Iatrogenic laryngotracheal injuries are common, especially when endotracheal intubation is performed under unfavourable emergency conditions. A tracheal mucosal tear is a rare entity which is almost always undiagnosed. However, a tracheal mucosal flap may be suspected when changes in patient position alter the nature and severity of the resultant stridor and/or respiratory distress. In such cases, an inflated tracheostomy tube cuff should be kept in place for an adequate period, to act as a stent and help keep the flap in place while healing occurs.

The skull base attachment of the second lamella and suprabullar pneumatization are likely to be consistent landmarks if they are systematically classified. This study aimed to classify the pneumatization pattern according to the second lamella skull base attachment. A total of 202 computed tomography sides of 101 patients who underwent endoscopic sinus surgery were studied. Suprabullar pneumatization was defined as air cells present above the ethmoid bulla between the second and third lamellae. Its pattern was classified according to the air cell number and location as in the frontal cell classification. Type 0 suprabullar pneumatization was defined as no air cells between the ethmoid bulla and skull base; type 1, as a single suprabullar cell; and type 2, as multiple suprabullar cells above the ethmoid bulla. In type 3 pneumatization, the second lamella extended into the frontal sinus forming a frontal bullar cell. Type 2 was the most prevalent (40.1 %), followed by types 1, 3, and 0 (24.3, 23.3, and 12.4 %, respectively). The distance between the second lamella and anterior ethmoid artery was 8.93, 8.30, 8.50, and 11.25 mm in types 0, 1, 2, and 3 pneumatization, respectively. No patients had intraoperative injuries in the anterior ethmoid artery or lateral lamella. The second lamella skull base attachment and suprabullar pneumatization pattern could be systematically classified and be a consistent landmark to identify the frontal sinus opening.

BackgroundThis study investigated on bacterial contamination of the rhinoplasty field. The effect of preoperative chlorhexidine treatment on decreasing bacterial contamination in the rhinoplasty field is examined. MethodsThirty patients who underwent rhinoplasty were block randomized into a chlorhexidine, regular-soap, or control group comprising ten participants each. The chlorhexidine group was subjected to chlorhexidine showering, shampooing, and facial-cleansing 12 h prior to the operation. The regular-soap group was subjected to cleansing with regular soap, and the control group did not have any skin pretreatment. Bacterial cultures were done 12 h preoperatively from nasal cavity and perinasal skin, immediately preoperatively from perinasal skin and at 1 and 2 h intraoperatively from operation field. Culture results were compared between the three groups, according to operation time, or whether infection-prone procedure was performed.ResultsThe bacterial species and colony-forming unit numbers at preoperative nasal cavity and perinasal skin were similar. In all three groups, Coagulase-negative staphylococcus was the most common bacteria found in the rhinoplasty field. The numbers of Staphylococcus aureus and Corynebacterium decreased rapidly after preoperative chlorhexidine treatment. The infection-prone procedure was associated with increased bacterial numbers over time during the operation. In all three groups, there was no postoperative infection in a follow-up period of 6 months.ConclusionRhinoplasty is confirmed as a clean contaminated operation with skin flora consistently found in the operation field. Chlorhexidine pretreatment in rhinoplasty patients has a tendency to decrease the numbers of Staphylococcus aureus and Corynebacterium on the perinasal skin.Level of evidenceRandomized controlled trial, Level I.

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