Der funktionelle Aspekt der Septorhinoplastik

Introduction

Rhinosurgeons emphasize the functional aspect of septorhinoplasty (SRP). So far only a few publications with exact data exist.

Patients and methods

Fifty-two patients (33 ♂; 19 ♀, average age: 37 years) were examined before and approx. 1 year after SRP. Rhinomanometry, olfactometry, and photographic documentation were carried out. Using a questionnaire they were asked about the functional outcome and about their original personal aims concerning the SRP.

Results

All patients suffered from a deviated septum. Regarding the external aspect 38 patients had a crooked nose with or without a hump, 7 patients had a hump without external deviated nose, and 7 patients had a saddle nose or other deformities. If total nasal airflow is considered rhinomanometry showed no significant improvement postoperatively (p=0.115). If only the worse nasal side is considered rhinometry showed a highly significant improvement (p=0.002). In the questionnaire 34 patients (65%) indicated an improvement, 14 patients (27%) no change, and 4 patients a deterioration of the nasal airflow. The final aesthetic outcome was assessed by 39 patients (75%) as an improvement, by 12 patients (23%) as unchanged, and by 1 patient (2%) as worse. There were no significant changes in the olfactory function. Asked about their personal aims 29 patients (56%) wished first of all an improvement of nasal airflow, 5 patients (10%) a good aesthetic result, and 18 patients (34%) both aspects.

Conclusions

The results show that use of the term “functional” SRP is justified. In the majority of cases a simultaneously existing functional-plastic problem is solved. Our results support the importance of rhinomanometry as an objective parameter in the perioperative diagnostic battery of nasal obstruction.     

Simultaneous intranasal procedures to improve chronic obstructive nasal breathing in patients undergoing maxillary (le fort I) osteotomy.

PURPOSE: The aim of this study was to evaluate the safety and efficacy of septoplasty and inferior turbinate reduction, carried out through a Le Fort I osteotomy as part of the correction of a dentofacial deformity, designed to improve nasal breathing in patients who reported pre-existing nasal airway obstruction and had documented septal deviation and inferior turbinate hypertrophy. PATIENTS AND METHODS: A validated outcomes instrument, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, was used to objectively assess the extent of clinical nasal obstruction both before and after septoplasty and inferior turbinate reduction performed at the time of Le Fort I down-fracture. The study group comprised 43 consecutive patients scheduled for orthognathic surgery (including Le Fort I osteotomy) over a 12-month period who complained of chronic nasal obstruction and were found (by an independent otolaryngology evaluation) to have septal deviation and inferior turbinate hypertrophy unresponsive to medical therapy, who met the inclusion criteria, and who agreed to the procedures (septoplasty and turbinate reduction). The data collected included age, gender, health and social history, type of dentofacial deformity, concomitant surgical procedures, and any associated postoperative complications. RESULTS: For the 43 study patients, significant improvement in nasal breathing was documented (by NOSE scores) at 3 months (P < .001) after the procedures (Le Fort I osteotomy, septoplasty, and inferior turbinate reduction). Comparison of the 3-month and 6-month NOSE scores showed maintenance of improved nasal breathing with further improvement that did not demonstrate statistical significance. CONCLUSIONS: The findings of this study indicate that simultaneous management of the maxillary jaw deformity (Le Fort I osteotomy) and intranasal pathology (septoplasty and reduction of inferior turbinates) were effective for the symptomatic relief of nasal airway obstruction. The complication rate for the intranasal procedures completed simultaneously with a Le Fort I osteotomy was minimal and not dissimilar to the rates reported for each procedure performed as an isolated event.     

