Dr Paulose

World Class ENT Plastic and Laser Surgeon

Nose

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Testimonial of a Snoring and Sleep Apnea Sufferer.

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Over the years, I have treated thousands of patients suffering from snoring and sleep apnea. Many of them write me to tell how treatment has changed and improved their lives. Many of them were hooked on CPAP machine to live, but multilevel OSA Surgery have cured many of them and were able to give up CPAP Machine completely for good.

Please read the following Testimonial from one of my patient- Rev Fr.Shaji, who is a Christian preacher and priest from Bangalore India.

“A Whole New Life….”

My Testimony…

I am Rev Shaji Thomas who was suffering from severe Obstructive Sleep Apnea since 15 years.  After the sleep study I was advised to use CPAP Machine in 2011 but it was not at all successful for me. I was not able to travel in Train or in any other means with the public because of my unbearable snoring.  Day time sleepiness was my major problem. I felt very tired every day and was fully exhausted due to lack of oxygen supply to the brain. As a result of my OSA I was caught with BP and started medication since 2012 and other difficulties with my heart also occurred. I had to also start medication to control my cholesterol. One of ENT Specialist suggested undergoing a nasal surgery to remove the polyps in the sinus and also to rectify my deviated septum. For a second opinion I had an opportunity to visit Dr K O Paulose and after thorough check up and assessment including sleep study he advised me to to undergo CAUP (Coblator assisted Uvolopalatopharyngopasty. Coblator Tonsillectomy and Fess with Septoplasty and CAPT Turbinoplasty) . I was little worried about this surgery especially about my voice. Doctor guaranteed me for 80% result and I decided to undergo this multi level surgery on 7th June 2016 at Jubilee Memorial Hospital, Trivandrum. By God’s grace and by the committed treatment of Dr K O Paulose I am 100% alright after my surgery. Now my snoring has stopped and more energetic and fresh in all my activities-a whole new life now. The cost of Surgery was not too expensive also.

My heartfelt thanks to Dr K O Paulose and the staff of Jubilee Hospital which is a Christian Mission Hospital in Trivandrum, Capital of Gods Own Country Kerala in South India. All of them  became instrumental in my healing.

About the Surgeon-Doctor K O Paulose is more than a Doctor. He is good friend, counsellor, a family member, a man with compassion, a man of prayer and a person who is deeply committed to his Mission with no hidden agenda.

 

Rev Shaji Thomas

(A Priest of the Mar Thoma Syrian Church presently working at Bangalore)

Mobile – 09740812910

[email protected]

For Consultation:

http://drpaulose.com/consult

OR

Make Physical Consultation  with-

Dr.K.O.Paulose FRCS, Consultant ENT Surgeon

Jubilee Hospital Trivandrum Kerala South India

Tel. 0471 3080300 , 0471 233 4561

OP Clinic  Mon-Wed-Friday 9 AM -12 Noon

Operation Days Tues-Thu-Saturday 8 AM -2 PM

To Reach Jubilee Hospital: jubileehospitaltrivandrum

http://www.jubileehospital.org/

 

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Revision Rhinoplasty in India.

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Rhinoplasty – Cosmetic nose reshaping is also known as Rhinoplasty. The procedure can reduce or increase the size of the nose, narrow the span of the nostrils, change the angle between the nose and upper lip, and change the tip or bridge of the nose. It can also correct some breathing problems.

Revision Rhinoplasty

Rarely patient needs to have revision surgery-touch up procedures, if not happy with the primary surgery. The goal of revision or secondary rhinoplasty is to correct the problems that appear after a previous rhinoplasty.

The principles of “secondary rhinoplasty,” or nasal surgery on a nose that has already been operated on, are very much the same as those in the primary rhinoplasty situation. It is important to consider nasal balance, function, deformities of cartilage and bone, areas that need additional support or reshaping, and to devise a safe plan that satisfies, to the greatest degree possible, the patient’s aesthetic goals.

Usually, the unintended outcomes are related partly to the nose appearance specifically to its contour and shape and the nose function particularly breathing. The most common deformities are polly beak, saddling, mid nasal asymmetry, bossa and columellar retraction. Other abnormalities that can be fixed with revision rhinoplasty are over-reduction, under-reduction, and asymmetry.

Revision rhinoplasty is always more difficult and will require more surgical experience than the first rhinoplasty but it will give you significant improvement and astonishing results. The psychological benefits are very important to take into account as well. There must be an honest rapport between the surgeon and the patient in order to set the proper expectations. The psychological relief of the patient must be of primary concern for the surgeon as well.

