Евaлуaцијa нa поÑтоперaтивните резултaти кaј пaциенти Ñо функционaлнa и еÑтетÑкa ÑепториноплaÑтикa

oai:ojs.pkp.sfu.ca:article/244The objectives of the surgical technique septorhinoplasty are to remodel and redesign the nose, to remove the excessive bone and cartilaginous structures, and/or to correct the nasal insufficiencies in order to obtain a harmonious proportion of the nose in regards to the other facial structures. Furthermore, septorhinoplasty is one of the most frequently used aesthetic-surgical otorhinolaryngological procedures. The cartilaginous part of the nasal septum is an integral part of the isthmus’s region and has a significant role in the air’s circulation and turbulence. Due to this central role of the nasal septum, it is of crucial importance to undertake an adequate surgical technique since it is the key for a successful treatment both in the functional, and the esthetic rhinosurgery. The deformities of the nasal septum might be localized in the bone or in the cartilaginous structures, but most often, they are present in both of the structures. The cartilaginous deviations are the ones which are most responsible for the obstruction of the nasal respiratory flow. For that reason, they have been adequately classified. In this in-depth study, the aims have been: 1. To objectify the nasal air resistance (nasal obstruction) using rhinomanometry while selecting patients for septorhinoplasty. 2. To evaluate the frequency and the intensity of the nasal symptoms in patients that are about to undergo septo/rhinoplasty, before and after the intervention. 3. To classify the deviations of the nasal septum in regards to the septal structural and anatomical changes based on the CT of the nose and the paranasal sinuses and on the intrasurgical findings. 4. To determine an adequate psychological personality model while selecting patients for septo/rhinoplasty. Confirmed by clinically relevant data, the goal of this study has been to ensure its acceptance and implementation as a protocol for selecting patients for septo/rhinoplasty. The author points out that this is a prospective, as well as non-randomized study where a statistical analysis has been conducted on a total of 140 patients experiencing deviations of the nasal septum (deviatio septi nasi) separate from or along with the deformities of the nasal pyramid: rhinokyphosis, rhinoscoliosis, rhinolordosis (“saddle noseâ€), and “functional tension noseâ€. The examined patients were added on the list for surgical septo/rhinoplasty procedures performed at the ENT Clinic at University Hospital in Skopje, during the period of September, 2008 till September, 2013. The rhinomanometry examinations were performed at the Institute of Occupational Medicine in Skopje, while the psychological tests were carried out with the assistance of a clinical psychologist and a psychiatrist at the Psychiatry Clinic at University Hospital in Skopje. The examined groups were divided according to the following parameters: a) According to the degree of nasal obstruction, the patients were divided into 3 groups: Group IA – patients with a severe degree of nasal obstruction (severe degree of nasal resistance). Group IB – patients with a moderate degree of nasal obstruction (moderate degree of nasal resistance). Group II – patients with a mild degree of nasal obstruction (mild degree of nasal resistance), clinically monitored for a year, and then agreed upon to undergo surgical intervention.In all patients candidates for septo/rhinoplasty, nasal symptoms such as: nasal obstruction, rhinorrhea, nasal pain, headache, hyposmia, snoring, nasal voice, epistaxis and others were pre-surgically monitored. After the surgical intervention, a survey was conducted in order to find out how satisfied the patients were after the performed correction. The patients were offered with 5 scores, that is, 5 modalities: 1 – very satisfied, 2 – satisfied, 3 – undecided, 4 – dissatisfied and 5 – extremely dissatisfied. b) According to the type of surgical technique applied while performing the surgical intervention, the patients were divided into two groups:- group I – 1: in which septoplasty was performed; the group was constituted of patients with Dg. Deviatio septi nasi.