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Sazgar AA, Sazgar MA, Zarringhalam MA, Sazgar AK. Simultaneous Rhinoplasty and Septal Perforation Repair Using the Bone-Cartilaginous Unit. Aesthet Surg J 2024; 44:1023-1031. [PMID: 38648541 DOI: 10.1093/asj/sjae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Various techniques are employed for septal perforation repair but success rates still vary. Numerous mucosal flaps are used for septal perforation closure; however, a scaffold is essential for proper positioning and enhanced mucosal growth. OBJECTIVES The aim of this study was to assess the effectiveness of utilizing a septal bone/cartilage composite graft (BC unit) to close septal perforations in rhinoplasty patients and evaluate patient satisfaction. METHODS This case series included patients with septal perforation undergoing rhinoplasty and perforation repair between 2019 and 2023. BC units were used to cover the cartilaginous perforations in all patients. Patients were followed for a minimum of 1 year, assessing surgical results and postoperative satisfaction with the 10-item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). RESULTS In this study, 31 patients (22 female, 9 male), with a mean [standard deviation] age of 34.80 [10.31] years (range, 19-59 years), were enrolled. Nine had previousl undergone septoplasty, while four had undergone septorhinoplasty. The preoperative perforation size ranged from 6 to 27 mm (mean, 14.1 mm). At final follow-up, 26 cases (83.8%) achieved complete closure, while 3 had incomplete closures, and 2 experienced reperforation. Analysis revealed a notable mean decrease of 31.93 [26.47] in obstruction domain scores (SCHNOS-O) and a mean decrease of 44.19 [25.37] in cosmesis domain scores (SCHNOS-C). CONCLUSIONS Septal perforation repair and rhinoplasty can be safely and effectively performed concurrently with BC units for suitable candidates. LEVEL OF EVIDENCE: 3
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Caimi E, Balza A, Vaccari S, Bandi V, Klinger F, Vinci V. Optimizing Postoperative Care in Rhinoplasty and Septoplasty: A Review of the Role of Nasal Packing and Alternatives in Complication Management. Aesthetic Plast Surg 2024; 48:2812-2817. [PMID: 38485786 DOI: 10.1007/s00266-024-03907-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/05/2024] [Indexed: 08/07/2024]
Abstract
Rhinoplasty, a common surgical procedure for nose reshaping, demands meticulous preoperative evaluation and precise execution. When coupled with septoplasty to address medical issues stemming from a deviated nasal septum, these procedures can lead to noteworthy postoperative complications. These encompass early issues like epistaxis and hematoma, as well as long-term challenges such as scarring and aesthetic deformities. Strategies like steroids and tranexamic acid are employed to prevent and manage these complications. A contentious aspect in postoperative care is the use of nasal packing. While some argue it aids healing and hemostasis, others avoid it due to patient discomfort. This review assesses the pros and cons of postoperative nasal packing following rhinoplasty and septoplasty. A thorough literature review spanning 2000-2023 yielded 30 relevant articles from 62. Discussion reveals that nasal packing offers limited benefits in reducing bleeding, edema and ecchymosis. In conclusion, the decision to employ nasal packing in rhinoplasty and septoplasty should be made carefully, considering patient comfort and surgical context. Evidence suggests that nasal packing may not consistently provide significant advantages and could lead to adverse outcomes. Nasal splints offer similar advantages and may be considered viable alternatives. Surgeons should tailor their approach to individual patient needs, with further research needed to refine postoperative management for these procedures.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Edoardo Caimi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve EmanueleMilan, Italy
| | - Arianna Balza
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve EmanueleMilan, Italy
| | - Stefano Vaccari
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, BIOMETRA, Humanitas Clinical and Research Hospital, University of Milan, Via Manzoni, 56, 20072, Milan, Italy.
