The Academic Center at MouradNYC

Warm intranasal saline irrigation reduces intraoperative blood loss during functional endoscopic sinus surgery: a propensity score-matched cohort study

Tsai YF, Chang Y, Luo SD, et al. · Annals of medicine · 2026 · PMID 42324996 · DOI 10.1080/07853890.2026.2690712

BACKGROUND: To evaluate whether warm intranasal saline irrigation (38-40 °C) during functional endoscopic sinus surgery (FESS) is associated with reduced intraoperative bleeding compared with standard cold irrigation (18-21 °C). METHODS: We performed a single-centre retrospective cohort study of consecutive FESS procedures under inhalational general anaesthesia (January 2017-December 2022). After exclusions, 1,990 cases were eligible. One-to-one propensity score matching (age, sex, ASA class, and type of inhaled anaesthetic) yielded 409 warm and 409 cold cases. Primary outcomes were estimated blood loss and blood loss >50 mL. Secondary outcomes included anaesthesia duration, intraoperative medication requirements, and lowest recorded temperature. Multivariable logistic regression adjusted for BIS monitoring utilisation, intravenous fluid rate, and intraoperative antihypertensive medication use. RESULTS: Median blood loss was 50 mL (IQR 50-50) with warm irrigation versus 50 mL (IQR 50-100) with cold irrigation (p = 0.001). Blood loss >50 mL occurred in 18.6% versus 32.0%, respectively (p < 0.001). Warm irrigation remained independently associated with lower odds of blood loss >50 mL (adjusted OR 0.45, 95% CI 0.31-0.66; p < 0.001). BIS monitoring was also protective (adjusted OR 0.57, 95% CI 0.37-0.87; p = 0.009). Warm irrigation was associated with shorter anaesthesia duration (median 2.82 vs 3.38 h; p < 0.001) and a slightly higher nadir temperature (35.6 vs 35.5 °C; p = 0.007). CONCLUSIONS: Warm intranasal saline irrigation at 38-40 °C was associated with fewer clinically significant bleeding events during routine FESS and may represent a simple, low-cost adjunct to perioperative haemostatic management.

Depemokimab: A twice yearly anti-IL 5 biologic for chronic rhinosinusitis with nasal polyps (CRSwNP) - A narrative review

Park MJ, Han JK, Lam KK · Human vaccines & immunotherapeutics · 2026 · PMID 42234701 · DOI 10.1080/21645515.2026.2658911

Depemokimab is a monoclonal antibody that targets interleukin-5 with enhanced binding affinity and an extended terminal elimination half‑life of 6-8 weeks. The unique pharmacodynamic features of depemokimab enable sustained suppression of type 2 inflammation with twice‑yearly subcutaneous dosing. This narrative review provides details of depemokimab's molecular profile, pharmacokinetics, and pharmacodynamics and results regarding the clinical efficacy and safety of depemokimab from recently published Phase 3 clinical trials for the treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP). In 528 severe adult CRSwNP patients (ANCHOR‑1/‑2 trials), depemokimab achieved Δ total endoscopic nasal polyp score by -0.70 (p < .001) and Δ nasal obstruction verbal response scale by -0.24 (p = .003) at week 52, compared to placebo. Twice‑yearly 100 mg depemokimab provides durable eosinophil suppression and with a safety profile comparable to placebo in Phase 3 trials for CRSwNP. Future work should refine biomarkers and assess comparative cost‑effectiveness and long‑term adherence, safety, and effectiveness.

Comprehensive MRI analysis of olfactory bulb morphology and olfactory sulcus depth in chronic rhinosinusitis, migraine, and post-COVID patients

Li S, Kim K, Li Z, et al. · Neuroscience · 2026 · PMID 42162730 · DOI 10.1016/j.neuroscience.2026.05.020

OBJECTIVE: This study aimed to provide a comprehensive MRI-based assessment of olfactory bulb (OB) morphology and olfactory sulcus (OS) depth in patients with chronic rhinosinusitis (CRS), post-COVID, and migraine, representing distinct etiologies of olfactory dysfunction. METHODS: High-resolution T2-weighted MRI scans were analyzed in 88 participants (20 post-COVID, 30 migraine, 18 CRS; mean age = 41.32 ± 13.91). OB volume, height, width, and anterior-posterior diameter (APD), as well as OS depth, were measured bilaterally. OB shape was classified as oval, flat, or irregular. Group differences were assessed using ANOVA, and correlations with olfactory performance (Sniffin' Sticks threshold, discrimination, identification, and TDI scores) were examined. RESULTS: OB volume, height, and width were generally larger in controls than in patient groups, with no significant differences between patient groups. Olfactory performance was preserved in migraine but reduced in post-COVID and CRS. Positive correlations between OB volume/width and olfactory function were observed in controls, migraine, and CRS, whereas post-COVID patients showed a negative association with OB width. Shape analysis revealed reduced symmetry and more atypical forms, particularly in CRS. CONCLUSIONS: OB atrophy was present across patient groups, but its relationship with olfactory function differed by condition. While OB volume remains a sensitive marker, additional measures such as width, shape, and OS depth provide complementary insights. Structural alterations may reflect underlying olfactory system impairment rather than direct functional loss. Increased asymmetry, especially left-sided atypical forms in CRS, suggests potential lateralized vulnerability. Overall, a multidimensional structural assessment enhances understanding of olfactory dysfunction.

Modern methods of dorsal augmentation rhinoplasty

Go BC, Xiao R, Jang YJ · Current opinion in otolaryngology & head and neck surgery · 2026 · PMID 42267496 · DOI 10.1097/MOO.0000000000001139

PURPOSE OF REVIEW: Dorsal augmentation rhinoplasty is a technically demanding procedure that requires careful selection of grafting materials and techniques to achieve durable and aesthetically pleasing results. This review summarizes contemporary approaches to dorsal augmentation rhinoplasty, emphasizing material selection, surgical indications, and evolving techniques. RECENT FINDINGS: Autologous grafts (septal, auricular, and costal cartilage) are widely used due to their lack of immunogenicity and relatively low rates of infection and extrusion. Diced cartilage techniques have gained recent popularity due to their flexibility and smooth dorsal contouring. Alloplastic and allogeneic materials can be carefully considered in specific patient populations who accept their associated risks. Injection filler rhinoplasty may be considered for patients seeking a lower-cost, temporary option for nasal augmentation with minimal downtime. SUMMARY: A comprehensive understanding of the spectrum of surgical techniques for dorsal augmentation rhinoplasty is essential for individualized surgical planning. Familiarity with the indications, strengths, and limitations of each approach will enable surgeons to optimize outcomes in dorsal augmentation rhinoplasty.

