The accuracy of different methods for diagnosing septal deviation in patients undergoing septorhinoplasty: A prospective study

Early Septoplasty Versus Closed Reduction for Acute Nasoseptal Fracture: A Systematic Review and Meta-analysis

OBJECTIVE

Accurate management of acute nasoseptal fractures can mitigate cosmetic and functional complications. There is a lack of consensus on the ideal approach to manage acute nasoseptal fractures, which are often addressed with closed nasal and/or septal reduction (CN/SR) but sometimes addressed using an open approach with septoplasty. We aimed to systematically assess and compare outcomes of CN/SR versus open approaches to treat acute nasoseptal fractures.

DATA SOURCES

PubMed, Scopus, and CINAHL.

REVIEW METHODS

Studies evaluating outcomes of adults with acute nasoseptal fractures treated within 3 weeks of injury with either CN/SR or open approach were included. Meta-analysis was performed to examine the pooled frequency of complications including persistent obstruction, cosmetic deformity, and need for revision surgery.

RESULTS

Of 1630 unique articles identified, 27 were included (63% retrospective, 29.6% prospective, 7.4% randomized controlled trial). Data included 1117 patients (n = 712 CN/SR, n = 423 open approach), with a mean age of 30.5 years. Patients who underwent CN/SR only were more likely to experience persistent obstruction compared to patients who underwent open approach (22.2% [95% confidence interval, CI, 8.7%-39.5%] vs 5.9% [95% CI, 2.4%-10.7%], P < .0001). Patients who underwent CN/SR were more likely to require revision surgery within 3 years (30.9% [95% CI, 15.8%-48.4%] vs 6.0% [95% CI, 3.3%-9.9%], P < .0001.

CONCLUSION

Patients with nasoseptal fractures who underwent open septoplasty in the acute period were less likely to experience complications. Prospective trials are needed to confirm results of this meta-analysis.

Patient Age Predicts Nasal Septal Deviation in Orthognathic Surgery: A Non-Randomized Clinical Trial of 102 Participants

Background and Objectives: Orthognathic surgery is used to restore a correct anatomical and functional relationship between the jaws, with postoperative nasal septal deviation (NSD) being a common complication of Le Fort I osteotomy (LF-IO). The aim of this study was to evaluate the occurrence of NSD after LF-IO and to identify possible risk factors. Materials and Methods: Pre- and postoperative cone beam computed tomography (CBCT) scans from 2018 to 2023 of 102 patients after LF-IO were analyzed. After categorizing the preoperative NSDs according to the Mladina classification, the next step was to measure the angle of deviation and classify the severity grades. Pre- and postoperative NSDs were compared using a paired Wilcoxon signed-rank test and postoperative changes in NSD were correlated with surgery-relevant characteristics by calculating Spearman's correlation coefficients. Results: Postoperatively, an increase in NSD was observed in 62 cases and 35 patients showed a decrease. In both cases with an increase and a decrease in NSD, the preoperatively measured deviations showed a highly significant difference compared to postoperative NSDs (both p < 0.001). Age correlated significantly with increases in deviation (r = 0.28, p = 0.014, CI: -1.0--0.068) and anterior maxillary displacement showed a significant correlation with a decrease in NSD (r = 0.296, p = 0.042, CI: 0.006-1.0). Gender, cranial and caudal movements of the maxilla had no influence on the results of the NSDs. Conclusions: LF-IO has an influence on NSD and can both intensify and attenuate it. In addition, the risk of an increase in nasal deviation after this surgical procedure rises with the patient's age and decreases with anterior displacement of the maxilla.

Nasal Septal Deviation: A Comprehensive Narrative Review

The nasal septum is an osteocartilaginous wall that divides the nose into two nasal cavities. Asymptomatic minor deviation of the septum is considered a normal developmental variation found in the majority of the population. The reported global prevalence rates had great variation due to the extent of deviation considered in the reporting studies. Previous classification systems have been proposed to classify the nasal septal deviation according to the characteristics of the nasal septum seen horizontally and vertically. For some patients, the degree of the deviation may affect the nasal airflow causing obstruction or impairing the olfactory function. Headache, rhinosinusitis, high blood pressure, obstructive sleep apnea, and breathing sounds are also among the clinical presentations of nasal septal deviation. Clinical assessment is sufficient to make the diagnosis while imaging techniques are required for decision-making. Radiological imaging techniques such as computed tomography (CT) are used to classify and assess the severity of the deviated septum. Surgical correction is the treatment option for nasal septal deviation. Septoplasty is the most common procedure used for nasal correction with high satisfaction levels and low complication rates. In this review, we present a comprehensive summary of the concept, presentation, diagnosis, management options, and quality of life of patients with nasal septal deviation.

