Primary aesthetic rhinoplasty

Rhinoplasty is the aesthetic surgical intervention that covers the reshaping of the external nasal pyramid. It includes aesthetic and functional aspects, and addresses developmental or acquired pathology. Characteristically, it is associated with significant psychological overlay and due to the complex three-dimensional nasal structure it is the object of intense patient scrutiny involving fine detail from multiple angles. Nasal physiology characteristics dictate that aesthetic alterations can have profound physiological effects that need to be considered carefully in the design and execution of rhinoplasty surgery.

Woakes’ syndrome: Case report

Woakes’ syndrome is a rare entity, defined as severe recurrent chronic rhinosinusitis with nasal polyps, which has as a consequence the deformation of the nasal pyramid, produced by the continuous pressure and the inflammation maintained by the size of the polyps. This paper reviews the main features of Woakes’ syndrome by describing a clinical case. The patient presented to the ENT Outpatient Clinic for aggravation of an obstructive nasal respiratory syndrome, associated with rhinor-rhea, headache, anosmia and deformity of the nasal pyramid. The ENT clinical examination, the nasal endoscopic examination and the craniofacial CT scan established the diagnosis of Woakes’ syndrome. Functional endoscopic sinus surgery was performed. The follow-ups performed at 10 days and later, a month after surgery, showed a favourable evolution, without signs of local recurrence and a narrowing of the nasal pyramid compared to the preoperative moment. Proper management and proper adherence to the therapeutic protocol are factors that can prevent the onset of this syndrome.

High Anti-Leishmania IgG Antibody Levels Are Associated With Severity of Mucosal Leishmaniasis

BackgroundMucosal leishmaniasis (ML), the most inflammatory form of tegumentary leishmaniasis, is predominantly caused by Leishmania braziliensis. The disease is characterized by the development of lesions, mainly in the nasal mucosa. An exacerbated inflammatory response has been associated with the presence of destructive and disfiguring lesions, with stages of severity ranging from small nodulations to the complete destruction of the nasal pyramid architecture. As Leishmania is an intracellular parasite, most immunological studies have emphasized the cell-mediated immune response, while relatively few studies aimed to investigate the role antibodies in protection against, or the pathology of ML.MethodsPatients with a confirmed diagnosis of ML were classified according to clinical staging criteria. Serum levels of Leishmania-specific IgG, IgG1 and IgG2 antibodies were determined by ELISA before and after treatment with antimony or antimony plus pentoxifylline.ResultsPatients in stages IV and V produced higher concentrations of IgG and IgG1 antibodies when compared to those in stage I and II. Significant reductions were seen in the concentrations of IgG and IgG2 antibodies in most patients who responded well to treatment.ConclusionsOur data demonstrate an association between IgG antibody titers and the severity of mucosal disease. The observed reduction in antibody production after successful treatment in most patients preliminarily indicates that these tests can be used to aid in the assessment of therapeutic response.

Adult-onset Woakes’ syndrome: a rare entity

Woakes’ syndrome (WS) is a rare entity, defined as severe recalcitrant nasal polyposis with consecutive deformity of the nasal pyramid. WS occurs mainly in childhood and its aetiology remains unclear. We report a case of a 68-year old woman, with aspirin-exacerbated respiratory disease, who presented with recurrent nasal polyposis and progressive broadening of the nasal dorsum. CT scan revealed extensive bilateral nasal polyposis and diffuse osteitis, with anterior ethmoidal calcified lesions. The patient underwent revision endoscopic sinus surgery and nasal pyramid deformity was successfully managed without osteotomies.

Protetor facial confeccionado por meio do fluxo digital

The interdisciplinary performance between the specialties of Sports Dentistry with Radiology aided by technology makes possible to perfect and optimize the manufacture of facial protectors. This case report aims to show a case of making a face shield for an athlete after fracturing the nasal pyramid with the aid of digital flow. It was concluded that the facial protector was an effective device to protect the athlete’s face who has recently suffered an orofacial injury. The protector prevents the bone from undergoing refracture or displacement and allows the athlete not to be temporarily stay away of sports practing.

