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Gardiner LA, Goyal LK, McCoy JL, Gillman GS. The Role of Nasal Endoscopy in the Preoperative Evaluation of Nasal Airway Obstruction. Otolaryngol Head Neck Surg 2023; 169:1329-1334. [PMID: 37132657 DOI: 10.1002/ohn.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To examine the prevalence and nature of nasal endoscopic findings in patients referred for structural nasal obstruction, and analyze how such findings influence the preoperative evaluation or operative plan. STUDY DESIGN Cross-sectional study. SETTING University-based academic otolaryngology practice. METHODS Nasal endoscopy was performed by a single surgeon and the exam findings were documented. Patient demographics, variables in the patient history, Nasal Obstruction Symptom Evaluation scores, and an Ease-of-Breathing Likert Scale were tested for associations with findings on endoscopy. RESULTS A total of 82 of 346 patients (23.7%) had findings on rigid nasal endoscopy not appreciable on anterior rhinoscopy. Prior nasal surgery (p = .001) and positive allergy testing (p = .013) were significantly associated with findings on nasal endoscopy. Endoscopic findings prompted additional preoperative studies in 50 (14.5%) patients, and a change in the operative plan in 26 (7.5%) patients. CONCLUSION In patients referred for surgical management of nasal obstruction, findings on nasal endoscopy otherwise undetected with anterior rhinoscopy are most common in but certainly not limited to those with prior nasal surgery or allergic rhinitis. Routine nasal endoscopy should be considered for all patients being evaluated for nasal airway surgery. These results may benefit future updates of the clinical consensus statements regarding the role of nasal endoscopy in the evaluation of nasal valve compromise and septoplasty.
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Affiliation(s)
- Lauren A Gardiner
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lindsey K Goyal
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jennifer L McCoy
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Grant S Gillman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Gillman GS, Bakeman AE, Soose RJ, Wang EW, Schaitkin BM, Lee SE, Chang YF, Mims MM. Will nasal airway surgery improve my sense of smell? A prospective observational study. Int Forum Allergy Rhinol 2023; 13:1511-1517. [PMID: 36413461 DOI: 10.1002/alr.23115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 07/25/2023]
Abstract
BACKGROUND The effect of nasal airway surgery on olfaction has not been well established. The goal of this study is to assess changes in olfaction after septoplasty with inferior turbinate reduction through both objective and patient-reported measures. METHODS Prospective, observational study was conducted of patients with nasal airway obstruction presenting between July 2017 and October 2019 who underwent septoplasty with inferior turbinate reduction. Nasal airflow was characterized with the Nasal Obstruction Symptom Evaluation (NOSE) scale and an 11-point ease-of-breathing (EOB) Likert scale, and olfaction with an 11-point olfactory Likert scale and the 40-item University of Pennsylvania Smell Identification Test (UPSIT), pre- and postoperatively. Pearson correlations were used to assess the relationship between measures of nasal obstruction and olfaction. RESULTS Among 80 patients, mean NOSE scores improved from 67.4 preoperatively to 19.6 postoperatively (p < 0.001). EOB Likert scores improved from a mean of 3.9/10 to 8.1/10 after surgery (p < 0.001). Olfactory Likert scores improved from a baseline of 6.1/10 preoperatively to 7.9/10 after surgery (p < 0.001). No statistically significant difference was noted in UPSIT testing pre- versus postoperatively. A moderate correlation was noted between the degree of change in NOSE scores and improved olfactory Likert scores (r = 0.51, p < 0.001), and similarly between the degree of change in EOB Likert scores and improved olfactory Likert scores (r = 0.55, p < 0.0001). CONCLUSIONS Based on our data, subjective tests of olfaction may improve with nasal airway surgery in some patients. Changes in olfaction best correlate with the extent to which surgery can improve subjective nasal obstructive symptoms.
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Affiliation(s)
- Grant S Gillman
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anna E Bakeman
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ryan J Soose
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eric W Wang
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Barry M Schaitkin
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stella E Lee
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Yue-Fang Chang
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark M Mims
- Department of Otolaryngology - Head and Neck Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
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McCorkle CE, Seethala RR, Gillman GS. An uncommon case of lip swelling: Granulomatous cheilitis associated with Crohn's disease. Am J Otolaryngol 2021; 42:102897. [PMID: 33429182 DOI: 10.1016/j.amjoto.2020.102897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/27/2020] [Indexed: 11/27/2022]
Abstract
Unbeknownst to most otolaryngologists, there is quite a range of oral manifestations which commonly manifest in the context of inflammatory bowel disease. As providers who will encounter such patients in consultation it is beneficial to be aware of that association. Lip swelling (granulomatous cheilitis) is just one such presentation, which is often otherwise mistaken for angioneurotic edema and can lead to unwarranted testing and misdirected treatment. We present such a case to highlight the educational value of this patient encounter.
