[The growing nose]

Children noses have special anatomical and functional characteristics. Early interventions performed before the end of the child's growth have been a main topic as they may cause adverse effects on the subsequent development and the function. This chapter describes the characteristics of the nasal pyramid and the septum at different stages of growth. Should one's approach be very cautious in children surgical indications, one should not hesitate opting for the treatment of congenital malposition or acquired when they jeopardize the nasal function. Considering possible procedures and specific conditions within pediatric field are discussed in this chapter.

Efficiency of external nasal dilators in pediatric nasal septal deviation

INRODUCTION

Nasal septal deviation results from irregular development of the nasomaxillary complex and trauma. Treatment of nasal septal deviation in pediatric patients is one of the biggest challenges in rhinology. Surgery may alter craniofacial growth patterns, and so it may be indicated only in the selected cases. The use of external nasal dilators is a relatively new treatment modality in nasal obstruction.

OBJECTIVE

This study was performed to assess the efficacy of external nasal dilator in pediatric nasal septal deviation patients.

METHODS

Seventy-six children who were diagnosed with nasal septal deviation at our outpatient clinic were included in the study. The patients were divided into 2 groups: the external nasal dilator group was composed of 48 children that had used an external nasal dilator for at least 1 month and still been using, while the control group was comprised of 28 children that had not received any treatment and had not used an external nasal dilator. The parents of the children were asked to complete the obstructive sleep apnea 18 questionnaire. In addition, the external nasal dilator group was asked to complete the questionnaire after stopping external nasal dilator use for 2 weeks and the control group also repeated the obstructive sleep apnea 18 questionnaire.

RESULTS

The obstructive sleep apnea 18 questionnaire results were significantly different between the external nasal dilator group and the control group at the beginning of the study (i.e., when patients in the external nasal dilator group were still using their dilators, P = 0.000). On the other hand, there was no difference between the 2 groups after the patients in the external nasal dilator group had stopped using their external nasal dilator (P = 0.670).

CONCLUSION

External nasal dilator use relieved nasal septal deviation, which narrows the nasal valve. The results of this study suggest that external nasal dilator could be used in patients that are not candidates for septoplasty.

[Surgical anatomy of the nose]

Thorough knowledge of the anatomy of the nose is an essential prerequisite for preoperative analysis and the understanding of surgical techniques. Like a tent supported by its frame, the nose is an osteo-chondral structure covered by a peri-chondroperiosteal envelope, muscle and cutaneous covering tissues. For didactic reasons, we have chosen to treat this chapter in the form of comments from eight key configurations that the surgeon should acquire before performing rhinoplasty.

A novel way of trans-septal splint suturing without nasal packing for septoplasty

Nasal packing has evolved over the years. Though effective in preventing postoperative bleeding complications, they are associated with significant morbidity and pain. In recent years nasal splints have been used to reduce the duration of nasal packs. The aim of this study is to compare the postoperative results in 200 nasal surgeries where in nasal packing was replaced by trans-septal splint suturing. Two hundred cases of septoplasties were prospectively studied over a period of 5 years at Adichunchanagiri Institute of Medical Sciences. In 100 cases (group A) nasal packing was done postoperatively whereas in other 100 (group B) trans-septal splint suturing was done. Post operatively patients were followed up in both groups regarding the presence of pain, bleeding, crusting and synechiae for a period of 6 months. Two hundred patients were prospectively studied over a period of 5 years with a male-female ratio of 1.35:1 and the mean age was 31. In group A out of 100 patients followed postoperatively, ten had mild bleeding on second day after pack removal none of which required repacking, 22 patients had mild pain on second and third day, 18 had moderate crusting on day 4, 12 had synechiae after 2 weeks. In group B, out of 100 patients, minimal bleeding was noted in 13 patients on day 1 and 2, mild discomfort was noted in the nose in 34 patients till day 7 (day of splint removal), crusting was noted in six patients, synechiae was noted in one patient. Elimination of pain and discomfort for the patients and absence of complications like synechiae. Also the hospital stay is less than with nasal packing. Therefore, suturing of the nasal septum with a splint after septoplasty should be a preferred alternative to nasal packing.

