Publications
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Howard T, Williams I, Navaratnam A, et al., 2024, "Should Pediatric Septal Surgery and Septorhinoplasty Be Performed for Nasal Obstruction?"-A Systematic Review of the Literature., Facial Plast Surg
Corrective septal surgery for children with nasal obstruction has historically been avoided due to concern about the impact on the growing nose, with disruption of midfacial growth. However, there is a paucity of data evaluating complication and revision rates post-nasal septal surgery in the pediatric population. In addition, there is evidence to suggest that failure to treat nasal obstruction in children may itself result in facial deformity and/or developmental delay. The aim of this systematic review is to evaluate the efficacy and safety of septal surgery in pediatric patients with nasal obstruction. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. MEDLINE, Embase, and the Cochrane Library were searched. Original studies in pediatric patients (<18 years of age) with nasal obstruction were eligible for inclusion. Patients with cleft lip or palate as their primary diagnosis were excluded. Our primary outcomes were patient-reported outcome measures (PROMs), postsurgical complications, and revision rates. Secondary outcomes included surgical technique, anatomical considerations, and anthropometric measurements. Eighteen studies were included (1,080 patients). Patients underwent septoplasty, septorhinoplasty, rhinoplasty, or a combination of procedures for nasal obstruction. Obstruction was commonly reported secondary to trauma, nasal septal deviation, or congenital deformity. The mean age of the patients was 13.04 years with an average follow-up of 41.8 months. In all, 5.6% patients required revision surgery and there was an overall complication rate of 7.8%. Septal surgery for nasal obstruction in children has low revision and complication rates. However, a pediatric-specific outcome measure is yet to be determined. Larger prospective studies with long-term follow-up periods are needed to determine the optimal timing of nasal surgery for nasal obstruction in the pedia
Poto R, Pelaia C, di Salvatore A, et al., 2024, Imaging of chronic rhinosinusitis with nasal polyps in the era of biological therapies., Curr Opin Allergy Clin Immunol
PURPOSE OF REVIEW: Chronic rhinosinusitis (CRS) is a chronic inflammatory disorder of the sinonasal cavities classified into two major phenotypes: CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). The diagnosis of CRS is based on clinical symptoms associated with imaging and/or nasal endoscopy findings of mucosal inflammation. RECENT FINDINGS: Recently, novel biological therapies have emerged as therapeutic options for CRSwNP. Imaging is helpful in deciding whether surgery is likely to be beneficial and in guiding surgery. It can also help demonstrate a clinical response to medical therapy. However, specific guidelines concerning the role of imaging in CRwNP are lacking. SUMMARY: This article provides a comprehensive and critical multidisciplinary review of the role of conventional radiology, computed tomography (CT), and magnetic resonance imaging (MRI) in the diagnosis and characterization of CRSwNP. Since the complete characterization of nasal polyps on CT or MR images is very challenging, we provide a critical review of the best imaging methods and essential reporting elements used to assess nasal polyps.
Rosario E, Navaratnam AV, Ferguson M, et al., 2024, A feasibility study of using a high-definition intra-operative exoscope in teaching septorhinoplasty., J Laryngol Otol, Vol: 138, Pages: 115-117
OBJECTIVE: This pilot study aimed to assess the feasibility of using a high-definition intra-operative exoscope in teaching septorhinoplasty. METHODS: The exoscope was used in septorhinoplasty cases with different trainers and trainees. A high-definition screen displayed real-time, magnified images. Post-procedure, a questionnaire was completed by trainer and trainees, assessing the feasibility, safety and content validity of the exoscope as a septorhinoplasty training tool. RESULTS: Trainees and trainers assigned favourable ratings to all aspects of the exoscope as a training tool, particularly with regard to teaching anatomy and improving visualisation. CONCLUSION: The exoscope is a potentially effective training tool in septorhinoplasty, and is especially useful in improving visualisation, without restricting the operator. Annotatable intra-operative photographs and videos allow trainees to study cases outside of the operating theatre environment. The use of an exoscope for septorhinoplasty in the UK may facilitate increased hands-on involvement earlier in training than is currently typical.