- group I – 2: in which septorhinoplasty was performed: the group was constituted of patients who besides nasal septum deviation, also had some deformity of the nasal pyramid, such as: rhinokyphosis, rhinoscoliosis, rhinolordosis (“saddle noseâ€), and “functional tension noseâ€.These two groups were then divided into two subgroups: - subgroup I2-a: in which lateral and medial osteotomy was performed - subgroup I2-b: in which osteotomy was not performed. c) Psychological analysis was performed solely on patients candidates for septorhinoplasty who voluntarily accepted to fill in the questionnaire for selection of patients candidates for septorhinoplasty and assessment of their psychological predispositions. Based on a numerous world standardized tests and questionnaires that would be applicable to the patient candidate for intervention, a similar questionnaire, adapted to our region was devised, in which the following parameters were included: Selecting a patient for septo/rhinoplasty and assessing their psychological predispositions (Psychological testing – a questionnaire for self body image), Brief Symptom Inventory Test (BSI) with which an analysis was carried out on the acquired results of the questions posed to the patients candidates for septo/rhinoplasty. Through the Brief Symptom Inventory (BSI) test, which is a standard psychological test, the following psychological symptoms in patients were recognized: somatization, obsessive-compulsive reactions, interpersonal sensibility, depression, anxiety, phobic anxiety, and paranoid ideas. There have also been patients who have not displayed any of these symptoms. The methods used throughout the examination are rhinomanometry, as a method for objectifying the nasal air resistance and computed tomography of the nasal and paranasal sinuses. The examined nasal symptoms were then recorded and grouped in the scale of subjective nasal symptoms.Intraoperatively, the structural deformities of the nasal septum were classified into six groups. The psychological tests for selecting patients for septorhinoplasty and assessing their psychological predispositions were carried out by means of specific questionnaires. Therefore, a surgical protocol was established, as well as surgical procedures and actions needed for septo/rhinoplasty. Throughout the examination, the PhD candidate had not strictly held close to one rigid course of action or another while performing esthetic or functional rhinosurgery. The surgical procedure performed at a particular case rather depended on the pathology of the septum. The statistical methods used for the analysis of the obtained results are also listed. Based on the results, the statistical processing, as well as through discussion, the following conclusions have been drawn: 1. Rhinomanometry is a method that objectively determines the degree of nasal obstruction. It is clinically a very important method because it provides a pre-surgical real objectification of the degree of nasal obstruction. In the study, the use of rhinomanometry was beneficial since it attained the clinical objective to distinguish and group the patients who were truly in need of septo/rhinoplasty and the patients that were supposed to be monitored and receive medicament treatments. Likewise, the study brought about evidence that there is indication for septoplasty in patients with mild degree of nasal resistance (mild deviation of the nasal septum which even though monitored for a year, without use of drugs/medicine or topical nasal steroids, was still present, therefore the need of septoplasty was unavoidable.In many patients that are in a need of both functional, and aestethetic-functional septorhinoplasty the open question is posed of whether there is a connection between the degree of nasal obstruction, the incidence and the intensity of the occurrence of nasal symptoms that are a result of the deviated nasal septum. Admittedly, it has been expected that most of these patients would suffer from asymmetrical nasal flow through the nostrils due to the deviation of the nasal septum and if the deviation of the nasal septum is more severe and the nasal resistance is greater, then the nasal symptoms are prominent which has led to one-sided or double sided hypertrophy of the nasal cavity. 