V02N1 – JOURNAL OF CONTEMPORARY DISEASES AND ADVANCED MEDICINE

BODY DYSMORPHIC DISORDER IN RINOPLASTLY CANDIDATES: COMPARATIVE ANALYSIS OF SCORES WITH PRE-OPERATORY SIMULATION

Administrador — Wed, 13 Dec 2023 14:11:28 +0000

In patients who wish to modify the nasal appearance through rhinoplasty, the state of mental health is important, as patients with psychopathologies related to body image distortion have high rates of dissatisfaction with the surgical result. This research becomes relevant, as it aims to assess the prevalence of Body Dysmorphic Disorder (BDD) in candidates for rhinoplasty through the application of questionnaires, the Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD- YBOCS) and Body Dysmorphic Symptoms Scale (BDSS), in its validated version for Portuguese, that is, Corporal Dysmorphism Symptoms Scale, and through preoperative 2D simulation guided by the patient’s desire, analyzes whether there is a correlation between the scores obtained in the questionnaires with the intensity of the nasal change desired by the patient, that is, whether patients who are candidates for rhinoplasty with positive screening or higher scores in the BDD questionnaires present greater self-image distortion during the 2D simulation when compared to patients with negative screening for BDD. The survey was applied to 28 volunteer participants at Hospital Paranaense de Otorrinolaringologia IPO in Curitiba. It was found that the female public was the one that most presented complaints related to nasal aesthetics, there were 19 female participants (67.9%) and 9 male participants (32.1%). The average age was 29 years. It was found that 3 participants (10.7%) were screened positive for BDD. There was a direct correlation between higher scores on the BDSS questionnaire and greater changes in the nasolabial angle (p 0.043) and nasofrontal angle (p 0.048) variables, while the BDD-YBOCS questionnaire showed a direct correlation between higher scores on the questionnaire and greater changes only in the nasolabial angle variable (p 0.026). It was concluded that the prevalence of BDD in rhinoplasty candidates was 10.7% and that patients with positive screening or higher scores in the questionnaires presented greater self-image distortion during the 2D simulation, as they wanted more intense changes in nasal aesthetics as when compared with patients who screened negative for BDD.

COMPARATIVE TOMOGRAPHIC ANALYSIS OF THE FRONTAL BEAK AND ITS CORRELATIONS

Administrador — Wed, 13 Dec 2023 14:07:27 +0000

Introduction: The frontal sinus has a complex and varied anatomy, being considered challenging in the nasosinusal surgical approach. Tomographic anatomical landmarks, such as the frontal beak (FB), are essential for understanding and planning strategies for the treatment of this region. Objective: to investigate tomographic measurements of the FB and its correlations, focusing on the angle formed between the FB, columella and frontal sinus ostium (FCO). Methods: Retrospective and analytical study, based on the review of medical records of computed tomography scans of the paranasal sinuses, independently evaluated by two otolaryngologists. Divergent data were reassessed by a third experienced surgeon. The data were statistically analyzed. Results: CT scans of 50 patients aged 19 to 73 years were studied, totaling 100 images. Columella-FB distance and FB thickness were higher in men (p≤0.001); the size of the frontal ostium (FOD) was smaller the greater the number of frontal cells (p=0.012) and FCO angle (p=0.003); the FCO angle varied according to the position of the FB (FOG) (p<0.001), level of surgical difficulty (p<0.001) and columella-FB distance (p=0.017); the most prevalent frontal cell was the agger nasi (97%). Discussion: Thickness and location of the FB, as well as FOD, are known to be related to the difficulty of surgical access to the frontal recess, and the FCO angle showed a significant correlation with the measures studied. Conclusion: The frontal beak is a constant structure, which measurements and correlations, such as the FCO angle, can configure an auxiliary tool for the otolaryngologist and serve as basis for future studies.

INFECTIONS IN FUNCTIONAL AND AESTHETIC RHINOSEPTOPLASTY: NARRATIVE LITERATURE REVIEW

Administrador — Wed, 13 Dec 2023 14:05:02 +0000

Introduction: Rhinoseptoplasty is among the most performed surgical procedures in the world. Postoperative infection is the second major complication, and there is still no consensus on the use of antibiotics in prophylaxis. Methodology: Review articles from the last 10 years to describe and discuss the benefits of using antibiotic prophylaxis in this procedure. Results: Found 12 articles on the subject, analyzing the postoperative complications and the use of antibiotics. Discussion: Infection, despite being the second main complication after the procedure, is rare. The use of prophylactic antibiotics is recommended in books that describe the procedure, however, studies show that there is no great benefit in its use without a good preoperative evaluation. Two other studies also suggest that the culture of the site to be operated on could better support the use of antimicrobials. Conclusion: Antibiotic prophylaxis should be indicated with caution as it may favor antimicrobial resistance. Furthermore, there is no consensus in the literature about the real benefit of its use.

