A self-retaining nasal splint
Letters to the Editor
A self-retaining
zyx
of polyvinyl bond is spread over the outer surface of the
applied Microfoam” tape. The soft AquaplastR is dried and
placed over the nasal dorsum and moulded it7 situ.’
The
pressure and contact are maintained
for a few minutes,
allowing adequate adhesion between the Microfoam”
tape
and the Aquaplast” mould.
To date we have treated 10 patients with this method. 9
patients had nasal fractures. and 1 had a reduction rhinoplasty. The results after removal of the splint appeared
satisfactory to both patients and surgeons.
Since the splint is confined only to the nasal dorsum
without any extension onto the forehead region (Fig. l), we
have found patient acceptance and compliance to be good.
None of the patients complained
of discomfort
and most
were able to continue
their everyday activities without
difficulty. Multiple sticky tapes applied to the face to hold
the splint to the nose are thus not needed. increasing the
patients’ acceptance of this method.
This method is cost effective and inexpensive. The cost of
the splint made of a small piece of perforated Aquaplast”.
Microfoam”
tape and a layer of polyvinyl bond comes to
about S$l.OO. The Microfoam”
tape, being hypoallergic. is
nasal splint
Sir,
A patient presenting with a fractured nasal bone or bony
nasal deformity needing manipulation
of the nasal skeleton
requires further moulding and immobilisation
with a nasal
splint for about 2 weeks.
Plaster of Paris moulds are messy and need additional
sticky tape for support.
Prefabricated
nasal splints arc
presently very costly. We have fabricated
a splint using
perforated Aquaplast” (Smith & Nephew), a thermoplastic
polymer. Microfoam” tape (3M. St. Paul, MN., USA) and a
polyvinyl bond.
After manipulation
of the nasal skeleton. the skin over the
nose is wiped dry. Tincture
Benzoin solution is gently
applied over the dorsum of the nose and allowed to dry. The
Microfoam” tape is cut into a trapezoid shape to fit the nose
and applied.
The Aquaplast”
is cut slightly smaller than the applied
MicrofoamR tape and placed in warm water to make it soft
and pliable. As soon as the AquaplastK is ready a thin layer
Fig. 1
Figure I-Patient
with nasal splint.
714
zy
715
Letters to the Editor
An important and earlv sign 01‘ undcrllmg
I;isciitih that
the authors fail to meniion is that ot’ reduced pinprick
sensation over the affected area of skin.” This sign precedes
the development of frank gangrene and thus debridcmcnt at
this stage may be more conservative.
Once the tissues are
opened. the presence of fasciitis can be conlirmtd. and linger
dissection used to determine the limits of undermining.
Your5 faithfull\. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
A number of zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONM
c a usa tive organisms ha\-e been implicated in
T. C. Lb, FRCS.
nccrotising fasciitis. which is usually due to miscd infection.
Nitin Mokal, MS (Plastic Surgery),
In cervicofacial cases. the combination
of a \ iridans %trcpWalter T. L. Tan, FRCS,
tococcus and an anaerobic
organism
has been reported
Division of Plastic Surgery.
frequently and initial antibiotic therapy should take this into
Department
of Surgery.
account whilst awaiting confirmation
by hacteriolo~ical
National
Ilniwrstty
Hospital.
examination.’
Furthermore.
the uhe of frozen suction blnpLower K#:nt Ridge Road.
sies in addition to conventional microbiological
samptcs has
Singapors: 051 I zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
been recommended
as a method that permits early diagnosis
of this condition. leading to a reduction in mortality.
This paper esemplities
the problems of duplication
ol
Reftrences
material which may occur in the medical literature. particularly among the many diffeerent specialist journals.
It
I McC‘lrth! JG. M’ood-Smith D. Rhinoplasty. In: McCarthy JG.
hIghlights the need for meticulous care when performing
cd. Plastic Surger! Vol 3. The Face Part 2. Philadelphia:
literature searches and underlines the need to consider othcl
WE Sannder\ Co I YW: I X?il-5.
specialties and their journals as a source of int‘ormation on
conditions that are not frequent11 cncountercd in one‘s ou II
practice.
well tolerated by the patient. The results we have obtained
from our small study have thus far been very encoura$ng.
WC wi:;h to thank MS Josephine
Chow. Head of the
Department
of Rehabilitation
Medicine for providing the
perforated Aquaplast”
for the study, and Ms Pauline Tan
for the sec~retarial support.
Yours faithfull>.