Effect of Anesthesia on Postoperative Pain in Patients after Septoplasty

The aim of the study was to assess acute pain syndrome in patients after septoplasty using different tactics of general anesthesia. All patients received local anesthesia with 2% procaine solution. In group 1 (95 patients), premedication with 2% promedol solution and 60 mg of ketorolac in the evening was used; group 2 (72 patients) was administered with fentanyl, propofol, cisatracuria besylate, tranexamic acid, atropine, and metoclopramide; and group 3 (89 patients) received atracuria besylate, sodium thiopental, nitrous oxide, and halothane. In groups 2 and 3, 100 mg of ketoprofen was administered intramuscularly in the evening on the day of surgery. Anterior tamponade was performed with parolon tampons in glove rubber. In groups 1 and 2, the tamponade was removed on day 2, and in group 3 it was removed 1 day after surgery. Pain syndrome was assessed on 1, 3, and 6 h and on days 1 and 2 after surgery. It was found that the scheme of anesthesia in group 2 is the most preferable, and the nasal tamponade must be removed on the 2nd day after the surgery.

Is there a relationship between Eustachian tube dysfunction and nasal septal deviation in a sample of the Lebanese population?

Background

The Eustachian tube (ET) is considered an organ by itself due to its specific functions. An ET Dysfunction (ETD) is discussed when this tube is unable to ventilate the middle ear properly. Clinically, the patient reports usually some aural fullness, “popping”, “under water” sensation as if the ear is clogged. This condition is common affecting at least 5% of the adult population. It can impair quality of life and become disabling. On the other side, the prevalence of nasal septal deviation (NSD) is believed to be around 22.83% in the adult population. Nasal septal deviation is thought to cause a decline in the middle ear ventilation according to certain authors. The primary outcome is to define the predictive value of the side of Eustachian Tube Dysfunction (ETD) symptoms vis-à-vis the side of nasal septal deviation (NSD) in patients having the two conditions concomitantly.

Methods

A cross-sectional study was conducted between July 2018 and September 2019. Overall, 60 consecutive subjects (total of 120 ears), randomly seen at the Otorhinolaryngology Outpatient Clinics at the Eye and Ear International Hospital, Lebanon, all year-round were enrolled and tested without any geographic preferences. The Eustachian Tube Dysfunction Questionnaire (ETDQ) -7 questionnaire was used to evaluate ETD.

Results

A significantly higher ETD score was found in males compared to females, in those with left septal deviation compared to right and in those who have symptoms on the left compared to right side. Frequent exposure to higher changes in altitude (commute from home to workplace) was also significantly associated with higher ETD scores (r = 0.265), whereas higher Left Tympanometric peak pressure (TPP in daPa) on tympanometry was significantly associated with lower ETD score (r = − 0.467). Furthermore, 25 patients who had symptoms on the left side had also a septal deviation to the left side (86.2%), whereas 29 (93.5%) patients who had the symptoms on the right side had septal deviation to the right side (p < 0.001).

Conclusion

Our data highlighted the importance of altitude and geographic distribution of patients especially in a population exposed to barotrauma on a daily basis like the Lebanese population. Tympanometry, on the other hand, failed to correlate with patient reported symptoms and thus needs further evaluation. The reported ETD symptoms of the patient correlates to the side of NSD.

Nasal Floor Asymmetry Is Associated With Nasal Obstruction

PURPOSE

The role of morphologic characteristics of the nasal cavity in nasal obstruction is not yet sufficiently understood. The aim of this study was to determine which morphometric parameters of the nasal cavity severely impair nasal breathing and when.

PATIENTS AND METHODS

In a hospital-based, computed tomography-morphometric cross-sectional study, we evaluated computed tomography coronal scans of patients with known nasal obstruction scheduled to undergo functional nasal surgical procedures (cases) and trauma patients without facial involvement or known nasal obstruction (controls). The primary predictor variable was case versus control. In both groups, we measured and compared the piriform aperture width; nasal floor canting; piriform aperture vertical height, height-width ratio, and total cross-sectional area; height difference between the right and left nasal floors; and nasal septal thickness; as well as age and gender differences. Metric data means, standard deviations, and 95% confidence intervals were calculated and analyzed.

RESULTS

The sample was composed of 60 patients evenly divided between cases and controls. Of these, 30 were men. The average age of the cases and controls was 27.4 ± 7.8 years and 38.5 ± 18.6 years, respectively (P < .001). The differences in piriform aperture width were not statistically significant between cases and controls (23.3 ± 1.9 mm and 23.8 ± 1.7 mm, respectively; P > .2). In contrast, we noted statistically significant differences between cases and controls in nasal floor canting (5.4° ± 4.6° and 1.8° ± 1.5°, respectively; P < .001) and height difference between the right and left nasal floors (1.8 ± 1.2 mm and 1.0 ± 0.7 mm, respectively; P = .002).

CONCLUSIONS

Nasal floor canting of 3° or greater and a height difference between the right and left nasal floors of 1.5 mm or greater may contribute to the etiology of clinically relevant nasal obstruction. A piriform aperture width of 22 mm or less may be considered narrow. Future studies can determine when and how exactly to surgically address a clinically relevant narrow piriform aperture and nasal floor canting.