Use of Biodegradable Implant in Rhinoplasty and Nasal Septum Surgery

The nasal septum has a significant influence on the form and function of the nose, as it is a key element of the nasal framework. Its shape, size, position, and integrity help determine not only the patency of the nasal fossae but also the appearance of the nasal pyramid. Achieving satisfactory functional and aesthetic results presents a real challenge for the surgeon in a wide range of nasal septal deformities. During the last decade, the absorbable biodegradable plate DePuySynthes Rapidsorb fixation system has been used to repair pediatric facial fractures. It provides stability during the initial period of healing until the bony fracture segments have reunited. There are many differently sized and shaped plates with varying thickness available. We believe this is a useful technique to improve the rate of septoplasty success, and with further experience, the indications and role in septal surgery can be better defined.

Computed Tomography Evaluation of Nasal Dimensions among Different Singaporean Ethnicities

Osteotomies in rhinoplasty are performed to correct deformities in nasal contour. The size of osteotome used is dictated by the thickness of the bony nasal pyramid along the osteotomy route. The aim of this study is to determine whether nasal bony dimensions differ between different ethnic groups in Singapore. Randomly selected patients' computed tomography (CT) scans of the face performed between the years 2010 to 2013 in our institution (Khoo Teck Puat Hospital) were evaluated. The setting was a tertiary government hospital. CT images of 309 patients (233 Chinese [147 males, 86 females], 32 Malays [16 males, 16 females], and 44 Indians [33 males, 11 females]) were evaluated. Anthropomorphic measurements of the nasal bone along the track of the lateral, medial, and intermediate osteotomies, as well as the nasal bone length and pyriform aperture width were measured on the CT images by two independent observers. Statistical analysis was performed using Student's t-test and two-way analysis of variance (ANOVA) test. There was no significant difference between the nasal pyramid bone thickness between different ethnicities along the osteotomy tracks (p > 0.05; degrees of freedom [df] = 2). However, there was a significant difference between males and females of the same ethnicity at the low level of the lateral osteotomy (p = 0.003) and the midlevel (p = 0.002) and high-level (p = 0.004) of the intermediate osteotomy. There was a statistically significant difference in nasal pyramid length (p < 0.05, df = 2) and pyriform aperture width (p < 0.05, df = 2) among the races and between the genders (p < 0.05). The mean difference in nasal pyramid length of 2.54 mm and pyriform aperture width of 1.89 mm was particularly significant between the Chinese and the Indians. Gender and ethnic differences in nasal bony dimensions should be considered in surgical planning for rhinoplasty.

The Segmental Preservation Rhinoplasty: The Split Tetris Concept

Dorsal preservation rhinoplasty has seen considerable advances in the recent years as many doctors have improved and developed new ideas on the subject. In the era of minimal trauma surgery, it is important to achieve a beautiful nasal aesthetic result with minimum injury to the nose. Preserving the main structures of the nasal pyramid has been pursued for more than a century, and some different approaches have been described and developed since then. Their strengths and weakness have been shown. The present society's demand for perfection is an added reason for improving the stability and predictability of preservation rhinoplasty. We describe a brand-new philosophy of approaching the nasal dorsum hump that combines both safety and delicacy in dealing with the anatomical structures with elegancy and accuracy and achieving the aesthetic goal required.

Extramedullary plasmacytoma with intranasal localization

Plasmacytoma is a rare, non-epithelial, malignant tumor, affecting soft or bony tissues, which can have a unique location (solitary or extramedullary solitary plasmacytoma), or multiple (multiple myeloma). In the ENT sphere, it is most commonly encountered in its extramedullary form, which develops in the region of the head and neck, at the level of the submucosa. Most commonly, it affects the elderly, who have cardinal symptoms such as unilateral nasal obstruction, nasal or facial swelling, tissue necrosis or mucosal ulcerations, perforation of the nasal septum with dysmorphia of the nasal pyramid, recurrent unilateral epistaxis. Radiotherapy is the treatment of choice for extramedullary plasmacytoma. The prognosis is a reserved one, the risk of recurrence or conversion to multiple myeloma also existing 15 years after treatment.