| | - Valeria Bandi
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, BIOMETRA, Humanitas Clinical and Research Hospital, University of Milan, Via Manzoni, 56, 20072, Milan, Italy
| | - Francesco Klinger
- Department of Health Sciences, Ospedale San Paolo, University of Milan, Via Antonio di Rudinı`, 8, 20142, Milan, Italy
| | - Valeriano Vinci
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve EmanueleMilan, Italy
- Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089, Milan, Italy
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Aldhwaihy L, Alhazzani H, Alkarzae M. Comparison on the Effectiveness and Safety of Transseptal Suturing Versus Intranasal Splints After Septoplasty: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-04066-2. [PMID: 38767656 DOI: 10.1007/s00266-024-04066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/09/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The application of transseptal suturing as an alternative to intranasal splints in preventing postoperative complications, such as synechia, and maintaining nasal septal stability following Septoplasty, remains controversial. This meta-analysis aims to systematically compare the effectiveness and safety of transseptal suturing with intranasal splints after Septoplasty. METHODS A comprehensive systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. The review included randomized clinical trials (RCTs) identified through a database search in July 2023, comparing postoperative complications following Septoplasty with the transseptal suturing technique versus intranasal splints. RESULTS Eight published RCTs involving 570 participants were included in the meta-analysis. The analysis revealed no significant difference between the transseptal suturing and intranasal splint techniques following Septoplasty in postoperative complications, including postoperative hemorrhage, synechia, septal hematoma, septal perforation, local infection, crusting, and residual septal deviation. CONCLUSIONS Transseptal suturing can be applied following Septoplasty as an alternative to intranasal splints without increasing the rate of postoperative complications. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Lulu Aldhwaihy
- Otorhinolaryngology - Head and Neck Surgery, Security Forces Hospital, Riyadh, Saudi Arabia.
| | | | - Mohammed Alkarzae
- Otorhinolaryngology - Head and Neck Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
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Abi Zeid Daou C, Zaytoun G, Hadi U, Fakhri S, Korban Z. The use of different intranasal splints Doyle splints versus Reuter bivalve splints versus no splints in primary septal surgeries: A randomised clinical trial looking at morbidity. Clin Otolaryngol 2024; 49:87-93. [PMID: 37424214 DOI: 10.1111/coa.14080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/25/2023] [Accepted: 06/11/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE The objective of this study is to compare the morbidity of different types of intranasal splints (Doyle splints and Reuter bivalve splints) with no intranasal splints in primary septal surgeries and concomitant submucosal reduction of the inferior turbinate. DESIGN Randomised clinical trial SETTING: Single-Center trial at a tertiary care facility PARTICIPANTS: In this randomised clinical trial, 123 consecutive patients underwent primary septoplasty with bilateral submucosal reduction of the inferior turbinate, with no other concurrent procedure. Patients were randomised into three groups: Doyle splints, Reuter bivalve splints and patients with no splints placed. MAIN OUTCOME MEASURES Following surgery, the patients were seen at three consecutive visits. During each visit, the Visual Analogue Scale score for headache, nasal obstruction, overall pain and bleeding and an endoscopic score for secretions, oedema and synechiae was filled. RESULTS Patients were randomised into three groups, 42 received Doyle splints, 41 Reuter bivalve splints and 40 had no splints inserted. When comparing the three groups, the first two post-op visits were scheduled significantly earlier in patients with splints (p < .05). The scores from both groups with splints were statistically higher for headache, nasal obstruction and pain, for the first visit only (p < .05). There was no statistical difference between groups when looking at each subset of the endoscopic score, at each visit (p > .05). CONCLUSION Increased post-operative pain, headaches and nasal obstruction scores were encountered in patients who had splints after surgery. However, endoscopic scores were statistically similar across the three groups with no difference in post-operative endoscopic scores at each visit. and no difference was seen in symptom scores and endoscopic scores between patients with different splints.