2. The feeling of impaired breathing was described by the patients candidates for septo/rhinoplasty as a dominant symptom of nasal obstruction. The results from the research have demonstrated that pre-surgically, as well as during the check-ups in 3, 6 and 12 months, the patients who experienced mild nasal obstruction that had not posed a problem in their everyday life and sleep were the fewest. Listing headache as a predominant symptom in patients with nasal septal deviation and its constancy in the post-surgical period showed that the headache is also caused by certain subjective reasons most commonly of psychogenic nature, such as anxiety, restlessness and great expectations of the intervention. The rhinorrhea was drastically diminished as a result of the correction of the nasal septum that reduced the edema and the hypertrophy of the nasal mucosa, especially the changes in the nasal concha, which has led to the decrease of the exudation of the nasal secretion. The occurrence of epitaxis was detected along the nasal septal deviations in the front and front-back sections, but it was of no significance. Therefore, it was inferred that all other causes that might be of functional, inflammatory, subjective or other nature might bring about the occurrence of these symptoms. 3. The results showed the significant correlation between the anatomical (objective) and the psychological (subjective) causes that determined the frequency and the intensity of the occurrence of the nasal symptoms. An analysis was made on the classifications of the nasal septal deviations on Mladina, as well as on the classification based on the coronal transections of the nasal septum acquired by coronal and axial transections of the nasal septum obtained with computed tomography. Likewise, a comparison was made in regards to the correlation between the nasal deviation and the consequent changes in the middle nasal cavity by comparing the examinations with the ones performed by Baumann and associates in the study of classification of the nasal septal deviation. The systematic classification of the deviations of the nasal septum done in this study has a lot of advantages compared to the other previously mentioned classifications because the previously mentioned ones mostly encompassed the classifications in the region of the cartilaginous septum, without taking into account the role that the position of the nasal septum has in regards to the external configuration of the nose. The objective of this classification is to encompass all the pathological alterations of the nasal septum and to document them, in order to implement an adequate surgical technique. Other objectives of this classification are to make the systematic training of young rhino surgeons in septoplasty easier, as well as to make this occupation more interesting and more appealing.In the chapter on the Surgical Protocol during septo/rhinoplasty, the surgical procedures and actions while performing a surgical intervention of septo/rhinoplasty were determined and established.4. Through several surgical techniques, one modern approach to performing the surgical technique septoplasty was demonstrated. The ultimate objective of this surgical procedure was to indicate that not only a medial location of the nasal septum, but also a medial location of the space between the septum and the nasal cavities was of vital importance for a proper nasal respiration. The motto as well as the benefit of an adequately performed intervention in septal surgery and surgery of the nasal concha is: “Not the septum, nor the nasal concha, but the space between them is the point". 5. By testing the psychological profile of a patient’s personality, the idea was that the patient would come to a mature decision by being fully aware of the possible change that would take place and would change their life, not only physically, but spiritually as well. This would also be beneficial to the surgeon in making the right decision regarding the surgical course of the intervention; it would also be of great use in the post-surgical clarification of the objective expectations of the surgeon by the performed surgical procedure and the expectations of the patient.Last but not least, a maxim that sums up the importance of experience.Oперативната техника ÑепториноплаÑтика има за цел да го ремоделира и редизајнира ноÑот, да ги отÑтрани екцеÑивните коÑкени или ʼрÑкавични Ñтруктури, и/или Ñо неа да Ñе корегираат ноÑните инÑуфициенции, Ñо цел ноÑот да претÑтавува хармонична единица во Ð¾Ð´Ð½Ð¾Ñ Ð½Ð° оÑтанатите лицеви Ñтруктури. Таа воедно претÑтавува една од најфреквентните еÑтетÑко - хируршки отоларинголошки процедури. Kартилагинозниот дел на назалниот Ñептум претÑтавува интегрален дел во регионот на иÑтмуÑот и има значајна улога во Ñтруењето и турбуленцијата на воздухот. Поради оваа централна улога на ноÑната преграда, многу е важна адекватноÑта на преземената оперативна техника како клуч за уÑпешен третман, како во функционалната така и во еÑтетÑката ринохирургија. Деформитетите на ноÑната преграда можат да бидат локализирани во коÑкениот или ʼрÑкавичниот дел, но најчеÑто Ñе комбинација од двете. ʼРÑкавичните девијации имаат најголем удел во нарушувањето на назалниот реÑпираторен проток. Затоа e направена нивна адекватна клаÑификација.