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Revision Rhinoplasty Procedure

Revision rhinoplasty is considered as a more challenging procedure than primary rhinoplasty. This is because the initial nose anatomy has changed and there is already build up of scar tissue. Moreover, there may have been side effects and complications from the previous surgery already.

Depending on the problems developed after rhinoplasty, the patient\’s preferences, and the surgeon\’s recommendation, there are various surgical techniques available. The diversity of the techniques is related to the repair procedure, the types of implant material, and grafting. In general, the revision rhinoplsty deals with adjusting the cartilage or bone tissues. It attempts to correct what was not accomplished during the first rhinoplasty.

The revision rhinoplasty must be done by an open approach. Usually, the patient\’s tissues are used to rebuild the nasal framework. Grafts may be harvested from septal, ear, or rib cartilage. This will depend on what nasal part has to be reconstructed. For instance, if the bridge of the nose has to be rebuilt then the rib cartilage is often used.

Revision rhinoplasty is performed under general anesthetic. This gives the anesthetist complete control over the airways and will keep any drainage from getting into your lungs.

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Patient selection

Revision rhinoplasty is a surgical procedure designed to repair problems of form and function of the nose that were a result form previous unsuccessful rhinoplasty procedures. Men and women who are physically healthy, realistic in their expectations, and have a strong desire to improve the results from the previous rhinoplasty are ideal candidates for revision rhinoplasty.

Secondary rhinoplasty can be just as successful as the primary rhinoplasty, although because the initial problem is worse, there is a higher chance that second operations or minor touchups may be needed to produce the best result. In my practice, the revision rate for patients who undergo secondary rhinoplasty is about 5-10 percent. This is a higher number than for other surgeons, but it reflects both the expectations of my patient population and my own desire to produce the best possible result.

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Nasal Septal Perforation-Surgical Repair

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In the days of SMR operations, the iatrogenic septal perforations were very common. But after the septoplasty procedure came into being, the incidence of septal perforation is much less.( Iatrogenic means caused by surgeons). The next common cause is trauma, after septal hematoma.

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Nasal Septal Perforation is defect in the nasal septum which is the structure between the nostrils that separates the nasal passages. Any damage to the mucoperichondrium reduces blood supply in the septum, the cartilage begins to die, and a hole develops.

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Traumatic causes of septal perforation may be divided into external, self-inflicted, and iatrogenic causes. External trauma includes nasal-septal fracture. A septal hematoma results in elevation of the mucoperichondrium from the quadrangular cartilage, ischemia, and subsequent necrosis of the cartilage, with resultant perforation. Self-inflicted trauma, such as digital manipulation, may cause a septal perforation. Iatrogenic trauma includes a history of septoplasty, nasal packing or cauterization for epistaxis, and nasotracheal intubation. Chronic use of vasoconstrictor nasal sprays and steroid nasal sprays may cause septal perforations. In addition, the use of cocaine may result in septal perforations. Chronic use of vasoconstrictor nasal sprays and steroid nasal sprays may cause septal perforations. In addition, the use of cocaine may result in septal perforations.

Small perforations refer to those with a diameter of ≤ 0.5 cm; medium perforations with a diameter ranging between 0.5-2 cm; large perforations with a diameter > 2 cm.

The symptoms associated with septal perforations include nasal congestion or obstruction, nasal crusting and drainage, recurrent epistaxis, and a whistling sound from the nose.

Many perforations do not need to be closed. Septal perforations are difficult to repair especial medium to large size perforations. Surgery is indicated in the presence of symptomatic perforations while surgical repair is not usually recommended for perforations not presenting subjective and functional disorders.

Small perforations may need only frequent rinsing with saline and applying lubricating gels.

Surgery aimed at correcting nasal septal perforations is based on two main principles: repairing the perforation using mucosal mucoperichondrial and/or mucoperiosteal flaps from the internal nasal cavity, and connective tissue autografts interposed between the mucosal flaps.

Surgical repair of septal perforation can be carried out using either the closed technique or open technique. The advantage of the former is that it does not leave any external scar. However, drawbacks related to difficulties due to the narrow operating field may be encountered. Many surgeons prefer the open rhinoplasty technique, as it offers a wider operating field, thus allowing better access. Surgeon may use cartilage tissue from inside your nose or from another part of your body (autograft) to stitch into the hole. One can raise tissue flap to cover the perforation.

Contraindications for surgery include chronic nasal inflammatory processes including Sarcoidosis, Wegener Granulomatosis, TB, Syphilis etc..

As far as concerns perforation size, regardless of the case, technique and material used, small and medium perforations are generally treated successfully. Although many techniques for repairing septal perforations have been described, no standardized surgical protocol has been established.