Hemodynamic Effects of Topical Adrenaline During Septoplasty

Vasoconstrictors agents is used in septal surgery, in attempt to improve haemostasis and thereby improve the surgical field. We aimed to compare the effect of lignocaine with adrenaline injection and alone lignocaine injection with topical adrenalin on perioperative hemodynamic effect, hemorrhage and postoperative pain. Patients undergoing surgery were randomised into two groups: group I in whom infiltration was performed with lignocaine (2 %) with adrenaline (1:100,000), group II in whom infiltration was performed with lignocaine (2 %) injection with topical adrenalin application (1:10,000). The two groups were matched by age, sex, body weight, pre-anesthesia blood pressure, heart rate, oxygen pressure and hemorrhage. The hemostatic effects postoperative pain in each group were analyzed. No statistically significant differences in operation time, hemodynamic effect, and intraoperative blood loss were reached between the two groups of patients (p > 0.05). But also group I had significantly better pain scores versus control group in the 2nd, 4th, 6th postoperative hours (p < 0.05). We suggest that the use of adrenaline infiltration during septal surgery is unnecessary and may subject the patient to the risk of cardiogenic side-effects of systemic absorption.

Does septoplasty improve the quality of life in children?

OBJECTIVES

The aim of this study is to evaluate the outcomes of septoplasty and the effects of septoplasty on the quality of life and to determine postoperative patient satisfaction in children using nose obstruction symptom evaluation (NOSE) and visual analog scale (VAS).

METHODS

Only pediatric patients who underwent septoplasty were included in the study. Patients who underwent adenoidectomy, endoscopic sinus surgery, or turbinate surgery in addition to septoplasty and total septal reconstruction with open technique septorhinoplasty were excluded from the study. Patients and their parents were inquired about their nasal obstruction symptoms using the NOSE scale before and 3 and 12 months following the surgery. VAS was used to analyze overall satisfaction of the patients and their parents on the outcomes of surgery, at the last follow-up examination 12 months after the surgery.

RESULTS

Thirty-five patients with a mean age of 13.4 ± 2.8 (8-16) were included in the study. There was a very significant improvement in NOSE score at 3 months after septoplasty. The mean subjective satisfaction score measured with VAS at the 12th month postoperatively was 7.9 ± 2.1. Improvement in NOSE score was correlated with patient satisfaction.

CONCLUSION

Septoplasty is a very effective and satisfactory treatment for nasal obstruction caused by nasal septal deviation in children. The NOSE scale can be used for the evaluation of nasal obstruction symptoms.

The efficacy of preemptive analgesia with pregabalin in septoplasty

Objectives

Pregabalin is used to treat neuropathic pain and has shown analgesic properties in postoperative pain. The aim of this study was to investigate the effectiveness and safety of pregabalin in reducing postoperative pain in patients after septoplasty.

Methods

Forty-seven patients scheduled for elective septoplasty were randomly assigned to groups that received either pregabalin (150 mg) or placebo, both one hour before surgery and 12 hours after the initial dose. Pain (verbal numerical rating scale, VNRS) and side effect assessments were performed at 6, 12, 12 to 24, and 24 to 48 hours postoperatively.

Results

From 1 to 12 hours postoperatively, VNRS scores for pain were lower in the pregabalin group (n=24) than in the placebo group (n=23; P<0.05). The number of patients who needed rescue analgesics was lower in the pregabalin group (P=0.042). The incidence of nausea and vomiting did not differ between groups (P=0.666), and the incidence of sedation was higher in the placebo groups (P=0.022).

Conclusion

The perioperative administration of oral pregabalin (150 mg twice) is an effective and safe way to reduce early postoperative pain in patients undergoing septoplasty.