Pendolino AL, Benshetrit G, Navaratnam AV, et al., 2023, The role of ANCA in the management of cocaine-induced midline destructive lesions or ENT pseudo-granulomatosis with polyangiitis: a London multicentre case series., Laryngoscope
OBJECTIVE: In this multicentric study involving three London hospitals, we compared ANCA-positive and ANCA-negative cocaine-induced midline destructive lesions (CIMDL) patients to assess how presence of antineutrophil cytoplasmic antibodies (ANCA) may correlate with disease severity. Our secondary aims are to better classify etiology centered around ANCA positivity and, consequently, better disease management. METHODS: A retrospective review was performed to identify patients with CIMDL seen between January 2019 and December 2022. Population data including age, sex, presentation, endoscopic findings, duration of cocaine use and active use of cocaine, type of treatment, laboratory (including ANCA serology), radiological, and histological findings were collected. RESULTS: Forty CIMDL patients (25 male, median age of 42 years) were identified. The majority of them (72.5%) presented with either a septal perforation, a saddle nose deformity (22.5%), and/or a palatal fistula (20.0%). ANCA was positive in 71.1% of cases (66.7% p-ANCA). No statistically significant differences in the general characteristics, type of treatment, laboratory results, radiological or histological findings were observed when comparing ANCA-positive and ANCA-negative CIMDL patients or when comparing p-ANCA and c-ANCA patients. Similarly, no statistically significant difference was obtained when comparing the pattern of distribution of lesions between the two groups. CONCLUSIONS: A large percentage of CIMDL patients showed positive ANCA test (71.1%) and in the majority of the cases a p-ANCA pattern specifically targeting PR3 (p-ANCA, PR3 + MPO-). However, ANCA positivity or presence of a specific ANCA pattern was not associated with more severe presentation or more aggressive disease. Given its similarities to granulomatosis with polyangiitis (GPA), we recommend the use of the term "cocaine-induced ENT pseudo-GPA" instead of CIMDL. LEVEL OF EVIDENCE: IV Laryngosc
Rosario EM, Ferguson M, Machado PB, et al., 2023, Description of a Novel Technique to Address Both External Nasal Valve Collapse and the Aesthetic of the Nasal Tip., Facial Plast Surg, Vol: 39, Pages: 307-310
Severe concavity of the lateral crura can lead to an unsightly aesthetic deformity of the nasal tip and narrowing of the external nasal valve. Concurrently, if the lateral crura are structurally weak, this can lead to a functional issue. We report a previously undescribed technique of combining a lateral crural reversal with a turn-in flap. This achieves dual goals of aesthetic improvement and structural reinforcement, without the need for grafting.
Ross T, Arwyn-Jones J, Navaratnam AV, et al., 2023, Litigation in Septorhinoplasty Surgery: A Pan-Specialty Review of National Health Service (the United Kingdom) Data., Facial Plast Surg, Vol: 39, Pages: 142-147
Success in septorhinoplasty surgery can be difficult to assess due to a lack of objective and measurable outcomes. If patients' expectations are not met, it places surgeons performing septorhinoplasty at risk of litigation which can be stressful and costly. The National Institute of health (NHS) Resolution is a government-funded organization in the United Kingdom that provides expertise to the NHS on resolving patient concerns. Data were requested from NHS Resolution for claims involving septorhinoplasty surgery over a period of 5 years between April 2015 and April 2020. Rhinoplasty claims performed by all specialties were included. Data included the claim status, incident details, alleged injury, damages claimed, and damages paid. A total of 31 claims were identified by the study, equating to a total cost of £1,347,336.10. Of the 31 claims for rhinoplasty or septorhinoplasty, 9 cases were open (29%, £962,361.00) and 22 cases were closed (71%, £384,975.10). The common causes for claims were "intraoperative problems (32%)," "failure to warn-informed consent (19%)," and "foreign body left in situ (13%)." The most common injuries were "cosmetic disfigurement (39%)," "unnecessary pain (29%)," and "additional/ unnecessary operation (29%)." This study highlights the need for improved awareness of clinical negligence claims among surgeons who perform septorhinoplasty. Results are applicable to all specialties who perform the procedure. The study highlights the importance of assessing patients' motives and expectations prior to surgery and emphasizes the need for a well-documented rigorous consent process.
