Tip plasty in a crooked nose is a challenging step in rhinoplasty and can significantly affect a patient’s quality of life. Different grafts and surgical techniques have evolved in the past decade to achieve satisfactory functional and aesthetic outcomes. In the present study, we have discussed the utility of septal extension grafts (SEGs) in crooked Indian noses and evaluated their functional and aesthetic outcomes. This is a retrospective study of 25 patients who underwent septorhinoplasty at a tertiary care referral hospital from May 2020 to January 2024. In all cases, septal extension grafts (SEGs) were used to reconstruct the nasal tip. The functional and aesthetic outcomes were evaluated at 6 and 12 months after the surgery. There was significant improvement in functional (VAS, NOSE score) and aesthetic outcomes (ROE) up to 12 months after surgery (p < 0.001). There was a significant improvement in the angle at the internal nasal valve 12 months after surgery (p < 0.001). When the aesthetic outcomes (nasolabial angle, tip projection, and Goode’s ratio) were compared between the preoperative and postoperative periods, the differences were significant (p < 0.001). Septal extension grafts can be successfully used to reconstruct the nasal tip, ensuring projection, rotation, and improving functional and aesthetic outcomes after rhinoplasty in crooked noses. Despite a small sample size, the functional and aesthetic results were encouraging in the Indian population. The study findings can be revalidated in a large prospective study with long-term follow-up.
Counterclockwise rotation (CCWR) of the maxillomandibular complex (MMC) enhances facial aesthetics, optimizes occlusal function, and improves overall biomechanics with substantial augmentation in the three-dimensional configuration of the upper airway. The aim of the study is to quantitatively evaluate the linear-volumetric correlation between Pogonion advancement and airway volume changes following CCWR of MMC. A retrospective cohort study including 30 patients who underwent CCWR of MMC was performed. Pre- and post-operative CBCT scans were obtained in natural head position. DICOM data were segmented and study parameters (airway volume, length, cross-sectional area, retropalatal, and retroglossal area) were measured correlated with skeletal landmarks (Pogonion, B point, ANS, and PNS). The results demonstrated a significant relation between percent increase in airway volume and pogonion advancement (Pearson correlation coefficient (r) = 0.55, p = 0.001) with B point advancement (r = 0.498, p = 0.005). Paired t-test confirmed a significant decrease in post-surgical airway length (t=-2.71, p = 0.011), an increase in minimum cross-sectional area (t=-6.60, p < 0.001), retropalatal (t=-10.13, p < 0.001), and retroglossal areas (t=-8.27, p < 0.001), respectively. The current study suggested that for every 1 mm increase in Pog advancement, airway volume increased by approximately 10.8
Nasotracheal intubation (NTI) is routinely performed in maxillofacial surgery to provide unobstructed surgical access; however, it is commonly associated with epistaxis and mucosal trauma. Mechanical dilation of the nasal passage using a nasopharyngeal airway (NPA) may reduce these complications. To evaluate the effect of pre-intubation insertion of a nasopharyngeal airway on bleeding and ease of nasotracheal intubation in patients undergoing elective maxillofacial surgery. This prospective randomized comparative study included 40 adult patients undergoing elective maxillofacial surgery requiring NTI under general anaesthesia. One patient was excluded after randomization owing to a change in airway management strategy; the remaining 39 patients (NPA group, n = 20; control group, n = 19) were analysed on a per-protocol basis. Ease of intubation, bleeding during intubation, and post-intubation pharyngeal bleeding were assessed using standardized ordinal grading systems. Statistical analysis was performed using the Mann–Whitney U test, and standardized effect sizes were calculated. Bleeding during intubation was significantly lower in the NPA group than in the control group (median [IQR], 1 [0–1] vs. 1 [1–2]; P = 0.038; effect size r = 0.40). No statistically significant differences were observed in ease of intubation (P = 0.81) or post-intubation pharyngeal bleeding (P = 0.46). Demographic characteristics and endotracheal tube size were comparable between groups. Pre-intubation insertion of a nasopharyngeal airway was associated with reduced bleeding during nasotracheal intubation without a significant difference in ease of tube passage. The technique may represent a simple and inexpensive adjunct for reducing bleeding during nasotracheal intubation; however, larger multicentre studies involving multiple operators are required to confirm these findings and establish their generalisability.
Healing of mandibular third molar extraction sockets remains a significant clinical challenge. The present randomized controlled trial compared platelet-rich fibrin (PRF) with amoxicillin and β-tricalcium phosphate (β-TCP) with amoxicillin for postoperative healing. To compare soft tissue healing, incidence of alveolar osteitis, bone fill, and bone density following mandibular third molar surgery. Twenty patients were randomly allocated into two equal groups. Group A received PRF with amoxicillin and Group B received β-TCP with amoxicillin. Clinical healing was assessed using Landry’s Wound Healing Index, while bone regeneration was evaluated using CBCT at four months. All permissions were granted from institutional ethical committee with approval number DCA/IEC/91/2025 and clinical trial registration number REF/2026/06/040169. The β-TCP group demonstrated superior soft tissue healing, lower incidence of alveolar osteitis, greater bone fill, and significantly higher bone density than the PRF group. β-TCP combined with amoxicillin appears to be a promising socket-preservation material following mandibular third molar surgery.