Во оваа опÑежна Ñтудија главните цели беа:1. РиноманометраÑки, да Ñе објективизира назалната воздушна резиÑтенција (назална опÑтрукција) при Ñелекција на пациентите за ÑепториноплаÑтика.2. Да Ñе изврши евалуација на фреквенцијата и интензитетот на назалните Ñимптоми кај пациентите за ÑепториноплаÑтика пред и по интервенцијата.3. Да Ñе клаÑифицираат девијациите на ноÑната преграда во Ð¾Ð´Ð½Ð¾Ñ Ð½Ð° Ñепталните Ñтруктурно-анатомÑки промени врз база на КТ на Ð½Ð¾Ñ Ð¸ параназални ÑинуÑи и интраоперативниот наод.4. Да Ñе одреди адекватен пÑихолошки модел на личноÑÑ‚ при Ñелекција на пациентите за ÑепториноплаÑтика.Поддржана од клинички важни информации, целта на оваа Ñтудија, беше да биде прифатена како протокол при Ñелекција на пациентите за ÑепториноплаÑтика. Aвторот наведува дека оваа Ñтудија е проÑпективна нерандомизирана каде ÑтатиÑтички беа анализирани вкупно 140 пациенти Ñо девијација на ноÑната преграда (deviatio septi nasi) одделно или во Ñклоп Ñо деформитети на ноÑната пирамида: rhinokyphosis, rhinoscoliosis, rhinolordosis (ÑедлеÑÑ‚ ноÑ), „долг ноц(анг: functional tension nose). ИÑпитуваните пациенти беа Ñтавени на оперативна лиÑта за ÑепториноплаÑтика која беше доÑтавена до УниверзитетÑката клиника за уво, Ð½Ð¾Ñ Ð¸ грло – Клинички центар во Скопје, во периодот од Ñептември 2008 г., до Ñептември 2013 г. РиноманометриÑките иÑпитувања беа изведувани на ИнÑтитутот за Медицина на труд - Скопје, а пÑихолошките теÑтирања беа извршени Ñо помош на клинички пÑихолог и пÑихијатар на Клиниката за пÑихијатрија.ИÑпитуваните групи беа поделени Ñпоред Ñледниве параметри:a) Според Ñтепенот на назална опÑтрукција, пациентите беа поделени во 3 групи:Група IA – иÑпитаници кои имаа тежок Ñтепен на назална опÑтрукција (тежок Ñтепен на назална резиÑтенција).Група IБ – иÑпитаници кои имаа Ñреден Ñтепен на назална опÑтрукција (Ñреден Ñтепен на назална резиÑтенција).Група II– иÑпитаници кои имаа леÑен Ñтепен на назална опÑтрукција (леÑен Ñтепен на назална резиÑтенција), а кои беа опÑервирани клинички една година, а потоа Ñе донеÑе одлука за оперативна интервенција.Кај Ñите пациенти-кандидати за ÑепториноплаÑтика, предоперативно беа Ñледени назалните Ñимптоми: назална опÑтрукција, ринореа, назална болка, главоболка, хипоÑмија, ʼрчење, назален говор, епиÑтакÑа и оÑтанато, и беа евидентирани на Ñкалата на назални Ñимптоми.По извршената оперативна интервенција, иÑпитаниците беа анкетирани колку Ñе задоволни од извршената корекција, при што им беа понудени 5 Ñкорови, одноÑно модалитети: 1-многу задоволни, 2-задоволни, 3-неодредени, 4-незадоволни и 5- екÑтремно незадоволни.б) Според видот на оперативната техника, при изведба на оперативната интервенција, пациентите беа поделени во две групи: - група I -1: каде Ñе изведе Ñамо ÑептоплаÑтика; тоа беа пациенти Ñо Dg: Deviatio septi nasi.- група I-2: каде Ñе изведе ÑепториноплаÑтика: тоа беа пациенти кои оÑвен девијација на ноÑната преграда имаа и деформитет на ноÑната пирамида од типот на: rhinokyphosis, rhinoscoliosis, rhinolordosis (ÑедлеÑÑ‚ ноÑ) „долг ноц(анг: functional tension nose).Од двете групи, пациентите беа поделени во две подгрупи:- подгрупа I2-а: во која Ñе изведе лателарна и медијална оÑтеотомија;- подгрупа I2-б: во која не Ñе изведе оÑтеотомија.в) ПÑихолошка анализа Ñе направи Ñамо на пациентите-кандидати за ÑепториноплаÑтика кои доброволно прифатија да го пополнат прашалникот за Ñелекција на пациентите-кандидати за ÑепториноплаÑтика и нивните пÑихолошки ÑклоноÑти. Врз база на повеќе ÑветÑки Ñтандардни теÑтови и прашалници кои би ги пополнил пациентот-кандидат за интервенција, Ñе формира Ñличен прашалник, Ñе разбира адаптиран за нашето поднебје во кој влегоа Ñледните параметри:- Селекција на пациентот за ÑепториноплаÑтика и неговите пÑихолошки ÑклоноÑти (ПÑихолошко теÑтирање-прашалник за self body image), Brief Symptom Inventory (BSI) теÑÑ‚, Ñо кој беа анализирани добиените резултати добиени од прашањата поÑтавувани на пациентите кандидати за ÑепториноплаÑтика. Преку Brief Symptom Inventory (BSI) теÑтот, кој претÑтавува еден Ñтандарден пÑихолошки теÑÑ‚ беа Ñледени Ñледните пÑихолошки Ñимптоми кај пациентот: Ñоматизација, опÑеÑивно-компулÑивни реакции, интÐ