Unilateral Versus Bilateral Spreader Grafts to Correct Cartilaginous Deviations in Structural Rhinoplasty: A Comparative Study on the Aesthetic and Functional Outcomes

Gimeno-Torres L, Calvo-Gómez J, Pérez-Carbonell T, et al. · Facial plastic surgery : FPS · 2026 · PMID 41265885 · DOI 10.1055/a-2750-9411

INTRODUCTION: Spreader grafts (SG) are used in rhinoplasty to correct cartilaginous deviations. There are no studies that compare aesthetic and functional outcomes of unilateral (USG) and bilateral SG (BSG). OBJECTIVES AND HYPOTHESES: Compare whether USG or BSG is better to correct cartilaginous deviations, if there are differences in dorsal width ratio (DWR) and in patient-perceived aesthetic and functional outcomes. METHODS: Retrospective study of 35 patients who underwent septorhinoplasty with USG or BSG. Deviation angle and DWR were calculated in frontal images before and 6 months postsurgery. Aesthetic and functional results were measured using nasal obstruction symptom evaluation (NOSE) and visual analog scales (VAS). RESULTS: BSG significantly improved postoperative nasal deviation compared to USG (179.6 degrees vs. 172.9 degrees; p < 0.05). In minor preoperative deviations, there were no significant differences between BSG and USG (179.57 degrees vs. 177 degrees, respectively; p > 0.05). In major preoperative deviations, BSG provided better correction (179.62 degrees vs. 170.5 degrees; p < 0.05). DWR increased more with BSG compared to USG (0.12 vs. 0.04; p < 0.05). VAS and NOSE scores were similar in both groups. CONCLUSION: BSG is more effective in correcting major cartilaginous deviations, while both USG and BSG effectively correct minor deviations. Though BSG increases DWR, this does not negatively impact patient-perceived aesthetic or functional outcomes.

A Multidisciplinary Approach to Rhinoplasty: The Facial Plastic Surgeon and the Psychologist

Auer D, Saroha S, Unadkat SN, et al. · Facial plastic surgery : FPS · 2026 · PMID 41248892 · DOI 10.1055/a-2741-2458

INTRODUCTION: Rhinoplasty is one of the most frequently requested aesthetic procedures. However, a subset of patients presents with complex psychological profiles that can adversely impact surgical outcomes. Early psychological assessment is crucial to optimizing patient safety and satisfaction. OBJECTIVES AND HYPOTHESES: This narrative review aims to explore the role of integrated psychological assessment within multidisciplinary facial plastic surgery services. It hypothesizes that early psychological input improves patient selection, manages expectations, and reduces revision rates. STUDY DESIGN: Narrative review. METHODS: We conducted a structured narrative review of PubMed/MEDLINE, PsycINFO, Embase, and Scopus (from inception to June 2025), supplemented by clinical experience from a high-volume United Kingdom rhinoplasty center. Search terms included rhinoplasty, psychology, BDD, screening, and multidisciplinary care. Eligible sources comprised peer-reviewed studies, reviews, and guidelines on psychological assessment or outcomes in aesthetic rhinoplasty. RESULTS: Integrated psychological assessment can identify patients at risk of dissatisfaction, enhance patient selection, reduce revision surgeries, and improve overall outcomes. CONCLUSION: Multidisciplinary collaboration between surgeons and psychologists improves rhinoplasty outcomes, enhances patient safety, and supports the ethical principle of nonmaleficence.

Costal Cartilage Calcification in a Caucasian Population: Machine Learning Recommendations for Chest CT-guided Rhinoplasty Planning

van Dam VS, Berzenji D, van den Berg AS, et al. · Facial plastic surgery : FPS · 2026 · PMID 41145129 · DOI 10.1055/a-2731-5948

INTRODUCTION: Autologous costal cartilage calcification (CCC) can impact the course and long-term results of rhinoplasty. Preoperative information about the presence, severity, and pattern of CCC helps to assess donor site suitability and rhinoplasty planning. OBJECTIVE: To use machine learning to identify a sex-specific age threshold beyond which a preoperative chest CT is likely to reveal CCC relevant for rhinoplasty planning. STUDY DESIGN: Cross-sectional retrospective study of 662 Caucasian adults. METHODS: Prevalence, severity, and patterns of CCC in ribs five to eight were assessed by three independent reviewers. A machine learning algorithm was used to predict the age threshold beyond which a chest CT scan is beneficial to rhinoplasty planning. RESULTS: The prevalence of CCC in Caucasian adults was 89.6%. Nearly all individuals over the age of 50 exhibited some form of CCC. In young females CCC was more severe and prevalent in the central core of ribs five to eight compared with age-matched males. CONCLUSION: A chest CT is recommended in females over 23 years and males over 40 years. No data-driven recommendations regarding an upper age limit for costal cartilage use could be determined from the data.

Mature Cleft Rhinoplasty: Morphologic Outcomes of Septal Cartilage Grafting

Perez Rivera LR, Brett M, Staffenberg DA, et al. · The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association · 2026 · PMID 41042940 · DOI 10.1177/10556656251382536

ObjectiveTo evaluate morphologic outcomes following mature cleft rhinoplasty using exclusive septum cartilage grafting.DesignRetrospective, observational study.SettingSingle institution, 8-year retrospective review.Patients/ParticipantsA total of 31 facially mature patients with non-syndromic unilateral cleft lip were included in this study.InterventionsPatients underwent mature cleft rhinoplasty using septum cartilage as the exclusive graft source.Main Outcome MeasuresPreoperative and postoperative photographs (at least 1 year after surgery) were analyzed using 8 distinct anthropometric parameters to assess for statistical significance in the changes to nasal morphology. Paired-samples t-tests were performed, and statistical significance was defined as P < .05.ResultsThe mean changes following mature cleft rhinoplasty were: alar cant 1.96 to 0.95 (P < .001), alar height angle 1.90 to 1.21 (P = .006), nasal tip deviation 2.90 to 1.99 (P < .001), vertical alar height ratio 0.95 to 0.95 (P = .4), nasofacial angle 28.52 to 31.48 (P = .003), nasolabial angle 83.15 to 87.96 (P = .01), columellar angle 9.09 to 3.30 (P < .0001), and nostril height ratio 0.80 to 0.88 (P < .001).ConclusionsThe nasal septum can be considered as a reliable initial choice for cartilage grafts during mature cleft rhinoplasty.

The Role of Oral Isotretinoin in Thick Skin Rhinoplasty: A Systematic Review

Yip HM, Fernandez-Carrera I, Chopra S, et al. · Facial plastic surgery : FPS · 2026 · PMID 40921203 · DOI 10.1055/a-2697-3029

INTRODUCTION: Thick skin poses a challenge in rhinoplasty, often resulting in an undefined tip and supratip deformities. OBJECTIVES AND HYPOTHESES: This study evaluates oral isotretinoin as an adjuvant treatment for thick-skinned rhinoplasty patients. STUDY DESIGN: This is a systematic review conducted in accordance with PRISMA guidelines. METHODS: Two independent investigators performed a comprehensive literature search to identify studies that assessed perioperative oral isotretinoin treatment in thick skin rhinoplasty patients. Key outcome measures include skin thickness reduction, cosmetic surgical outcomes, and postoperative patient satisfaction. RESULTS: Five studies met the study inclusion criteria. Their findings demonstrated that oral isotretinoin effectively reduces skin thickness and improves cosmetic outcomes and satisfaction up to 6 months postoperatively, with no major complications reported. CONCLUSION: Although evidence is limited, oral isotretinoin shows promise in enhancing short-term rhinoplasty outcomes for thick-skinned patients. Further, high-quality trials are needed to confirm these results and develop standardized treatment protocols.

