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Migliavacca RDO, Lavinsky M, de Souza OE, Friedrich EP, Cionek OAGD, Subda LF, Bernardi BL. Modified extracorporeal septoplasty: prospective study. Braz J Otorhinolaryngol 2024; 90:101398. [PMID: 38430860 PMCID: PMC10912845 DOI: 10.1016/j.bjorl.2024.101398] [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: 08/22/2023] [Revised: 11/13/2023] [Accepted: 12/26/2023] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate quality-of-life and satisfaction outcomes in patients undergoing the MES using the Portuguese version of the Nasal Obstruction Symptom Evaluation (NOSE-p) and Rhinoplasty Outcome Evaluation (ROE), and also to evaluate the frequency of possible complications of this technique. METHODS We conducted a single-center prospective study with patients who had the indication for MES, from May 2016 to September 2020 at the Facial Plastic Surgery Clinic of Otolaryngology Department of the Hospital de Clinicas de Porto Alegre. The primary outcome was the relative postoperative change in NOSE-p. Secondary outcome was the variation in ROE, a validated quality-of-life questionnaire for rhinoplasty patients. RESULTS Of the 31 patients submitted to extracorporeal septorhinoplasty who were evaluated, twenty-seven patients were included. Preoperative and postoperative NOSE-p scale scores were 65.2 ± 29.9 and 23.5 ± 26.7, respectively (mean differences of 42.04; [95% CI 27.35-56.73]; p < 0.0001). Pre and postoperative ROE scores were 38.3 ± 24.3 vs. 67.29 ± 29.7, respectively (mean differences of -29.02; [95% CI -40.5 to -17.5]; p = 0.0001). Residual septal deviation was verified in 2 patients (7.4%). CONCLUSION Most of the patients submitted to modified extracorporeal septoplasty had a significant improvement in quality of life scores of nasal obstruction, with good aesthetical outcomes and low indices of postoperative complications. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Raphaella de Oliveira Migliavacca
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil
| | - Michelle Lavinsky
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Olívia Egger de Souza
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Eduardo Priesnitz Friedrich
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil.
| | - Otávio Augusto Gonçalves Dias Cionek
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Leonardo Ferreira Subda
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Bárbara Luiza Bernardi
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil
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Ganesan P, Golla UR, Balashanmugam B, Munuswamy GL. Evaluation of Malocclusion Types in Adult Patients with Nasal Septal Defects - An Observational Cross-Sectional Analysis. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S1147-S1153. [PMID: 38882724 PMCID: PMC11174212 DOI: 10.4103/jpbs.jpbs_408_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 06/18/2024] Open
Abstract
Introduction The nasal septum is crucial in the development of the craniofacial structures. Deviated nasal septum is one of the anatomical causes of mouth breathing which in turn lead to malocclusion. Aims and Objectives To evaluate the dentofacial and cephalometric characteristics in individuals with nasal breathing obstruction brought on by nasal septal deviation, as well as the relationship between these defects and various malocclusions and the degree of facial asymmetry. Materials and Methods A two-point evaluation was adopted for the selected patients, one at the ENT department using clinical examination and CT-PNS and the severity classified according to the Mladina classification and another at the dental department, using clinical examinations, PA cephalograms, lateral cephalograms, and facial photographs. Results and Discussion The association between malocclusion and various grades of septal deviation was statistically significant with a P value of 0.006. Results showed that 13 patients are with Class I skeletal pattern, 20 patients with Class II, and 7 patients with Class III skeletal pattern. None of the grade 7 nasal septal deviation patients had class I malocclusion and none of the grade 2 nasal septal deviation patients had class III malocclusion. Class II division I malocclusion was the most common type noted in patients with nasal septal deviation. Grade 7 nasal septal deviation was associated with the maximum amount of ANS and mentioned deviation indicating significant facial asymmetry. Conclusion Class-II Division-1 malocclusion was the most common type noted and Class III malocclusion was more common in higher grades of nasal septal deviation. Maxillary and mandibular asymmetry worsens significantly with an increase in the grade of nasal septal deviation and is one of the significant factors in causing facial asymmetry.