No impact of nasal septoplasty on the outcome of endoscopic dacryocystorhinostomy

OBJECTIVE

To compare the outcomes of combined endoscopic dacryocystorhinostomy (endoDCR) with nasal septoplasty for deviation of the nasal septum to endoDCR alone in cases of nasolacrimal duct obstruction (NLDO).

METHODS

A retrospective cohort study that included 107 consecutive patients with NLDO, who underwent endoDCR with or without concomitant nasal septoplasty in our institution between October 2009 and October 2017.

RESULTS

A total of 117 operations were performed (107 patients, 80.4% females; mean age ± SD 51.1 ± 19.5 years). Twenty-five (21.4%) endoscopic surgeries were combined with septoplasty (the endoDCR + septoplasty group), and 92 (78.6%) comprised endoDCR alone (the endoDCR group). There was no difference in anatomical success and functional success rates between the two groups (P = 0.76 and P = 0.18, respectively). There were no complications attributed to the septoplasty component of the surgical procedure.

CONCLUSION

Considerable numbers of patients undergoing endoDCR also require a septoplasty. Combining an additional procedure (septoplasty), that was not performed for its original indication but rather for facilitating the main surgical intervention (endoDCR), yields surgical success and associated complications equivalent to those of endoDCR alone.

A Five-Year Retrospective Cohort Study Analyzing Factors Influencing Complications after Nasal Trauma

The purpose of this study was to assess the outcomes of patients with nasal trauma during a long period of time and determine factors predisposing to complications after nasal trauma treatment. A retrospective cohort study was conducted that included all patients who were attended for a nasal trauma between January and December 2010. In 2015, the charts were retrospectively reviewed and the patients were prospectively followed up looking for outcomes after treatment of nasal trauma. A univariate analysis between complications and risk factors was performed and a logistic regression model was used to explore the prognostic role of the variables considered to have clinical relevance and to estimate the odds ratio for the occurrence of postoperative complications. A total of 220 consecutive patients with nasal trauma were included in the study. The mean follow-up was 44.3 ± 10.3 months (3-67) with 10% of lost patients. The most important factors determining complications after nasal trauma treatment were male gender, acute septal injury, chronic septal deviation, displaced or comminuted fractures in the radiologic study, and late nasal reduction surgery. A decision-making algorithm is proposed based on the fact that nasal bone fracture is not a minor problem and that closed nasal bone reduction is not the treatment of choice for all patients with nasal trauma.

The Effects of Air Pollutants on the Prevalence of Common Ear, Nose, and Throat Diseases in South Korea: A National Population-Based Study

Objectives

The effects of air pollutants on upper airway disease development have been seldom studied. In this study, we evaluated the effects of air pollution on the prevalence of ENT diseases.

Methods

We identified cases of ENT disease occurring in 2009, as recorded by the Korea National Health and Nutrition Examination Survey, and explored their associations with the levels of five air pollutants: sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), carbon monoxide (CO), and particulate matter (PM₁₀ particles; particulates ≤10 μm in aerodynamic diameter). Subjects diagnosed with at least one of the five studied ENT diseases were included in analysis, but those aged under 19 years were excluded. Linear associations between ENT disease frequency and pollutant levels were evaluated by calculating Spearman correlations. After adjusting for age, gender, and geographic region, multivariate logistic regression was used to obtain odds ratios (OR) with 95% confidence intervals (CI).

Results

A total of 7,399 subjects with ENT diseases were identified. A linear association was evident between PM₁₀ concentration and the frequency of septal deviation (Spearman coefficient, 0.507; P=0.045). After adjustment, the PM₁₀ level was associated with high odds ratios for chronic rhinosinusitis (1.22; 95% CI, 1.02 to 1.46) and septal deviation (1.43; 95% CI, 1.22 to 1.67). Both of these conditions were more prevalent in males.

Conclusion

We found that increased ambient concentrations of PM₁₀ particles were clearly associated with increased the risk of chronic rhinosinusitis and septal deviation; the exposure-response relationship was definitive.

Complications in septoplasty based on a large group of 5639 patients

Purpose

Septoplasty is a common surgical procedure used for correction of the nasal obstruction caused by a deviated septum. The aim of the study was to identify complications in septoplasty and analyze incidence depending on the surgical technique, based on the material from 2009 till 2017.

Methods

The material consisted of 5639 medical records from patients aged 16–69, operated in the tertiary referral center. Patients were divided into two groups (2784 exclusively with septoplasty and 2855 with combined septoplasty and turbinoplasty). Z test for the equality of two proportions was made to investigate the assumption that the proportions from two populations are equal, based on two samples, one from each population.

Results

Complications were listed according to international standards. Among the whole study group, different types of complications were noted in 193 patients (3.42%). The most frequent complication was excessive bleeding. Significant differences were observed between the two investigated groups. In patients with combined septoplasty and turbinoplasty septal hematoma, hyposmia, prolonged healing due to infection, adhesions and temporary reduced visual acuity were significantly more often encountered.

Conclusions

Meticulous attention to detail in identifying the appropriate anatomy and maintaining good visualization is the key to a safe and effective septoplasty, enabling for very low complication rate.