How to resolve the caudal septal deviation? Clinical outcomes after septoplasty with bony batten grafting

OBJECTIVES/HYPOTHESIS

Caudal septal deviation interrupts normal nasal breathing, due to the narrowing of the external valve area and nasal valve angle. In this study, we found a different approach for correction of caudal septal deviation with no associated deformity of the external nose.

STUDY DESIGN

Individual case-control study.

METHODS

The 39 patients completed questionnaires by interviews postoperatively for assessment of nasal obstruction. In addition, patients assessed the severity of their nasal symptoms (i.e., mouth breathing, mouth dryness, hyposmia, rhinorrhea, epistaxis, snoring, postnasal drip, and headache) preoperatively and postoperatively using a visual analog scale (VAS). Improvement in the treatment of nasal obstruction using a VAS and a questionnaire for subjective satisfaction were evaluated 3 months after septoplasty. To evaluate outcomes objectively, endoscopic photographs of the nasal cavity and acoustic rhinometry before and after surgery were evaluated. For comparison between preoperative and postoperative status, the Wilcoxon signed ranks test was used.

RESULTS

Patients reported a significant decrease in the VAS severity of all nasal symptoms. The minimal cross-sectional area (MCA1) of the convex side after vascular constriction using acoustic rhinometry showed significant widening. Patients were divided into a turbinoplasty group and a nonturbinoplasty group, and the turbinoplasty group showed a significant increase in both the convex side and concave side in MCA1 and in the convex side in the anterior portion of the inferior turbinate.

CONCLUSIONS

Endonasal septoplasty using bony batten grafting for caudal septal deviation resulted in an improvement of nasal obstruction symptoms and acoustic rhinometry components.

Effects of septoplasty on speech and voice

OBJECTIVES

The aim of this study was subjective and objective evaluation of changes in acoustic features of voice before and after septoplasty surgery.

STUDY DESIGN

Prospective.

METHODS

Twenty patients scheduled for septoplasty procedure were included in the study. Before and 1 and 3 months after septoplasty surgery, acoustic analysis were performed. The recordings of /a/ vowel were used to evaluate average fundamental frequency (F0), Jitter percent, and Shimmer percent. In spectrographic analyses, F3-F4 values for the vowels /i, e, a, o, and u/, nasal formant frequencies of the consonants /m/ and /n/ in the word /mana/, and four formant frequencies (F1, F2, F3, and F4) for nasalized /a/ vowel following a nasal consonant /n/ in the word /mana/ were compared. For the perceptual evaluation, the patients were asked to read the Turkish "Dere" passage. The differences in nasal resonance and subjective evaluations were rated.

RESULTS

A statistically significant change was not observed in F0 (P=0.307), Jitter (P=0.919), and Shimmer (P=0.024) values measured before and after the operation for vowel /a/. Nasal formants measured before and after the operation for nasal formant /m/ and nasal formant /n/ in the word /mana/, which contains nasal consonants, and nasalized vowel /a/, which comes after a nasal consonant, did not differ statistically significant (P=0.096 and P=0.034, respectively). Comparisons among F1, F2, F3, and F4 values did not reveal a statistically significant change for nasalized vowel /a/, which comes after a nasal consonant in the word /mana/.

CONCLUSIONS

Our study shows that a complete therapeutic approach to patients affected by nasal septum deviation do not reveal significant voice abnormalities.

A comparative study of endoscopic septoplasty versus conventional septoplasty

Nasal obstruction due to deviated nasal septum is a common problem encountered by otolaryngologists. A variety of surgical procedures have been tried in the treatment of the same. This study was conducted to evaluate the outcomes and complications of endoscopic and conventional septoplasty. This is a prospective, randomized study. Fifty patients with symptomatic deviated nasal septum were included in the study, 25 of them underwent conventional septoplasty and the rest underwent endoscopic septoplasty. The difference in the functional outcome of both the surgeries was insignificant. There was a significant difference with respect to complications. Endoscopic septoplasty had better outcome with respect to complications. It is easier to correct posterior deviations and isolated spurs with endoscopic septoplasty. Complications are lesser with endoscopic septoplasty.

