Sami Alharethy

Effect of periosteum elevation on periorbital ecchymosis in rhinoplasty

Figure 1 Left eye, ecchymosis grading system. A technique used to reduce the degree of postoperative ecchymosis following osteotomy is periosteal preservation at the osteotomy site, achieved by elevating the periosteum prior to performing the osteotemy. The intact periosteum is then supposed to act as a barrier for the blood to extravasate to the subcutaneous tissue. However, a recent study by Kara et al. on 18 patients showed that the opposite is true. The aim of this study is to reinvestigate this factor in a prospective group of patients. Seventy-eight patients were included in this prospective study from March 2004 to March 2006. All patients included in the study were medically fit and all agreed to sign an informed consent. All operations were performed under general anaesthesia and 1% lidocaine with 1:200 000 epinephrine solution used for local infiltration. After removing the dorsal hump a lateral low to high osteotomy was performed using a 4 mm guarded (curved) osteotome. The osteotomy was performed bilaterally using the same instruments in all patients. Every patient acted as his own control. The osteotomy was done without periosteal elevation on one randomly selected side and after periosteal elevation on the contralateral side using McKenty Freer. The incisions were made at the pyriform aperture just above the level of the anterior end of the inferior turbinate and were not closed thereafter. The subperiosteal tunnel extended from the incision site to the inner canthal level. The osteotomy was completed with a gentle greenstick fracture. After surgery all patients received the same postoperative care, including head elevation at 45 ; no steroids were given.

Surgical Outcomes of Bony Batten Grafting to Correct Caudal Septal Deviation in Septoplasty

Improtance Correction of caudal septal deviation with a batten graft has been popularized recently. However, few reports have documented the surgical outcomes of this technique, especially the use of bony batten grafts in septoplasty. Objective To evaluate the surgical outcomes of bony batten grafting for the management of caudal septal deviation in endonasal septoplasty. Design, Setting, and Participants This retrospective cohort study evaluates the medical records of 141 patients with caudal septal deviation who underwent septoplasty using bony batten grafts from September 1, 2011, through February 29, 2016, at a tertiary referral hospital. Patients were divided into primary and secondary surgery groups. Patients were also divided into the septoplasty plus turbinate surgery and the septoplasty only group. Endoscopic assessment of deviation correction was performed, and postoperative complications were analyzed. Main Outcomes and Measures Patient satisfaction and symptom improvement were evaluated via telephone interviews by using the Nasal Obstruction Symptoms Evaluation (NOSE) scores. Results Of the 141 patients (24 women [17%] and 117 men [83%]; mean [SD] age, 32.8 [12.9] years), 86 (61%) rated their symptoms in the postoperative survey as much improved; 50 (35.5%), improved; 4 (2.8%), no change; and 1 (0.7%), worse. All patients had significantly improved mean (SD) postoperative NOSE scores (28.7 [22.0]; 95% CI, 25.0-32.4) compared with preoperative scores (70.5 [26.7]; 95% CI, 66.0-75.0; P < .001). No significant intergroup differences were observed in surgical outcome between the 116 patients undergoing primary surgery (mean [SD] NOSE score, 28.2 [21.9]) and 25 undergoing secondary surgery (mean [SD] NOSE score, 30.8 [24.3]; P = .34). No significant difference in surgical outcome was found between the 102 patients in the turbinate surgery group (mean [SD] NOSE score, 28.1 [20.8]) and 39 in the septoplasty only group (mean [SD] NOSE score, 30.4 [23.7]; P = .65). On endoscopic examination for surgical outcome, 128 patients (90.8%) had a straight septum and 13 (9.2%) had improved but residual caudal deviation. Postoperative complications included septal hematoma in 4 patients, hyposmia in 2, and chondritis in 1; all patients were treated successfully. Four patients required revision surgery because of incomplete functional correction or a desire for rhinoplasty. Conclusions and Relevance Septoplasty using bony batten grafts is useful for correcting caudal septal deviation with favorable surgical outcomes and an acceptable complication rate. Level of Evidence 3.