The Impact of the Nasal Trauma in Childhood on the Development of the Nose in Future

AIM: To prevent and to treat nasal trauma in children properly, because it can lead to displacement or depression of the nasal bones or septum. Second, our aim was, for the patient to recognise and create a mature decision for eventual nose changes which will be made with the operative intervention or they are not mature enough and the decisions were made by their parents.MATERIAL AND METHODS: Our retrospective study was made at University Clinic for Ear, Nose and Throat, Faculty of Medicine, Ss Cyril and Methodius University of Skopje in the period of 6 years (2005 -2016). Seventy-three patients were admitted with recent or previous nasal trauma or nasal deformity. The first group of 32 were children and adolescents from 6-14 years old who were admitted to our hospital because of recent nasal trauma. The second group of 41 children and adolescents from 6-14 years old were admitted to our hospital because of previous nasal trauma, which was not treated on time, or it was not treated properly. They were admitted to our clinic for surgical intervention septo/rhinoplasty. The second group of patients fills the brief psychological questioner prepared by Clinical psychiatrist from University Clinic of Psychiatry, in Skopje, and their psychological reactions were taken into consideration.RESULTS: Eleven of the children and adolescents who had nasal fracture without dislocation, who have no symptoms, minimal swelling, and no septal deviation or hematoma, were observed with a specific follow-up: 3 days after nasal fracture, then every week in the first month, after 1 month, and after 3 months period. Sixteen of children and adolescents who had a nasal fracture with subluxation of nasal septum were operated with closed reduction (repositio nasi) under general anaesthesia. The others with septal hematomas and subperichondrial abscess were treated as in adults’ patients. The second group of 41 children and adolescents from 6-14 years old consisted with with the previous nasal trauma which was not treated on time or it was improperly treated. In 24 (58.54%) of these patients septoplasty was performed and in 17 (41.46%) was performed rhino septoplasty.CONCLUSION:Often, difficult septal deformations in children are followed with deformation of the nasal pyramid (rhino scoliosis, rhino lordosis). In those cases, we cannot solve septal pathology without nasal pyramid intervention in the same time and opposite. Clinical reports have not produced solid evidence for the statement that septal surgery has no negative effect on nasal growth or can serve for correcting abnormal growth. The functional and esthetic problems of the patient, however, mean a continuous stimulus for further clinical and experimental investigations.Â