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Affiliation(s)
- Poornima Ganesan
- Department of Orthodontics and Dentofacial Orthopaedics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Usha Rao Golla
- Department of Orthodontics and Dentofacial Orthopaedics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Baskaranarayanan Balashanmugam
- Department of Orthodontics and Dentofacial Orthopaedics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Geetha Lakshmi Munuswamy
- Department of Orthodontics and Dentofacial Orthopaedics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
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Carrie S, Fouweather T, Homer T, O'Hara J, Rousseau N, Rooshenas L, Bray A, Stocken DD, Ternent L, Rennie K, Clark E, Waugh N, Steel AJ, Dooley J, Drinnan M, Hamilton D, Lloyd K, Oluboyede Y, Wilson C, Gardiner Q, Kara N, Khwaja S, Leong SC, Maini S, Morrison J, Nix P, Wilson JA, Teare MD. Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT. Health Technol Assess 2024; 28:1-213. [PMID: 38477237 PMCID: PMC11017631 DOI: 10.3310/mvfr4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Background The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking. Objective The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum. Design This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation. Setting The trial was set in 17 NHS secondary care hospitals in the UK. Participants A total of 378 eligible participants aged > 18 years were recruited. Interventions Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190). Main outcome measures The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes - Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements - peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms. Results At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were -20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval -23.6 to -16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively. Limitations COVID-19 had an impact on participant-facing data collection from March 2020. Conclusions Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid. Trial registration This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Sean Carrie
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James O'Hara
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Alison Bray
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jemima Dooley
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michael Drinnan
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly Lloyd
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Wilson
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Quentin Gardiner
- Ear, Nose and Throat Department, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Naveed Kara
- Ear, Nose and Throat Department, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Sadie Khwaja
- Ear, Nose and Throat Department, Manchester Royal Infirmary, Manchester University Foundation NHS Trust, Manchester, UK
| | - Samuel Chee Leong
- Ear, Nose and Throat Department, Aintree Hospital, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sangeeta Maini
- Ear, Nose and Throat Department, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | - Paul Nix
- Ear, Nose and Throat Department, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Segalerba E, Dini Ciacci G, Quadrio M, Pralits JO. On the comparison between pre- and post-surgery nasal anatomies via computational fluid dynamics. Biomech Model Mechanobiol 2024; 23:305-314. [PMID: 37902893 PMCID: PMC10902155 DOI: 10.1007/s10237-023-01776-5] [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: 04/12/2023] [Accepted: 09/21/2023] [Indexed: 11/01/2023]
Abstract
Nasal breathing difficulties (NBD) are widespread and difficult to diagnose; the failure rate of their surgical corrections is high. Computational fluid dynamics (CFD) enables diagnosis of NBD and surgery planning, by comparing a pre-operative (pre-op) situation with the outcome of virtual surgery (post-op). An equivalent comparison is involved when considering distinct anatomies in the search for the functionally normal nose. Currently, this comparison is carried out in more than one way, under the implicit assumption that results are unchanged, which reflects our limited understanding of the driver of the respiratory function. The study describes how to set up a meaningful comparison. A pre-op anatomy, derived via segmentation from a CT scan, is compared with a post-op anatomy obtained via virtual surgery. State-of-the-art numerical simulations for a steady inspiration carry out the comparison under three types of global constraints, derived from the field of turbulent flow control: a constant pressure drop (CPG) between external ambient and throat, a constant flow rate (CFR) through the airways and a constant power input (CPI) from the lungs can be enforced. A significant difference in the quantities of interest is observed depending on the type of comparison. Global quantities (flow rate, pressure drop and nasal resistance) as well as local ones are affected. The type of flow forcing affects the outcome of the comparison between pre-op and post-op anatomies. Among the three available options, we argue that CPG is the least adequate. Arguments favouring either CFR or CPI are presented.