Pulley-Stitch: An Innovative Technique for Optimizing the Lateral Crus in Rhinoplasty

Marianetti T, Iademarco A, Perna L · Facial plastic surgery : FPS · 2026 · PMID 40907565 · DOI 10.1055/a-2695-3697

INTRODUCTION: Managing nasal tip support and lateral crura malposition remains a challenge in rhinoplasty. OBJECTIVES AND HYPOTHESES: This study aimed to evaluate the effectiveness of a novel suture technique-the Pulley-Stitch-in correcting lateral crura malposition. Primary outcome: Change in lateral crura angle; secondary outcome: Long-term stability. STUDY DESIGN: Prospective cohort study (N = 42), reported in-line with STROBE guidelines. METHODS: Forty-two patients underwent open rhinoplasty. The angle between the caudal margin of the medial crus and the anterior third of the lateral crus was measured from intraoperative images at T0 (prestitch) and T1 (poststitch). Standardized postoperative images were analyzed at 1 month (T2) and 12 months (T3). RESULTS: The angle increased from a mean of 18.2 to 26.9 degrees (p < 0.05), reflecting improved anatomical alignment and external nasal valve patency. Stability was confirmed at 12-month follow-up. CONCLUSION: The Pulley-Stitch is a safe, effective technique to improve nasal tip structure, cephalic rotation, and ala contour.

Preservation Concepts in Secondary Rhinoplasty: Is There Any Role?

Robotti E, Ilambarathi G, Cottone G, et al. · Facial plastic surgery : FPS · 2026 · PMID 40897332 · DOI 10.1055/a-2689-1798

INTRODUCTION: Secondary rhinoplasty presents complex challenges due to anatomical distortions, scar tissue, and multiple iatrogenic deformities. OBJECTIVES & HYPOTHESES: Although a traditional structural approach is the time-honored benchmark against which any other technique should be measured, preservation concepts can be integrated together with structural techniques. STUDY DESIGN: This study is based on a retrospective review of cases. METHODS: Preservation concepts applicable to secondary rhinoplasty are outlined in detail. A paradigm case highlighting the strategic application of preservation techniques is included. RESULTS: Preservation concepts pose an evident advantage in avoiding unnecessary dissection, further destabilization, and overgrafting while maintaining native structures that can be preserved and limiting dead space. Scar tissue can be used advantageously rather than discarded. However, introducing a "preservationist mindset" in revision rhinoplasty needs a refined approach, mastery of diverse techniques, and a flexible operative strategy. CONCLUSION: Preservation concepts can lead to improved outcomes even in secondary rhinoplasty.

The adult cleft lip and palate patient: beyond primary repair

Mahendran G, Cullinane RR, Shaye DA · Current opinion in otolaryngology & head and neck surgery · 2026 · PMID 42093265 · DOI 10.1097/MOO.0000000000001133

PURPOSE OF REVIEW: Cleft lip and palate (CL/P) is the most common congenital craniofacial anomaly worldwide. While surgical techniques and multidisciplinary cleft care have advanced substantially, much of the literature focuses on pediatric outcomes. The long-term experiences of adults living with CL/P remain comparatively underexplored. This article aims to review the functional, psychological, and social experiences of adults with CL/P and consider how these factors influence long-term care. RECENT FINDINGS: Adults with CL/P face persistent functional challenges including speech difficulties, hearing loss related to chronic eustachian tube dysfunction (ETD), nasal airway obstruction, and dentofacial abnormalities that may require orthognathic correction. Psychological studies reveal higher rates of depression, anxiety, and social stigma among adults with CL/P, with protective factors including family support and engagement with the cleft community. Patient-reported outcome measures suggest that satisfaction with surgical outcomes varies by cleft phenotype, with bilateral clefts often associated with lower satisfaction and a higher likelihood of revision procedures such as secondary rhinoplasty. SUMMARY: Adults with CL/P face challenges of ongoing functional adaptation, psychosocial navigation, and decisions regarding additional interventions. Attention to patient-reported outcomes, psychosocial support, and lifelong engagement with cleft care may improve the long-term well being of adults living with CL/P.

The Princess and the Pea Graft-A Solid Cartilaginous Tip Graft for Noses with Thick Skin Envelope

Ng CL, Loh SBJ, Chua NYM, et al. · Facial plastic surgery : FPS · 2026 · PMID 41490608 · DOI 10.1055/a-2764-2712

INTRODUCTION: Thick skin-soft tissue envelope (SSTE) and weak cartilage make nasal tip definition challenging in many Asian rhinoplasty patients. OBJECTIVES & HYPOTHESES: We aimed to assess whether the Princess and the Pea (PP) graft-a solid, conical costal cartilage tip graft-can improve tip projection and definition in thick-SSTE patients. We hypothesized that it would yield reliable aesthetic and functional results with minimal complications. STUDY DESIGN: Prospective clinical study with 12-month postoperative follow-up. METHODS: Sixty patients of East, South, and Southeast Asian descent received a PP graft anchored to the lower lateral cartilages. Outcomes were measured using SCHNOS and a 5-point Likert satisfaction scale. RESULTS: Mean satisfaction was 4.5/5, average SCHNOS score 0.54, and no graft-related complications occurred. CONCLUSION: The PP graft is a safe and effective method for enhancing nasal tip projection and definition in thick-SSTE patients.

Transcription factor STAT1 upregulates IL-36γ to mediate the sensitivity of human nasal epithelial cells to ferroptosis and promote inflammatory progression in chronic rhinosinusitis

Fan T, Li X · Molecular immunology · 2026 · PMID 42247985 · DOI 10.1016/j.molimm.2026.05.012

Chronic rhinosinusitis (CRS) is an epidemic disease characterized by persistent inflammation and tissue remodeling of sinus mucosa, and its pathophysiology is still unclear. This study revealed the key role of the signal transducer and activator of transcription 1 (STAT1) /Interleukin-36γ (IL-36γ) signal axis in the pathogenesis of CRS for the first time. In vitro experiments showed that STAT1 overexpression can induce damage to human nasal epithelial cells (HNECs); whereas STAT1 knockdown significantly inhibits Erastin-induced ferroptosis, as evidenced by the restoration of Ferritin Heavy Chain 1 (FTH1), solute carrier family 7 member 11 (SLC7A11) and Glutathione Peroxidase 4 (GPX4) expression, reduced accumulation of Acyl-CoA Synthetase Long Chain Family Member 4 and Transferrin receptor protein 1 (TFRC) expression, and decreased Malondialdehyde (MDA) content and lipid reactive oxygen species (ROS). The mechanism study showed that STAT1, as a transcription factor, regulated the IL-36γexpression by directly binding to its promoter region, thereby enhancing the sensitivity of HNECs to ferroptosis through the upregulation of IL-36γ. Further experiments found that IL-36γ promoted the release of ferroptosis and inflammatory cytokines, a process potentially involving the p38 MAPK pathway. In the CRS mouse model, the STAT1 inhibitor Fludarabine can effectively alleviate pathological injury, reduce the infiltration of macrophages, CD4+ T cells, CD8+ T cells, and neutrophils, and mitigate the inflammatory reaction and ferroptosis of the nasal mucosa. This study provides a new perspective for understanding the pathogenesis of CRS, and the discovery of the STAT1/IL-36γ signaling axis also provides a new direction for developing potential therapeutic strategies for CRS.

