Iraqi Postgraduate Medical Journal

BACKGROUND:
osteotomies are commonly used in rhinoplasty to improve irregularities in the brow- tip aesthetic line and correct open roof deformities (diastasis of the nasal bones) associated with bony dorsum reduction. They can be performed laterally, medially, or intermediately. Lateral osteotomy could be done through either internal (endonasal) or external (percutaneous) approaches depending on surgeon preference and experience.
OBJECTIVE:
Is to compare results between internal and external lateral osteotomy in primary open rhinoplasty in regard to post-operative ecchymosis and edema, mucosal tear, Bone alignment and irregularities, nasal patency and Scaring in the external approach.
PATIENTS AND METHODS:
60 patients underwent primary open rhinoplasty in otorhinolaryngology / head and neck surgery department in Al-Shaheed Ghazi Al-Hariri hospital for surgical specialties in medical city complex at Baghdad for period from first of October 2018 to first of October 2019. Twenty five patients underwent internal lateral osteotomy and 35 patients underwent external lateral osteotomy. Assessed preoperatively by detailed history, examination, photography and subjectively using NOSE and ROE scores. Then they were followed up regularly at 2nd and 7th day post-operative to evaluate edema and ecchymosis scoring according to the scoring system of Kara and Gokalan, mucosal tear also checked using endoscopy. Then seen at 1st, 3rd, 6th months to assess bone alignment and irregularities, nasal patency and scar (for external lateral osteotomy approach).
RESULTS:
Edema was more prominent among the internal group in 2nd and 7th days with p value of (0.0001, 0.0004) respectively. Ecchymosis also was more prominent in internal group at 2nd and 7th days with p value of (0.0001). All patients in internal group had mucosal tear at 2nd day with significant p value (0.0001). Bone alignment and irregularities were more obvious among internal group with p value of (0.0001). Nasal patency scale was better among external group with p value of (0.031). Scar was imperceptible and did not bather the patients in external group.
CONCLUSION:
External lateral osteotomy is a safe and precise method offered a more predictable pathway and less post-operative complications.

management of acute perioperative pain for abdominal and chest wall procedures has widely changed over the years. Neuraxial analgesia along with possible opioid administration were once the standard of care for postoperative pain control. Those methods however were accompanied by complications and increased costs due to the invasive nature of epidural/intrathecal methods and increased abuse potential with opiate administration.(1) Alternative techniques such as truncal nerve blocks have changed the management of perioperative pain for intrabdominal and intrathoracic procedures. These blocks utilize ultrasound guided regional anesthesia to provide safe and effective pain control with surgery. Truncal nerve blocks are now one of the key components of multimodal pain management.(2)
This review aims to explore the different forms of truncal nerve blocks and their impact on approaching perioperative pain management. The review will go in depth on the transversus abdominis block (TAP block), the rectus sheath block, the quadratus lumborum block, the erector spinae block, the serratus anterior block, and the pectoralis block (PEC 1/PEC 2 Block).