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Affiliation(s)
- Christophe Abi Zeid Daou
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Georges Zaytoun
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Usamah Hadi
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samer Fakhri
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Otolaryngology and Head and Neck Surgery, University of Texas, Houston, Texas, USA
| | - Zeina Korban
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Zavdy O, Nakache G, Alkan U, Hazan A, Reifen E, Ritter A. Prophylactic antibiotics in septoplasty with intranasal septal splints: A comparative analysis. Clin Otolaryngol 2024; 49:94-101. [PMID: 37817421 DOI: 10.1111/coa.14104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 09/15/2023] [Accepted: 09/23/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES Postoperative antibiotic therapy is a common practice following septoplasty with intra-septal splints placement (ISS), even though there is a lack of evidence to support it. We sought to investigate the role of antibiotic therapy in septal surgeries with the placement of ISS. DESIGN A retrospective comparative study was conducted using the electronic charts of adult patients who underwent septoplasty with the placement of ISS with or without turbinate reduction. Nasal cultures were taken routinely during surgery as part of the department's protocol for monitoring infectious diseases. The ISS were also routinely examined for the presence of bacteria after their removal on the eighth day following surgery. SETTING A large otolaryngology department in a tertiary medical center. PARTICIPANTS Adult patients who underwent septoplasty in our institution. MAIN OUTCOME MEASURES We analyzed all post-operative infections to search for risk factors in the cohort. RESULTS Post-operative infection rates following septoplasty with ISS were low at 6%, which is consistent with previously published rates. Infection rates were significantly higher in patients who were not treated with antibiotics (OR = 8.2, 95%CI: 1.63-41.1; p = .01, φ = 0.04). Diabetes was associated with an increased risk of postoperative infection regardless of prophylactic antibiotic therapy (OR = 5.2, 95%CI: 1.15-23.5; p = .032, φ = .04). The detection of Klebsiella pneumonia before surgery was associated with an increased rate of postoperative infection (OR = 16.6, 95%CI: 3.02-91.54; p = .001, φ = 0.12). CONCLUSIONS Patients undergoing septoplasty with the placement of ISS are at increased risk of gram-negative bacterial colonisation, and development of postoperative nasal infection. A single preoperative dose of IV antibiotic therapy should be considered a potential prophylactic option for septoplasty with ISS.
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Affiliation(s)
- Ofir Zavdy
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Nakache
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology, Head and Neck Surgery, Sheba Medical Center, Ramat-Gan, Israel
| | - Uri Alkan
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alain Hazan
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ella Reifen
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Ritter
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Conventional septoplasty complications: A Systematic review and meta-analysis. Am J Otolaryngol 2023. [DOI: 10.1016/j.amjoto.2023.103811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Noach N, Lavy E, Reifen R, Friedman M, Kirmayer D, Zelinger E, Ritter A, Yaniv D, Reifen E. Zinc chloride is effective as an antibiotic in biofilm prevention following septoplasty. Sci Rep 2023; 13:8344. [PMID: 37221180 DOI: 10.1038/s41598-023-35069-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023] Open
Abstract
Biofilm-state bacterial infections associated with inserted medical devices constitute a massive health and financial problem worldwide. Although bacteria exhibit significantly lower susceptibility to antibiotics in the biofilm state, the most common treatment approach still relies on antibiotics, exacerbating the phenomenon of antibiotic-resistant bacteria. In this study, we aimed to assess whether ZnCl2 coating of intranasal silicone splints (ISSs) can reduce the biofilm infections associated with the insertion of these devices and prevent the overuse of antibiotics while minimizing waste, pollution and costs. We tested the ability of ZnCl2 to prevent biofilm formation on ISS both in vitro and in vivo by using the microtiter dish biofilm formation assay, crystal violet staining, and electron and confocal microscopy. We found a significant decrease in biofilm formation between the treatment group and the growth control when ZnCl2-coated splints were placed in patients' nasal flora. According to these results, infections associated with ISS insertion may be prevented by using ZnCl2 coating, thereby obviating the overuse and abuse of antibiotics.
