Administrador – JOURNAL OF CONTEMPORARY DISEASES AND ADVANCED MEDICINE

COMPARATIVE ANALYSIS OF THE THREEDIMENSIONAL RECONSTRUCTION OF FACIAL CT SCANS AND THEIR RESPECTIVE STEREOPHOTOGRAMMETRY

Administrador — Tue, 26 Mar 2024 13:15:43 +0000

The use of 3D technology has become important in the practice of surgeons, due to the limitations of 2D photographs. This is a prospective, analytical, and comparative study, which aims to analyze in a comparative way the three-dimensional reconstruction of two different systems, through computed tomography of the face and the respective stereophotogrammetry acquired from the same face. It was possible to reconstruct a total of 25 meshes from participants who underwent facial tomography and photogrammetry at the IPO Hospital. The study aims to describe the computerized technique of three-dimensional reconstruction of the face and mainly to evaluate the equivalence of the surface of the face obtained by two different techniques that propose the analysis of the anatomy. The first mesh was obtained by computed tomography. The second by the stereophotogrammetry technique, with capture performed by the clOner scanner and with the reconstruction of the mesh in the Reality Capture application. In addition, to demonstrate a three-dimensional facial evaluation system without ionizing radiation, low cost, and high availability. The results obtained were sufficient to demonstrate the equivalence between the meshes. Thus, stereophotogrammetry of the face is a new option for anatomical analysis of the face. It does not cause discomfort or risks to the patient and increases the possibilities of analysis.

THE PERCEPTION OF BODY DYSMORPHIC DISORDER IN RHINOPLASTY BY FACIAL PLASTIC SURGEONS

Administrador — Tue, 26 Mar 2024 13:14:08 +0000

Rhinoseptoplasty is among the most performed aesthetic/functional procedures in the world. Among those who seek surgery are those whose aesthetic defect, real or imagined, is interpreted by themselves in a disproportionate way, leading to suffering and/or significant impairment of psychosocial functioning and quality of life. These are diagnosed with Body Dysmorphic Disorder (BDD). These are patients who commonly have high expectations regarding the surgical outcome and who are often not satisfied post-operatively. The objective of this study was to correlate the profile of the rhinoplasty surgeon with the perception of BDD in their daily practice, analyzing whether the professional’s profile influences the perception or approach of patients with body self-image disorders. This is a cross-sectional and analytical study carried out with 80 surgeons, who completed a questionnaire related to the surgeon’s profile, professionals’ level of knowledge about TDC and how they approach these patients. Results: There was a very similar distribution of respondents in terms of gender, with a slight predominance of male surgeons, the vast majority of whom were otorhinolaryngologists with up to two years of practice in the specialty. Most respondents stated that they were unfamiliar with BDD, not even carrying out the assessment or screening, and were unaware of the disorder’s diagnostic methods. Most participants reported having come across patients with BDD in the last year, including operating on them, and showing less satisfaction with the result of the procedure, which led to threats in some cases. The frequency of screening for Body Dysmorphic Disorder was associated with length of time in the profession, and having knowledge about BDD was also associated with years of practice in rhinoplasty and the number of annual rhinoplasties. Overall, having knowledge about TDC was associated with years of rhinoplasty practice, as well as with the number of rhinoplasties performed per year.

ANALYSIS OF THE NASAL MICROBIOME IN PATIENTS PRE AND POST RHINOPLASTY: EXPLORING THE POSSIBLE CLINICAL IMPLICATIONS IN A PRIVATE HOSPITAL AND OTORHINOLARYNGOLOGY

Administrador — Tue, 26 Mar 2024 13:12:35 +0000

Rhinoplasty is a common and effective plastic surgery to improve the aesthetics of the nose and, in some cases, respiratory function. This surgery remodels nasal structures, not only visibly, but also affecting the nasal microbiota, a community of microorganisms. The objective of this study was to understand how rhinoplasty influences the nasal microbiota, focusing on the prevalence of pathogenic bacteria, as well as the clinical implications of these changes. To investigate these changes, the research was conducted in a private otorhinolaryngology hospital environment. Bilateral nasal swabs were collected and bacterial culture was performed. Statistical analysis was used to explore possible associations between altered nasal microbiota and postoperative complications, as well as the quality of healing and recovery time of patients undergoing rhinoplasty. In 8 patients, rhinoplasty showed an initial prevalence of Staphylococcus aureus (62.5%) and Klebsiella aerogenes (25%). After surgery, 66.7% presented undetected results, suggesting a potential improvement in the nasal microbiota. Individual variability highlights the need for personalized approaches in preventing post-surgical infections. No statistically significant correlation was observed between nasal microbiota and surgical complications. Other characteristics were not significant on the effect of surgery and culture results. This research deepened the understanding of the nasal microbiome in patients undergoing rhinoplasty. In total, data from 8 patients were analyzed, revealing intriguing microbiological patterns. The decrease in post-surgery bacterial detection suggests potential benefits in reducing infectious risks, pointing to practical implications in clinical practice. Although valuable, we recognize the limitations of the study, encouraging future expansive research to consolidate and expand this knowledge.