Navaratnam AV, Pendolino AL, Andrews PJ, et al., 2023, Safety of day-case endoscopic sinus surgery in England: An observational study using an administrative dataset., Clin Otolaryngol, Vol: 48, Pages: 191-199
INTRODUCTION: As elective surgical services recover from the COVID-19 pandemic a movement towards day-case surgery may reduce waiting lists. However, evidence is needed to show that day-case surgery is safe for endoscopic sinus surgery (ESS). The aim of this study was to investigate the safety of day-case ESS in England. DESIGN: Secondary analysis of administrative data. METHODS: We extracted data from the Hospital Episodes Statistics database for the 5 years from 1 April 2014 to 31 March 2019. Patients undergoing elective ESS procedures aged ≥17 years were included. Exclusion criteria included malignant neoplasm, complex systemic disease and trans-sphenoidal pituitary surgery. The primary outcome was readmission within 30 days post-discharge. Multilevel, multivariable logistic regression modelling was used to compare outcomes for those operated on as day-cases and those with an overnight stay after adjusting for demographic, frailty, comorbidity and procedural covariates. RESULTS: Data were available for 49 223 patients operated on across 129 NHS hospital trusts. In trusts operating on more than 50 patients in the study period, rates of day-case surgery varied from 20.6% to 100%. Nationally, rates of day-case surgery increased from 64.0% in the financial year 2014/2015 to 78.7% in 2018/2019. Day-case patients had lower rates of 30-day emergency readmission (odds ratio 0.71, 95% confidence interval 0.62 to 0.81). Outcomes for patients operated on in trusts with ≥80% day-case rates compared with patients operated on in trusts with <50% rates of day-case surgery were similar. CONCLUSIONS: Our data support the view that ESS can safely be performed as day-case surgery in most cases, although it will not be suitable for all patients. There appears to be scope to increase rates of day-case ESS in some hospital trusts in England.
Saleh HA, Navaratnam AV, 2023, Septorhinoplasty and Nasal Reconstruction, Bailey & Love’s: Essential Operations in Oral and Maxillofacial Surgery, Pages: 511-521, ISBN: 9781032030562
Rhinoplasty and septorhinoplasty are the most common facial plastic procedures. Although a detailed description of this anatomy is beyond the scope of this chapter, a thorough understanding of the nasal structures as well as the overlying superficial musculoaponeurotic system and the skin soft tissue envelope is essential when undertaking septorhinoplasty surgery. The extensive topic of graft materials is outside the remit of the chapter but surgeons undertaking complex and revision septorhinoplasty procedures should be aware of the potential sources of graft materials especially when undertaking cases where nasal septal cartilage may be insufficient. If the tip support mechanisms have been disrupted during a septorhinoplasty, it is essential that the tip is reconstructed to maintain tip support and prevent tip ptosis or columellar retraction in the future. A multitude of augmentation, suture and grafting techniques can be employed to support the lower lateral cartilages and nasal tip which are beyond the scope of this chapter.
Navaratnam AV, Stoenchev KV, Acharya V, et al., 2022, The Ageing Nose: Challenges and Solutions, Current Otorhinolaryngology Reports, Vol: 10, Pages: 253-261
Purpose of Review: Rhinoplasty has traditionally been considered an elective procedure for younger patients. However, increasingly older patients are undergoing nasal surgery for both functional and aesthetic indications. We provide an overview of the common problems with rhinoplasty in the elderly and the surgical techniques that can be reliably utilised to address them to produce predictable and longstanding results. Recent Findings: Outcomes from studies of older rhinoplasty patients emphasise the need for a tailored approach that preserves natural structures. However, if reinforced structural support is required, especially in functional cases, grafting techniques such as septal extension grafts, spreader grafts and alar strut grafts are required. Furthermore, special consideration must be made for the nasal skin in older patients, and utilisation of dorsal onlay grafts is often necessary. Summary: Surgery for the ageing nose is a complex challenge for the rhinoplasty surgeon. Preoperative assessment is critical and must include detailed facial analysis that considers the amplification of facial asymmetry due to the ageing process and an appreciation that expectations in this population may differ from younger patients. A comprehensive understanding of the age-related anatomical changes in the nasal structure and the wide repertoire of operative techniques are required to restore form and function.
