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.

Ventricular septal perforation (VSP) is a rare but fatal complication of acute myocardial infarction. An 83-year-old man experienced VSP with septal dissection after an anteroseptal infarction. Two weeks later, a double-patch repair using the sandwich technique was performed. Intraoperative residual leakage into the dissected septum caused left ventricular rupture, which was successfully repaired by a third bovine pericardial patch through a left ventricular incision for closure. Postoperative echocardiography confirmed no residual shunt and preserved ventricular function. This case underscores the challenges of VSP with septal dissection and emphasizes the value of an additional patch to prevent leakage and rupture.

Granulomatosis with polyangiitis is a necrotizing granulomatous vasculitis that predominantly involves the upper and lower respiratory tracts and the kidneys. Although sinonasal manifestations are common, they are often nonspecific and can mimic benign inflammatory conditions, leading to delayed diagnosis. In contrast, strictly localized disease limited to the nasal septum without systemic involvement is exceptionally rare. We report the case of a 27-year-old woman presenting with persistent nasal obstruction and rhinorrhea. Nasal endoscopy revealed a septal perforation. Computed tomography demonstrated focal nasal septal lysis without paranasal sinus involvement. Laboratory investigations showed markedly elevated c-ANCA levels, and histopathological examination of a septal biopsy confirmed granulomatosis with polyangiitis. Systemic imaging revealed no pulmonary or renal involvement, supporting a localized form of the disease. The patient was treated with systemic corticosteroids and methotrexate, resulting in clinical remission at 5 months. This case highlights the crucial role of imaging in detecting early structural abnormalities and guiding biopsy in atypical presentations of GPA. Early recognition of localized disease is essential to initiate appropriate immunosuppressive therapy and prevent progression to systemic involvement.

Contemporary data of saphenous vein graft (SVGs) use in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) are limited. We examined the frequency, characteristics, and outcomes of SVG use during retrograde CTO PCI. Retrograde CTO PCI cases in the PROGRESS-CTO registry (2017 to 2025) were compared based on SVG versus non-SVG use; non-native targets, arterial grafts, mixed collaterals, and multi-CTO procedures were excluded. Among 4,330 retrograde procedures (4,321 patients), SVGs were used in 545 (12.6%). These patients were older with more comorbidities, higher anatomic complexity and PROGRESS-CTO score, but similar J-CTO score. Procedure time was longer, yet contrast and radiation exposure were lower. A primary retrograde strategy was used more frequently (54.5% vs 36.0%; p <0.001) in the SVG-group. Technical success was higher with SVGs (82.1% vs 78.5%; p = 0.049), while procedural success (79.9% vs 76.7%; p = 0.092) and in-hospital major adverse cardiac events (MACE) (3.3% vs 2.9%; p = 0.6) were similar. SVG collateral use was independently associated with higher technical success (Odds Ratio 1.60, 95% CI 1.24 to 2.09; p <0.001). Pericardiocentesis was less frequent (0.2% vs 1.6%; p = 0.008) and perforation rates were comparable, but mortality and stroke were higher in the SVG group. Among prior-CABG patients, SVG use was associated with higher technical success but also higher in-hospital MACE (3.3% vs 1.3%; p = 0.011). SVG use for retrograde crossing occurred in approximately 1 in 8 overall and 1 in 3 prior-CABG retrograde CTO PCIs. Despite greater clinical and anatomic complexity, SVG use was associated with higher technical success compared with septal/epicardial collaterals.

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis with frequent otolaryngologic manifestations, including nasal septal perforation (NSP) secondary to ischemic necrosis of the septal cartilage. While conservative therapy is often first-line, surgical repair may be indicated in patients with symptomatic or refractory perforations. Limited literature exists regarding septal perforation repair in patients with GPA. We report 1-year postoperative results on the case of a 19-year-old male with a 5-year history of GPA, medically controlled on immunosuppressive therapy, who presented with progressive nasal obstruction, crusting, epistaxis, and whistling. Nasal endoscopy demonstrated a 1.5 × 1.5 cm septal perforation with surrounding mucosal ulceration. After conservative management failed to provide adequate symptom relief, the patient underwent open septorhinoplasty with nasal septal repair using a free temporoparietal fascia (TPF) graft wrapped around a polydioxanone sheet (PDS). The use of a free TPF-PDS composite graft offers structural support, promotes mucosal healing, and has shown promising success rates in non-vasculitic perforations. This case represents the first comprehensive report of successful septal perforation repair utilizing this technique in a medically-managed GPA patient on immunosuppression. TPF-PDS grafting may represent a viable and durable reconstructive option for septal perforation repair in GPA patients with controlled disease. This may also be a promising option for patients with nasal septal perforation in the context of other rheumatologic conditions.