Effectiveness of chondrofascial ‘cigar’ graft in contouring the nasal dorsum

Irregularities of the nasal dorsum after rhinoplasty are frustrating for the patient and the surgeon. Different grafts and implants have been adopted to camouflage this nasal imperfection. This study was performed to assess the outcome of a composite chondrofascial ‘cigar’ graft for contouring an irregular nasal dorsum. Thirty-six patients who underwent rhinoplasty between May 2014 and October 2016 were studied prospectively. The cartilaginous core of the graft was obtained from the septal or conchal cartilage, while the graft outer sleeve was harvested from the right lateral thigh fascia lata. The graft was secured over the nasal dorsum through an external rhinoplasty approach. The patients were followed up for at least 18 months postoperative. All participants were evaluated objectively by two independent rhinoplasty surgeons and subjectively by Rhinoplasty Outcome Evaluation (ROE) score. Donor site morbidity was also assessed. All patients had satisfactory aesthetic results with no apparent irregularities detected over the nasal dorsum. The ROE score improved, from a mean of 20.94 ± 8.67 (range 8–58) preoperatively to a mean of 79.56 ± 10.65 (range 50–96) postoperatively. Insignificant donor site morbidity was encountered, with inconsequential effects. The chondrofascial cigar graft is a reliable method for contouring dorsal irregularities, particularly in patients with thin nasal skin.     

Perceptions and satisfaction of aesthetic outcome following secondary cleft rhinoplasty: Evaluation by patients versus health professionals

ObjectiveTo explore how improvement in facial appearance is related to patients' perception and satisfaction following cleft rhinoplasty.DesignA cross-sectional survey.Participants35 cleft rhinoplasty patients treated between 2005 and 2010. 45 observers comprised of healthcare professionals.Main outcome measuresEvaluation of patient satisfaction including Rhinoplasty Outcome Evaluation (ROE) questionnaire, Preoperative and Postoperative Semi-quantitative Ordinal Scale Rating (PPSOSR) and a specifically designed semi-structured questionnaire. Evaluation by panel of observers using Asher-McDade Aesthetic Index (AMAI) Rating and PPSOSR.ResultsPatient satisfaction was high, based on the ROE questionnaire (score 76.1). 91% of patients rated their appearance as improved, 3% remained ‘uncertain’ and 6% felt ‘different but not improved.’ Teenage females (score 94.1) showed statistically higher satisfaction, when compared to older females (score 75.5), or their male counterparts (score 69.8). The preoperative appearance ratings were not statistically different between patients and panel members but postoperatively, patients' rating of their appearance was statistically higher.All components of the AMAI were scored between ‘good’ to ‘fair’ (score 9.3). Seventy percent of the panel rated the postoperative appearance as improved. Interestingly, 10% rated the postoperative appearance as ‘unchanged’, while 3% reported a ‘worsened’ appearance. There was no correlation between panel assessment of aesthetic outcome and patient satisfaction.ConclusionsCleft rhinoplasty contributes to subjective patient satisfaction as a result of their perceived improvement in appearance and function, even though this was not correlated to objective aesthetic rating by panel members.     

Secondary unilateral cleft lip nasal deformity: functional and esthetic reconstruction

Secondary correction of residual unilateral cleft lip nasal deformities is necessary in a number of patients for functional and cosmetic purposes. Myriads of techniques and modifications have been reported. Most of these publications, however, deal with the correction of the esthetic aspects of the deformity, and little attention has been given to the functional problems associated with the deformity and to the functional outcome of these procedures. A comprehensive protocol of care for correction of residual nasal deformities describing our preoperative anatomical and physiological evaluation, our surgical techniques, and postoperative outcome is presented here. The first 30 consecutive patients managed with this protocol were evaluated clinically and physiologically with rhinomanometry. Significant functional improvement was identified in 73.3% of our patients. It is recommended that airway obstruction be evaluated and addressed in all patients with residual cleft nasal deformities. Component rhinomanometry provides objective information about airway obstruction, and postoperative testing and comparison with preoperative data provide for an objective evaluation of results and assist the surgeon to evaluate the outcome of all procedures critically and to modify or improve them appropriately.     

Long-term effects of pharyngeal flaps on the upper airways of subjects with velopharyngeal insufficiency.

