BI22: A three‐patient case series: methotrexate‐induced nasal septal perforation, mucositis and widespread ulceration

2021 ◽  
Vol 185 (S1) ◽  
pp. 152-152
Keyword(s):  
Case Series ◽  
Septal Perforation ◽  
Patient Case ◽  
Nasal Septal Perforation

Septal Perforation Repair Utilizing an Anterior Ethmoidal Artery Flap and Collagen Matrix

2018 ◽  
Vol 33 (3) ◽  
pp. 256-262 ◽  
Author(s):  
Marina N. Cavada ◽  
Carolyn A. Orgain ◽  
Raquel Alvarado ◽  
Raymond Sacks ◽  
Richard J. Harvey
Keyword(s):  
Corticosteroid Injection ◽  
Case Series ◽  
Collagen Matrix ◽  
Contralateral Side ◽  
Septal Perforation ◽  
Closure Rate ◽  
Reliable Technique ◽  
Nasal Septal Perforation ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery

Background Nasal septal perforation repair remains a challenge with no standard technique for repair recognized. Objective To describe the combination of an anterior ethmoidal artery flap with a collagen matrix inlay as a successful technique for nasal septal perforation repair. Methods A case series of consecutive patients who underwent nasal septal perforation repair with an anterior ethmoidal artery flap with an inlay collagen graft was conducted. Demographic data, preoperative features of the perforation (size, location, and presence of chondritis), and postoperative outcomes were analyzed; closure rate, mucosalization rate (of the contralateral side at 21 and 90 days), and complications (crusting, bleeding, obstruction, infection, and rehospitalization <30 days) were documented. Results Thirteen patients (age: 49 ± 15 years, 30.8% women) were assessed. The perforation size was 1.6 ± 0.9 cm (range: 0.3–3.5 cm) and located 1.2 ± 0.5 cm (range: 0.5–2.0 cm) posterior to the columella. Chondritis was present in 69.2%. The closure rate was 100% (95% confidence interval [CI]: 77%–100%) at both 21 and 90 days. One patient required a free mucosa graft to an area of persistent crusting on the contralateral side (7.7%). Complications were low; bleeding 0%, obstruction 7.7% (requiring corticosteroid injection of anterior ethmoidal artery flap), and 0% infection/rehospitalization. Conclusion Anterior ethmoidal artery flap with an inlay collagen matrix is a reliable technique to repair nasal septal perforation. This technique, with robust vascularity and wide angle of rotation, enables the closure of perforations both large (<50% total septum) and with anterior locations.

Nasal Septal Perforation Closure by “Sandwich Grafts”: Technique, Initial Results

2021 ◽  
Author(s):  
Mattis Bertlich ◽  
Friedrich Ihler ◽  
Maya Bertlich ◽  
Mark Jakob ◽  
Martin Canis ◽  
...  
Keyword(s):  
Nasal Septum ◽  
Case Series ◽  
Septal Perforation ◽  
Auricular Cartilage ◽  
Reliable Technique ◽  
Temporal Fascia ◽  
Nasal Septal Perforation ◽  
Foreign Materials ◽  
Septal Perforations ◽  
Initial Results

AbstractNasal septal perforation closure represents a considerable surgical challenge. Many techniques rely on the implantation of foreign materials that pose a persisting threat of infection. The authors have identified a reliable technique closing septal perforations by an autologous “sandwich graft.” It is layered around a piece of auricular cartilage, covered with temporal fascia, thus emulating the physiological layers of the nasal septum. Finally, the prepared graft is then sewn into the perforation in an underlay technique and kept in place by septal splints for 4 weeks. The technique is easily feasible and strives to reconstruct the nasal as physiological as possible. The data obtained from a case series of 11 patients highlights the efficacy of the technique.

Perioperative Management of Nasal Septal Perforation: A Case Series and Review

2021 ◽  
Author(s):  
William James Wakeford ◽  
Eamon Shamil ◽  
Alwyn Ray D'Souza
Keyword(s):  
Patient Selection ◽  
Surgical Techniques ◽  
Case Series ◽  
Postoperative Management ◽  
Good Effect ◽  
Septal Perforation ◽  
Closure Rate ◽  
Surgical Closure ◽  
Clear Cut ◽  
Nasal Septal Perforation