Necrotising
fasciitis
Nicholas M. Whear, MBBS, FDSRCS. FRCS.
zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
Senior Registrar. Department
of Maxillofacial Surgery.
Sir.
Necrotising Fasciitis in the head and neck region. Maqbool.
M.. Ahmad. R.. Ahmed. R., Qazi. S. British Journal of
Plastic Surgery. 45. 38 1.
Richard R. J. Cousley. BSc, BDS,
House Oficcr, Department of M;lxillofacial
St. Thomas’ Hospital.
Lambeth Palace Road.
London SEI 7EH
Surgery.
We have read with interest the case report by Maqbool c’r(II.’
and feel that while it may be a valuable addition to the
References
existing body of knowledge on this condition. certain points
raised bq the authors should be addressed.
I. Maqhool M. Ahmad R. Ahmed R. Qar~ S kecrotiaing tasclitlr
While undoubtedly
necrotising fasciitis affects the head
in the head and neck regwn. British Journ,
of Pl;t\tic Surger\
and neck region less frequently than other sites. we must
lYY2: 15: 1x1.
2. Balcerak RJ. Slsto JM. Bosack RC C’er\wllaaal
neclotihmg
disagree with the authors’ statement that “no case with head
fasciitia: Report ol three cases xnd literature rc\ww. Jonrn;~l
and neck involvement
has been reported
so far”. It is
of Oral and Mauillofac~al Surgery IY)t;X:Jh- _(iO.
certainly not zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
as uncommon
as suggested by this statement.
3. Wilson B. Necrotising
fasciitis. The Amenc;~n Surgeon lY52,
and such casts have indeed been reported in the relevant
IX: 416.
specialist Journals. We would respectfully draw the authors’
4. Steel 4. An unusual case ofnecrotising
fiwlltis. Brltlsh Journal
attention to an excellent review of 27 cases of cervicofacial
of Owl and Maxillofacial
Surger! 1987: 75. 32s.
necrotising fasciitls by Balcerak c’f (I/.~ Indeed. both max5. S~amenkovic 1. Lew PD. Early rcco@lo,rl ol’potentially fatal
illofacial and otorhinolaryngology
journals contain numernecrotisinp
fasciitis. The use of fro/en wct11)n biopsy. The
ous reports of head and neck involvement in this condition.
Neu England Journal ol Medicine IYYJ, 7 IO 16X9
A self-retaining
zyx
of polyvinyl bond is spread over the outer surface of the
applied Microfoam” tape. The soft AquaplastR is dried and
placed over the nasal dorsum and moulded it7 situ.’
The
pressure and contact are maintained
for a few minutes,
allowing adequate adhesion between the Microfoam”
tape
and the Aquaplast” mould.
To date we have treated 10 patients with this method. 9
patients had nasal fractures. and 1 had a reduction rhinoplasty. The results after removal of the splint appeared
satisfactory to both patients and surgeons.
Since the splint is confined only to the nasal dorsum
without any extension onto the forehead region (Fig. l), we
have found patient acceptance and compliance to be good.
None of the patients complained
of discomfort
and most
were able to continue
their everyday activities without
difficulty. Multiple sticky tapes applied to the face to hold
the splint to the nose are thus not needed. increasing the
patients’ acceptance of this method.
This method is cost effective and inexpensive. The cost of
the splint made of a small piece of perforated Aquaplast”.
Microfoam”
tape and a layer of polyvinyl bond comes to
about S$l.OO. The Microfoam”
tape, being hypoallergic. is
nasal splint
Sir,
A patient presenting with a fractured nasal bone or bony
nasal deformity needing manipulation
of the nasal skeleton
requires further moulding and immobilisation
with a nasal
splint for about 2 weeks.
Plaster of Paris moulds are messy and need additional
sticky tape for support.
Prefabricated
nasal splints arc
presently very costly. We have fabricated
a splint using
perforated Aquaplast” (Smith & Nephew), a thermoplastic
polymer. Microfoam” tape (3M. St. Paul, MN., USA) and a
polyvinyl bond.
After manipulation
of the nasal skeleton. the skin over the
nose is wiped dry. Tincture
Benzoin solution is gently
applied over the dorsum of the nose and allowed to dry. The
Microfoam” tape is cut into a trapezoid shape to fit the nose
and applied.
The Aquaplast”
is cut slightly smaller than the applied
MicrofoamR tape and placed in warm water to make it soft
and pliable. As soon as the AquaplastK is ready a thin layer
Fig. 1
Figure I-Patient
with nasal splint.