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Gillman GS, Staltari GV, Chang YF, Mattos JL. Response to Letter to the Editor Regarding "A Prospective Study of Outcomes of Septoplasty with Turbinate Reductions in Patients with Allergic Rhinitis". Otolaryngol Head Neck Surg 2020; 162:780-781. [PMID: 32354318 DOI: 10.1177/0194599820904668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gillman GS, Staltari GV, Chang YF, Mattos JL. A Prospective Study of Outcomes of Septoplasty with Turbinate Reductions in Patients with Allergic Rhinitis. Otolaryngol Head Neck Surg 2019; 160:1118-1123. [PMID: 30909804 DOI: 10.1177/0194599819838761] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Examine outcomes of septoplasty with turbinate reductions in patients with allergic rhinitis as compared to patients without allergic rhinitis using validated outcome and quality-of-life (QOL) instruments. STUDY DESIGN Prospective observational cohort study. SETTING Single surgeon, university hospital. SUBJECTS AND METHODS Consecutive study-eligible patients with a symptomatic nasal septal deviation, with (n = 30) or without (n = 30) documented allergic rhinitis, were enrolled from March 2014 to February 2017. All patients subsequently underwent nasal septoplasty and inferior turbinate reductions. Outcomes were studied using the Nasal Obstruction Symptom Evaluation (NOSE) scale, mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini-RQLQ), and Ease-of-Breathing (EOB) Likert scores completed preoperatively and, together with a patient satisfaction Likert, at 3 and 6 months postoperatively. RESULTS NOSE scores, EOB scores, and mini-RQLQ scores improved significantly in both groups at 3 and 6 months postoperatively. Results were sustained from 3 to 6 months. Although mini-RQLQ scores in allergic patients were higher at all intervals, the magnitude of change in scores in both groups was comparable. CONCLUSION Although patients with allergic rhinitis report greater allergy-related QOL impairment (mini-RQLQ) on a day-to-day basis than nonallergic patients, this does not appear to attenuate the benefit they might experience from septoplasty and turbinate reductions when indicated for nasal obstruction. Furthermore, the symptomatic relief of their structural nasal obstruction appears to significantly improve their overall allergy-related quality of life. If appropriate expectations are set pre-operatively, allergic rhinitis is neither a contraindication nor a deterrent to septoplasty and turbinate reductions and these patients can reasonably expect a high degree of satisfaction post-operatively.
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Affiliation(s)
- Grant S Gillman
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Giuseppe V Staltari
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yue-Fang Chang
- 2 Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jose L Mattos
- 3 Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
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Abstract
OBJECTIVE (1) Evaluate the impact of nasal airway surgery on sleep quality using validated outcome measurements, (2) compare the utility of Epworth Sleepiness Scale (ESS) versus Pittsburgh Sleep Quality Index (PSQI) as a reflection of sleep quality, and (3) identify perioperative variables that might correlate with a beneficial effect of nasal surgery on sleep quality. STUDY DESIGN Prospective outcome study of patients with symptomatic nasal obstruction undergoing nasal airway surgery. SETTING Academic medical center. METHODS Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale, ESS, PSQI, and Ease-of-Breathing and Sleep Quality Likert scales preoperatively and 3 months postoperatively. A nonparametric analysis compared pre- and postoperative values, and associations were examined using Spearman correlations. RESULTS Sixty-one patients completed the study. Mean NOSE scores decreased significantly from 68.2 preoperatively to 17.5 three months after surgery. Mean ESS scores and PSQI scores improved (P < .0001) over that same interval (7.5 to 5.3 and 7.8 to 4.6, respectively). There was a correlation seen between the degree of change in both NOSE scores and Ease-of-Breathing scores and the change in sleep quality measured using the PSQI or Sleep Quality Likert scores. The PSQI correlated better with Sleep Quality Likert scores than the ESS. Overall, 86.9% of subjects reported subjective improvement in sleep quality postoperatively. CONCLUSION In patients undergoing nasal airway surgery there may be a secondary improvement in subjective sleep quality. The degree of change in sleep quality correlates with the severity of nasal obstruction preoperatively and the degree of improvement in obstruction with surgery.