Unadkat S, Saleh H, 2022, Southern mediterranean nose correction, Mediterranean Rhinoplasty, Pages: 211-220, ISBN: 9783031055508
The Mediterranean is a region of rich heritage with an array of influence from differing cultures and populations. The Southern Mediterranean region in particular has been the subject of much cross-cultural migration from mainland Europe right through to Northern Africa and the Arabian Gulf. As a result, there are distinct characteristics of the Southern Mediterranean nose that need to be appreciated prior to embarking on rhinoplasty. Specific hallmarks include prominent nasal dorsums with small humps, ptotic nasal tips, thick nasal skin and, in a large proportion of patients, weaker underlying cartilage. A greater preference is thus given to structural rhinoplasty techniques for their long-term stability and, where necessary, involvement of a dermatologist to treat the skin. The present chapter discusses these characteristics in detail and surgical techniques to overcome some of the anatomical challenges.
Patel PN, Kandathil CK, Buba CM, et al., 2022, Global Practice Patterns of Dorsal Preservation Rhinoplasty., Facial Plast Surg Aesthet Med, Vol: 24, Pages: 171-177
Background: Dorsal preservation rhinoplasty (DPR) has recently received significant academic attention in part due to theoretical benefits over excisional surgical methods. The purpose of this study was to assess the global practice patterns regarding this technique. Materials and Methods: An 11-item questionnaire was electronically distributed to regional academies/societies representing rhinoplasty surgeons worldwide. Respondent exposure to and use of DPR were assessed based on geographic location. Results: Eight hundred thirty-six responses were received. Despite early publications on DPR originating largely from Western Europe and the United States, Turkey and Mexico have the greatest use of DPR techniques currently. The familiarity across many regions with preservation techniques appear to be secondary to courses and conferences rather than incorporation into training. Mexico demonstrates the greatest exposure to DPR during training. One hundred twenty-five respondents had previously used but abandoned dorsal preservation techniques. Poor results, less predictability, and complications (largely hump recurrence) are cited as common reasons for this. Conclusion: There is variability in the global practice of DPR across regions and this will likely continue to evolve.
Koumpa F-S, Ferguson M, Saleh H, 2021, Delayed-onset neuropathic pain after septoplasty, Case Reports in Otolaryngology, Vol: 2021, ISSN: 2090-6765
Postoperative pain following a septoplasty is expected to be mild and limited to a few days after the operation. Chronic pain following the procedure is rare. No cases of delayed-onset neuropathic pain or allodynia have been described in the literature. This paper presents a case of delayed-onset neuropathic pain after septoplasty in a previously pain-free asthmatic patient that was successfully managed by administration of intranasal local anaesthesia. Physical examination and imaging excluded any other cause of neuralgia. A literature review revealed reports of chronic pain in patients following septoplasty if there were nasal contact or compression points or nasal tumours. Separately, acute postseptoplasty allodynia is documented in iatrogenic maxillary nerve damage. However, delayed-onset neuralgic pain, exacerbated by certain environmental triggers, has not been previously described. Facial pain can be debilitating; successfully managing this neuralgic pain with administration of intranasal local anaesthetic had a substantial effect on the patient's quality of life.