Fractional exhaled nitric oxide and nasal nitric oxide as biomarkers in chronic rhinosinusitis

Solinas A, Zalar I, Paoletti G, et al. · Current opinion in allergy and clinical immunology · 2026 · PMID 42235000 · DOI 10.1097/ACI.0000000000001163

PURPOSE OF REVIEW: This article summarizes current evidence on the role of fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) as noninvasive biomarkers in chronic rhinosinusitis with nasal polyps (CRSwNP), focusing on their potential to refine endotype-driven diagnosis and monitoring in the context of united airways disease. RECENT FINDINGS: Recent studies show that nNO levels are markedly reduced in CRSwNP, especially in eosinophilic phenotypes, where they correlate inversely with radiologic severity and may reflect both ostiomeatal obstruction and epithelial nitric oxide synthase dysfunction. FeNO, conversely, is often elevated in CRSwNP, even in the absence of overt asthma, is higher than in chronic rhinosinusitis without nasal polyps, and associates with type 2 inflammatory markers, symptom burden, and extended nitric oxide parameters indicating diffuse lower airway involvement. Surgical and biologic therapies targeting type 2 inflammation rapidly modify FeNO and nNO, with postoperative nNO increases and FeNO reductions, and early parallel improvements during dupilumab treatment suggesting that both indices can serve as dynamic markers of treatment response. SUMMARY: FeNO and nNO capture complementary aspects of CRSwNP pathophysiology, integrating information on sinonasal ventilation, epithelial function, and type 2 inflammation along the nose-lung axis, but their routine clinical use is currently limited by methodological heterogeneity, lack of validated cut-offs, and scarcity of longitudinal, combined assessments. Standardized measurement protocols and multicenter studies are needed to validate FeNO and nNO as reliable tools for endotype-based stratification, early detection of lower airway involvement, and personalized selection and monitoring of medical or surgical interventions in CRSwNP.

How to Optimally Prepare the Patient for a Facelift Procedure

Mariani M, Fabbri M, Serra PL, et al. · Facial plastic surgery : FPS · 2026 · PMID 41183544 · DOI 10.1055/a-2732-5021

INTRODUCTION: Facelift surgery is among the most commonly performed aesthetic procedures. Achieving optimal outcomes requires careful preoperative planning, particularly in managing airway positioning and maintaining a clean surgical field from the forehead to the neck. OBJECTIVES AND HYPOTHESES: This study aims to outline standardized perioperative protocols for facelift surgery, hypothesizing that such measures improve surgical access and reduce intraoperative complications. STUDY DESIGN: Retrospective case series (N > 5) conducted by senior authors. The study adheres to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational studies. METHODS: Patients undergoing facelift under general anesthesia with endotracheal intubation were reviewed. Focus was placed on tube positioning, scalp access, and hair management. No institutional review board approval was required. RESULTS: Standardized protocols enhanced tube stability, optimized exposure, and minimized operative delays. CONCLUSION: Precise airway management and field preparation are essential for efficient, safe facelift surgery and should be standardized in clinical practice.

The Phylogeny and Ontogeny of Facial Superficial Musculoaponeurotic System

Ullas G, Garg S, Raghavan U · Facial plastic surgery : FPS · 2026 · PMID 41061757 · DOI 10.1055/a-2718-3928

INTRODUCTION: The superficial musculoaponeurotic system (SMAS), a complex network of fibromuscular tissue, is a fundamental component of facial anatomy, playing a key role in both dynamic function and aesthetic appearance. Although the anatomy of the SMAS has been widely studied, several aspects remain unclear-particularly the presence of its fascial component, the variability in its attachment to deeper tissues, the possibility of distinct SMAS layers, and the association of facial nerve branches with first arch structures. In this study, we propose a hypothesis to explain the anatomical variations in SMAS observed during deep-plane facelift procedures. METHODS: A comprehensive review of the literature on the phylogeny and ontogeny of the facial SMAS was conducted. While numerous studies address the development of the face and SMAS, many report conflicting findings. For the purpose of this hypothesis, we have relied on the most widely accepted interpretations. RESULTS: Current understanding suggests that the facial SMAS originates from the primordial panniculus carnosus, a primitive muscular layer present in many lower vertebrates. Our analysis indicates contributions from the platysma myoides, platysma cervicalis, and sphincter colli profundus. The latter two structures undergo regression and are represented in the adult form as fascia. The relationship of the SMAS to deeper tissues appears to depend on whether it lies deep to the platysma cervicalis or the platysma myoides. Additionally, existing literature on the embryology of the facial nerve explains the presence of its branches among first arch structures, as well as their maintained connections with the SMAS. CONCLUSION: The phylogeny and ontogeny of the facial SMAS represent a complex developmental process that likely accounts for the observed anatomical variations and inconsistencies in its relationship with surrounding fascial planes and facial nerve branches.

Costal Cartilage Allograft Processing and User Patterns in Rhinoplasty

Vasudev M, Liu L, Lonergan A, et al. · Facial plastic surgery & aesthetic medicine · 2026 · PMID 42464436 · DOI 10.1177/26893614261470249

BACKGROUND: Specific allograft processing methods may contribute to high failure rates. OBJECTIVES: To characterize commonly used proprietary costal cartilage allograft processing techniques among tissue banks and assess surgeon preferences for graft sterilization methods in rhinoplasty. METHODS: A comprehensive review of American Association of Tissue Banks (AATB)-certified cartilage providers was performed using public databases, United States Patent and Trademark Office records, PubMed, and consultation with research scientists. An international survey of rhinoplasty surgeons in the Evidence-Based Rhinoplasty Reading Group assessed allograft preferences for rhinoplasty. RESULTS: Among 41 AATB-certified cartilage providers, 12 distinct proprietary processing protocols were identified. Gamma irradiation (1.0-5.0 Mrad) was used in 63.6% of methods. Peroxide-based detergents, including hydrogen peroxide, were used in 36.4%, and alcohol-based detergents, including isopropyl alcohol, in 36.4%. Antibiotic or aseptic solutions (bacitracin, polymyxin B, gentamicin) were incorporated in 45.4% of protocols. Survey respondents favored fresh-frozen costal cartilage allograft, although most surgeons (74.6%) reported exclusive use of autologous costal cartilage. CONCLUSIONS: Substantial heterogeneity exists in costal cartilage allograft processing methods and surgeon selection preferences. Variability in processing may contribute to differences in reported clinical outcomes. Greater understanding of these methods may guide future research and support evidence-based graft selection.