AbstractNasal septal perforation is a prevalent pathology, and its successful treatment remains a significant challenge. Surgical closure is complex, and there are a plethora of accounts of various surgical techniques within the existing literature. Much less has been written about perioperative considerations, which are arguably just as important. This article therefore focuses predominantly on the pre and postoperative management of patients with septal perforation. By drawing both on the existing literature and a series of 64 cases managed over several years by our department, this review aims to consolidate guidance on patient selection, timing of surgical intervention, postoperative splinting, use of antibiotics, and patient advice. It is clear that the size of the perforation (relative to the size of the septum), health of surrounding mucosa, and the systemic health and age of the patient remain essential considerations in patient selection and operative timing. Internal and external splints are widely used to good effect, but the role of nasal packing is less clear-cut. This article suggests packing, but with an increasing preference for NasoPore over BIPP (bismuth iodoform paraffin paste). Use of prophylactic antibiotics remains controversial. The complete closure rate for the series presented here was 81.3%, with an average perforation diameter of 15.1 mm (range: of 6–32 mm), and that for perforations with a diameter below 22 mm was 97.9%.

Prospective case series on the use of peripheral nerve stimulation for focal mononeuropathy treatment

2019 ◽  
Vol 9 (6) ◽  
pp. 551-558 ◽  
Author(s):  
Jessica Oswald ◽  
Varun Shahi ◽  
Krishnan V Chakravarthy
Keyword(s):  
Peripheral Nerve ◽  
Case Series ◽  
Suprascapular Nerve ◽  
Intercostal Nerve ◽  
Nerve Stimulator ◽  
Patient Case ◽  
Peripheral Nerve Stimulator ◽  
Pain Scores ◽  
Early Results ◽  
Prospective Case Series

Aim: This case series looks at outcomes in 39 patients implanted using the Bioness Stimrouter system on various isolated mononeuropathies. Patients & methods: A case series of 39 patients with a total of 42 implants were enrolled starting August 2017 at various pain management centers. Results: Of 39 patients studied, 78% of the participants noticed an improvement in their pain. There was a 71% reduction in pain scores with the average preprocedure score of 8 improving to 2 post-implant. Participants noted on average a 72% improvement in activity with the greatest observed in the brachial plexus (80%) and suprascapular nerve (80%) and smallest in the intercostal nerve (40%). Approximately 89% of those implanted with a peripheral nerve stimulator experienced a greater than 50% reduction in opioid consumption. Conclusion: Peripheral nerve stimulators are a new, minimally invasive neuromodulation modality that shows promising early results in our 39-patient case series.

Assessing Patient Symptoms Due to Nasal Septal Perforation: Development and Validation of the NOSE-Perf Scale

2021 ◽  
pp. 019459982199201
Author(s):  
Cullen M. Taylor ◽  
Stephen F. Bansberg ◽  
Michael J. Marino
Keyword(s):  
Nasal Obstruction ◽  
Discriminant Validity ◽  
Assessment Tool ◽  
Tertiary Care ◽  
Control Group ◽  
Septal Perforation ◽  
Specific Symptom ◽  
Nose Scale ◽  
Nasal Septal Perforation ◽  
Patient Reported

Objective Reporting patient symptoms due to nasal septal perforation (NSP) has been hindered by the lack of a validated disease-specific symptom score. The purpose of this study was to develop and validate an instrument for assessing patient-reported symptoms related to NSP. Study Design Validation study. Setting A tertiary care center. Methods The Nasal Obstruction Symptom Evaluation (NOSE) scale was used as an initial construct to which 7 nonobstruction questions were added to measure septal perforation symptoms. The proposed NOSE-Perf instrument was distributed to consecutive patients evaluated for NSP, those with nasal obstruction without NSP, and a control group without rhinologic complaints. Questionnaires were redistributed to the subgroup with NSP prior to treatment of the perforation. Results The study instrument was completed by 31 patients with NSP, 17 with only nasal obstruction, and 22 without rhinologic complaint. Internal consistency was high throughout the entire instrument (Cronbach α = 0.935; 95% CI, 0.905-0.954). Test-retest reliability was demonstrated by very strong correlation between questionnaires completed by the same patient at least 1 week apart ( r = 0.898, P < .001). Discriminant validity was confirmed via a receiver operating characteristic ( P < .001, area under the curve = 0.700). The NOSE-Perf scale was able to distinguish among all 3 study groups ( P < .001) and between NSP and nasal obstruction ( P = .024). When used alone, the NOSE scale could not discriminate between NSP and nasal obstruction ( P = .545). Conclusions The NOSE-Perf scale is a validated and reliable clinical assessment tool that can be applied to adult patients with NSP.

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