OBJECTIVES: To investigate the long-term effects of pharyngeal flap surgery (PFS) on nasal and nasopharyngeal dimensions of patients with velopharyngeal insufficiency (VPI) and to correlate the findings with the onset of respiratory complaints after surgery. DESIGN/PARTICIPANTS: Prospective study in 58 nonsyndromic patients with repaired cleft palate and VPI, evaluated 2 days before and 5 months (POST1) and 1 year (POST2) after PFS, on average. Patients were divided into two groups: one consisting of patients with postoperative respiratory complaints (RC group) and the other without complaints (NRC group). Interventions: Superiorly based PFS. MAIN OUTCOME MEASURES: Respiratory complaints (self reports of mouth breathing, snoring, and other sleep obstructive events) assessed at POST1 and POST2, and minimum nasal (NCSA) and nasopharyngeal (NPA) cross-sectional areas assessed by rhinomanometry at POST2. RESULTS: Respiratory complaints were reported by 55% and 36% of the patients evaluated at POST1 and POST2, respectively. Posterior rhinomanometry showed a significant postoperative reduction of mean NCSA in the RC and NRC groups (p < .05), to subnormal levels in some of them. The decrease was more pronounced in the RC group. No significant changes in NCSA were observed by anterior rhinomanometry. Similar results were obtained when NPA was assessed by modified anterior rhinomanometry. CONCLUSION: In the long-term, PFS yielded a significant reduction in upper airways dimensions beyond what should be expected and associated with persistent respiratory complaints in some cases.     

Beurteilung von Form und Funktion der Nase nach offener Rhinoplastik bei einseitigen Lippen-Kiefer-Gaumen-Spalten

Secondary septorhinoplasty in patients with cleft lip and palate (CLP) is performed to improve nasal form and function. The purpose of this study was to compare the initial findings and the surgical outcome in 30 patients with unilateral CLP. Open rhinoplasty was carried out to correct nasal deformity. Nasal soft tissue analysis was done by measurement of standardized raster photographs of the nose and lateral teleradiography. Deviations from the ideal form regarding nasal symmetry, nasal width, and alar base line were determined. The nasal profile was assessed by measuring the nasofacial and nasolabial angle, the angle between the upper lip and the Frankfurt horizontal plane (FHP), and the angle between the columella and the FHP. Nasal patency was evaluated by rhinomanometry. The overall flow (cm³/s) was determined and the flow of the cleft side and non-cleft side compared. Evaluations were made immediately before and 6 months after surgery. In the frontal plane, nasal symmetry was significantly improved and the alar form adjusted. The deep position of the columella was corrected. The acute nasofacial angle and the drooping ala were not significantly improved. An increase in the overall flow and correction of the quotient cleft/non-cleft side was achieved by the surgical procedure. In this study, aesthetically and functionally relevant findings were objectified and can be used for quality control.     

Computational fluid dynamics and NOSE scale to assess nasal respiratory function,and correlation with linear maxillary measurements after surgically assisted rapid maxillary expansion

Nasal obstruction is common in patients with a transverse maxillary deficiency. The aim of this study was to determine the variation in nasal airway resistance in adult patients with a transverse maxillary deficiency before and after surgically assisted rapid maxillary expansion (SARME) by computational fluid dynamics (CFD) using computed tomography scans, and to correlate this variation with maxillary linear measurements obtained by means of plaster models. The subjective symptoms of nasal obstruction were also analysed using a visual analogue scale (VAS) for nasal breathing and the Nasal Obstruction Symptom Evaluation (NOSE) scale. There was a median reduction of 21% in nasal airway resistance post SARME (P = 0.002). The NOSE scale score decreased (P < 0.001) and nasal breathing quality VAS scores increased in both nostrils (P < 0.001). Transverse measurements between the upper canines (C–C), premolars (PM–PM), and molars (M–M), and maxillary perimeter showed significant increases (P < 0.001), while the anteroposterior maxillary arch length showed a significant decrease (P = 0.016). An inverse proportional correlation was found between PM–PM and nasal airway resistance (r = −0.395; P = 0.034) and between M–M and nasal airway resistance (r = −0.383; P = 0.040). These results demonstrate that surgically expanding the posterior region of the maxilla results in decreased nasal airway resistance, decreased obstructive symptoms, and improved patient respiratory quality.     