Antibiotic Prophylaxis and Surgical Site Infections in Septoplasty

Sainio S, Fierens E, Mäkitie A, et al. · Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery · 2026 · PMID 42454626 · DOI 10.1111/coa.70145

BACKGROUND: Surgical site infection is one of the most common complications of septoplasty. The use of antibiotic prophylaxis has been debated for years. Since the practice at our centre has shifted towards a more frequent use of prophylactic antibiotics in septoplasties, our aim was to review its use and effect on the postoperative infection rate. METHODS: We retrospectively reviewed the medical records of all adult patients who had undergone septoplasty at the Helsinki University Hospital (Helsinki, Finland) during 2019-2023. Patient and surgery characteristics, use of surgical antibiotic prophylaxis, surgical site infections and their management were reviewed. RESULTS: The series consisted of 1169 septoplasties, and antibiotic prophylaxis was used in 90.1% of the cases. A postoperative infection was diagnosed in 1.9%. Longer operative time and the use of silicone splints were associated with a higher risk of postoperative infections (p = 0.007 and p = 0.03, respectively). There was no significant difference in the infection rate between those who received preoperative antibiotic prophylaxis and those who did not. Among those using a preoperative course of topical antibiotic cream, no infections were seen. Compared with previous studies on septoplasty infections at our centre, the infection rate has decreased whilst the use of antibiotic prophylaxis has increased. CONCLUSION: Based on the present results, antibiotic prophylaxis does not affect postoperative infection rate after septoplasty. A preoperative course of nasal mupirocin seems to be a promising and less harm-causing form of prophylaxis. To confirm our results, there is a need for analysis of larger patient cohorts and prospective, controlled studies.

What Lies Beneath: Carotid Artery Depth and the Safe Use of Hemostatic Nets in Facelift Surgery

Gupta S, O'Shea AW, Edalatpour A, et al. · Aesthetic surgery journal · 2026 · PMID 41992563 · DOI 10.1093/asj/sjag075

BACKGROUND: Previous studies have demonstrated the effectiveness of the hemostatic net in reducing postrhytidectomy hematomas; however, its safety in relation to the proximity to the carotid vessels is unknown. OBJECTIVES: The aim of this study was to provide anatomical data on the depth of the carotid artery and its branches along the neck to inform data-based guidelines for hemostatic net placement to decrease the risk of inadvertent vessel injury. METHODS: The authors retrospectively studied rhytidectomy patients at a single-academic aesthetic surgery center who had subsequent neck imaging within 10 years. They studied the common, internal, and external carotid arteries bilaterally at the C2 (angle of mandible), C3 (hyoid), and C4 (thyroid cartilage). For each, the distance between the corresponding left and right vessels and vessel depth from the skin were measured. RESULTS: Thirty-three patients (81.9% female; average age at rhytidectomy = 64.2 years and at imaging = 69.1 years) had images of sufficient quality. At C2-C4, carotid depths ranged from 20.5 to 32.9 mm. The closest artery to the skin along the neck is the internal carotid artery at the level of the thyroid cartilage (C4). CONCLUSIONS: A thorough understanding of the vascular structures in postrhytidectomy neck underlies safe placement of the hemostatic net. Assuming the use of a ⅜ circle suture needle, a 24 mm needle (19 mm chord length) offers greater inherent margin relative to the mean vessel depth at C4 (20.5 mm). However, with a 32 mm needle (25 mm chord length), safe use depends on controlled bite depth and surgical technique (more oblique needle entry) to maintain a safe margin from carotid vessels.

Pediatric septoplasty and functional septorhinoplasty: A survey of ASPO members

Lambert EM, Kirkham EM, Parikh SR, et al. · International journal of pediatric otorhinolaryngology · 2026 · PMID 42462583 · DOI 10.1016/j.ijporl.2026.112921

BACKGROUND: Pediatric septoplasty and functional septorhinoplasty remain controversial due to concerns for the effect of surgery on the developing nose. We aimed to assess practice patterns among pediatric otolaryngologists who perform pediatric septoplasty and septorhinoplasty. METHODS: A cross-sectional survey was distributed to members of the American Society of Pediatric Otolaryngology (ASPO). Descriptive statistics were employed to summarize the typical indications and the most common techniques used in pediatric septoplasty and septorhinoplasty. RESULTS: Eighteen percent (105/577) of ASPO members completed the survey. Of respondents, 91 (87.0%) performed septoplasty, while 29 (27.9%) performed septorhinoplasty. Those who did not perform septorhinoplasty most commonly referred to Facial Plastics and Reconstructive Surgery (74.7%). Impacts on patient-reported quality of life were the most common criterion for both septoplasty and septorhinoplasty (82.2% and 76.4%, respectively). The NOSE was the most common patient-reported outcome instrument utilized. Among respondents, 38.9% did not use a strict age cutoff to perform septoplasty and 24.1% for septorhinoplasty. The most common techniques reported were columellar strut grafts for caudal septal deviation (66.7%), spreader grafts for internal nasal valve collapse (86.7%), alar batten grafts for external nasal valve collapse (55.2%), and lateral osteotomies for external bony deviations (85.2%). Spreader grafts only are used more than spreader flaps only to treat internal nasal valve collapse (62.1% vs 3.4%), while lateral osteotomies are used more than transverse osteotomies for bony deformity (85.7 vs 0%). CONCLUSION: Diminished patient-reported quality of life was the most common indication for pediatric septoplasty and functional septorhinoplasty among respondents. Columellar strut grafts, spreader grafts, alar batten grafts, and lateral osteotomies were common techniques used. Further work is needed to develop guidelines on septoplasty and functional septorhinoplasty in children and adolescents.

Impact of Septoplasty on Cognitive Function

Huseynzada S, Çakır Çetin A, Evin Eskicioğlu H, et al. · Medeniyet medical journal · 2026 · PMID 42444161 · DOI 10.4274/MMJ.galenos.2026.58291

OBJECTIVE: This study explored the impact of septoplasty on cognitive functions, including selective attention, information processing speed, and response inhibition and investigated the factors associated with these effects. METHODS: A total of 73 patients who underwent septoplasty for septal deviation were included. Assessments were conducted at baseline and again at six months postoperatively to evaluate the nasal obstruction symptom evaluation (NOSE) score, peak nasal inspiratory flow (PNIF), Sniffin' Sticks (SS), retronasal olfactory threshold test (ROTT), and Stroop test. Wilcoxon signed-rank and McNemar's tests were used to analyse differences between repeated measurements obtained before and after surgery. Additionally, Spearman's correlation, linear regression, and logistic regression analyses were performed. Results with p-value ≤ 0.05 were considered significant. RESULTS: Postoperative assessments revealed statistically significant improvements in NOSE, PNIF, SS discrimination, SS TDI, ROTT, and Stroop A-D scores (each p<0.05). SS TDI and ROTT scores were significantly correlated both preoperatively (r=0.238) and postoperatively (r=0.295). Furthermore, significant correlations were observed among NOSE, PNIF, SS, ROTT, and Stroop tests. However, PNIF, SS, and ROTT did not show any statistically significant improvement in the postoperative cognitive test results. CONCLUSIONS: Septoplasty significantly improved nasal airflow, both orthonasal and retronasal olfaction, and cognitive functions, including selective attention, information-processing speed, and response inhibition. However, it is unclear whether cognitive improvements are attributable to enhanced olfactory function or alleviation of nasal obstruction.