714
zy
715
Letters to the Editor
An important and earlv sign 01‘ undcrllmg
I;isciitih that
the authors fail to meniion is that ot’ reduced pinprick
sensation over the affected area of skin.” This sign precedes
the development of frank gangrene and thus debridcmcnt at
this stage may be more conservative.
Once the tissues are
opened. the presence of fasciitis can be conlirmtd. and linger
dissection used to determine the limits of undermining.
Your5 faithfull\. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
A number of zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONM
c a usa tive organisms ha\-e been implicated in
T. C. Lb, FRCS.
nccrotising fasciitis. which is usually due to miscd infection.
Nitin Mokal, MS (Plastic Surgery),
In cervicofacial cases. the combination
of a \ iridans %trcpWalter T. L. Tan, FRCS,
tococcus and an anaerobic
organism
has been reported
Division of Plastic Surgery.
frequently and initial antibiotic therapy should take this into
Department
of Surgery.
account whilst awaiting confirmation
by hacteriolo~ical
National
Ilniwrstty
Hospital.
examination.’
Furthermore.
the uhe of frozen suction blnpLower K#:nt Ridge Road.
sies in addition to conventional microbiological
samptcs has
Singapors: 051 I zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
been recommended
as a method that permits early diagnosis
of this condition. leading to a reduction in mortality.
This paper esemplities
the problems of duplication
ol
Reftrences
material which may occur in the medical literature. particularly among the many diffeerent specialist journals.
It
I McC‘lrth! JG. M’ood-Smith D. Rhinoplasty. In: McCarthy JG.
hIghlights the need for meticulous care when performing
cd. Plastic Surger! Vol 3. The Face Part 2. Philadelphia:
literature searches and underlines the need to consider othcl
WE Sannder\ Co I YW: I X?il-5.
specialties and their journals as a source of int‘ormation on
conditions that are not frequent11 cncountercd in one‘s ou II
practice.
well tolerated by the patient. The results we have obtained
from our small study have thus far been very encoura$ng.
WC wi:;h to thank MS Josephine
Chow. Head of the
Department
of Rehabilitation
Medicine for providing the
perforated Aquaplast”
for the study, and Ms Pauline Tan
for the sec~retarial support.
Yours faithfull>.
Necrotising
fasciitis
Nicholas M. Whear, MBBS, FDSRCS. FRCS.
zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
Senior Registrar. Department
of Maxillofacial Surgery.
Sir.
Necrotising Fasciitis in the head and neck region. Maqbool.
M.. Ahmad. R.. Ahmed. R., Qazi. S. British Journal of
Plastic Surgery. 45. 38 1.
Richard R. J. Cousley. BSc, BDS,
House Oficcr, Department of M;lxillofacial
St. Thomas’ Hospital.
Lambeth Palace Road.
London SEI 7EH
Surgery.
We have read with interest the case report by Maqbool c’r(II.’
and feel that while it may be a valuable addition to the
References
existing body of knowledge on this condition. certain points
raised bq the authors should be addressed.
I. Maqhool M. Ahmad R. Ahmed R. Qar~ S kecrotiaing tasclitlr
While undoubtedly
necrotising fasciitis affects the head
in the head and neck regwn. British Journ,
of Pl;t\tic Surger\
and neck region less frequently than other sites. we must
lYY2: 15: 1x1.
2. Balcerak RJ. Slsto JM. Bosack RC C’er\wllaaal
neclotihmg
disagree with the authors’ statement that “no case with head
fasciitia: Report ol three cases xnd literature rc\ww. Jonrn;~l
and neck involvement
has been reported
so far”. It is
of Oral and Mauillofac~al Surgery IY)t;X:Jh- _(iO.
certainly not zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
as uncommon
as suggested by this statement.
3. Wilson B. Necrotising
fasciitis. The Amenc;~n Surgeon lY52,
and such casts have indeed been reported in the relevant
IX: 416.
specialist Journals. We would respectfully draw the authors’
4. Steel 4. An unusual case ofnecrotising
fiwlltis. Brltlsh Journal
attention to an excellent review of 27 cases of cervicofacial
of Owl and Maxillofacial
Surger! 1987: 75. 32s.
necrotising fasciitls by Balcerak c’f (I/.~ Indeed. both max5. S~amenkovic 1. Lew PD. Early rcco@lo,rl ol’potentially fatal
illofacial and otorhinolaryngology
journals contain numernecrotisinp
fasciitis. The use of fro/en wct11)n biopsy. The
ous reports of head and neck involvement in this condition.
Neu England Journal ol Medicine IYYJ, 7 IO 16X9