A new approach to studying the nasal and oral breathing routes

INTRODUCTION

Nasal obstruction is often reported by patients. It is a consequence of a subjective feeling of impaired airflow through the nasal cavity. Currently, objective measures of nasal patency rates are very limited. Functional tests only analyze nasal breathing; they do not simultaneously assess airflow through the mouth.

OBJECTIVE

The aim of this study is to present a new functional test that assesses a single-stage nasal and oral breathing route.

METHODS

The NOFA (Nasal-Oral Flow Analyzer) is a three-channel flow meter used to perform continuous and simultaneous measurements of nasal and oral respiratory parameters. We present the application of the device and the proposed study protocol.

RESULTS

The respiratory tracks of four selected patients are presented. Different breathing patterns are visible: exclusive nasal, exclusive oral, and mixed nasal-oral ventilation pattern.

CONCLUSIONS

The preliminary results suggest the potential use of the NOFA in ENT practice. Further studies are necessary to evaluate the usefulness of this device in the diagnosis of patients with upper respiratory tract disorders.

A novel wedge technique to correct the curved deviation of the cartilaginous nasal septum

OBJECTIVE

To introduce a novel wedge technique in endonasal septoplasty to correct the curved deviation of the cartilaginous septum and describe the surgical procedure and results.

METHODS

A retrospective analysis was performed on 17 patients who had septoplasty using the wedge technique to correct the curved deviation of their cartilaginous septum. A 2-2.5-cm-long wedge made of either septal cartilage or ethmoid/vomer bone was inserted through an incision located 1.5-2 cm caudal to the bony-cartilaginous junction near the dorsum. Materials used for the wedge, objective evaluation of the surgical results, subjective symptom improvement and surgical complications were investigated.

RESULTS

The degree of deviation was moderate to severe in all patients. Bony septum was used as the wedge material in 9 patients and septal cartilage in 8 patients. Among 17 patients, 15 had a completely straight septum while 2 had a minimal curvature remaining. Subjective symptoms of nasal obstruction evaluated by the Visual Analog Scale score and Nasal Obstructive Symptom Evaluation scale improved in all patients. In acoustic rhinometry, minimal cross-sectional area and nasal volume change showed some improvement without statistical significance. There were no major complications including saddle nose and revision surgery.

CONCLUSION

Our novel wedge technique can be an effective and safe technique to straighten the curved deviations of the cartilaginous septum in selected patients.

Revision septoplasty: a prospective disease-specific outcome study

OBJECTIVES/HYPOTHESIS

1) Study outcomes of revision septoplasty using a validated disease-specific questionnaire and a patient satisfaction survey; 2) assess the effect of surgery on the use of medication to treat nasal congestion; and 3) report on sites of persistent septal deviation identified at revision septoplasty.

STUDY DESIGN

Prospective, single-center outcome study of patients with symptomatic nasal obstruction and persisting septal deviation despite prior septal surgery.

METHODS

The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered preoperatively and at 3 and 6 months following revision surgery. Patients were also questioned regarding ease of breathing and medication use preoperatively and postoperatively, as well as satisfaction with the surgical outcome. Anatomic site(s) of residual septal deviation were recorded intraoperatively.

RESULTS

Thirty-nine patients completed the study. Mean NOSE scores decreased significantly from 75.9 preoperatively to 14.9 3 months after revision surgery. Mean Ease-of-Breathing scores over this interval improved from 3/10 preoperatively to 8.5/10. Both results were sustained at 6 months (P <0.0001). Patient satisfaction was very high, and many patients required less medication to treat symptoms of nasal congestion postoperatively. Deviations persisting from prior surgery most commonly involved the dorsal or caudal septum.

CONCLUSION

In patients who experience ongoing nasal obstruction with a persistent septal deviation despite prior septoplasty, revision surgery significantly improves disease-specific quality of life, results in high patient satisfaction, and may diminish the need for nasal medications postoperatively. Caudal or dorsal deflections may be more difficult to correct, leading to the need for revision surgery.