USE OF NASAL SPLINT IN RHNOSEPTOPLASTY SURGERY STRUCTURED BY OPEN TECHNIQUE

Administrador — Tue, 26 Mar 2024 13:11:10 +0000

The Nasal Splint in rhinoseptoplasty aims to support and anatomically reconstruct the nasal cavity, in addition to preventing adhesions. Although it is a medical device specially designed to be used in supporting the nasal septal cartilage to avoid the formation of edemas and hematomas, its postoperative symptoms have been poorly assessed in the literature. The objective of this study was to evaluate postoperative nasal symptoms in patients who underwent rhinoseptoplasty with the use of a Splint. The study was carried out using online questionnaires, applied to patients undergoing primary rhinoseptoplasty using Splint from June to September 2023.It aimed to assess the degree of sensation of congestion, obstruction, difficulty in breathing, or difficulty in sleeping in the postoperative period. Additionally, frequencies and percentages of patients were evaluated based on the difference in discomfort scores before and after the removal of the Nasal Splint, stratified into a score up to 5 points for increase or decrease. A statistical analysis was performed using the non-parametric Wilcoxon test, values of p<0.05 were considered. A total of 39 patients were included. Regarding nasal congestion and the feeling of a congested nose in the postoperative period of Rhinoplasty, the results were: 34.2% felt nothing; 39.5% felt very little; 23.7% felt moderately, and 2.6% felt reasonably a lot. The median of patients who experienced this before the removal of the Splint was 2, and after removal, it was 3, with p = 0.311. The result indicates that there is no significant difference between the two assessments concerning the degree of postoperative discomfort when comparing pre- and post-removal evaluations of the Nasal Splint. The use of Splints was well tolerated by patients, with no statistical difference observed in relation to discomfort before and after removal of the Nasal Splint, but the evaluation of postoperative symptoms is still poorly evaluated in the literature.

USE OF PROBIOTICS IN ALLERGIC RHINITS: A PILOT STUDY

Administrador — Tue, 26 Mar 2024 13:09:40 +0000

Allergic rhinitis (AR) is a nasal inflammatory disease. It manifests itself with nasal obstruction/blockage, rhinorrhea, itching and sneezing in response to contact with allergens. Its diagnosis is clinical and confirmed with allergy tests. Its treatment may involve antihistamines, topical corticosteroids, as well as immunotherapy, which is considered the only treatment capable of altering the clinical history of the disease. To evaluate the use of probiotics to control allergic rhinitis symptoms. This is a comparative experimental pilot study in which 11 adult employees were evaluated in 4 weeks and, of these, 9 were also evaluated in 8 weeks. Everyone used 0.9% physiological solution, budesonide 200 mcg/day nasally and desloratadine, when necessary. Among the volunteers, 7 also used the combination of probiotics, Lactobacillus helveticus R0052 and Bifidobacterium longum R0175, one capsule a day. There was statistical relevance in the probiotic group for sneezing in the 4-week evaluation and for nasal obstruction in the 8-week evaluation. The results of this comparative pilot study may have been influenced by the small sample size. Even so, it was possible to find data with statistical relevance that confirmed the benefit of using probiotics, mainly to reduce sneezing and nasal obstruction. Despite being a promising form of RA treatment, more studies are needed on the use of probiotics for this purpose.

AUDIOLOGICAL RESPONSE IN THE USE OF INTRATYMPANIC DEXAMETHASONE IN SUDDEN DEAFNESS AT HOSPITAL IPO

Administrador — Tue, 26 Mar 2024 13:07:46 +0000

Sudden sensorineural hearing loss (SSNHL) is an otolaryngological urgency yet to be fully understood, which can be treated with intratympanic steroid injections (ITSI), a treatment that, yet does not have a strict protocol. The objective of this study was to assess de efficacy of ITSI in patients afflicted with SSNHL treated in Hospital IPO. For that, thirty-four patients who underwent ITSI had their charts and audiometric exams reviewed to assess treatment efficacy both in audiological and symptomatic improvement and certain factors that could influence a positive outcome. In a mostly female (64.7%) study group, with an average 52.5 years that underwent ITSI as a secondary treatment in 91.2% of cases, the use of such treatment resulted in audiological improvement in 50% of patients and symptomatic improvement in 61.2%. There was significant correlation between less advanced age groups and number of injections and better treatment results. Nonsignificant parameters were in accordance with current literature, which is still divided on what impacts the positive treatment outcome. ITSI with dexamethasone in our study group matches efficacy rates in current literature. Some aspects deserve more study to create a protocol of ITSI use and improve its effectiveness.

COMPARISON OF PHOTOCEPHALOMETRY METHODS IN RHINOPLASTY

Administrador — Tue, 26 Mar 2024 13:03:02 +0000

Cephalometric measurements are widely used and essential when planning rhinoplasty and other surgical and non-surgical facial interventions. They provide measurements and simulations, which are extremely useful both for more iterative communication with the patient, as well as for more accurate planning of surgical techniques and maneuvers to be used during surgery. Despite its importance in facial aesthetic evaluation, the different forms of implementation often generate misunderstanding by professionals when planning and simulating images because they suffer from slight distortions in relation to the real measurement. The main objective of the present study was to compare three measuring instruments used in the facial surgeon’s clinical practice: rigid ruler (RR), millimeter glasses (MG), and millimeter adhesive tape (MAT), evaluating whether there would be a difference between the measurements obtained by each of them in the analysis of digital photographic images. It was observed that in the profile view all the instruments used presented significantly different measurements from each other, and something similar was verified in the frontal view when comparing MG and MAT with RR. It was evident that the use of these widely disseminated objects, despite initially appearing useful, can bring different values to each other, eventually leading to inaccurate measurements, planning, and simulations. New studies are necessary to elucidate which of the methodologies would be the most appropriate for estimating real measurements.

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.