Quantitative analysis of aesthetic outcomes of morphofunctional septorhinoplasty for secondary cleft lip nasal deformity

The main aim of this study was to assess nasal symmetry after morphofunctional septorhinoplasty, more specifically, symmetry of the alar base and nostrils, and nasal projection, in patients with unilateral and bilateral cleft nasal deformities. Secondary cleft rhinoplasty was performed using morphofunctional septorhinoplasty techniques in 150 patients with unilateral and bilateral cleft lip and nose deformities. Nasal changes were analysed by measuring nasal tip projection, nostril height, nostril width, alar base width, and nasal gap area preoperatively and postoperatively on standard submentovertex view 2-dimensional photographs. In the unilateral cleft group there were statistically significant improvements (p<0.001) in ratios of nasal height and width (p=0.024) and nasal gap area, and in nasal tip projection and alar base width. In the bilateral cleft group there were statistically significant improvements in nasal gap area ratio (p=0.009), nasal tip projection, and alar base width. The morphofunctional septorhinoplasty technique improved aesthetic outcomes.     

Evaluation of the results of delayed rhinoplasty in cleft lip and palate patients: Functional and aesthetic implications and factors that affect successful nasal repair

Patients born with cleft lip and palate (CLP) present with a variety of nasal deformities. These are either congenital or iatrogenic. Our aim was to establish a correlation between aesthetic and functional nasal impairments in patients with CLP whose nasal reconstruction had been delayed. Fifty-four randomly selected patients with CLP deformities, all of whom had delayed nasal repairs were evaluated objectively, aesthetically in three planes, and functionally for symptoms of nasal obstruction, chronic maxillary sinusitis, and olfactory disturbances. Aesthetically the patients were analysed from 1:1 life-size full face, profile, and submental-vertex photographs, and full skull cephalograms. Nasal patency was assessed by rhinomanometry. The presence of chronic maxillary sinusitis and olfactory disturbances were deduced from the history. The degree of nasal dismorphism correlated with the severity of nasal functional impairments. Delayed nasal repairs in patients with CLP did not produce satisfactory aesthetic or functional results, probably because growth was retarded and midfacial development was disturbed at the time of delayed rhinoplasty and resulted in asymmetry. In CLP the nose should be repaired during the early primary cheilorhinoplasty, as this is essential for the restoration of a normally functioning and aesthetically pleasing nose.     

Importance of the levator labii alaeque nasi muscle in dorsal septal deviations

Deviated cartilages structures of the nose can be affected by nasal muscles, and deviation becomes conspicuous when the patient smiles. This condition depends on activity of nasal muscles, particularly the levator labii alaeque nasi muscle. A total of 124 septorhinoplasty operations were performed to correct dorsal concave septal deviation between 2005 and 2009 years. The 70 women and 54 men included in the study had an average age of 28 years. The average follow-up period was 12 months. Open septorhinoplasty was preferred in all cases. The medial part of the levator labii alaeque nasi muscle was extensively dissected from the lateral crus and surrounding tissues. The lateral crura of the alar cartilages were separated from the upper lateral cartilages in the scroll area. The dorsal septal deviation was corrected by combination of bilateral spreader grafts, which reinforced cartilage with horizontal control sutures. Early postoperative period was uneventful. Nasal obstruction was reduced after surgery, and significant subjective postoperative improvements were observed in all patients. Comparison of preoperative and postoperative photographs demonstrated improved dorsal nasal contour. Revision operation was performed in 3 cases. The corrected septal cartilage was in a good position in all revised cases; therefore, septal surgery was not performed in the revision operations. In conclusion, surgical disruption of the anatomic relationship between the muscle with the dorsal septal cartilage and reinforcement of the dorsal septal cartilage with spreader grafts and horizontal control sutures can decrease risk of recurrence.     