LEVEL OF EVIDENCE

2C.

Viability and Regeneration of Chondrocytes after Laser Cartilage Reshaping Using 1,460 nm Diode Laser

Objectives

Cartilage reshaping by laser irradiation is used to correct septal and auricular cartilage deformities. Chondrocyte viability following laser irradiation and reshaping has been well established. However, the regeneration process of chondrocyte after laser irradiation has not been revealed yet. The aims of this study were to determine the mechanism of cartilaginous thermal injury and the regenerative process of damaged cartilage following laser irradiation.

Methods

Laser irradiation was performed on human septal cartilage and rabbit auricular cartilage using a 1,460-nm diode laser. We observed change in the shape of cartilage and evaluated the extent of cartilage injury using live/dead cell assay via confocal microscopy. Hoechst and propidium iodide (PI) staining was used to evaluate the mechanism of chondrocyte injury after laser irradiation. To evaluate the regeneration of cartilage, laser irradiated cartilages were reimplanted into a subperichondrial pocket and were harvested at 1, 2, and 4 weeks after reimplantation for viability assessment and histologic examination.

Results

Laser irradiation using a 1,460-nm diode laser produced a marked shape change in both human septal and rabbit auricular cartilages. Thermal damage on cartilage was correlated with the exposure time and the laser power. Hoechst and PI staining showed that chondrocyte death by laser irradiation was due to mainly necrosis, rather than apoptosis. In lower power treatment group (0.3 W and 0.5 W), all the chondrocytes regenerated within 4 weeks, however, in 1 W treatment group, chondrocytes could not regenerate until 4 weeks.

Conclusion

Reshaping of cartilage using 1,460 nm diode laser was attained concurrently with the thermal injury to the chondrocytes. The extent of thermal damage on chondrocytes was dependent on the exposure time and the laser power and the damaged chondrocytes irradiated with lower level of laser power could be regenerated after reimplantation into subperichondrial pocket.

The role of septal surgery in cosmetic rhinoplasty

Septoplasty is performed to resolve breathing problems, but it often becomes pivotal to correct external nasal deviation, representing a central step in rhinoplasty surgery. Even in patients with no functional problems, septal surgery may represent the best solution for obtaining a proper realignment of the external nasal pyramid. One-stage septorhinoplasty has become the standard of treatment for a deviated nose, hence septoplasty cannot be considered as a separate procedure to perform before or after rhinoplasty or as a partial operation subject to later revision. The aim of this article is to discuss the close relationship between the nasal septum and the aesthetics of the nose, and how a graduated surgical approach for the correction of septal deviations could affect the external deviated nose.

Comparison of septoplasty with and without nasal packing and review of literature

Septoplasty is routinely performed for symptomatic deviated nasal septum. The most unpleasant part of this procedure is the pain during removal of nasal pack. The objective of this study was to compare the results of septoplasty with and without post-operative nasal packing and thereby assess the necessity of nasal packing after septoplasty. This descriptive study was carried out in ENT Department of D.Y. Patil Hospital, Kolhapur. 50 patients between the age groups of 18-50 years, having symptomatic deviated septum were selected. Out of which 25 patients underwent septoplasty with packing and 25 patients underwent septoplasty without packing with quilting sutures taken on the septum. Patients who underwent septoplasty without packing, experienced less pain and bleeding was minimal. Only one patient developed septal hematoma postoperatively. All the patients were satisfied at the end of 3 months. Simple DNS can be safely treated with septoplasty without Anterior Nasal Packing and by taking Quilting sutures on the septum. The sutures are also useful for closing any inadvertent tears of the septal mucosa and providing additional support for the cartilage pieces retained in septoplasty. Nasal packing should be should be reserved only for the patients with increased risk of bleeding.

[Endoscopic dacryocystorhinostomy: role of the ophthalmologist]

OBJECTIVE

To evaluate the results of endoscopic dacryocystorhinostomy (DCR) with or without support of the ophthalmologist.

