No abstract

Juvenile nasopharyngeal angiofibroma (JNA) are locally growing highly vascular tumours treated primarily by surgical excision (open approach as wide as a mid facial degloving or endoscopic approach). All our patients underwent exclusive endoscopic tumour excision after a pre-operative embolisation. The tumours were completely resected with acceptable blood loss and no recurrences or residual masses were seen. Post-operative morbidity was minimal without external scar-marks. To conclude endoscopic excision is a very effective method to resect JNA even for extensive tumours.

Extracorporeal septoplasty is a valuable tool in the armamentarium of the nasal surgeon for the reconstruction of the severely deviated septum. Extracorporeal septoplasty offers the surgeon the opportunity to correct the septum under direct visualization, shape the nasal vault and address the nasal dorsum with the ultimate goal of providing both form and function for the patient with a complex septal deviation. The study was conducted with the aim to measure the outcomes of extracorporeal septoplasty in severely deviated nasal septum, relief of symptoms (nasal obstruction), surgical complications, if any, revision, if any with objective to evaluate the functional outcome and aesthetic aspects of extracorporeal septoplasty. This was a prospective observational study of 35 patients with severe deviated nasal septum with or without external deformity of nose attending the ENT OPD between Jan 2015 and Jan 2016 at Sri Aurobindo Medical College and Post Graduate Institute, Indore (M.P.). In this study, 17 patients (48.57%) shows excellent improvement on VAS scale, out of which 13 patients shows excellent improvement and 4 patients shows good improvement on photographic assessment. 11 patients (31.43%) show good improvement on VAS as well as photographic assessment and 7 patients (20%) show moderate improvement on VAS scale and fair improvement on photographic assessment. Extracorporeal septal reconstruction is an important surgical option for the correction of the markedly deviated nasal septum. Fixation of the straightened and replanted septum at the nasal spine and dorsal septum border with the upper lateral cartilages is essential. Spreader grafts for stabilization of the internal nasal valve and dorsal onlay grafts to prevent dorsal irregularity are strongly encouraged.

Rhinoplasty has grown and developed over so many years but the choice of the graft material in revision rhinoplasty and rhinoplasty for post-traumatic cases still remains debatable. In such patients, non-availability of adequate autogenous graft, multiple septal fractures and skin fibrosis are a challenge to the rhinologist. To deal with this problem authors have used diced cartilage pieces as a grafting material. Secondary rhinoplasty for correction of the nasal dorsum was done in 32 patients and evaluated. The study, highlights the distinct advantages of using diced cartilage wrapped in fascia for dorsal augmentation. Full length grafts were used in all patients and this was supported on a L-shaped cartilage fixed between the two upper lateral cartilage. Fascial tube was prepared from fascia lata and conchal, rib or septal cartilage was the source of diced cartilage (0.5-1 mm sized pieces). The L-shaped structural support was prepared from the remnant of septal cartilage if any or from the conchal or rib cartilage. Patients were followed for a period of 6 months-3 years. In 30 patients post-op course was uneventful with good reconstruction results.Step-deformity was encountered in one patient and in another patient the tube opened with extrusion of diced cartilage pieces. Both these patients were effectively managed. In conclusion, diced cartilage wrapped in fascial tube has distinct advantages like it is simpler procedure and graft material is adequate and autogenous. Grafts can be prepared as per the desired length, shape and size to fit the specific defect. These being highly malleable can be used without any tension on the already thickened and fibrosed skin and soft tissue. Complications like step deformity and extrusion rarely occur and can be easily managed. Over correction and graft visibility were not met with.

Correction of a saddle nose deformity due to atrophic rhinitis is a formidable task. The thick and puckered skin secondary to long standing disease makes the creation of a dorsal subdermal pocket difficult. On the one hand, these patients tolerate synthetic implants poorly and on the other they show an unusually high rate of absorption of autologous bone graft. Our experience of treating 15 patients with saddle nose defor mity secondary to atrophic rhinitis is presented.