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Affiliation(s)
- Eric Segalerba
- Department of Civil, Chemical and Environmental Engineering, University of Genova, Via Montallegro, 1, 16145, Genoa, Italy
| | - Gabriele Dini Ciacci
- Department of Aerospace Sciences and Technologies, Politecnico di Milano, Campus Bovisa, 20156, Milano, Italy
| | - Maurizio Quadrio
- Department of Aerospace Sciences and Technologies, Politecnico di Milano, Campus Bovisa, 20156, Milano, Italy.
| | - Jan O Pralits
- Department of Civil, Chemical and Environmental Engineering, University of Genova, Via Montallegro, 1, 16145, Genoa, Italy.
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Daneshi A, Mohebbi S, Mohebi N, Mohebbi A, Roomiani M, Taheri R, Arab M, Ghanbari H. Role of Electrodiagnostic Modalities in Detection of Nasal Septal Deviation. Indian J Otolaryngol Head Neck Surg 2024; 76:403-407. [PMID: 38440467 PMCID: PMC10908955 DOI: 10.1007/s12070-023-04172-8] [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: 07/24/2023] [Accepted: 08/20/2023] [Indexed: 03/06/2024] Open
Abstract
Nasal Septal Deviation (NSD) is a common sign in otorhinolaryngology that can lead to facial asymmetry. In this case-control observational study, we assessed the role of EMG and NCS in the diagnosis of NSD and its effect on neuromuscular function. Participants were divided into two groups based on paranasal sinus computed tomography scan (PNS CT) results: NSD cases (n = 21) and controls without NSD (n = 13). EMG and NCS were performed on both groups to assess nasal alar muscles at the root of the zygomatic nerve. Our findings showed a significant correlation between NSD and EMG/NCS tests (P-value = 000) and a significant association between septal deviation and nasal alar lateralization (P-value = 000). EMG/NCS can be useful in assessing NSD by providing a better understanding of related neuromuscular structures and neuromuscular function of the nasal alar dilator muscles and aid in the diagnosis of NSD. Nasal Septal Deviation, EMG (electromyography), NCS (nerve conduction studies), Neuromuscular function, Facial asymmetry, Otorhinolaryngology, Paranasal sinus, Computed tomography, Nasal alar muscles, Zygomatic nerve, Nasal Obstruction, Nasal alar lateralization, Diagnosis.
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Affiliation(s)
- Ahmad Daneshi
- ENT and Head and Neck Research Center and Department, Department of Otolaryngology, Head and Neck Surgery, Hazrat Rasoul Akram Hospital, The Five Senses Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Saleh Mohebbi
- Department of Neurology Rasool Akram Medical Complex, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Nafiseh Mohebi
- Department of Neurology Rasool Akram Medical Complex, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Alireza Mohebbi
- ENT and Head and Neck Research Center and Department, Department of Otolaryngology, Head and Neck Surgery, Hazrat Rasoul Akram Hospital, The Five Senses Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Roomiani
- ENT and Head and Neck Research Center and Department, Department of Otolaryngology, Head and Neck Surgery, Hazrat Rasoul Akram Hospital, The Five Senses Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Reza Taheri
- ENT and Head and Neck Research Center and Department, Department of Otolaryngology, Head and Neck Surgery, Hazrat Rasoul Akram Hospital, The Five Senses Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Arab
- ENT and Head and Neck Research Center and Department, Department of Otolaryngology, Head and Neck Surgery, Hazrat Rasoul Akram Hospital, The Five Senses Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Hadi Ghanbari
- ENT and Head and Neck Research Center and Department, Department of Otolaryngology, Head and Neck Surgery, Hazrat Rasoul Akram Hospital, The Five Senses Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Manjunatha HA, Prashanth KB, Muskaan S, Prateeksha D, Arora S, Hiremath YP. Polysomnographic Assessment on Osahs Outcomes in Patients with Nasal Obstruction Undergoing Septoplasty with Partial Inferior Turbinectomy. Indian J Otolaryngol Head Neck Surg 2024; 76:770-774. [PMID: 38440456 PMCID: PMC10909015 DOI: 10.1007/s12070-023-04277-0] [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: 06/21/2023] [Accepted: 10/08/2023] [Indexed: 03/06/2024] Open