Short- and long-term effect of surgically assisted maxillary expansion on nasal airway size

Transverse maxillary deficiency (TMD) may reduce nasal dimensions and lead to oral breathing. The objective of the present study was to investigate the short- and long-term effects of surgically assisted maxillary expansion on nasal airway size of patients with TMD. Eleven subjects with TMD and skeletal maturity were submitted to posterior rhinomanometry to determine the minimum nasal cross-sectional area (CSA) before and 3, 6, and 12 months after surgery. Subjects were also investigated concerning their habitual diurnal and nocturnal breathing mode (oral, nasal, and oronasal). A statistically significant increase in mean CSA was observed in the early postoperative period (3 months), followed by a decrease to the preoperative levels in the subsequent periods (6 and 12 months). No variations were observed in the breathing mode for 63.6% of the subjects. The results showed that, in the short-term, maxillary expansion most frequently produced an increase in nasal patency. However, it was observed that the effect did not persist over time in most subjects.     

Closed reduction of nasoseptal fractures: key concepts for predictable results

Nasal complex injuries are the most common facial fracture encountered in the trauma population. Multiple surgical techniques for treatment of these fractures have been described with varying results. The goal of this study was to review the efficacy of closed reduction of nasal and septal fractures using a technique based upon several key concepts. We reviewed the records of patients who had undergone isolated nasal and/or septal fractures with closed reduction at our institution between January 2013 and November 2021. Inclusion criteria consisted of preoperative CT imaging, surgical treatment within fourteen days of initial injury, and follow up of at least one year. All patients were treated under general or deep sedation. The same surgical technique was applied with closed reduction of the septum and nasal bones with internal and external postoperative splints. Of the 232 records initially reviewed, 103 met inclusion criteria. Four patients had undergone revision septorhinoplasty (3.9%). Mean (range) follow up was 2.7 (1–8.2) years. Three patients had undergone revision nasal repair due to persistent airflow obstruction with complete resolution of symptoms after revision. The other patient received multiple revisions at another institution as a result of their dissatisfaction with cosmesis without improvement. Closed reduction of nasal and septal fractures can be a highly successful procedure and yield predictable results, limiting the need for post-traumatic open septorhinoplastic surgery. Five critical concepts of nasal fracture repair can help surgeons achieve predictable functional and cosmetic results: selection, timing, anaesthesia, reduction, and support.     

Scar flap for extension of the nasal and lip soft tissue shell in secondary cleft deformities: final aesthetic touches in clefts-part iii

A scar flap is formed with the pedicle at the lateral part of the columella base at the cleft side, that is, in the center of the affected region. It enables flap placement according to individual need. A prospective evaluation was performed in a group of 76 patients with cleft lip and palate, all operated on by the same plastic surgeon. The flap was used to improve the height of the columella and the extent of nasal mucosa on the frontal septum and on the nostril base in the vestibule. In the lip, the flap raised its height and improved proportionality. The average area of flap used in a unilateral deformity was 42 mm. Both flaps in a bilateral deformity were 77 mm. The average follow-up was 22.4 months. Neither local nor general complications were noted apart from a recurrence of the deformity of the nasal septum in 7.9% of patients. The nasal passage was improved in 59.9% of patients and normalized in 19.6% upon follow-up rhinomanometry, but nevertheless, only one third of patients overcame their dynamic stereotype of breathing by the mouth. Anthropometric measurements showed an absence of statistically significant differences between patients after surgery and healthy individuals in crucial parameters (nasal tip projection, length of columella, nasolabial angle, nasal angle, and lip angle). The loss of the stigmatizing deformity is based on rotation of the nasolabial angle in relation to the aesthetic axis of the face. Direct examination proved aesthetic and functional improvement as statistically significant in 92.1% of patients.     