Impact of Nasal Obstruction Severity on Carotid Intima-Media Thickness in Patients with Nasal Septal Deviation

Ulusoy B, Tunçez A, Gül O, et al. · The Journal of laryngology and otology · 2026 · PMID 42421331 · DOI 10.1017/S0022215126105374

Comparison of Dorsal Preservation Rhinoplasty and Dorsal Hump Reduction Rhinoplasty: A Systematic Review and Meta-Analysis of Postoperative Outcomes

Khatib M, Skorochod R, Wolf Y · Aesthetic plastic surgery · 2026 · PMID 42418006 · DOI 10.1007/s00266-026-06105-6

BACKGROUND: Rhinoplasty is one of the most popular facial cosmetic procedures. Compared to dorsal hump reduction (DHR), a dorsal "preservation" rhinoplasty (DPR) approach has been developed to reduce the risk of complications and achieve an appealing dorsum. METHODS: An electronic search for articles comparing DHR to DPR was conducted on major databases. Results were screened through title/abstract and full-text stages. Included articles were extracted for information on demographics, surgical and patients reported outcomes, and for safety information. Newcastle-Ottawa scale and Cochrane's RoB 2.0 tool were utilized to assess the risk of bias in included article. RESULTS: Our search yielded (257) articles, of which nine articles describing a total of 1364 patients were fit for inclusion. The mean age was 30.59 ± 7.27 years, and majority were females (75.22%). Open surgical approach 772 (56.6%) was utilized more than closed approach 592 (43.4%). A mean difference of 0.03 [95% C.I. - 0.06-0.11, p = 0.52] (I2=83.5%, p < 0.01) in postoperative MCA1 was recorded, which was not significant. However, a significant mean difference of 0.03 [95% C.I. 0.01-0.06, p=0.019] (I2=17.4%, p=0.3) in MCA2 was found. Both MCA1 and MCA2 estimates were in favor of DHR, although significance is questionable. SNOT-22 showed a change of -2.88 [95% C.I. - 4.89-0.87, p < 0.01] (I2=0%, p=0.53) between groups. The rate of complications was low. Forty-six incidents of early postoperative complications were reported, with nasal tip edema reported most (n=18, 39.13%) followed by nasal obstruction (n=10, 21.74%) and dorsal irregularity (n=6, 13.04%). Late complications were reported more, and a total of 128 incidents were reported. Contour irregularities occurred in 53 (41.41%) cases. Revisions were needed in 27 (21.09%) patients. Hump recurrence and nasal valve collapse occurred in 16 (12.5%) and 11 (8.59%) patients, respectively. For early complications, three studies were eligible for meta-analysis (OR=0.66 [95% C.I. 0.35-1.25, p=0.2], (I2=0%, p=0.38)). For late surgical complications there was a significant difference in late complication rate, favoring DPR compared to DHR (OR=0.21, [95% C.I. 0.13-0.33, p<0.01]) (I2=0%, p=0.5). CONCLUSION: DHR and DPR are comparable in effect, with each offering a promising outcome. DPR has a safety profile comparably beneficial to DHR, while DHR choice is appropriate in cases with substantial structure reshaping. Nevertheless, further research and clinical trials are necessary to establish the benefits of this alternative surgery. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Invited Commentary on: Lu et al.'s "Functional and Aesthetic Considerations for Selective Facial Neurectomy with Simultaneous Deep Plane Facelift and Structural Neck Contouring for Facial Paralysis with Synkinesis"

Yver CM, Hadlock TA · Facial plastic surgery & aesthetic medicine · 2026 · PMID 42417282 · DOI 10.1177/26893614261465165

Functional and Aesthetic Considerations for Selective Facial Neurectomy with Simultaneous Deep Plane Facelift and Structural Neck Contouring for Facial Paralysis with Synkinesis

Lu RJ, Hsue V, Thuman J, et al. · Facial plastic surgery & aesthetic medicine · 2026 · PMID 42417279 · DOI 10.1177/26893614261458127

Invited Commentary on: Lu et al.'s "Functional and Aesthetic Considerations for Selective Facial Neurectomy with Simultaneous Deep Plane Facelift and Structural Neck Contouring for Facial Paralysis with Synkinesis"

Wamkpah NS, Pepper JP · Facial plastic surgery & aesthetic medicine · 2026 · PMID 42417277 · DOI 10.1177/26893614261465163

Preoperative Pollen Exposure and Chronic Rhinosinusitis Outcomes After Endoscopic Sinus Surgery: A Pilot Investigation

Tullis B, Mace JC, Massey C, et al. · Laryngoscope investigative otolaryngology · 2026 · PMID 42416540 · DOI 10.1002/lio2.70498

BACKGROUND: Although particulate matter is an environmental factor that may increase the risk of developing chronic rhinosinusitis (CRS), the impact of pollen on CRS outcomes is understudied. Here, we analyzed the effects of preoperative pollen exposure on disease-specific and general quality-of-life (QOL) outcomes after endoscopic sinus surgery (ESS). METHODS: Prospectively enrolled patients with medically refractory CRS, who self-selected ESS, completed the 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) surveys at enrollment and follow up. Preoperative pollen counts were obtained from the National Allergy Bureau using residence zip codes and total pollen was divided into tree, ragweed, and grass/weed subcategories. Spearman's correlation coefficients (r s) and 95% confidence intervals (CI) were calculated and compared. RESULTS: Seventy-nine patients met inclusion criteria with a mean follow-up of 8 months. Higher average total pollen and tree pollen exposure 1 week before ESS were associated with less postoperative improvement in SNOT-22 scores at follow up (r s = -0.26; 95% CI: -0.46, -0.03; p = 0.021 and r s = -0.27; 95% CI: -0.47, -0.04; p = 0.017, respectively). Pollen exposure did not attenuate improvement of SF-6D scores. CONCLUSION: In this pilot investigation, increased preoperative pollen exposure attenuated improvement in SNOT-22 scores after ESS.

Cost-effectiveness of immediate septoplasty versus medical management with the option for delayed septoplasty for nasal airways obstruction: a multicentre, open-label, randomised controlled trial

Homer T, Carrie S, Fouweather T, et al. · BMJ open · 2026 · PMID 42409405 · DOI 10.1136/bmjopen-2025-107402

OBJECTIVES: To estimate the cost-effectiveness of immediate septoplasty compared with 6 months of medical management with the option for delayed septoplasty in individuals with nasal obstruction associated with septal deviation. DESIGN: Economic evaluation alongside a multicentre, open label, randomised controlled trial. SETTING: 17 otolaryngology clinics in the UK, recruiting from January 2018 to December 2019. PARTICIPANTS: Adults aged≥18 years with symptoms of nasal obstruction associated with septal deviation with at least moderate symptoms of nasal obstruction (score>30 on the Nasal Obstruction and Symptom Evaluation scale). INTERVENTIONS: Participants were randomised to receive either septoplasty within 12 weeks of recruitment or 6 months of medical management (nasal steroid and saline spray) with the option for delayed septoplasty. PRIMARY AND SECONDARY OUTCOME MEASURES: Incremental cost per quality-adjusted life year (QALY) gained at 12 months. A UK National Health Service perspective was adopted, and surgery costs were estimated using a tariff and micro-costing. QALYs were estimated based on responses to the Short Form-36 (SF-36). Seemingly unrelated regression was used to estimate incremental costs and QALYs. A model-based analysis was used to extrapolate costs and effects to 24 months. Sensitivity analyses were used to illustrate uncertainty. RESULTS: In the within-trial analysis, immediate septoplasty was on average more costly (mean difference (95% CI) £1193 (£1018 to £1368)) and more effective (mean difference (95% CI) 0.044 QALYs (0.03 to 0.06)) when compared with 6 months of medical management with the option for deferred septoplasty. Immediate septoplasty had an incremental cost per QALY gained of £27 114 in the base case analysis, which decreased to £16 682 when micro-costing was used to estimate surgery costs. Immediate septoplasty had a 15% and 78% probability of being considered cost-effective at a £20 000 threshold for an additional QALY, respectively. In the model-based analysis, immediate septoplasty remained more costly and more effective than 6 months of medical management with the option for deferred septoplasty but had a 99% probability of being considered cost-effective at a £20 000 threshold for an additional QALY. CONCLUSIONS: Over a 24-month time horizon, immediate septoplasty would be cost-effective in the management of deviated nasal septum. STUDY REGISTRATION: ISRCTN16168569.