THREE-DIMENSIONAL SCANNING IN RHINOPLASTY AND INDIVIDUAL PATIENT EXPERIENCE

Administrador — Wed, 13 Dec 2023 13:59:48 +0000

Introduction: Three-dimensional facial scanning has been the object of study for decades and increasingly being used in rhinoplasty, and has recently been applied to surgical simulation. The patient’s perspective in this context should be explored, so that surgeons can individualize their approach. Objectives: Acess the patient’s perspective on three-dimensional scanning in rhinoplasty and their experience during the evaluation and simulation processes in preoperative consultation. Material and methods: Longitudinal, prospective and qualitative study, with the application of a questionnaire to patients who searched for rhinoplasty, during the preoperative consultation after obtaining images through 3D scanning and case simulation. Results: All participants agreed that three-dimensional scanning optimizes patient-surgeon communication; that it should become routine in the preoperative evaluation of cosmetic surgeries; and they felt more confident about the surgery after this process. None of the interviewees mentioned discomfort while obtaining the images. More than 60% were surprised by the images obtained by the three-dimensional facial scanning and by the result of the simulation. Discussion: The use of computerized imaging in the preoperative consultation transforms patients from passive listeners to active participants, who express their intentions and are involved in the discussion of the objectives of the surgery to which they will be submitted. Reservations regarding cost, additional time, and increased patient expectations must be considered. Conclusion: Three-dimensional facial scanning is an additional tool in the rhinoplasty preoperative period, bringing benefits to the communication and relationship between physicians and patients.

USE OF THE NUCLEUS SMARTNAV® SYSTEM IN INTRAOPERATIVE TELEMETRY OF COCHLEAR IMPLANT

Administrador — Wed, 13 Dec 2023 13:57:15 +0000

Tests performed intraoperatively are routine tools in cochlear implant (CI) programs worldwide. Recently, Cochlear™ launched the Nucleus Smartnav® system that describes new parameters measured during insertion of the electrode array into the cochlea, verifies its position, tests impedance and AutoNRT. Objective: To describe the use of the Cochlear™ Nucleus SmartNav® system as an intraoperative measurement tool in cochlear implant surgery. Material and Methods: Patient with bilateral and congenital profound prelingual deafness. He has been using an individual sound amplification device (PSAD) bilaterally since childhood, has reasonable speaking skills and good understanding of others’ speech. Although IC was previously indicated, he chose to keep the hearing aid. However, given the inefficient gain, mainly in the left ear, a bimodal adaptation was suggested: CI in the left ear and hearing aids in the right. At the age of 48, he underwent CI surgery on the left, using the Cochlear™ CI622 model with CP1001 speech processor and intraoperative measurements performed by the Nucleus® SmartNav system. The impedance test and NRT were also performed intraoperatively using the Nucleus® SmartNav system, after reviewing the insertion of the electrodes. Result: The measurements obtained during the insertion of the electrode array in the cochlea allowed greater intraoperative control by enabling fine adjustments in the surgical technique. Conclusion: The Nucleus Smartnav® system endorses technologies that aim to increase surgical precision and reduce complications.

COMPARATIVE ANALYSIS OF PRICK TEST PRE AND POST SUBLINGUAL IMMUNOTHERAPY FOR ALLERGIC RHINITIS

Administrador — Wed, 13 Dec 2023 13:52:24 +0000

Introduction: Allergic rhinitis is an immune-mediated reaction, the diagnosis of which can be complemented with the immediate hypersensitivity skin test using the prick test. Allergen-specific immunotherapy (AIT) is indicated for specific cases and is the only disease-modifying treatment. So far, there is not a biomarker to objectively monitor its evolution. Objectives: To compare the degree of pre- and post-sublingual immunotherapy (SLIT) skin sensitization in patients with allergic rhinitis, in order to validate the prick test as an objective measure of response to treatment. Material and methods: Observational, analytical and retrospective study, which compared, for each allergen, the skin reactions of the prick test before and after starting sublingual immunotherapy. Results: 71 patients were included. There was a reduction in skin sensitization in patients undergoing SLIT to grasses (p<0.05). The same statistical relevance was not found for those submitted to SLIT for mites (p>0.05). A positive correlation was found between the interval of skin tests and the reduction of skin sensitization to Dermatophagoides pteronyssinus. Discussion: The prick test can be considered an objective marker of response to treatment only for patients with seasonal allergic rhinitis. The present study suggests that the longer the SLIT, the greater the reduction in skin sensitization, evidencing the importance of completing the treatment for a better outcome. Conclusion: Studies are still needed to determine an objective marker of treatment response that reliably correlates with the patient’s clinical response.