MATERIAL AND METHODS

A retrospective study of 100 cases of endoscopic DCR surgery conducted by an otolaryngologist between June 2008 and December 2009. Of the 100 cases, 50 were operated with surgical support of the ophthalmologist, who inserted Bowman probes in the upper and lower canaliculi, while in the other 50 cases it was the otolaryngologist who performed this, without support of the ophthalmologist. The evaluation of the results after 2 years included the subjective perception, the lacrimal patency after lacrimal syringing, and lacrimal functional test after modified Jones test.

RESULTS

Of the 100 DCR reviewed, more than 50% required complementary treatment by the otolaryngologist, mainly septoplasty. As for the resolution of epiphora, without support of the ophthalmologist, 75% the patients reported an overall subjective improvement, but this reached 92% in the surgical group with support of the ophthalmologist, which was a statistically significant difference.

CONCLUSIONS

Endoscopic DCR is effective in the treatment of epiphora, but its results improve when the ophthalmologist inserts the probes in the lacrimal canaliculi during the surgical procedure.

The evaluation of nasal mucociliary activity after septoplasty and external septorhinoplasty

The aim of this study was to evaluate the nasal mucociliary activity after septoplasty (SP) and external septorhinoplasty (eSRP). Twenty patients who had SP operation (group 1) and 15 patients who had eSRP operation (group 2) were enrolled in the study. On each case, mucociliary clearance (MCC) measurement was performed by saccharine test before surgery, and on the first and third months of postoperative period. Saccharine clearance time (SCT) of 28 healthy volunteers were measured to establish control values. The mean SCT in control group was 8.79 ± 2.63 min, in group 1 patients before surgery was 14.03 ± 1.68 min, in group 2 patients before surgery was 14.34 ± 1.70 min. The preoperative SCT values of the group 1 and group 2 were significantly higher than healthy controls (p < 0.05). While there were statistically significant differences between preoperative and postoperative third month SCT values of group 1 patients, and postoperative first month and postoperative third month SCT values of group 1 patients (p < 0.05), there was no statistically significant difference between preoperative and postoperative first and third months SCT values of group 2 patients. Nasal septal deviation impairs the nasal mucociliary activity. Septoplasty operation positively affects the MCC mechanism. On the other hand, we observed no significant effect of eSRP operation on mucociliary activity on the first and third months of postoperative period as compared with preoperative.

The efficacy of submucosal tramadol in the postoperative treatment of pain following septoplasty operations

Tramadol is a centrally acting opioid which is effective for moderate-severe pain and is being used for various acute and chronic pain scenarios. The primary endpoint of this controlled, randomized double blind study was to evaluate the effect of submucosal tramadol on VAS scores after septoplasty operations and secondary endpoint was to investigate the effects on total opioid and additional analgesic consumption and patient satisfaction. 60 patients scheduled for septoplasty under general anaesthesia were enrolled. In Group T, at the end of surgery following hemostasis, 2 mg/kg tramadol was applied as submucosal infiltration to both surgical sites, 2 ml (total 4 ml), by the surgeon. In Group P, at the end of surgery following hemostasis, 2 ml isotonic solution (total 4 ml) was applied as submucosal infiltration to both surgical sites by the surgeon. Total opioid consumption, VAS scores, patient satisfaction was evaluated at the end of 24 h VAS values were higher in Group P on the first and second postoperative hours. Patient controlled analgesia demand and delivery values were higher in Group P on the postoperative 1, 2, 4, 6, 12 and 24th hours. Patient satisfaction was higher and opioid consumption was lower in Group T compared to Group P. There was no difference in additional analgesic consumption between two groups. The results show that patients receiving tramadol had lower VAS scores compared with the placebo groups postoperatively.

Central retinal artery occlusion and third cranial nerve palsy following nasal septoplasty

BACKGROUND

Postoperative vision loss following routine nasal surgery is an extremely rare and devastating complication. We report a case of unilateral blindness due to central retinal artery occlusion associated with third cranial nerve following septoplasty.