Trends and demographic characteristics of Saudi cosmetic surgery patients

Objectives: To present the demographic characteristics of Saudi patients undergoing cosmetic procedures. Methods: This prospective study survey was conducted in 3 private cosmetic surgery centers in different regions of Saudi Arabia (Riyadh and Jeddah) between January and August 2016. Validated questionnaire with modification was used and the following patient’s information were provided: age group, height and weight, marital status, number of children, age of the patient’s spouse, educational level, monthly income, name of the cosmetic procedure, names of any previous cosmetic procedures and their reason for cosmetic procedure. Results: The present study revealed that a typical Saudi cosmetic surgery patients are university graduates, married (46.8%), employed (68.3%), and middle aged 20-40 years of age (70%), with a fairly high typical monthly income. Conclusion: There is a possible positive correlation between gender and undergoing cosmetic procedure. Laser hair removal, botox, liposuction, filler, and scar revision are common among females, while rhinoplasty is a common procedure among males.

Medical residents’ attitudes and emotions related to Middle East respiratory syndrome in Saudi Arabia. A cross-sectional study

Objectives: To determine medical residents’ emotions, attitudes, and knowledge related to Middle East respiratory syndrome (MERS) outbreaks. Methods: In this is a cross sectional study, self-administered questionnaires were distributed and collected before resident education activities in 4 tertiary hospitals in Riyadh, Kingdom of Saudi Arabia, between November 2015 and January 2016. The questionnaire included questions related to residents’ demographic data and their emotions, attitudes, and knowledge related to an MERS outbreak. Results: Of the 228 participants analyzed, 85.5% believed their work put them at risk of infection, and two-thirds believed their family was exposed to a greater risk of infection. However, only 2.6% would change their job. Nearly half of the residents indicated that their hospital had a clear plan, and only 28% considered themselves not well prepared for an MERS outbreak. Conclusions: Our study highlights medical residents’ attitude and emotions related to MERS outbreaks. Residents’ concerns and emotions in relation to MERS should be considered in greater detail by hospital policymakers.

Anthropometry of Arabian Nose using Computed Tomography Scanning

BACKGROUND The nose plays a critical role in determining the external appearance of an individual. We studied the craniofacial anthropometrics by CT scanning since previous studies in the field were conducted in Saudi populations using photometric analysis. OBJECTIVES Obtain objective and quantitative data that can help surgeons plan cosmetic procedures for the nose. DESIGN A cross-sectional analytical study. SETTING Department of Otorhinolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia from February 2015 to December 2015. PATIENTS AND METHODS Facial CT scans were performed on native Saudis who underwent CT of the paranasal sinuses. MAIN OUTCOME MEASURE(S) Three anthropometric parameters: the nasofrontal angle, the pyramidal angle, and the linear distance between the nasion and the tip of the nasal bone. RESULTS In 160 native Saudis (86 males and 74 females) who underwent CT, the mean nasofrontal angle was 125.3° in males and 135.6° in females. The mean linear distance between the nasion and the tip of the nasal bone was 23.0 mm for males and 20.9 mm for females. The mean nasal pyramidal angle was 110.8° in males and 111.9° for females at the level of the nasal root, 105.6° in males and 104.8° in females at the mid-level of the nasal bone, and 116.8° males and 107.9° in females at the level of the tip of the nasal bone. CONCLUSION Nasal bone lengths and angles can be obtained accurately from CT scans. These angles differ in different ethnic groups. LIMITATIONS The sample represents native Saudis but not a cross section of the Saudi population. The relatively small sample size is a limitation of the study, but we consider these to be initial findings.

Common Nasal Deformities among Rhinoplasty Patients in a University Hospital in Saudi Arabia

BACKGROUND Rhinoplasty has become one of the most common aesthetic procedures in the world. Few studies from the Middle East have described rhinoplasty patients in the region. OBJECTIVE To investigate common nasal deformities in individuals seeking rhinoplasty at a single institution in Saudi Arabia. DESIGN Retrospective study and chart review. SETTING King Abdulaziz University Hospital, Riyadh, Saudi Arabia. PATIENTS AND METHODS All patients seeking primary rhinoplasty who were 15 years of age and older were included. The types of external nasal deformities were compared by gender and age groups. MAIN OUTCOME MEASURE Types of external nasal deformities. RESULTS Of the 248 patients investigated, 113 were male and 135 female. The most common external nasal deformity was a broad dorsum (n=163; 65.7%), followed by a bulbous columella (n=154; 62.1%), and deviation (n=150; 60.5%). Upward columella was most common in older patients, and deviation decreased with age. CONCLUSION The most common deformity among the study population of Saudis was a wide nasal dorsum, bulbous nasal tip and deviated nose. Studying nasal deformity in some ethnic groups has an influence in selecting and practicing specific rhinoplasty approaches. LIMITATIONS Study conducted in one hospital and may not be generalizable.