Septoturbinal surgery in contact point headache syndrome: long-term results

Facial pain syndrome secondary to sinonasal pathology is reported by the International Headache Society (IHS) classification (1988). It is underlined that a clear and proven nasal pathology with adequate painful stimuli must be present, i.e., acute sinusitis, vacuum sinus, or other unspecified pathologies. No clear role of septal abnormalities and turbinate hypertrophy has been attributed in the genesis of pain by the IHS classification. One of the most difficult problems in dealing with patients with sinonasal headaches is the definition of the primary cause of the pain. In our experience possible guidelines are history, endoscopic evaluation, diagnostic blocks, and computed tomography. The data reported here is from a long-term follow-up study of facial pain in a group of 34 patients with facial pain and nasal obstruction due to septoturbinal contact that did not respond to medical therapy. Patients, free from sinus disease or other causes of headache, were treated by septoplasty/rhinoseptoplasty,and middle turbinate electrocauterization. Pre- and postoperative patency was assessed by endoscopic evaluation and nasal resistance was assessed by anterior rhinomanometry. Patients were interviewed regarding pre- and post-operative intensity of pain (subjective pain was evaluated using the 0-10 Visual Analogue Scale (VAS) and frequency of the facial pain. The follow-up period ranged from 12 to 47 months (mean: 26.7 +/- 8.5 months). In 25% of the cases the pain relapsed post-operatively (from two days to one year); but in only three patients (8%) the relapses were persistent. Two out of three, however, reported a decreased VAS score after surgery. These results seem to indicate septoplasty and turbinate decongestion to be a fairly good surgical option in treating facial pain due to septoturbinal contact resistant to conservative nasal therapy.     

The long-term effect of maxillary advancement and impaction on subjective and objective nasal patency: A retrospective case-control study

The aim of this study was to investigate the change of nasal patency after maxillary advancement and impaction (MAX_ADV + IMP) in subjects with skeletal class III malocclusion (cases) and after removal of maxillary cysts in close proximity to the nasal floor in subjects that served as controls. NOSE score, volume derived by computed tomography (VOL), and acoustic rhinometry and rhinomanometry were retrospectively evaluated, before and one year after surgery. The movement of specific landmarks was also measured. NOSE score did not change after surgery, neither in 17 cases (p = 0.10) nor in 17 controls (p = 0.14). In cases, VOL_postop (10088 ± 4200 mm³) was significantly higher than VOL_preop (7807 ± 3721 mm³; p = 0.036). Maxillary advancement and inferior displacement of the ventral maxilla were noted by the movement of incisive foramen in the coronal (3.9 ± 5.4; p = 0.011) and Frankfurt Horizontal plane (2.2 ± 2.0; p = 0.001), respectively. In controls, VOL_postop (9749 ± 3654 mm³) was also significantly higher than VOL_preop (8473 ± 2624 mm³; p = 0.050). Cross-sectional areas, nasal flow and nasal resistance changed significantly after surgery in cases (6/30 pairs; p < 0.018), but not in controls (all p > 0.066). MAX_ADV + IMP increased nasal patency, but did not change the feeling of nasal breathing. Physicians should proceed with caution when informing patients about improvement of nasal breathing after MAX_ADV + IMP.     

牙颌面畸形患者术后留置胃管对口腔健康相关生活质量的影响

目的: 探讨牙颌面畸形患者术后留置胃管对口腔健康相关生活质量的影响,为正颌患者术后进食方式的选择提供参考。方法: 研究对象为2016年10月—2017年5月我院口腔颅颌面科的正颌手术住院患者,分为鼻饲组（术后拔出鼻插管后2 h,经胃管进食流质超过24 h）和口饲组（术后拔出鼻插管后2 h,经口进食流质）。采用患者一般状况和口腔健康影响程度量表(OHIP-14),调查患者口腔健康相关生活质量。采用SPSS 18.0软件包对调查数据进行统计学分析。结果: 共纳入正颌患者102例,平均年龄（24.1±4.4）岁;63.7%为女性;本科及以上文化程度占63.8%;55.9%为在职人员,28.4%是学生;82.4%为未婚。2组在年龄、性别、文化程度、职业和婚姻状态方面无统计学差异。口饲组和鼻饲组口腔健康影响程度得分分别为35.2±9.295和31.36±7.505,差异具有统计学意义(P﹤0.05)。各维度在功能受限、能力限制的得分差异均有统计学意义（P<0.05）。正颌患者术后留置胃管3 d,可提高营养液摄入量,尤其是术后第1天和第2天,鼻饲营养液量显著高于口饲量（P<0.01）。结论: 正颌患者术后留置胃管3 d,可提高口腔健康相关生活质量和术后营养液摄入量,为患者术后早日康复提供保障。     