Anwar M, Madani G, Saleh H, et al., 2021, Challenges in sinonasal and anterior skull base imaging, Head and Neck Imaging: A Multi-Disciplinary Team Approach, Pages: 329-354, ISBN: 9783030808976
Recent advances in image-guided techniques allow endoscopic surgery to extend beyond the sinonasal cavity to the pterygopalatine fossa, orbit, anterior skull base and petrous apex. These techniques reduce complication rates compared with traditional open surgery (craniotomy or trans-facial) and require a multidisciplinary team review of imaging and pathology to accurately determine the endoscopic trajectory and surgical margins. This requires accurate delineation of vital neurovascular structures on both CT and MRI. In this chapter, the roles of CT (for bony anatomy, normal variants, sinus drainage pathways, and neural/vascular foramina) and MRI (for soft tissue characterisation, determining disease extent and involvement of vital structures) are discussed in the context of image-guided endoscopic surgical planning and follow-up. For image guidance, CT and MRI datasets acquired pre-surgery are indexed to surface anatomy of the face to provide intra-operative spatial registration. Processes with which the head and neck team members should be familiar have been selected to outline the scope of these surgical advances. This includes a case-based review of the causes, evaluation and treatment options for CSF rhinorrhoea, mucocele, orbital infection plus sinonasal fungal infection, along with the indications and potential complications of orbital decompression (including thyroid eye disease), as well as potential endoscopic approaches available for disease at the petrous apex.
Saibene AM, Allevi F, Ayad T, et al., 2021, Appropriateness for SARS-CoV-2 vaccination for otolaryngologist and head and neck surgeons in case of pregnancy, breastfeeding, or childbearing potential: Yo-IFOS and CEORL-HNS joint clinical consensus statement, European Archives of Oto-Rhino-Laryngology, Vol: 278, Pages: 4091-4099, ISSN: 0937-4477
PURPOSE: SARS-CoV-2 vaccines are a key step in fighting the pandemic. Nevertheless, their rapid development did not allow for testing among specific population subgroups such as pregnant and breastfeeding women, or elaborating specific guidelines for healthcare personnel working in high infection risk specialties, such as otolaryngology (ORL). This clinical consensus statement (CCS) aims to offer guidance for SARS-CoV-2 vaccination to this high-risk population based on the best evidence available. METHODS: A multidisciplinary international panel of 33 specialists judged statements through a two-round modified Delphi method survey. Statements were designed to encompass the following topics: risk of SARS-Cov-2 infection and use of protective equipment in ORL; SARS-Cov-2 infection and vaccines and respective risks for the mother/child dyad; and counseling for SARS-CoV-2 vaccination in pregnant, breastfeeding, or fertile healthcare workers (PBFHW). All ORL PBFHW were considered as the target audience. RESULTS: Of the 13 statements, 7 reached consensus or strong consensus, 2 reached no consensus, and 2 reached near-consensus. According to the statements with strong consensus otorhinolaryngologists-head and neck surgeons who are pregnant, breastfeeding, or with childbearing potential should have the opportunity to receive SARS-Cov-2 vaccination. Moreover, personal protective equipment (PPE) should still be used even after the vaccination. CONCLUSION: Until prospective evaluations on these topics are available, ORL-HNS must be considered a high infection risk specialty. While the use of PPE remains pivotal, ORL PBFHW should be allowed access to SARS-CoV-2 vaccination provided they receive up-to-date information.
Unadkat SN, Pendolino AL, Auer D, et al., 2021, The Evidence Base for the Benefits of Functional Septorhinoplasty and its Future Post COVID-19., Facial Plast Surg, Vol: 37, Pages: 625-631
Ever since the introduction of the concept of Procedures of Limited Clinical Value (PoLCV), procedures such as functional septorhinoplasty have been subject to additional funding restrictions within the British National Health Service. Recent publications have suggested that 10% of Clinical Commissioning Groups in the United Kingdom no longer fund septorhinoplasty surgery irrespective of the indications, including congenital malformations or post-trauma, and despite the strong evidence available in the literature in treating a range of health conditions. Thus, inequity exists across the country. At present functional septorhinoplasty surgery is frequently but incorrectly grouped together with aesthetic rhinoplasty, both of which are deemed to be cosmetic interventions. Moreover, as we exit the peak of the current coronavirus disease 2019 (COVID-19) pandemic, procedures deemed to be of lower clinical priority will potentially be at risk throughout Europe. The purpose of this review is twofold; the first is to put forward the evidence to commissioners in favor of functional septorhinoplasty surgery on patient well-being and mental health; the second is to demonstrate why functional septorhinoplasty surgery is a distinct procedure from aesthetic rhinoplasty and why it ought not to be classified as a procedure of limited clinical value.