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Affiliation(s)
- Amanda L Stapleton
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yue-Fang Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ryan J Soose
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Grant S Gillman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Gillman GS, Egloff AM, Rivera-Serrano CM. Revision septoplasty: a prospective disease-specific outcome study. Laryngoscope 2013; 124:1290-5. [PMID: 23945947 DOI: 10.1002/lary.24356] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/05/2013] [Accepted: 07/22/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS 1) Study outcomes of revision septoplasty using a validated disease-specific questionnaire and a patient satisfaction survey; 2) assess the effect of surgery on the use of medication to treat nasal congestion; and 3) report on sites of persistent septal deviation identified at revision septoplasty. STUDY DESIGN Prospective, single-center outcome study of patients with symptomatic nasal obstruction and persisting septal deviation despite prior septal surgery. METHODS The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered preoperatively and at 3 and 6 months following revision surgery. Patients were also questioned regarding ease of breathing and medication use preoperatively and postoperatively, as well as satisfaction with the surgical outcome. Anatomic site(s) of residual septal deviation were recorded intraoperatively. RESULTS Thirty-nine patients completed the study. Mean NOSE scores decreased significantly from 75.9 preoperatively to 14.9 3 months after revision surgery. Mean Ease-of-Breathing scores over this interval improved from 3/10 preoperatively to 8.5/10. Both results were sustained at 6 months (P <0.0001). Patient satisfaction was very high, and many patients required less medication to treat symptoms of nasal congestion postoperatively. Deviations persisting from prior surgery most commonly involved the dorsal or caudal septum. CONCLUSION In patients who experience ongoing nasal obstruction with a persistent septal deviation despite prior septoplasty, revision surgery significantly improves disease-specific quality of life, results in high patient satisfaction, and may diminish the need for nasal medications postoperatively. Caudal or dorsal deflections may be more difficult to correct, leading to the need for revision surgery. LEVEL OF EVIDENCE 2C.
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Affiliation(s)
- Grant S Gillman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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Setzen G, Ferguson BJ, Han JK, Rhee JS, Cornelius RS, Froum SJ, Gillman GS, Houser SM, Krakovitz PR, Monfared A, Palmer JN, Rosbe KW, Setzen M, Patel MM. Clinical Consensus Statement. Otolaryngol Head Neck Surg 2012; 147:808-16. [DOI: 10.1177/0194599812463848] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective To develop a consensus statement on the appropriate use of computed tomography (CT) for paranasal sinus disease. Subjects and Methods A modified Delphi method was used to refine expert opinion and reach consensus by the panel. Results After 3 full Delphi rounds, 33 items reached consensus and 16 statements were dropped because of not reaching consensus or redundancy. The statements that reached consensus were grouped into 4 categories: pediatric sinusitis, medical management, surgical planning, and complication of sinusitis or sinonasal tumor. The panel unanimously agreed with 13 of the 33 statements. In addition, at least 75% of the panel strongly agreed with 14 of 33 statements across all of the categories. Conclusions For children, careful consideration should be taken when performing CT imaging but is needed in the setting of treatment failures and complications, either of the pathological process itself or as a result of iatrogenic (surgical) complications. For adults, imaging is necessary in surgical planning, for treatment of medical and surgical complications, and in all aspects of the complete management of patients with sinonasal and skull base pathology.
