V01N1 – JOURNAL OF CONTEMPORARY DISEASES AND ADVANCED MEDICINE

INFERIOR TURBINOPLASTY: COMPARISON BETWEEN THE DIRECT VISION AND NASAL ENDOSCOPIC TECHNIQUES

Administrador — Mon, 10 Jan 2022 12:15:45 +0000

The hypertrophy of inferior turbinates is considered one of the main causes of nasal obstruction. There are clinical and surgical options for treatment. If clinical control fails, the volumetric reduction of those structures is usually recommended. Theendoscopic approach is considered safe, as it enables a comprehensive assessment of the extent of the turbinate anatomy and effective hemostasis. Turbinoplasty is a procedure that requires manual skill and has the advantages of non-exposure of raw area, less chance of bleeding and less crusting. This study aimed to compare the postoperative outcome of patients who underwent inferior turbinoplasty under direct vision and via nasal endoscopy, through a prospective randomized study conducted at the IPO hospital (Instituto Paranaense de Otorrinolaringologia, Curitiba/PR, Brazil). In this study, 17 patients were evaluated and divided into two groups according to the surgical technique used. Both groups underwent flexible nasofibroscopy on the 15th and 30th day postoperatively, were asked if they experienced cacosmia, and if there was any need for nasal packing during the period. Although the video technique offers a broad view of the nasal anatomy and of the inferior turbinates, it demands more adequate material and more experience from the surgeon, and its surgical time is longer. By considering these results, we can conclude that there are no statistical differences between the postoperative results of the two turbinoplasty techniques.

COMPARISON BETWEEN MICROSCOPIC AND ENDOSCOPIC STAPEDOTOMY

Administrador — Mon, 10 Jan 2022 12:14:47 +0000

Stapedotomy is a challenging ear surgery, with known risks and limitations, and with a great impact on the patient’s life. The microscope has long been established as the way to perform the procedure. With the advent of the endoscope, accompanied by a broad view of the anatomy of the middle ear and its structures, surgeons have increasingly opted for this means of access. Both have an endaural approach, showing similar audiometric results, each with its advantages and disadvantages. This study makes a comparison between the ways to perform stapedotomy: microscope and endoscope. Patients with otosclerosis and indication for surgery were selected, and microscopic or endoscopic stapedotomy were performed randomly, according to the surgeon’s preference. Two months after the intervention, audiometric results, intraoperative complications, postoperative symptoms, and time taken to perform each route were compared. Based on these data, it was observed that regardless of the means of access, the results were equivalent, with the advantage of a broader view using the endoscope, demanding a longer procedure time. The choice of method must be made according to the skill of each surgeon.

EVALUATION OF ADHERENCE TO SUBLINGUAL IMMUNOTHERAPY TREATMENT FOR ALLERGIC RHINITIS

Administrador — Mon, 10 Jan 2022 12:13:45 +0000

Introduction: Allergic rhinitis is an inflammatory condition of the inside of the nose, mediated by Immunoglobulin E, in response to an inhaled allergen. Clinically, it presents with nasal obstruction, runny nose, nasal and/or eye itching, and sneezing. For its symptomatic treatment, environmental control is essential and nasal steroids are the gold standard in the adult and pediatric population. Another form of treatment is immunotherapy, changing the response to the allergen via the immune tolerance mechanism. Subcutaneous immunotherapy (SCIT) is applied weekly to monthly, in contrast to sublingual immunotherapy (SLIT), which is performed daily by the patient. For an effective treatment of chronic disease, the period of treatment and discipline in maintaining it must be respected. Objective: Analyze the main reasons why the patient gives up treatment with sublingual immunotherapy. Methods: This prospective and linear study evaluated patients at the IPO Hospital (Instituto Paranaense de Otorrinolaringologia, Curitiba, Brazil) who were undergoing treatment with sublingual immunotherapy for allergic rhinitis and who, for some reason, discontinued the recommended treatment. Results: The study sample consisted of 148 patients, 79 women and 69 men. The mean duration of treatment for patients who dropped out was 8.3 months. The cost was the most cited reason, which was mentioned by 47.3% of patients; followed by irregularity of use and absence of improvement with treatment, both with 23% each. The presence of side effects was included as a reason by 9.5% and still, 25% of respondents cited several other reasons as obstacles to treatment. Conclusion: The present study concluded that the main barriers found for treatment adherence are long treatment duration, cost, and regularity of use.