The effect of spreader graft use on voice in rhinoplasty cases: a prospective randomized controlled study

Ulkumen B, Mutlu S, Celik O · Brazilian journal of otorhinolaryngology · 2026 · PMID 42302419 · DOI 10.1016/j.bjorl.2026.101847

OBJECTIVE: This study aimed to evaluate the impact of spreader graft placement during cosmetic rhinoplasty on both objective acoustic measures and subjective voice quality. METHODS: In this prospective, double-blind, controlled study, volunteers who underwent open structural rhinoplasty by the same surgeon between September 2022 and January 2025 were included. Participants were divided into two groups: Group A (with spreader grafts) and Group B (without spreader grafts). Voice recordings were obtained preoperatively and three months postoperatively in a dedicated voice and speech laboratory. All participants provided informed consent and completed the Turkish version of the Voice Handicap Index-10 (VHI-10) before and after surgery. Objective voice analysis was conducted using the Computerized Speech Lab (CSL) system and Multi-Dimensional Voice Program (MDVP) software (Kay Elemetrics Corp., Lincoln Park, NJ, USA). Acoustic parameters ‒ fundamental frequency (f0), jitter, jitter percentage, shimmer, shimmer percentage, and Noise-to-Harmonics Ratio (NHR) ‒ were measured from sustained /a/ phonations. Spectrographic analysis assessed formant frequencies (F1-F4) during production of nasal consonants (/m/, /n/) and the nasalized vowel /i/ in the word mini. RESULTS: In Group A, significant postoperative differences were observed only in F3 and F4 formant values for /m/. In Group B, significant changes were detected in shimmer (dB), jitter, and formant values (F2, F3, F4 for /n/ and F3, F4 for /m/). Postoperative group comparison revealed significant differences in F4 for /m/, F3 for /n/, and F3 for the nasalized vowel /i/. Regarding subjective measures, VHI-10 scores significantly increased postoperatively only in Group B. Preoperative VHI-10 scores did not differ significantly between groups, while postoperative scores showed significant differences. CONCLUSION: Cosmetic rhinoplasty may affect voice parameters, particularly formants F3 and F4, essential components of the singer's and actor's formant cluster. Spreader grafts appear to preserve these frequencies, suggesting their importance in patients who professionally rely on voice quality. LEVEL OF EVIDENCE: According to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence, this study qualifies as Level 1b evidence, as it is a prospective, double-blind, randomized controlled trial evaluating the effectiveness of an intervention.

Cleft Lip Repair: Trends of Nasoalveolar Molding, Concomitant Tip Rhinoplasty and/or Septoplasty, and Revisions Using a National Database Study

Lee AD, Palmer SK, Gomez D, et al. · The Journal of craniofacial surgery · 2026 · PMID 41871296 · DOI 10.1097/SCS.0000000000012565

BACKGROUND: The literature is limited regarding the prevalence of nasoalveolar molding (NAM), primary tip rhinoplasty and/or septoplasty, and revision surgery. Our study aims to evaluate national utilization rates of NAM, primary tip rhinoplasty or septoplasty, and lip revisions using an international database. METHODS: A retrospective review was performed on TriNetX, a de-identified claims database. Patients younger than 1 year with a primary unilateral or bilateral cleft lip repair from 2000 to 2023 were included. Procedures, including NAM, initial repair, primary tip rhinoplasty, and/or septo-rhinoplasty, and any subsequent cleft lip revision surgery, were identified by billed Current Procedural Terminology (CPT) codes and date of occurrence. Patient demographic data were extracted and analyzed through TriNetX. RESULTS: From 2000 to 2023, 5642 patients underwent cleft lip repair; 78% had unilateral cleft lip repair, 22% had bilateral cleft lip repair, and 48% concurrent tip rhinoplasty and/or septoplasty. A minority of patients (2.3%) underwent preoperative NAM. There was a high rate of cleft lip revisions at 9.7%. Prevalence of concomitant primary tip rhinoplasty and/or septoplasty increased from 14% to 59% from 2000 to 2023 ( R2 =0.86, P <0.001). NAM utilization progressively increased in the second decade of the study, reaching 2.2% by 2023. CONCLUSION: This study highlights the dynamic evolution of cleft care. Advancing surgical techniques may contribute to increased correction of cleft lip nasal deformity at the time of primary cleft lip repair, improved initial repair, and subsequent decrease in revision rates. Over the time period of the study, we have seen increased utilization of NAM.

Post-Operative Infection in Rhinoplasty With Autologous Versus Cadaveric Costal Cartilage Grafting

Dattilo LW, Ha LL, Lindsay RW · The Laryngoscope · 2026 · PMID 42365536 · DOI 10.1002/lary.70696

OBJECTIVE: To determine if post-operative infection rates after rhinoplasty differ based on use of autologous versus irradiated cadaveric costal rib grafting and use of prophylactic antibiotics. METHODS: Patients undergoing cosmetic or functional rhinoplasty or nasal valve repair with costal cartilage grafting during the years 2002-2025 were identified. Patients were separated into those who underwent autologous rib grafting versus irradiated homologous (cadaveric) costal cartilage grafting. Demographic data, rates of post-operative prescription of oral or IV antibiotics from post-operative day three to 30, and rates of return to OR for revision within the first 30 post-operative days were tabulated for each group and compared with chi-square and Fisher Exact tests. RESULTS: A total of 707 patients who underwent rhinoplasty with costal cartilage grafting were identified; 422 with autologous rib grafting (54% female; median age 48 years) and 285 with cadaveric costal cartilage grafting (52.6% female; median age 53 years). The rate of post-operative infection did not significantly differ between the autologous and cadaveric rib groups (2.3% vs. 2.3%, p = 0.99). One patient in the cadaveric group (0.34%) returned to the operating room for revision (washout of post-operative infection) within the first 30 post-operative days. Prescription of post-operative oral prophylactic antibiotics did not significantly decrease the post-operative infection rate (p = 0.13 for autologous group and p = 0.18 for cadaveric group). CONCLUSION: Post-operative infection rates after rhinoplasty did not significantly differ between patients undergoing cadaveric versus autologous rib grafting. The use of prophylactic antibiotics did not decrease the risk of post-operative infection.