CASE REPORT

We report a patient who developed an unusual central retinal artery occlusion with unilateral blindness following nasal surgery under general anesthesia. A 45-year-old man underwent a nasal septal surgery for severe epistaxis. Soon after recovery, the patient noticed loss of vision in his right eye and was unable to lift his upper eyelid. Upon ophthalmic examinations, we determined that he had right-sided third cranial nerve palsy with central retinal artery obstruction and ptosis of right upper eyelid, restriction of ocular movements, and no perception of light in the right eye. Postoperative computerized tomography scan revealed multiple fractures of the left medial orbital wall, including one near the optic canal. Ptosis and ocular defects were recovered partially, but visual loss persisted until the last follow-up.

CONCLUSION

This paper highlights one case of complete unilateral blindness from direct central retinal artery occlusion associated with third cranial nerve palsy following an apparently uneventful septorhinoplasty. Ophthalmologists and otolaryngologists should therefore be aware of the possible occurrence of such complications.

Retrospective analysis of 697 septoplasty surgery cases: packing versus trans-septal suturing method

The trans-septal suturing method has been developed in septoplasty as an alternative to packing. This study was carried out to compare the postoperative results of trans-septal suturing with the anterior Merocel packing technique. The study involved 697 patients who underwent septoplasty. Following surgery, patients were randomly divided into two groups, one with trans-septal suturing and the other with Merocel packing. Patients were asked to record pain levels using a visual analogue scale. Postoperative symptoms and complications were compared. A total of 697 nasal operations were evaluated in the postoperative period considering pain, bleeding, haematoma, septal perforation synechiae and septal perforation. The results for haemorrhage, haematoma, synechiae and perforation were not statistically different (p > 0.05) between groups. In contrast, the level of postoperative pain in patients undergoing trans-septal suturing was significantly less than in the group who received Merocel packing (p < 0.05). Patients with Merocel packing had significantly more pain and nasal discomfort when assessed 1 week after intervention. Therefore, the trans-septal suturing technique may be the preferred option to provide higher patient satisfaction.

Septoplasty can Change the Shape of the Nose

ENT surgeons are familiar with anatomy as well as physiology to improve the form and function of the nose. Conventional septoplasty is done to improve the function of the nose. The nasal septum contributes to the shape of the nose in many ways like it's height, length and position in the midline. And if septoplasty is extended to vary its' dimensions it can grossly contribute to the improvement of the shape of the nose and would truly be called septo-rhinoplasty. This fact that septal surgery alone can improve the shape of the nose shall encourage young ENT surgeons to practice these techniques and offer the resulting cosmetic advantages to their patients.

Nasal septal clips: an alternative to nasal packing after septal surgery?

Surgeons have debated since decades on the efficacy or inefficacy of nasal packing yet it is considered routine after septal surgery. Various types of septal splints have been tried as an alternative to nasal packs but most of them need to be sutured around the septum which requires a meticulous approach and expertise. Our aim is to assess and compare the immediate post-operative morbidity and the eventual outcome of septal surgery while using glove finger packs with that of septal clips with splints. This comparative study was done at MCV Memorial ENT Trust Hospital on 80 patients who were diagnosed to have DNS and underwent septal surgery. Patients were divided into two groups. Group A (n = 40) constituted of patients who had glove finger packs and Group B (n = 40) constituted of patients who had septal clips. In the immediate post-operative period patients were assessed for pain, headache, dysphagia, epiphora, dryness of mouth and post-operative bleed. On the first post-operative night, patients were assessed for oxygen saturation. Patients underwent tympanometry just before pack/splint removal and on reviews if the same was abnormal. Post-operative complications like septal perforation and synechiae were noted for both groups and compared. We found that the incidence of pain and various other signs and symptoms was significantly higher in Group A. The difference in the complication rates among the two groups was not statistically significant. We observed that nasal packing is a cause for significant morbidity and discomfort in the immediate post-operative period and does not give any added advantage over septal clips used in our study as far as the final outcome is concerned. Nasal septal clips with splints are a useful alternative to existing techniques of flap approximation after septal surgery. The method is not expensive and needs no special expertise.