POSTOPERATIVE ASPECTS OF SEPTOPLASTY WITH AND WITHOUT THE USE OF A NASAL SPLINT

Administrador — Mon, 10 Jan 2022 12:12:46 +0000

Septoplasty surgery is one of the most common procedures in the field of facial surgery. Although the rate of postoperative complications for this procedure is quite low, they can occur. To reduce the rate of these possible complications, several techniques were incorporated into the septoplasty procedure, including nasal packing, transseptal suture, nasal splint, among others. Thus, the present study aimed to evaluate the influence of using a nasal splint on postoperative comfort and nasal aspects. For this purpose, patients with indication for septoplasty surgery who met the inclusion criteria were selected. Half of the patients were randomly allocated to use a nasal splint, and the other half did not. Postoperatively, nasal aspects (mucosal edema, secretion aspect, bleeding, synechiae, presence of crusts) and patient comfort were evaluated by means of a questionnaire based on the adapted NOSE scale and pain assessment.

EPIDEMIOLOGICAL PROFILE AND OTORHINOLARYNGOLOGICAL MANIFESTATIONS IN PATIENTS DIAGNOSED WITH COVID-19 AT IPO HOSPITAL

Administrador — Mon, 10 Jan 2022 12:11:46 +0000

Introduction: 2020 was marked by the COVID-19 pandemic, a new type of coronavirus. It has a wide spectrum of action and can even be deadly.Methods: This is a prospective cross-sectional study, conducted in the form of an interview through telephone, with patients who were diagnosed with COVID-19 at the IPO Hospital, from March 2020 to July 2020. Results: Thirtysix patients, with an average age of 36.3 years, mostly females (63.9%), were interviewed. The most frequent symptoms were headaches, altered smell, and altered taste. There was statistical evidence of an association between altered smell and altered taste and nasal obstruction. Conclusion: Changes in smell are a strong predictor of suspicion for COVID-19.

EVALUATION OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME UNDERGOING FUNCTIONAL EXPANSION PHARYNGOPLASTY, IN A HOSPITAL IN CURITIBA

Administrador — Mon, 10 Jan 2022 12:10:46 +0000

Obstructive Sleep Apnea Syndrome (OSAS) has been increasingly recognized as a high prevalence condition and an independent risk factor for cardiac, metabolic, neurological, and perioperative morbidities, as well as erectile dysfunction, and traffic accidents, with non-standard surgical treatments and controversial results that do not seem to keep pace with the promising findings in the pathophysiology of the disease. The aim of this study was to evaluate the results of the Functional Expansion Pharyngoplasty technique in a group of patients with OSAS and small palatine tonsils. Preoperative and postoperative anthropometric and polysomnographic data from the medical records of 13 patients, of both sexes, in a renowned hospital in Curitiba (Brazil), were retrospectively analyzed. The 50% improvement in AHI (Apnea Hypopnea Index) and/or AHI below 20/h (Sher’s criteria) were considered surgical success. As a result, 84.6% of the patients achieved a significant AHI reduction (p=0.005), with 76.9% Sher’s success rate, and an also significant sleep time reduction, with oxyhemoglobin saturation below 90% (p=0.018). It can be concluded that the Functional Expansion Pharyngoplasty technique seems to be an effective alternative for the surgical treatment of patients with Obstructive Sleep Apnea Syndrome with small palatine tonsils.