Autologous versus prosthetic nasal and auricular reconstruction – patient,professional and layperson perceptions

The aim of this study was to retrospectively evaluate the perceptions of aesthetic outcome following the autologous and prosthetic reconstruction of nasal and auricular defects among patients, professionals (oral and maxillofacial surgeons and ear, nose and throat surgeons) and people unfamiliar with reconstructive surgery. The influence of anatomical subunits on the overall perception of nasal and auricular reconstructions was also determined. A total of 119 patients treated for nasal and auricular defects between 1997 and 2016, with a minimum follow-up period of 6 months, were selected, and photographs of 77 of these patients (65%) were presented in a digital survey and reviewed using a standardized questionnaire. No clinically relevant correlations were found between the age or gender of patients (as well as those of the respondents) and their scores. Prosthetic reconstructions of nasal and auricular defects were considered advantageous over autologous reconstructions in terms of the subjective aesthetic outcome in the view of the professionals, in particular oral and maxillofacial surgeons; however, the patients judged both techniques to be equally effective in terms of aesthetics. No anatomical subunits were found to have a significant impact on the overall match of a nasal or auricular reconstruction with the patient’s face.     

Revisional surgery following the superiorly based posterior pharyngeal wall flap. Historical perspectives and current considerations

The aim of this study was to describe the surgical and functional complications following superiorly based posterior pharyngeal wall (SBPP) flap surgery. Records of 130 patients with velopharyngeal insufficiency (VPI) who had undergone SBPP flap surgery as a secondary procedure to reduce nasal resonance in speech were reviewed. Complications were defined as the incidence of revisional surgery required to obtain a more satisfactory result. 20 patients (15%) required revisional surgery. In 4 patients (3%) early revisional surgery was indicated to treat surgical complications (1 postoperative bleeding, 3 flap dehiscences). In 16 patients (12%) late revisional surgery was indicated to achieve a better functional result with regard to nasal resonance in speech. The low incidence of surgical complications indicates that SBPP flap surgery is a safe procedure. After SBPP flap surgery, a satisfactory functional result with respect to nasal resonance was obtained in 88% of patients. This result was improved after revisional surgery. The hypothesis that the patients of an experienced surgeon have fewer complications and better functional results than those of a less experienced one was tested. The individual skill of the surgeon rather than their experience led to a better functional result.     

Functional outcomes after submandibular gland-sparing neck dissection in patients with oral squamous cell carcinoma

The feasibility of submandibular gland (SMG) preservation during neck dissection has been described. The aim of this study was to analyse the functional outcomes in patients undergoing SMG preservation during neck dissection for cT1–2N0 oral squamous cell carcinoma. Consecutive patients were divided into two groups based on the management of the SMG, and underwent a saliva flow test before surgery, 7 days after surgery, and at 3, 6, 9, and 12 months after surgery. All enrolled patients completed the fourth version of the University of Washington Quality of Life (UWQOL) questionnaire at 12 months after surgery. In patients who underwent SMG preservation during neck dissection, the flow rate at 7 days after surgery was significantly lower than that preoperative; however, it gradually returned to baseline at 9 months after surgery. The saliva flow rate at 9 months after surgery was similar to that at 12 months after surgery. Further, patients with SMG preservation had higher scores for the activity, swallowing, chewing, and saliva domains than patients without SMG preservation. The results of the study suggest that saliva secretion ability can be preserved following SMG-sparing neck dissection, and that SMG preservation improves postoperative quality of life.