Objective: Mucormycosis is an aggressive fungal infection which may still cause fatal complications. However, the rarity of this disease has made optimal treatment a controversial issue. This study aimed to evaluate the use of topical amphotericin B in endoscopic management of rhinocerebral mucormycosis.Subjects and methods: Thirty patients with infection limited to the nose and sinuses were selected. Patients underwent endoscopic debridement of all necrotic tissue; cottonoid pledgets soaked in amphotericin B solution were then placed in the nasal cavity. Subsequently, long-term antifungal therapy was administered.Results: The overall survival rate was 60 per cent (18 cases); survival rates in the diabetic and malignancy groups were 70.58 and 40 per cent, respectively. Apart from predisposing factors, orbital and maxillary sinus involvement also had a significant correlation with patient outcome.Conclusion: Topical use of amphotericin B combined with endoscopic surgical debridement, followed by intravenous amphotericin B treatment, may constitute acceptable management for selected patients, with less morbidity than conventional treatments.

Background: Internal nasal valve collapse is a preventable complication of rhinoplasty, for which the spreader graft is the gold standard. More recently, the spreader flap technique has been espoused as an alternative to spreader grafting. Here, we evaluated the efficacy of this technique in a randomized trial setting. Methods: The autospreader was used in 32 patients who were candidates for primary rhinoplasty; 34 who did not undergo a spreader flap procedure were recruited as a control group. Acoustic rhinometry was used in every patient preoperatively and 1 year postoperatively. Average volume and minimal cross-sectional area (MCA) of the nose and findings were collected. Also, the pre- and postoperative patients’ subjective assessment about their satisfaction from their appearance and nasal obstruction were evaluated according to visual analog scale (VAS). Results: Among the study group patients, 46 (69.7%) were female and 20 (30.3%) were male subjects. Their mean age was 50/5 ± 6/24 years. The difference in MCA in the control group was-0.1 and +0.6 (on right and left sides, respectively), and in the spreader flap group it was-0.03 and +0.05, which showed an increase in MCA in the left side and a decrease in the opposite side of both groups. However, their difference was not statistically significant (p = 0.50). Also, the differences between preoperative and postoperative VAS were not significant in either nasal obstruction (p = 0.68) and cosmetic satisfaction (p = 0.38). Conclusion: Spreader flap is an attractive technique in preserving the middle vault in nasal plastic surgery. However, its effect needs more evaluation.

Background: Chronic rhinosinusitis (CRS) is recognized as a common disease that imposes a big burden on the health system worldwide. There is ongoing evidence of the anti-inflammatory effect of long-term macrolide in the management of patients with CRS. Objective: The aim of this randomized clinical trial was to evaluate the efficacy of long-term consumption of low-dose azithromycin after functional endoscopic sinus surgery. Methods: Sixty-six patients who fulfilled the inclusion criteria were randomly divided into intervention and control groups. The subjects received the standard conventional treatment (fluticasone nasal spray plus normal saline solution irrigation) or the conventional treatment plus 250 mg of azithromycin on a daily basis for 3 months. Evaluation was made based on the 22-item Sino-Nasal Outcome Test (SNOT-22) immediately before surgery and 3 months after surgery. Results: The intervention group showed a statistically significant improvement in SNOT-22 scores after the treatment and a higher percentage change after 3 months of therapy compared with the control group. A significant correlation was found between the percentage change of SNOT-22 scores and smoking in the placebo group. Lund-Mackay scores, patient age, and the duration of symptoms had no significant correlation with the percentage change. Conclusion: Treatment with long-term low-dose azithromycin in combination with the conventional therapy could statistically reduce the recurrence rate of CRS symptoms after functional endoscopic sinus surgery, but there was not sufficient evidence to support clinical significance of azithromycin at the investigated dose. Further larger scale trials, along with a longer follow-up period, is needed to evaluate the effectiveness of the therapy.

Background: Rhinoplasty is one of the most challenging esthetic surgeries. The ability to achieve precise and predictable changes in the shape and position of the nasal tip is still among one of the demanding areas of rhinoplasty. Columellar strut is one of many techniques to ensure an adequate nasal tip projection and rotation; however, there is little evidence to support long-term efficacy of this technique. Methods: In a clinical trial, 93 patients who were rhinoplasty candidates were studied prospectively. They were randomly divided into two groups according to the use of columellar strut. The outcome measures were gaining and maintaining tip projection and rotation in the long term. Standardized photographs before and 3, 6, and 12 months after surgery were the measurements to compare the results between two groups. Results: The mean age was 23.3 ± 4.8 years. In 47 cases, surgery was performed using columellar strut and in 45 cases this method was not used. Preoperatively, nasolabial angle and tip projection were not significantly different between the two groups. In addition, postoperatively, the mean of nasolabial angel and tip projection were not significantly different in the two groups 3, 6, and 12 months after surgery. The decreasing of these parameters was not significantly different during follow-up in the two groups. Conclusion: It seems that columellar strut is not an essential technique to enhance and maintain tip projection and/or rotation in rhinoplasty. Using good techniques in qualified hands give the best results in the long term even without columellar strut.