Abstract
The relationship between nasal obstruction and obstructive sleep apnea has raised interest among otolaryngologists since years. There are studies that suggest that surgical correction of nasal obstruction improves sleep quality and reduces symptoms of sleep apnea. This lead to our study to understand the effect of nasal surgery on obstructive sleep apnea hypopnea syndrome (OSAHS). AIM To assess the effect of nasal surgery in improvement in Obstructive Sleep Apnoea Hypopnoea Syndrome in patients with nasal obstruction by Polysomnography (PSG). MATERIAL AND METHODS This study included 30 patients with nasal obstruction who underwent septoplasty and/or turbinate reduction procedure with pre and post operative assessment of respiratory distress index (RDI) including apnoea hypopnoea index (AHI), obstructive apnoea index (OAI), Snoring Index (SI) using polysomnography (PSG). RESULT Nasal correction surgery showed statistically significant improvement (p-value < 0.001) in RDI from 13.66 to 6.66, OAI from 6.34 to 3.18 and Snoring Index from 161.77 to 62.23 as assessed by polysomnography. There was statistically significant improvement in minimal saturation levels (during sleep) and positional sleep apnoea. CONCLUSION Isolated nasal surgery like septoplasty and/or turbinate reduction improved sleep parameters and alleviated OSA symptoms in patients with static nasal obstruction and obstructive sleep apnoea/hypopnoea syndrome. However, patients with multilevel or dynamic airway obstruction may need further intervention.
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Affiliation(s)
- H. A. Manjunatha
- Department of Otorhinolaryngology, J.J.M Medical College, Davangere, Karnataka India
| | - K. B. Prashanth
- Department of Otorhinolaryngology, J.J.M Medical College, Davangere, Karnataka India
| | - Syeda Muskaan
- Department of Otorhinolaryngology, J.J.M Medical College, Davangere, Karnataka India
| | - D. Prateeksha
- Department of Otorhinolaryngology, J.J.M Medical College, Davangere, Karnataka India
| | - Sahil Arora
- Department of Otorhinolaryngology, J.J.M Medical College, Davangere, Karnataka India
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Hsu LF, Ratanasereeprasert N, Wang SK, Chen JT, Chen YJ, Yeh TH, Sung HH, Yao CCJ. Craniofacial and olfactory sensory changes after long-term unilateral nasal obstruction-an animal study using MMP-3-LUC transgenic rats. Sci Rep 2024; 14:2616. [PMID: 38297007 PMCID: PMC10830476 DOI: 10.1038/s41598-024-51544-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/06/2024] [Indexed: 02/02/2024] Open
Abstract
Nasal obstruction exerts considerable physiological effects on the respiratory system and craniofacial morphology during the developmental stage. This study used MMP-3-LUC transgenic rats for in vivo tracking of long-term expression in the rat nasal region after unilateral nasal obstruction. Skeletal changes of the craniofacial, nasal, and sinus regions were measured through micro-computed tomography examination and analysis with 3D image processing and calculation. Matrix metalloproteinase-3 and olfactory marker protein expression were also investigated through immunohistochemistry (IHC). Unilateral nasal obstruction significantly reduced the MMP-3 signal in the nasal region of MMP-3-LUC transgenic rats, which was mainly expressed in the respiratory epithelium. Long-term obstruction also caused morphological changes of the craniofacial hard tissue, such as nasal septal deviation, longer inter-jaw distance, and increased maxillary molar dental height. It also caused compensatory growth in olfactory nerve bundles and the olfactory epithelium, as confirmed by IHC. In our study, long-term unilateral nasal obstruction caused nasal septal deviation toward the unobstructed side, hyper divergent facial development including longer molar dental height, and reduced MMP-3 production. However, further investigation is necessary to explore the mechanism in depth.