MEASUREMENTS OS PROJECTION AND ROTATION OF THE NASAL TIP IN PRIMARY RHINOSEPTOPLASTY: A LITERATURE REVIEW

Administrador — Wed, 13 Dec 2023 13:49:11 +0000

Introduction: Postoperative scarring can later modify the structure of the nose and there are few articles found in the literature that demonstrate anthropometric measurements in the evolution of the postoperative period of rhinoseptoplasty. Objective: To identify variations in projection and rotation results of the nasal tip after primary rhinoseptoplasty with the course of healing. Materials and methods: A literature review on projection and rotation of the nasal tip in primary rhinoseptoplasty, in addition to the illustration of three clinical cases of caucasian patients with medium skin who underwent open primary rhinoseptoplasty. Results: In the three illustrated cases, there was an increase in the rotation of the nasal tip in the seven-day postoperative, with an average of 13.68º in the female cases and 5.15º in the male case. There was an average reduction of 2.41º after six months of healing. There was no pattern of variation in the tip projection measurement. Discussion: The rotation of the nasal tip is measured from the nasolabial angle and the projection is equivalent to the distance that it projects from the face, which can be measured using the Goode method. Currently, one of the biggest discussions in rhinoplasty is the long-term maintenance of tip rotation and projection in closed access techniques with columellar strut and structured open access techniques using the septal extension graft. Conclusion: The rotation of the nasal tip varies considerably in the initial postoperative period, but it drops on average 2-3º six months later. The projection of the nasal tip did not present great differences. For more significant results, studies with a larger number of patients are necessary.

EFFECT OF PIEZO IN POST-OPERATIVE ECCHYMOSIS DURATION IN CLOSED RHINOPLASTY

Administrador — Wed, 13 Dec 2023 13:47:13 +0000

Introduction: Rhinoplasty is one of the most performed surgeries all over the world and advances in surgical techniques have been happening progressively, although postoperative skin and soft tissue complications, such as edema and ecchymosis, can induce anxiety for patients. Piezo, an instrument that uses ultrasonic vibrations, can provide greater precision and less damage to adjacent soft tissues, causing less surgical trauma and better behavior of soft and hard tissues during healing. Objective: To evaluate the effect of Piezo in duration of postoperative ecchymosis in closed rhinoplasty and the degree of discomfort of patients with this complication. Material and methods: Prospective, longitudinal, analytical, and interventional study in patients undergoing primary closed rhinoplasty, which were divided into 2 groups: Group 1 (control): patients undergoing closed rhinoplasty with conventional osteotomies and Group 2: patients undergoing closed rhinoplasty with osteotomies using Piezo. The evolution of ecchymosis was recorded through photographs sent to the research team until it was not present, the degree of discomfort with ecchymosis was graded from 0-10 at the end of the first week. Results: 13 patients were evaluated, 6 in Group 1 (control) and 7 in Group 2 (Piezo). Age ranged between 18 and 53 years (mean 33.1 years). We had a prevalence of females (69.2%) and the duration of ecchymosis ranged from 0-16 days. The mean duration of ecchymosis was longer in the control group (8 days) compared to the group that used Piezo (4 days). The discomfort in relation to ecchymosis was greater in patients in the control group (5) compared to patients in which Piezo was used (3). Discussion: Piezo has been shown to decrease postoperative morbidity in open and closed rhinoplasties or other surgical procedures. It provides a safe, reproducible and accurate way to perform lateral osteotomies, minor surgical trauma and better soft and hard tissue behavior during healing. In this way, it provides less swelling and ecchymosis compared to conventional osteotomy and can significantly increase overall patient satisfaction. Conclusion: Piezo helps reduce the duration of postoperative ecchymosis after closed rhinoplasty and can reduce the degree of discomfort with this type of complication.

THE INFLUENCE OF SOCIAL NETWORKS ON THE CHOICE OF FACE SURGERY IN PATIENTS UNDERGOING SURGERY AT HOSPITAL PARANAENSE DE OTORHINOLARYNGOLOGY

Administrador — Wed, 13 Dec 2023 12:48:55 +0000

Introduction: Social Networks Are An Integral Part Of Contemporary Society, Influencing The Way Interpersonal Relationships And The Doctor-patient Relationship Occur, Showing A Possible Influence Of These Means On Decision-making For Surgical Procedures. Objectives: To Identify The Influence Of Social Networks And Other Factors Such As Self-perception And Functional Changes, In The Intention To Undergo Facial Surgeries. Material And Methods: Prospective Study Carried Out From July To September 2022 In Patients Undergoing Facial Surgery At The Ipo Hospital Who Were Evaluated Using A Questionnaire. Including Age, Gender, Factors That Helped In The Decision For Such Procedure, Related Factors The Search For Information About The Professional And Personal Preferences In Relation To This Type Of Content. Results: Among The 49 Patients Included In The Study, 43 Were Female And 6 Were Male, With A Mean Age Of 37 Years. Of These, 39 Underwent Rhinoplasty. Self-perception Was Evaluated As A Determining Factor For The Decision To Perform The Procedure (79.6%). Patients Aged ≤ 30 Years Are Significantly Different Regarding The Use Of Instagram (use More), Facebook (use Less). Conclusion: Social Networks Are Important Tools In The Decision To Undergo Facial Surgeries, But Self-perception Was The Determining Factor. The Instagram Platform Was The Network Most Sought After By Patients When Seeking Information About Their Surgeons. The Media Format Preferred By Patients Is Short Duration (up To 1 Minute).