Georgalas C, Oostra A, Ahmed S, et al., 2021, International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea, INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY, Vol: 11, Pages: 794-803, ISSN: 2042-6976
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Unadkat SN, Saleh HA, 2021, Restoring Balance and Symmetry to the Aging Nose., Facial Plast Surg, Vol: 37, Pages: 205-210
Accurate assessment of facial symmetry is a key component of successful rhinoplasty surgery but is often overlooked by both surgeon and patient. Up to three-quarters of patients with a significantly crooked nose have been found to have concurrent marked facial asymmetry. Whilst not a contraindication to rhinoplasty, provided that facial asymmetry is identified in advance and expectations realistic, the correction of nasal deformities can improve perceived facial asymmetry. In the aging face, aside from soft tissue and bony resorption that can amplify facial asymmetry, there are specific surgical challenges to the aging nose; the normal tip support mechanisms deteriorate with age giving rise to distinctive changes to the aging nose-typically tip ptosis and a hanging columella; bone quality becomes more brittle and skin overlying this area becomes thinner. There is also weakening of the external nasal valve thus causing functional impairment too. As a result, rhinoplasty techniques used in younger patients may not be suitable in the aging nose. In this article, the authors describe their experience and outline the evidence on the management of the aging patient with facial and nasal asymmetry.
Magill JC, Unadkat S, Bullock E, et al., 2021, Rhinology in the COVID-19 era: Our experience from a rhinology tertiary referral hospital and implications for future practice, CLINICAL OTOLARYNGOLOGY, Vol: 46, Pages: 96-100, ISSN: 1749-4478
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Javanbakht M, Saleh H, Hemami MR, et al., 2020, A corticosteroid-eluting sinus implant following endoscopic sinus surgery for chronic rhinosinusitis: a UK-based cost-effectiveness analysis., PharmacoEconomics - Open, Vol: 4, Pages: 679-686, ISSN: 2509-4254
BACKGROUND: Chronic rhinosinusitis (CRS) is one of the commonest chronic health problems among adults in the UK. Around 15% of CRS patients undergo functional endoscopic sinus surgery (FESS) annually after failing medical treatment. However, as incomplete resolution of symptoms or complications post-operatively is common, the post-operative management is considered to be as important as the surgery itself. A bioabsorbable corticosteroid-eluting sinus implant (CESI) (Propel®, mometasone furoate 370 µg) has been used as an alternative post-FESS treatment. OBJECTIVE: The objective of this study was to assess the cost effectiveness of the corticosteroid-eluting implant versus non-corticosteroid-eluting spacer following FESS for treatment of patients with CRS. METHODS: A decision tree model was developed to estimate the cost and effectiveness in each strategy. Costs and effects were estimated from a UK National Health Service (NHS) and personal social services perspective over a 6-month time horizon. Model pathways and parameters were informed by existing clinical guidelines and literature and sensitivity analyses were conducted to explore uncertainties in base-case assumptions. RESULTS: Over a 6-month time horizon, inserting CESI at the end of FESS is less costly (£4646 vs. £4655 per patient) and is the more effective intervention [total quality-adjusted life-years (QALYs) over 6 months 0.443 vs. 0.444] than non-corticosteroid-eluting spacers; hence, it is a dominant strategy. The probabilistic analysis results indicate that CESI following FESS has a 62% probability of being cost effective at the £20,000/per QALY willingness-to-pay threshold and 56% probability of being a cost-saving intervention. CONCLUSIONS: The use of CESI after FESS results in fewer post-operative complications than non-corticosteroid-eluting implants and may be a cost-saving technology over a 6-month time horizon. Although the cost of initial treatment with the
Bertossi D, Mohsahebi A, Philipp-Dormston WG, et al., 2020, Safety guidelines for nonsurgical facial procedures during COVID-19 outbreak, Journal of Cosmetic Dermatology, Vol: 19, Pages: 1829-1837, ISSN: 1473-2130
BACKGROUND: The novel coronavirus (COVID-19) pandemic is expected to last for an extended time, making strict safety precautions for office procedures unavoidable. The lockdown is going to be lifted in many areas, and strict guidelines detailing the infection control measures for aesthetic clinics are going to be of particular importance. METHODS: A virtual meeting was conducted with the members (n = 12) of the European Academy of Facial Plastic Surgery Focus Group to outline the safety protocol for the nonsurgical facial aesthetic procedures for aesthetic practices in order to protect the clinic staff and the patients from SARS-CoV-2 infection. The data analysis was undertaken by thematic and iterative approach. RESULTS: Consensus guidelines for nonsurgical facial aesthetic procedures based on current knowledge are provided for three levels: precautions before visiting the clinic, precautions during the clinic visit, and precautions after the clinic visit. CONCLUSIONS: Sound infection control measures are mandatory for nonsurgical aesthetic practices all around the world. These may vary from country to country, but this logical approach can be customized according to the respective country laws and guidelines.