Simultaneous Presentation of Benign Paroxysmal Positional Vertigo and Meniere’s Disease – Case Report

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is one of the most common clinical entities, which develops spontaneously in most of the cases, but it can be secondary as a result of different conditions such as head injuries, viral neurolabyrinthitis, Meniere’s disease and vertebrobasilar ischemia. The aim of presenting this case is to point out to the need of taking a precise clinical history and performing Dix-Hallpike manoeuvre in all patients who complain about vertigo regardless of the previously diagnosed primary disease of the inner ear. CASE PRESENTATION: A 63-year-old female patient presented with the classical triad of symptoms for Meniere’s disease (fluctuating sensorineural hearing loss in the right ear, tinnitus and fullness in the same ear and rotary vertigo), two years later complained of brief episodes of vertigo linked to changes in head position relative to gravity. Dix-Hallpike manoeuvre showed a classical response in the head-hanging right position. Benign paroxysmal positional vertigo (BPPV) in the same ear was diagnosed in this patient. After treatment with Epley’s canal repositioning manoeuvre for a few days, the symptoms of positional vertigo resolved. CONCLUSION: The authors recommend complete audiological and otoneurological evaluation in all patients with vertigo for timely recognition/diagnosis of any inner ear associated pathology

Justification for Rhinoseptoplasty in Children – Our 10 Years Overview

BACKGROUND: Background: Nasal septal surgery and rhinoplasty are controversial in children. Traditionally, an attitude of restraint has been employed by most surgeons till an empirical age of 16 to 18 years. This is to avoid the possible adverse effects that the growth spurts may have on the nose and midface region.AIM: The aim of this paper was to present the results of rhinoplasty in children in order to restore the anatomy and function or to promote normal development and outgrowth of the nose.MATERIAL AND METHODS: Ninety seven children aged 6-14, with severe nose deformities and breathing problems through the nose, were admitted for septo/rhinoplasty at the University Clinic for Ear, Nose and Throat, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Republic of Macedonia. At our Clinic, they have been observed and photographed (with parent permission) in the period of 10 years (2006-2016). The most frequent cause of these deformities was the nasal trauma in early childhood which was ignored or untreated. All of them rhino/septoplasty were indicated in accordance with the above-mentioned recommendations for rhino/septoplasty in early childhood and in adolescents.RESULTS: In 51 children and adolescents septoplasty were prepared. Mostly there was a group of younger children age from 6-10 (68%) and adolescents (32%). In the other 31 children and adolescents, septorhinoplasty was prepared. Mostly there were children older than 12 years old and adolescents (70%). Only 30% were younger than 12 years, of course with severe nasal breathing problems, nasal septal deformities and deformities of the nasal pyramid.CONCLUSION:The growth centres of the nose have to be avoided if possible; long-term nasal issues will theoretically be minimised. If the surgeon replaces it, the cartilage of the nose becomes straighter but still intact.Â

Laryngotracheal Stenosis: A Retrospective Analysis of Their Aetiology, Diagnose and Treatment

BACKGROUND: Laryngotracheal stenosis created as a result of a long-term consequence of prolonged endotracheal intubation is a state of narrowing of the airway, which, depending on the degree of narrowing, can be from an asymptomatic to a potentially life-threatening condition. AIM: To understand the severity of postintubation laryngeal stenoses, their diagnosis, endoscopic evaluation, endoscopic and surgical treatment and their success in a multi-year period realised in the University Clinic for Ear, Nose and Throat in Skopje, Macedonia. MATERIAL AND METHODS: Through a proper history, physical examination, endoscopic and imaging evaluation of the ear, nose and throat in the Clinic, in the period of 8 years, that is, from 2010 to 2017, laryngotracheal stenosis was diagnosed in a total of 36 patients. During this period, 24 male or 66.7% were diagnosed, as were 12 female subjects or 33.3% of diagnosed patients. Of the analysed total of 36 patients, by Mayers cotton classification, 14 or 38% are patients with grade 1 stenosis, 5 or 13% are grade 2, and 10 or 27% are grade 3, while 7 or 19% are grade 4 stenosis RESULTS: It is essential for all laryngotracheal stenoses to exist or to provide a breathing path that depends on the degree of stenosis. Further course of treatment also depends on the characteristics of the stenotic zone that is visualised endoscopically. At the Clinic for ear nose and throat in Skopje, endoscopic treatment was performed through a series of dilatations within 21 patients, or 58 % of the examinee, as well as the administration of mitomycin and corticoderates in 21 patients or 52% of the examinee. The applied actions and procedures had shown 100% outcome on stenoses not longer than 2 cm, who have a fibro-inflammatory scar and by Myer cotton classification 1 and second stadium. Patients that have failed endoscopic treatment, surgical treatment are a method of choice. Surgical treatments have been performed in 4 patients with realised end of the anastomosis, and 3 crycotracheal reconstructions, which is decannulated. After an extensive follow-up of these patients, depending on their condition, multiple endoscopic evaluations have been decannulated to 21 patients or 58%, and after a series of multiple unsuccessful endoscopic treatments, a condition with tracheal stoma occurs in 8 patients or 22% of the examinee. CONCLUSION: The observations indicate that the methods used, which are explained previously, have good effects in terms of the achieved outcomes. Due to limited resources, it is necessary to improve new methods and approaches in the treatment of stenoses, depending on their type and severity, thereby improving patient outcomes. Also, to reduce laryngotracheal stenoses, appropriate tubes and low pressure of the caffeine in the endotracheal tubules should be used