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Affiliation(s)
- Gavin Setzen
- Albany ENT & Allergy Services, Albany, New York, USA
| | | | - Joseph K. Han
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - John S. Rhee
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Grant S. Gillman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Ashkan Monfared
- George Washington University School of Medicine, Washington, DC, USA
| | - James N. Palmer
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristina W. Rosbe
- University of California, San Francisco, San Francisco, California, USA
| | - Michael Setzen
- Michael Setzen Otolaryngology PC, Great Neck, New York, USA
| | - Milesh M. Patel
- American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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10
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Abstract
OBJECTIVES/HYPOTHESIS The depth of the frontal sinus was measured using axial computed tomography (CT) images to examine the safety of frontal sinus trephination at selected distances from the midline. STUDY DESIGN Review of 200 sinus CT scans. METHODS Two hundred sinus CT scans (400 frontal sinuses) were reviewed to measure the frontal sinus depth at 5 mm, 10 mm, and 15 mm from midline. RESULTS Males had a significantly deeper frontal sinus than females at all measurements points (P < .001). The measurements revealed a considerable number of small but nonhypoplastic frontal sinuses, which were shallower than the length of standard frontal trephine instruments (7 mm) and would risk penetration of the posterior table of the sinus. Of all frontal sinuses studied, 9.54% were <7 mm deep at 5 mm from the midline, 10.12% at 10 mm, and 8.96% at 15 mm from the midline. Overall, 15.3% of all frontal sinuses studied had at least one point where the measured depth was <7 mm. CONCLUSIONS Although the majority of patients have frontal sinuses deep enough to accommodate standard trephine instruments, surgeons should recognize that up to 15% of nonhypoplastic frontal sinuses may not be sufficiently deep at a given point to allow safe trephination without risking unintentional transgression of the posterior table. This study suggests that trephination routinely carried out at a given predetermined distance from the midline may be an unsafe practice. Careful evaluation of the imaging is essential in every case to avoid inadvertent injury and to help select the safest distance from the midline for frontal sinus trephination.
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Affiliation(s)
- Annie S Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Gillman GS, Lee AS, Schaitkin BM. Evaluating the Safety of Frontal Sinus Trephination. Laryngoscope 2009. [DOI: 10.1002/lary.21568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Affiliation(s)
- Krzysztof Conrad
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Cory Stephen Torgerson
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Grant S. Gillman
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
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Affiliation(s)
- George C. Yang
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
| | - Robert J. Chiu
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
| | - Grant S. Gillman
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
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Abstract
OBJECTIVE To study facial nerve recovery in patients with Bell's palsy of pregnancy compared with that of the nonpregnant population. METHODS A retrospective chart analysis was conducted of all patients seen within 6 weeks of the onset of Bell's palsy of pregnancy, with a minimum of 1-year follow-up. Recovery outcomes were compared with similarly chosen randomly selected groups of nonpregnant females 15 to 40 years old (group 1), nonpregnant females of all ages (group 2), males 15 to 40 years old (group 3), and males of all ages (group 4), all of whom were also seen within 6 weeks of onset. Recovery was categorized as satisfactory (House-Brackmann grade I to II) or unsatisfactory (House-Brackmann grade III or IV). The 2-tailed Fisher exact test was used to statistically analyze differences between groups. RESULTS Fifty-two percent of women with Bell's palsy of pregnancy whose facial palsy progressed to complete paralysis within 10 days of onset recovered to a satisfactory level compared with 77% to 88% of comparison patients. These differences were statistically significant in all cases. Recovery for those with an incomplete palsy was satisfactory in virtually 100% of all patients studied. CONCLUSION The prognosis for a satisfactory recovery for women who develop a complete facial paralysis with Bell's palsy while pregnant is significantly worse than for that for the general population. This information should be taken into consideration by all physicians involved in the counseling of these patients.
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Affiliation(s)
- Grant S Gillman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
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Abstract
Although uncommon, enophthalmos may be a presenting symptom of chronic maxillary sinusitis with secondary attentuation of the orbital floor. As such, as awareness of this entity, known as the "silent sinus syndrome," is important to all practising otolaryngologists. Two such cases are presented herein, together with a discussion of the pathophysiology, management, and current literature.
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Affiliation(s)
- G S Gillman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, PA 15232, USA
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Affiliation(s)
- G S Gillman
- Shadyside Facial Paralysis Center, Pittsburgh, PA 15232, USA
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Abstract
OBJECTIVES To identify preoperative risk factors and surgical techniques that influence the risk of developing postoperative nasal tip bossae in rhinoplasty. A secondary objective was to review the characteristics, management techniques, and outcomes of those study patients with postoperative bossae. DESIGN Univariate and multivariate analysis carried out in a case series. SETTING Private facial plastic surgery practice. PATIENTS All patients who underwent aesthetic nasal surgery that included surgical modification of the nasal tip, and in whom documentation was complete and photographic follow-up was available, were considered eligible. The study group consisted of 875 patients of whom 37 (4.2%) developed bossae postoperatively. MAIN OUTCOME MEASURES Potential risk factors for postoperative bossae included age, sex, previous nasal surgery, preoperative tip asymmetry, preoperative lobular bifidity, preoperative bossae, skin thickness, surgical tip technique, use of columellar struts, columellar battens, lobular crushed cartilage grafts, and tip shield grafts. RESULTS In the univariate analysis, females, patients undergoing primary rhinoplasty, younger age groups (12- to 22-year-olds), thin skin, and widened interdomal distance (bifidity) were all noted to have moderate or strong associations with nasal tip bossae. In the multivariate analysis, the younger age group, thin skin, and bifidity were statistically significant and independently associated with nasal tip bossae, independent of the type of tip surgery. In addition, clinically relevant associations were noted in females and patients undergoing primary rhinoplasty. Recognition of risk factors, preventive measures, and treatment methods is recommended.