Unadkat SN, Andrews PJ, Bertossi D, et al., 2020, Response to Whitehead et al. re: "Recovery of Elective Facial Plastic Surgery in the Post-Coronavirus Disease 2019 Era: Recommendations from the European Academy of Facial Plastic Surgery Task Force"., Facial Plast Surg Aesthet Med
Bujoreanu I, Ferguson M, Saleh H, 2020, Chemotherapy associated dural sinus thrombosis presenting as a cerebrospinal fluid leak., BMJ Case Reports, Vol: 13, Pages: 1-4, ISSN: 1757-790X
Despite the well documented increased risk of thrombosis in patients with cancer and during chemotherapy, cerebral venous sinus thrombosis (CVT) remains a rare entity. We present a rare case of cerebrospinal fluid (CSF) rhinorrhoea secondary to a left transverse sinus thrombus which occurred 2 years previously during chemotherapy for breast cancer. The patient underwent a three-layer repair using Neuro-Patch, septal cartilage and middle turbinate pedicle flap and was started on acetazolamide. There was no recurrence at 1-year follow-up. Raised intracranial pressure secondary to cerebral venous occlusion can erode the base of skull and predispose to CSF leaks. Despite the theoretical risk, there have been no cases reported where CSF leaks have occurred following chemotherapy induced CVT. We describe the first case and discuss pathophysiology and management.
Dimitrov L, Unadkat S, Khanna A, et al., 2020, ENT training amongst general practitioners: results from a questionnaire., J Laryngol Otol, Pages: 1-7
OBJECTIVES: To evaluate the level of undergraduate and post-graduate ENT exposure amongst general practitioners and their perceived quality of this training. A secondary aim was to examine whether general practitioners believe ENT department based rotations should remain in the undergraduate curriculum. METHOD: An online questionnaire-based survey was sent to general practices in England. RESULTS: A total of 417 general practitioners completed the questionnaire. Sixty-seven per cent had completed an ENT rotation at medical school whereas 27 per cent had undertaken a postgraduate placement in ENT. Fifty-one per cent had received post-graduate teaching in ENT, mainly in the form of lectures. The majority of general practitioners were not satisfied with their training in ENT at undergraduate and post-graduate levels. Eighty-five per cent of general practitioners believed formal hospital-based ENT training should remain in the undergraduate curriculum. CONCLUSION: General practitioners reported insufficient exposure to ENT during both post-graduate and undergraduate training. Proposals to outsource undergraduate ENT teaching to affiliated departments such as general practice are of concern.