The Pillars of the Nose-Crura Shortening for Over Projected Nose

BACKGROUND: The over projected nose, commonly referred to as the "Pinocchio" nose is a significant challenge to the rhinoplasty surgeon. Firstly, we speak about a very large nose, and secondly, we speak about the correction of nasal cartilages (alar and triangular). Surgical correction of the over projected nose is the most difficult and least predictable component of rhinoplasty surgery. AIM: By performing rhinoseptoplasty we aimed to achieve an ideal landmarks position according to concepts of nasal projection as well as by making preoperative analyses to determine the ideal position for the nasal tip after having understood and defined the ideal position for the nasion. METHODS: We performed a retrospective study of patients who were admitted to ENT University Clinic, University Campus “St. Mother Theresa†Skopje, the Republic of Macedonia in the period 2011-2019. A total of 70 patients were enrolled in the study; 46 women (33%) and 24 men (33%). Operative technique rhinoseptoplasty was realised in 70 patients. All of the 70 (100%) patients underwent preoperative and postoperative evaluation during this period regularly to record the effects of various approaches on nasal projection, rotation, need for revision, and patient satisfaction. RESULTS: All patients used one or more of the preferred methods to treat over projection. Patients who had undergone 2 previous rhino/septoplasty procedures were excluded from the study, and hence, a total of 70 patients were evaluated. Full-transfixion incisions were made in all patients. From 2011 to 2019, in 72 cases, 1 or more of the preferred methods were used to treat over projection. CONCLUSION: The crural anatomy of the nasal tip relates to the size and shape of the lower lateral cartilages (LLC) and their relationship with the caudal septum and upper lateral cartilages (ULC). Modification of nasal tip rotation and projection should attempt to preserve or reconstruct major tip mechanisms

Psychological Patient Reactions after Septorhinoplasty - Our Personal View

AIM: The aim of our study is to observe adequate and inadequate psychological reactions in patients who are candidates for septorhinoplasty, before and after surgery and to create an adequate psychological model of a person suitable for septorhinoplasty in this group of patients.MATERIAL AND METHODS: In this study, 140 patients with nasal septal deviation (deviatio septi nasi), alone or together with other nasal deformities, were observed in the period of 4 years (2011-2015 year). Our patients were psychologically observed using two standard psychological tests: Patients selection for septorhinoplasty and their psychological abilities (“Self-body image†questionnaire) and Brief Symptom Inventory (BSI) test.RESULTS: Most of the patients 43 (39.8%), thought that after rhinoseptoplasty their self-confidence arise, 32 (29.63%) expected changing's in their life's, few of them 9 (8, 3%) thought that the environment will act different with them. The Brief Symptom Inventory (BSI) in women group was shown that most of the women patients presented symptoms of somatisation; 23 (23.33%) and 15 (25%) one year after surgery.CONCLUSIONS: The patients made a sound decision for intervention, which was useful for the surgeon too, because it helped them choose an adequate operative technique and especially helped them in the postoperative period

Enduring Personality Changes after Intense Stressful Event: Case Report

BACKGROUND: World statistical data show that a large number of individuals suffer from posttraumatic stress disorder (PTSD) after exposure to the intense traumatic event. PTSD can have a chronic course with enduring changes in the functioning of the person.CASE PRESENTATION: Here we report two adult individuals of different gender and education who were exposed to the extremely severe stressful event after which difficulties in psychological functioning developed. The first case we present is a 46-year-old man, with completed high education, divorced, father of two children, who lives with his parents, and is retired. Disorders appeared 20 years ago when he was exposed to extremely severe stressful events in war circumstances that included captivity, torture, and loss of fellow soldiers. The second case is a 50-year-old female patient, with a university degree, professor of art, married, and mother of two children of whom the son died six years ago. She suffered from disorders after the sudden injury of her son that ended with his death.CONCLUSION: Posttraumatic stress disorder after the intense stress is a risk of development enduring personality changes with serious individual and social consequences.Â

NASAL SEPTUM DEVIATION AND CONDUCTIVITY HEARING LOSS IN CHILDREN

The human respiratory system is extremely com­plicated and it has been extensively investigated, yet the system has not been fully recognized. De­viation of the nasal septum, which changes the airflow in this part of the res­piratory tract, can af­fect the state of the paranasal sinuses as well as the functions of the auditory tube. It can also cause hypertrophy of adenoids. In the available literature on skeletal deviations of the nasal septum and their influ­ence on the state of hearing and, particularly, on the state of the auditory tube and middle ear, there are no uniform views

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.Peer reviewe