Objective: The goal of rhinoplasty is not exclusively aesthetic and the nasal function should always be considered. Several rhinoplasty techniques can participate in nasal valve dysfunction (eg, dorsal hump reductions). Therefore, mid-nasal vault reconstruction by spreader grafts or flaps is mandatory in these cases. To date, there is a literature gap in comparing both techniques objectively. This study shows an objective comparison between spreader grafts and flaps for mid-nasal vault reconstruction. Material and Methods: This study was a double-blind randomized controlled trial including 40 patients who were randomly divided into 2 groups. Group 1 (20 patients) underwent spreader grafts insertion, whereas group 2 (20 patients) underwent spreader flap placement technique. Pre-operative active anterior rhinomanometry measurements were compared to 6-month post-operative measurements. Data were summarized as mean (standard deviation) for the quantitative variables. Comparisons between the 2 groups were done using unpaired t test. Results: In both groups, a significant decrease in nasal resistance was noted in both the right and left sides 6 months post-operatively ( P < .001). However, the comparison between the 2 both groups showed no statistical significance. Conclusion: Both spreader grafts and flaps, which are used for the mid-nasal vault reconstruction, have comparable and effective results in reducing the nasal resistance as evidenced by active anterior rhinomanometry measurements.

Background: Adequate study of allergic fungal rhinosinusitis (AFRS) helped better understanding of the nature of the disease. It involves immediate hypersensitivity to fungus present in the nose and sinuses. This involves immunoglobulin E. Therefore the presence of serum IgE indicates the presence of the allergic reaction.The objective is to evaluate the relationship between systemic steroid therapy and the level of serum IgE in allergic fungal rhinosinusitis indicating adequate therapy. This is a prospective study. Subjects and Methods: Forty patients diagnosed as allergic fungal sinusitis were randomly divided into two equal groups: group A was given postoperative systemic steroids and local steroids, while group B was not given systemic steroids (local steroids only). The patients were followed up for three and six months by testing IgE levels in blood. Results: The total number of patients who had more than 10% increase in serum IgE after 6 months post-operative was 18 patients. Six of them were from group A (Systemic steroids) and 12 were from group B (Local steroids). Conclusion:There was a strong relation between systemic steroid therapy and the level of serum IgE. Thus, AFS should be treated by systemic steroids for a prolonged period after adequate clearance of the sinuses. Patients should be followed up at close intervals post-operative using serum Ig E as it can indicate increased fungal load and the need for further treatment.

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