it can be debilitating. In this article, the authors elucidate the distinction between ENS and atrophic rhinitis, and provide a systematic approach to the diagnosis and management of ENS. They urge a judicious and cautious approach to turbinate resection, to help better prevent this sequela of nasal surgery. They state that patients with ENS can be rehabilitated and their quality of life substantially improved with nasal augmentation as a means to help restore nasal anatomy toward the premorbid state.

Endoscopic resection of orbital hemangiomas

Cavernous hemangiomas are the most common orbital tumors in adults. Traditional orbitotomy approaches to resect these intraconal lesions are associated with patient morbidity due to difficulties with visualization and access in the region of the orbital apex.

The Surgical Management of Allergic Rhinitis

In their discussion of the treatment of allergic rhinitis, the authors present key features of the disease and its management, allergen responses, the role of the inferior turbinate, and reviews of outcomes with submucosal resection, total inferior turbinectomy, cryosurgery, laser cautery, radical turbinectomy, submucous turbinectomy, submucous electrocautery, and microdebriber turbinoplasty. The authors discuss radiofrequency ablation and coblation outcomes and complications, along with the role of endoscopic sinus surgery in allergic rhinitis and emphasize the need for Otolaryngologists to be facile with a variety of procedures for best outcomes.

Surgical risk factors for recurrence of inverted papilloma.

To identify variations in surgical technique that impact the recurrence of inverted papilloma following endoscopic excision.

Endonasal repair of septal perforations using a rotational mucosal flap and acellular dermal interposition graft

The closure of nasal septal perforations can be challenging based on the etiology, location, and method of closure. We report on a novel method of closure for nasal septal perforations using a unilateral mucosal rotational flap and acellular dermal interposition graft.

Compartmental endoscopic surgical anatomy of the medial intraconal orbital space

Surgical management of intraconal pathology represents the next frontier in endoscopic endonasal surgery. Despite this, the medial intraconal space remains a relatively unexplored region, secondary to its variable and technically demanding anatomy. The purpose of this study is to define the neurovascular structures in this region and introduce a compartmentalized approach to enhance surgical planning.

The nasoseptal flap for reconstruction of the medial and inferior orbit

Endoscopic endonasal orbital surgery may result in large orbital defects that mandate reconstruction to minimize the risk of diplopia and enophthalmos. The purpose of this study is to determine whether the nasoseptal flap can provide adequate coverage of maximal orbital defects.

Surgical options for the allergic rhinitis patient.

Purpose of reviewAllergic rhinitis is a very common disorder that affects millions of patients annually and the hallmark complaint of nasal obstruction significantly impacts the quality of life. Many surgical options exist for the treatment of allergic rhinitis, directed primarily at the underlying nasal obstructive component. The purpose of this review is to highlight and discuss the various surgical modalities and their historical efficacy. Recent findingsMuch of the literature has focused on reduction of the inferior turbinate for symptomatic improvement in patients afflicted with allergic rhinitis. Endoscopic sinus surgery and septoplasty play little role in the management of allergic rhinitis, unless when seen in conjunction with other conditions such as rhinosinusitis. SummaryAlthough no single modality has evolved as the gold standard for the treatment of allergic rhinitis, the mainstay of surgical intervention targets the inferior turbinate. It is very important for the otolaryngologist to be familiar with an armamentarium of surgical techniques.

Lateral arm microvascular free tissue reconstruction of a large neck keloid

Keloid scars pose a surgical challenge in the region of the head and neck. We present a rare case of a large infected and recurrent neck keloid that failed multiple prior reconstructive attempts. Ultimately, the tissue was resected and the surgical bed was repaired with a lateral arm microvascular free flap. This repair emphasizes the need for adequate coverage of the defect while maintaining neck mobility, ease of swallowing, and cosmesis. This is the second report in the literature of free tissue transfer as treatment for a large keloid scar, and the first to show the feasibility of early post operative low dose irradiation of the surgical bed.

Subcutaneous emphysema after otologic surgery: A case report

Subcutaneous emphysema of the head and neck after otologic surgery is exceedingly rare. The mechanism relates to the intimate relationship of the temporomandibular joint to the external auditory canal. We present a rare case of subcutaneous emphysema after otologic surgery for ear disease. An astute clinical index of suspicion coupled with prompt treatment can help minimize morbidity and improve patient outcomes.