Comprehensive proteomic analysis reveals SPRR3 as an early predictive biomarker for postoperative recurrence in pediatric chronic rhinosinusitis with nasal polyps

Ni L, Li R, Xia S, et al. · The World Allergy Organization journal · 2026 · PMID 42396394 · DOI 10.1016/j.waojou.2026.101414

BACKGROUND: Pediatric chronic rhinosinusitis with nasal polyps (CRSwNP) exhibits a high rate of postoperative recurrence, yet effective molecular predictors remain lacking. This study aims to explore recurrence-associated proteins and evaluate their predictive value. METHODS: Proteomic analysis was performed on nasal mucosa from a discovery cohort, with >1 year of follow-up to identify differentially expressed proteins (DEPs) associated with postoperative recurrence. Candidate proteins were validated in an independent cohort using western blotting, immunofluorescence, qRT-PCR, and serum ELISA. RESULTS: In the discovery cohort, 6 pediatric patients suffering postoperative recurrence were classified as rCRSwNP, and 10 as non-rCRSwNP. Proteomic analysis revealed distinct expression patterns among control, non-rCRSwNP, and rCRSwNP groups. Four candidate proteins (CERS4, PLEKHA6, RAB29, SPRR3) were identified by intersecting the top 50 DEPs. SPRR3 and RAB29 were significantly upregulated in rCRSwNP, primarily localized to the nasal epithelium, as confirmed by western blotting and immunofluorescence. qRT-PCR further validated their increase in the recurrence group. Notably, paired tissue samples showed increased SPRR3 expression at revision surgery compared to baseline, and ELISA revealed higher serum SPRR3 levels in recurrent cases, correlating with recurrence risk. ROC and Kaplan-Meier analyses demonstrated potential predictive value for serum SPRR3. CONCLUSION: Our study identified a recurrence-associated proteomic signature in pediatric CRSwNP, marked by selective epithelial upregulation of SPRR3. Elevated serum SPRR3 was strongly linked to postoperative recurrence risk, supporting its utility as a predictive biomarker for identifying children at higher risk of relapse.

Resting Angle Correction beyond Aesthetics: A Retrospective Cohort Study Demonstrating Its Role in Nasal Valve Repair

Daoud M, Fufezan ML, Bahaa-Eddin W, et al. · Facial plastic surgery : FPS · 2026 · PMID 42259383 · DOI 10.1055/a-2890-3279

INTRODUCTION: The resting angle forms between the lateral crus of the lower lateral cartilage (LLC) and the upper lateral cartilage. While conventional nasal valve repair relies on cartilage grafting for reinforcement of these structures, the functional significance of resting angle adjustment remains underexplored. OBJECTIVE AND HYPOTHESIS: We describe a technique to reposition the LLC, adjusting the resting angle to support the lateral nasal wall and restore external nasal valve (ENV) function without grafts, with the hypothesis that this approach improves functional and aesthetic outcomes. STUDY DESIGN: Retrospective cohort study. METHODS: We retrospectively identified patients with ENV collapse-related nasal obstruction who underwent the described surgery. Pre- and postoperative peak nasal inspiratory flow (PNIF) measurements and FACE-Q scores were compared to evaluate functional and aesthetic improvement, respectively. RESULTS: Thirty patients (22 female, 8 male) were included. Postoperatively, median PNIF increased from 74.0 L/minute (interquartile range [IQR]: 73.0-76.0; 95% confidence interval [CI]: 72.5-75.5) to 96.0 L/minute (IQR: 93.0-97.0; 95% CI: 94.0-97.5), and median FACE-Q Satisfaction with nose scores from 17 (IQR: 16.0-18.0; 95% CI: 16.0-17.5) to 37 (IQR: 35.0-38.0; 95% CI: 36.5-37.5); both improvements were statistically significant (p < 0.001). CONCLUSION: Resting angle correction may not only improve aesthetics, but also stabilize the lateral nasal wall to prevent or repair ENV collapse.

Awareness of rhinoplasty-related complications among adolescents and adults: A cross-sectional study

Say MA, Adigüzel T · Medicine · 2026 · PMID 42299548 · DOI 10.1097/MD.0000000000049286

Rhinoplasty is one of the most frequently performed aesthetic surgical procedures worldwide. Awareness of potential postoperative complications may differ between adolescents and adults and may influence expectations regarding surgery. The objective of this study was to compare baseline awareness of well-established rhinoplasty-related complications between adolescents and adults recruited from a general otorhinolaryngology outpatient setting. This cross-sectional survey included 372 participants (196 adolescents and 176 adults). The questionnaire assessed demographic characteristics, attitudes toward rhinoplasty, and awareness of specific rhinoplasty-related complications. Participants were stratified into adolescent and adult groups, and intergroup comparisons were performed using chi-square analysis, with statistical significance set at P < .05. Significant differences were observed between adolescents and adults in awareness of multiple rhinoplasty-related complications. Adults demonstrated significantly greater awareness of several intraoperative complications, including cautery burns (P = .023), collapse of the bony pyramid (P = .006), osteotomy-related complications (P < .001), and perinasal trauma (P < .001). No significant intergroup differences were identified for immediate postoperative complications. In contrast, pronounced differences were observed in early and late postoperative complications. Adults showed significantly higher awareness of septal hematoma (P< .001), wound dehiscence (P< .001), persistent edema (P = .007), cerebrospinal fluid rhinorrhea (P = .004), polybeak deformity (P < .001), synechiae formation (P < .001), septal perforation (P = .011), nasal valve collapse (P < .001), and patient dissatisfaction (P = .031). Baseline awareness of rhinoplasty-related complications differs significantly between adolescents and adults, with adults demonstrating greater knowledge across multiple complication domains.

Fractional exhaled nitric oxide and blood eosinophils in relation to lung function, allergy and nasal polyps in asthma

Abohalaka R, Lehtimäki L, Ercan S, et al. · The journal of allergy and clinical immunology. Global · 2026 · PMID 42382046 · DOI 10.1016/j.jacig.2026.100739

BACKGROUND: Type 2 inflammation plays a central role in asthma, but blood eosinophil count (BEC) and fractional exhaled nitric oxide (Feno) levels may reflect different type 2 pathways. Their associations with different asthma characteristics in unselected populations remain unclear. OBJECTIVES: To examine how BEC and Feno, independently and synergistically, are related to lung function, allergy, and nasal polyps in a population-based asthma cohort. METHODS: Data were analyzed from 1567 participants with physician-diagnosed asthma in the West Sweden Asthma Study. Lung function, bronchodilator responsiveness, and presence of allergy and nasal polyps were evaluated across categories of BEC and Feno labeled as low, medium, or high using various cutoffs. Associations were assessed using linear and logistic regression models in participants who were inhaled corticosteroid (ICS)-naive and ICS-treated separately. RESULTS: Of participants, 49% (n = 767) were on ICS treatment at the time of examination. Among those who were ICS-treated, BEC, independently of Feno, was associated with reduced FEV1 and forced vital capacity percentages, higher nasal polyps and clinical allergy, and together with Feno contributed to bronchodilator responsiveness. Interaction effects between Feno and BEC were observed primarily for FEV1 and forced vital capacity percentages, at high range of cutoff values. In contrast, among participants who were ICS-naive, neither Feno nor BEC showed independent associations with outcomes; instead, their synergistic effect was associated with lower FEV1 and forced vital capacity percentages and a higher prevalence of clinical allergy, with consistent effects across a range of cutoff values. CONCLUSION: BEC and Feno reflect distinct yet complementary aspects of type 2 inflammation in asthma. These findings support the joint use of BEC and Feno for obstructive airway diseases phenotyping.