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Affiliation(s)
- Noa Noach
- The Institute of Biochemistry, Food Science and Nutrition. The Robert H. Smith Faculty of Agriculture, Food & Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Eran Lavy
- The Koret School of Veterinary Medicine. The Robert H. Smith Faculty of Agriculture, Food & Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Ram Reifen
- The Institute of Biochemistry, Food Science and Nutrition. The Robert H. Smith Faculty of Agriculture, Food & Environment, The Hebrew University of Jerusalem, Rehovot, Israel.
| | - Michael Friedman
- The School of Pharmacy, The Faculty of Medicine, Ein Kerem Campus, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Kirmayer
- The School of Pharmacy, The Faculty of Medicine, Ein Kerem Campus, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Einat Zelinger
- FACSI-Faculty of Agriculture Center for Scientific Imaging. The Robert H. Smith Faculty of Agriculture, Food & Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Amit Ritter
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Dan Yaniv
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Ella Reifen
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
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Watson D, Crawford KL. Reducing Surgical Risks in the Rhinoplasty Patient. Facial Plast Surg Clin North Am 2023; 31:209-220. [PMID: 37001924 DOI: 10.1016/j.fsc.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Reducing complications after rhinoplasty is critical to ensuring optimal functional, aesthetic, and patient satisfaction outcomes. Many of the most frequent complications of rhinoplasty are technical in nature and can be prevented with meticulous attention to detail and preservation of critical nasal support structures. In this article, the authors review many of the common pitfalls of rhinoplasty and discuss preventative measures that can be used by the competent rhinoplasty surgeon.
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9
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Ivanova PP, Iliev G. Nasal Packing in Septal Surgery: A Narrative Review. Cureus 2023; 15:e36488. [PMID: 37090361 PMCID: PMC10118399 DOI: 10.7759/cureus.36488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Recently, alternatives to intranasal packing following septoplasty and rhinoseptoplasty have been widely used and promoted. Here, we aimed to systemically review and compare the different types of nasal packing used in these two surgeries. To assess patient comfort and surgical outcomes, we conducted a comprehensive search of multiple databases such as PubMed, MEDLINE, Web of Science, and Google Scholar to identify and evaluate relevant articles. A detailed and extensive search was performed with the help of the keywords "nasal packing," "septoplasty," "rhinoseptoplasty," "nasal splints," and "intranasal packing." Overall, our review findings indicate that alternative methods (e.g., trans-septal suturing and insertion of intranasal splints) are better options than intranasal packing.
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Affiliation(s)
- Polina P Ivanova
- Otolaryngology-Head and Neck Surgery, Saint Anna Hospital, Varna, BGR
| | - Georgi Iliev
- Otolaryngology-Head and Neck Surgery, University Hospital Saint Marina, Varna, BGR
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Gilman R, Ganesh Kumar N. Invited Discussion on: Comparison of the Ankaferd Blood Stopper Tampon and the Merocel Nasal Tampon after Septoplasty Surgery. Aesthetic Plast Surg 2023; 47:301-303. [PMID: 36018328 DOI: 10.1007/s00266-022-03073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Robert Gilman
- Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2130 Taubman Center, Ann Arbor, MI, 48109, USA.