Use of intravenous steroids at induction of anesthesia for septoplasty to reduce post-operative nausea and vomiting and pain: a double-blind randomized controlled trial

To determine the effectiveness of dexamethasone to reduce pain, nausea and vomiting after septoplasty. Study is a prospective double-blind randomized controlled trial. A total of 90 patients were enrolled and received an either of dexamethasone or placebo in the induction of anesthesia. The patients were asked to note the level of pain on the visual analogue scale in the first 24 h after surgery. They also had to record their severity of nausea and number of vomiting attacks. There were statistically significant differences between the two groups for the level of pain noted on the visual analogue scale. The severity of nausea was lower after treatment with dexamethasone but the difference between two groups was not significant. There was also a significant decrease in the number of vomiting attacks in patients treated with dexamethasone. A single dose of 8 mg of dexamethasone, given intravenously, at induction of anesthesia for septoplasty significantly decreased the pain, post-operative nausea and vomiting for the day of operation.

A comparative study of septoplasty with or without nasal packing

This study was conducted to compare the outcome of septoplasty with or without Nasal packing. The study subjects were randomly allocated into two groups. There was significant reduction in frequency of post operative pain, headache, discomfort and duration of hospital stay in patients who have undergone septoplasty without nasal packing. However there was no difference in post operative bleeding and septal perforation between two groups. Therefore after Septoplasty without nasal packing is preferred alternative to with nasal packing.

Sinonasal headaches and post-operative outcomes after septoplasty in patients with nasal septal deviation

INTRODUCTION

Investigators believe that anatomical abnormalities in the sinonasal region can be the cause of some chronic and refractory headaches that may respond well to surgical intervention. This study presents the prevalence of headache in patients with nasal septal deviation and their response to surgical treatment over a 2-year follow-up period.

MATERIALS AND METHODS

This descriptive and prospective study was conducted on 98 patients with nasal septal deviation who underwent septoplasty surgery in the Imam Hospital in Ahwaz. Preoperative information was acquired by asking the patients and by completing SNOT-20 questionnaires by patients. After the surgery, information about changes in the quality of headache in patients with dominant contact points in preoperative nasal endoscopy whose headache responded to topical anaesthesia with lidocaine 2%+naphazoline 0.5% was collected over a 2-year follow-up. Final data were analyzed by SPSS and descriptive statistics.

RESULTS

Ninety-eight patients were studied, comprising 58.2% men and 41.8% women. They ranged in age between 18 and 46 years (mean=24). Nasal obstruction (72.4%), snoring (58.1%), headache (46%) and epistaxis (17.3%) were the most frequent preoperative symptoms. The most common site of the headache was the frontal region (68.8%). Patients' headache was bilateral in 71.1% of cases. In 82.2% of patients, headache lasted less than four hours a day. The headache was pulsatile in 53.3%, sharp in 31.2% and compressive in 15.5% of cases. In the post-operative assessment, despite gradual decline in the referral patients for follow-up, a notable and gradual recovery in patients' headache was seen with 82.8% of the patients reporting complete or partial recovery of the headache at the end of the 2-year follow-up.

CONCLUSION

Headache is one of the most common symptoms in patients with nasal anatomical abnormalities such as septal deviation and usually responds well to surgical treatment. More studies with long-term follow-ups seems to be inevitable to determine the relationship between headaches and nasal anatomical abnormalities, accurate surgical results in patients' recovery and the recurrence rate of headaches.

Role of rhinomanometry to assess nasal airflow and resistance in patients undergoing septoplasty

Nasal obstruction is a common symptom. Rhinomanometry is a tool to objectively assess the nasal airway. A prospective study was undertaken to assess the nasal airflow and nasal resistance in 25 patients of deviated nasal septum undergoing septoplasty using rhinomanometry preoperatively and postoperatively. Rhinomanometric improvement in nasal airflow and decreased nasal resistance were found in 88% patients after surgery.