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Affiliation(s)
- Li-Fang Hsu
- Department of Dentistry, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei, 10048, Taiwan
| | - Nutthakarn Ratanasereeprasert
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei, 10048, Taiwan
| | - Shih-Kai Wang
- Department of Dentistry, National Taiwan University School of Dentistry, Taipei, Taiwan
| | - Jung-Tsu Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei, 10048, Taiwan
| | - Yi-Jane Chen
- Department of Dentistry, National Taiwan University School of Dentistry, Taipei, Taiwan
- Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Hsuan Sung
- National Laboratory Animal Center, National Applied Research Laboratories, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei, 10048, Taiwan.
- Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan.
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Jongkhum N, Arayasantiparb R, Boonpratham S, Saengfai NN, Chaweewannakorn C, Satravaha Y, Peanchitlertkajorn S. Association between nasal septum deviation and transverse maxillary development: A retrospective cross-sectional study. Am J Orthod Dentofacial Orthop 2023; 164:575-583. [PMID: 37212766 DOI: 10.1016/j.ajodo.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The few studies investigating the relationship between nasal septum deviation (NSD) and maxillary development, using different assessment methods and the age of subjects, reported contradicting results. METHODS The association between NSD and transverse maxillary parameters was analyzed using 141 preorthodontic full-skull cone-beam computed tomography scans (mean age, 27.4 ± 9.01 years). Six maxillary, 2 nasal, and 3 dentoalveolar landmarks were measured. The intraclass correlation coefficient was used to assess intrarater and interrater reliability. The correlation between NSD and transverse maxillary parameters was analyzed using the Pearson correlation coefficient. Each transverse maxillary parameter was compared among 3 groups of different degrees of severity using the analysis of variance test. Transverse maxillary parameters were also compared between the more and less deviated nasal septum sides using the independent t test. RESULTS A correlation between deviated septal width and palatal arch depth (r = 0.2, P <0.013) and significant differences in palatal arch depth (P <0.05) among 3 NSD severity groups classified with deviated septal width was noted. There was no correlation between septal deviated angle and transverse maxillary parameters and no significant difference for transverse maxillary parameters among the 3 groups of NSD severity classified by septal deviated angle. No significant difference in transverse maxillary parameters was found when comparing the more and the less deviated sides. CONCLUSIONS This study suggests that NSD can affect palatal vault morphology. The magnitude of NSD may be a factor associated with transverse maxillary growth disturbance.
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Affiliation(s)
- Nannapat Jongkhum
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Raweewan Arayasantiparb
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Supatchai Boonpratham
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | | | - Yodhathai Satravaha
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Kucukkaraca E. Is There a Relationship Between Unilateral/Bilateral Impacted Maxillary Canines and Nasal Septum Deviation? Cureus 2023; 15:e47931. [PMID: 38034237 PMCID: PMC10684973 DOI: 10.7759/cureus.47931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction A deviated nasal septum may be associated with some dentofacial deformities. The aim of the study was to determine whether there is a relationship between some craniomaxillary features of unilateral and bilateral maxillary impacted canines and nasal septum deviation. Methods This is a retrospective study consisting of cone beam computed tomography (CBCT) images of 51 patients. All patients were divided into three subgroups: unilateral maxillary impacted canines (UMIC) (n=19) bilateral maxillary impacted canines (BMIC) (n=15), and control group (MC) (n=17). The septal deviation angle and some angular and dimensional measurements were performed. Differences in linear and angular measurements between the groups were analyzed using One-way ANOVA and the Kruskal-Wallis test. Pearson's correlation analysis was performed to determine the relationship between the septal deviation angle, septal deviation direction, nasal floor angle, and other parameters, and