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Affiliation(s)
- G S Gillman
- Department of Otolaryngology, Simons Center for Nasal and Facial Plastic Surgery, University of Miami, School of Medicine, Fla., USA
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Adamson PA, McGraw-Wall BL, Strecker HD, Gillman GS. Analysis of nasal air flow following repair of vestibular stenosis. J Otolaryngol 1998; 27:200-5. [PMID: 9711514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Vestibular stenosis is an uncommon but debilitating cause of nasal obstruction. The etiology of the stenosis is variable, but iatrogenic causes are by far the most common. A number of techniques have been described for repair of the stenotic segment. We present a surgical technique that employs the concepts of: excision of the stenotic segment, enlargement of the bony pyriform aperture, and placement of a full-thickness skin graft. RESULTS Our results have been very favourable, and we have documented improvement in nasal obstruction by performing preoperative and postoperative nasal airflow studies on all our patients. CONCLUSIONS These results suggest that significant improvement in nasal airflow can be obtained in most patients with the use of this technique.
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Affiliation(s)
- P A Adamson
- Department of Otolaryngology, University of Toronto, Faculty of Medicine, Ontario
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Gillman GS, Lampe HB, Allen LH. Orbitoethmoid Osteoma: Case Report of an Uncommon Presentation of an Uncommon Tumor. Otolaryngol Head Neck Surg 1997; 117:S218-20. [PMID: 9419153 DOI: 10.1016/s0194-59989770107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- G S Gillman
- Department of Otolaryngology, University of Western Ontario, London, Canada
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Affiliation(s)
- G S Gillman
- Department of Otolaryngology, University of Western Ontario, London, Canada
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Gillman GS, MacRae DL. Prospective evaluation of endoscopically assisted percutaneous dilational tracheostomy. J Otolaryngol 1996; 25:383-7. [PMID: 8972430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- G S Gillman
- Department of Otolaryngology, University of Western Ontario, London
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Gillman GS, Lampe HB. Issues in the surgical management of parathyroid disorders. J Otolaryngol 1996; 25:59-62. [PMID: 8816113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
At St. Joseph's Health Centre in London, Ontario, the Departments of Otolaryngology and Endocrinology of the University of Western Ontario work closely together in the medical and surgical management of patients with parathyroid disease. Recently, a multidisciplinary Grand Rounds was held during which current issues in the management of these patients were discussed, with particular emphasis on the role of localization studies as well as the potential difficulty inherent in distinguishing parathyroid adenomas from parathyroid hyperplasia. The following is an edited transcript from the Grand Rounds.
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Affiliation(s)
- G S Gillman
- Department of Otolaryngology-Head and Neck Surgery, St. Joseph's Health Centre, London, Ontario
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Gillman GS, Parnes LS. Acoustic neuroma management: a six-year review. J Otolaryngol 1995; 24:191-7. [PMID: 7674446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this investigation is to review the outcome of 83 consecutive acoustic neuroma patients, managed solely or in part by the Department of Otolaryngology at University Hospital, London, Ontario, over a 6-year period (1987 to 1993). The majority of patients underwent operative intervention, utilizing the middle cranial fossa, suboccipital, or most commonly, the translabyrinthine approach depending on the tumour size and level of residual hearing. Demographic, preoperative, intraoperative, and postoperative data are analyzed including complications of surgery. As well, we report on our experience with the use of fibrin glue in the dural closure following translabyrinthine resections and the resultant impact on the postoperative CSF leak rate. Overall, our results and complications are comparable to other large acoustic neuroma series in the literature. In addition, we feel that further study is merited in the use of fibrin glue in dural repair and its relationship to postoperative cerebrospinal fluid fistula.
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Affiliation(s)
- G S Gillman
- Department of Otolaryngology, University of Western Ontario Faculty of Medicine, London
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