| | - Nishant Ganesh Kumar
- Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2130 Taubman Center, Ann Arbor, MI, 48109, USA
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Senanayake P, Warfield-McAlpine P, Salati H, Bradshaw K, Wong E, Inthavong K, Singh N. The Impact of Adhesions on Nasal Airflow: A Quantitative Analysis Using Computational Fluid Dynamics. Am J Rhinol Allergy 2022; 37:273-283. [PMID: 36373577 DOI: 10.1177/19458924221137982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Nasal adhesions (NAs) are a known complication of nasal airway surgery. Even minor NAs can lead to significant postoperative nasal airway obstruction (NAO). Division of such NAs often provides much greater relief than anticipated. Objective We examine the impact of NAs at various anatomical sites on nasal airflow and mucosal cooling using computational fluid dynamics (CFD) and multiple test subjects. Methods CT scans of healthy adult subjects were used to construct three-dimensional nasal airway computational models. A single virtual 2.5 mm diameter NA was placed at one of five sites commonly seen following NAO surgery within each nasal cavity bilaterally, resulting in 10 NA models and 1 NA-free control for each subject. CFD analysis was performed on each NA model and compared with the subject's NA-free control model. Results 4 subjects were recruited to create 44 computational models. The NAs caused the airflow streamlines to separate, leading to a statistically significant increase in mucosal temperature immediately downstream to the NAs (wake region). Changes in the mucosal temperature in the wake region of the NAs were most prominent in anteriorly located NAs with a mean increase of 1.62 °C for the anterior inferior turbinate NAs ( P < .001) and 0.63 °C for the internal valve NAs ( P < .001). Conclusion NAs result in marked disruption to airflow patterns and reduced mucosal cooling on critical surfaces, particularly in the wake region. Reduced wake region mucosal cooling may be a contributing factor to the exaggerated perception of nasal obstruction experienced by patients with NAs.
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Affiliation(s)
- Praween Senanayake
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
| | | | - Hana Salati
- School of Engineering, RMIT University, Melbourne, Australia
| | - Kimberley Bradshaw
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Eugene Wong
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Kiao Inthavong
- School of Engineering, RMIT University, Melbourne, Australia
| | - Narinder Singh
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
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Fermin JM, Bui R, McCoul E, Alt J, Avila-Quintero VJ, Chang BA, Yim MT. Surgical repair of nasal septal perforations: A systematic review and meta-analysis. Int Forum Allergy Rhinol 2022; 12:1104-1119. [PMID: 34978162 DOI: 10.1002/alr.22965] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/10/2021] [Accepted: 12/24/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND A wide variety of techniques for the surgical repair of nasal septal perforations (NSPs) have been described. Surgical management of NSPs can be broadly divided into open versus endonasal approaches, with additional variables involving unilateral or bilateral flaps, use of grafts, and placement of splints. The objective of this study was to compare surgical approaches and their outcomes. METHODS PubMed, EMBASE, and CINAHL Plus databases were examined for patients undergoing NSP repair. English-language studies reporting surgical management of patients with the primary diagnosis of NSP were included. Outcome measures of interest included perforation size, surgical approach characteristics, and success rate defined as complete closure assessed by surgeon postoperatively. The quality of articles was assessed with the methodological index for nonrandomized studies (MINORS) criteria. A random-effects model was used to calculate pooled proportions for the different outcomes. RESULTS The electronic database search yielded 1076 abstracts for review. A total of 64 articles met the inclusion criteria, with 1591 patients: 1127 (71%) underwent an endonasal approach and 464 (29%) an open approach. The median (range) MINORS score was 10 (5-12) out of 16 points. Overall, 91% of patients had total closure (95% confidence interval [CI], 0.89-0.93, p < 0.01), with moderate heterogeneity between studies (I2 = 42.03%). There was no difference in closure success between open and endonasal approaches. Use of bilateral versus unilateral flaps, interposition grafts, and intranasal splints and packing were not associated with differences in outcomes. CONCLUSION Nasal septal perforation surgical repair success rates are comparable regardless of technique.
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Affiliation(s)
- Janmaris Marin Fermin
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University (LSU)-Health Sciences Center, Shreveport, Louisiana, USA
| | - Roger Bui
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University (LSU)-Health Sciences Center, Shreveport, Louisiana, USA
| | - Edward McCoul
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.,Ochsner Clinical School, University of Queensland, New Orleans, Louisiana, USA
| | - Jeremiah Alt
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Brent A Chang
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Michael T Yim
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University (LSU)-Health Sciences Center, Shreveport, Louisiana, USA
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