Unadkat S, Pendolino AL, Joshi A, et al., 2020, A national survey of functional septorhinoplasty surgery performed in the United Kingdom: a clinician end-user questionnaire to assess current practice and help inform future practice., Eur Arch Otorhinolaryngol, Vol: 277, Pages: 475-482
PURPOSE: The aim of this national survey is to assess the current practice of functional septorhinoplasty (SRP) surgery in the UK and better inform future practice. METHODS: An ENT-UK approved questionnaire was sent out to all 135 consultant members of the British Society of Facial Plastic Surgery (BSFPS). Data was collected on numbers of functional SRPs performed on the NHS, use of outcome measures, psychology and photography support, antibiotic use, referral base and consenting practice. RESULTS: The response rate was 38.5%, with 52 out of 135 completed. The median number of annual SRP cases per surgeon was 40. Most surgeons (95%) used clinical photography as an outcome measure. However, 27% of the respondents use a subjective outcome measurement and 3% of them use an objective outcome measurement. Only 34% had access to psychology support and 60% receive their referrals from primary care. All surgeons counsel patients for aesthetic change, 15% mention CSF leak and 38% mention olfactory disturbance. The key comment from our respondents was to relabel the rhinoplasty procedure as a functional SRP procedure with the aim to remove it from the Procedures of Limited Clinical Value (PoLCV) list. CONCLUSION: The majority of our respondents perform a large proportion of the SRP surgeries in the UK with each of the respondents performing an average of 40 SRP surgeries per year. There is a need to recatergorise functional septorhinoplasty as a functional operation and recommend functional SRP surgery to be removed from the PoLCV list.
Unadkat SN, Andrews PJ, Bertossi D, et al., 2020, Recovery of Elective Facial Plastic Surgery in the Post-Coronavirus Disease 2019 Era: Recommendations from the European Academy of Facial Plastic Surgery Task Force., Facial Plast Surg Aesthet Med, Vol: 22, Pages: 233-237
The impact of the COVID-19 pandemic has resulted in widespread disruption to routine surgical services across the globe. As the peak of the initial pandemic passes, surgeons will increasingly resume elective work to address the backlog. Whilst urgent cases such as cancer work will be prioritized, the safe resumption of facial plastic surgery will remain an ongoing challenge; particularly if there are secondary waves of infection. Rhinoplasty and nasal reconstructive surgery in particular poses a unique challenge to address due to the due to the potential for aerosolizing the virus. A task force of facial plastic surgeons from the European Academy of Facial Plastic Surgery has collaborated to create this document detailing recommendations for resuming a safe facial plastic surgery practice. These include the need to embrace telemedicine, advice on surgical prioritization, planning of clinical area flow plans, advice on pre-/peri- and postoperative care as well as recommendations on training for residents and well-being for surgeons. The recommendations have been made in line with the best available evidence in the literature and are applicable to facial plastic surgery colleagues from around the world in order to resume a safe practice.
Varadharajan K, Choudhury N, Saleh HA, 2019, Modified Z-plasty of the internal nasal valve-To treat mechanical nasal obstruction: How we do it., Clin Otolaryngol, Vol: 44, Pages: 1203-1204
Scholfield DW, Rennie C, Saleh HA, 2019, Chronic cough and pneumonitis secondary to cerebrospinal fluid leak: Resolution after repair, ACTA OTORRINOLARINGOLOGICA ESPANOLA, Vol: 71, Pages: 59-60, ISSN: 0001-6519
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Varadharajan K, Choudhury N, Saleh HA, 2019, Septo-columelloplasty-Anchoring the caudal septum to anterior nasal spine using a hypodermic needle as a trocar., Clin Otolaryngol, Vol: 44, Pages: 211-212
Saleh HA, Beegun I, Apaydin F, 2019, Outcomes in Rhinoplasty., Facial Plast Surg, Vol: 35, Pages: 47-52
In recent years, there is an increasing trend to use health-related quality of life questionnaires after surgical procedures. The idea is to prove the success of an operation by objectively measurable parameters. Rhinoplasty is by far the most frequently performed surgery of facial plastic surgery. One of the most difficult parts of rhinoplasty is to measure the outcomes after surgery. Rhinoplasty is a unique operation because the surgeon affects three aspects: shape, function, and psychology of the patient. In an ideal world, the surgeon should have objective means of screening that cover these three aspects before and after surgery to measure outcomes. The goal of this article is to review these tools and compare them.
Hill AT, Sullivan AL, Chalmers JD, et al., 2019, British Thoracic Society Guideline for bronchiectasis in adults, THORAX, Vol: 74, Pages: 1-54, ISSN: 0040-6376
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