ENDOSCOPIC SURGERY OF THE ANTERIOR ETHMOIDAL ARTERY IN EPISTAXIS: DESCRIPTION OF THE TECHNIQUE AND RESULTS

Administrador — Mon, 10 Jan 2022 12:09:47 +0000

Epistaxis is one of the most common otorhinolaryngological emergencies. Most cases are self-limiting and do not require medical support. While some bleeds require simple local compression to stop the bleeding, others require a more invasive approach, such as ligation or cauterization of the anterior ethmoidal artery or sphenopalatine artery. Anterior ethmoidal artery surgery by external access has been extensively described and studied in the literature. The advent of the endoscope for this procedure has offered the possibility of providing patients and surgeons with an alternative way to perform the surgery. In the present study, patients with epistaxis who underwent endoscopic cauterization of the anterior ethmoidal artery or sphenopalatine artery were selected, and the postoperative results, complications, and recurrence of bleeding were evaluated. In addition, the surgical technique used was described. From these data, it was concluded that endoscopic cauterization surgery of the anterior ethmoidal artery or sphenopalatine artery is effective in the treatment of epistaxis.

ANALYSIS OF THE CONCHAL BOWL DEPTH IN PROMINENT EARS PRE AND POST OTOPLASTY

Administrador — Mon, 10 Jan 2022 12:08:47 +0000

The prominent ear is the most common congenital ear disorder. Some of its discovered features include the overdeveloped concha and the underdeveloped antihelix. The present study focuses on the analysis of the conchal bowl, while assessing its depth before and after otoplasty. Despite its anatomical and surgical importance for the correction of protruding ears, that ear structure has been little discussed in the literature. With the aim of contributing, by providing fresh information, an attempt was made to recognize a surgical parameter of the concha, while assisting in the perception of the depth change after its partial resection, as well as to compare that change to the thickness of the studied cartilage, and to show the statistical data of that structure in the prominent ear. While reviewing the data from the study, it was noted that the mean conchal bowl depth of patients with prominent ears pre-otoplasty surgery was approximately 17 millimeters (mm). In the late postoperative period, a value of approximately 12 mm was reached. That means a mean depth difference of 5 mm in the surgical evolution, with no statistically significant difference between sexes, ear cartilage grading, and operated ear side. Most of the ears (96.9%) showed an increase in the conchal depth postoperatively, which is the main goal of every surgeon when performing conchal resection.

COMPARATIVE STUDY OF PRE- AND POSTOPERATIVE ANTHROPOMETRIC MEASUREMENTS OF PATIENTS SUBMITTED TO RHINOPLASTY

Administrador — Mon, 10 Jan 2022 12:07:47 +0000

Facial anthropometry has an important role in rhinoplasty, as it makes palpable for surgeons the irregularities they deal with, while also assisting in the choice of the tools to correct them. Thus, the aim of the present study was to determine the pre- and postoperative nasal anthropometric measurements of patients undergoing rhinoplasty in a tertiary hospital (IPO Hospital, Curitiba, Brazil), given that such studies are scarce in the Brazilian population. The evaluation of the nasal measurements was performed via specialized software and compared to classical values from the literature. Except for the nasolabial angle, the remaining values differed from the neoclassical canons of beauty, both pre- and postoperatively.The data corroborated a previous population study from the region, while showing the changes in this population thought to be mostly Caucasian.
The postoperative outcome indicates a narrower and shorter nose trend, with a more obtuse nasofrontal angle and nasolabial angle values preserved.

COMPARISON BETWEEN COLUMELLAR STRUT AND TONGUE-IN-GROOVE TECHNIQUE, AS TO THE ROTATION AND PROJECTION EFFECTS OF THE NASAL TIP: A RETROSPECTIVE STUDY

Administrador — Mon, 10 Jan 2022 12:06:45 +0000

Rhinoplasty is one of the most challenging facial plastic surgeries. Some authors claim that this surgery should include stabilization of the base of the nose by means of some technique — for example, grafts (columellar strut, septal extensor) or sutures (tongue-in-groove). To try to elucidate which technique is ideal, this study evaluated the effects on nasal tip rotation and projection, comparing columellar strut to the tongue-in-roove technique. A retrospective study was conducted, which consisted of a preoperative and postoperative photographic analysis of patients who underwent rhinoplasty, in 2017 and 2018, at the Instituto Paranaense de Otorrinolaringologia (Curitiba/PR, Brazil) The Rhinobase® program was used to obtain measurements. After data analysis, it was observed no statistically significant difference between the groups, which was also observed by some authors who carried out similar studies in other countries. It can be concluded that both strut and tongue-in-groove are similar techniques for maintaining nasal tip projection and rotation in the postoperative period of rhinoplasty