Validation of the Arabic version of the score for allergic rhinitis tool

BACKGROUND Allergic rhinitis (AR) is a common inflammation of the nasal mucosa in response to allergen exposure. We translated and validated the Score for Allergic Rhinitis (SFAR) into an Arabic version so that the disease can be studied in an Arabic population. OBJECTIVES SFAR is a non-invasive self-administered tool that evaluates eight items related to AR. This study aimed to translate and culturally adapt the SFAR questionnaire into Arabic, and assess the validity, consistency, and reliability of the translated version in an Arabic-speaking population of patients with suspected AR. STUDY DESIGN Cross-sectional. SETTING Tertiary care hospital in Riyadh. PARTICIPANTS AND METHODS The Arabic version of the SFAR was administered to patients with suspected AR and control participants. MAIN OUTCOME MEASURE Comparison of the AR and control groups to determine the test-retest reliability and internal consistency of the instrument. RESULTS The AR (n=173) and control (n=75) groups had significantly different Arabic SFAR scores (P<.0001). The instrument provided satisfactory internal consistency (Cronbach’s alpha value of 0.7). The test-retest reliability was excellent for the total Arabic SFAR score (r =0.836, P<.0001). CONCLUSION These findings demonstrate that the Arabic version of the SFAR is a valid tool that can be used to screen Arabic speakers with suspected AR. LIMITATIONS The absence of objective allergy testing

Nasal bone length in Saudi rhinoplasty: a clinical-radiological study.

BACKGROUND AND OBJECTIVES Hump reduction in the presence of short nasal bones can result in significant esthetic and/or functional problems in patients seeking rhinoplasty in the Middle East. The aims of this study were to determine the mean length of nasal bones, amount of nasal dorsum it forms in relation to the whole nose, and incidence of short nasal bones in the Middle Eastern population. DESIGN AND SETTINGS A prospective study that has been carried out in a tertiary care hospital. PATIENTS AND METHODS A total of 154 patients (80 females and 74 males) who were scheduled for computed tomography scan for the paranasal sinuses were included in the study. The inclusion criteria were adults with no history of facial/nasal trauma, sinus space occupying lesions, or surgery. RESULTS In males, the mean clinical nasal bone length was 19.59 mm and the mean radiological nasal bone length was 24.96 mm. In females, the mean clinical nasal bone length was 18.17 mm and the mean radiological bone length was 22.82 mm. CONCLUSION The bony vault represents 44.2% of the female nose and 44.3% of the male nose. In the present study, no patients displayed a short nasal bone that was less than one-third of the whole nasal length.

Aberrant internal carotid artery in the middle ear.

An aberrant internal carotid artery (ICA) in the middle ear space can present in 1% of the population. the clinical diagnosis can be difficult as most patients with this anomaly are either asymptomatic or have nonspecific clinical symptoms and signs. Moreover the diagnosis can easily be missed and only discovered when injurey occur to the ICA during middle ear surgey with resulting life-threatning complications. A knowledge of this anomaly and its differential diagnosis is of high importance to any practitioner dealing with otologic diseases and performing otologic surgeries. We report a 7-year-old girl with a right aberrant ICA presenting with hearing loss and review published studies concerning this disease entity presentation, diagnosis, and management.

Failure of Synthetic Implants: Strategies and Management

Abstract Dorsal augmentation with synthetic implants is the most commonly performed rhinoplasty procedure, especially in the East‐Asian region. However, as in all other surgical procedures, complications are inevitable. Complications that need to be managed surgically include displacement, deviation, suboptimal aesthetic outcome, extrusion, inflammation, infection, and changes in skin quality. Most complications can be easily managed with revision surgery. After the removal of the synthetic implant from the nasal dorsum, different dorsal implant materials such as dermofat, alloderm, or fascia‐wrapped diced cartilage, conchal cartilage with perichondrial attachment, and costal cartilage are preferred. An irreversible change in the skin/soft tissue envelope poses a challenge that usually requires reconstructive surgery with a local flap. Therefore, early detection and prompt management of the complication are essential for minimizing the severity of the deformity and the complexity of the surgical procedures.