multivariate linear regression analysis was performed to determine the effect of variables in the septal deviation angle. Results Bilateral or unilateral position of the impacted canines was found to be effective on septal deviation. The septal deviation angle and the nasal floor angle values were found to be significantly higher in the UMIC and BMIC groups (p<0.001) than in the MC group. Maxillary width was found to be significantly lower in the BMIC group compared to the UMIC (p<0.01) and MC group (p<0.001). Septal deviation angle was positively correlated with septal deviation direction and nasal floor angle (p<0.001). Palatal width and nasal floor angle were found to be negatively correlated (p<0.05), and palatal depth and septal deviation direction were found to be positively correlated (p<0.01). Groups and septal deviation angle, septal deviation direction, and nasal floor angle were found to be negatively correlated (p<0.001). The multivariate linear regression analysis revealed an association between septal deviation angle, group (p<0.01), and nasal floor angle (p<0.05). Conclusion Bilateral or unilateral position of the impacted canines was found to be effective on septal deviation. The septal deviation angle values were found to be higher when the maxillary impacted canine was unilateral. Unilateral or bilateral positions of the impacted canine and the nasal floor angle were found to be factors affecting the formation of septal deviation.
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Affiliation(s)
- Ebru Kucukkaraca
- Department of Orthodontics, Faculty of Dentistry, Ankara Yildirim Beyazit University, Ankara, TUR
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Kalsotra G, Saroch P, Gupta A, Kalsotra P, Saraf A. The Variations in Deviation of Nasal Septum and their Impact on Maxillary Sinus Volume and Occurrence of Sinusitis. Indian J Otolaryngol Head Neck Surg 2023; 75:1762-1766. [PMID: 37636701 PMCID: PMC10447346 DOI: 10.1007/s12070-023-03710-8] [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: 02/10/2023] [Accepted: 03/15/2023] [Indexed: 08/29/2023] Open
Abstract
To study the effect of variations in deviation of the nasal septum and their impact on maxillary sinus volume and occurrence of sinusitis. This prospective observational study was conducted in the department of ENT, Head &Neck surgery GMC Jammu from August 2021 to November 2022. 130 patients (90 males, 40 females), with age range of 18-47 years with DNS were included in the study. Grade of DNS was classified according to Mladina's classification and volume of maxillary sinus was calculated using geometric formula by performing 256 slice CT Scan. In our study mean age of the males was 32.8 ± 6.99 years and females was 33.7 ± 7.26 years with Male: Female ratio of 9:4.Patients with grade 1 DNS had mean maxillary sinus volume of 9.9 ± 1.97 cu mm while patients with grade 7 DNS had mean maxillary sinus volume of 3.8 ± 1.47 cu mm. Thus, with the increasing grade of DNS, the OMC blockage increased towards the side of DNS and so the occurrence of maxillary sinusitis. The study showed that with high grade DNS, the maxillary sinus volume decreases on the side of septum deviation and there is association of blocked OMC with increasing grade of DNS. The incidence of maxillary sinusitis findings on the side of septum deviation was significantly increased.
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Affiliation(s)
- Gopika Kalsotra
- Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir 180001 India
| | - Pallavi Saroch
- Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir 180001 India
| | - Anchal Gupta
- Department of Radiodiagnosis and Imaging, Government Medical College, Jammu, Jammu and Kashmir India
| | - Parmod Kalsotra
- Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir 180001 India
| | - Aditya Saraf
- Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir 180001 India
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11
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Susaman N, Çetiner H. Is septoplasty required whenever anterior septal deviation is present? J Laryngol Otol 2023; 137:404-407. [PMID: 35730214 DOI: 10.1017/s0022215122001505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Post-operative success and patient satisfaction were assessed following septoplasty for mild to severe anterior septal deviation. METHODS The study included patients with an anterior nasal septal deviation in the form of a 'C' shape and close to the nasal valve in the anterior septal area. Deviation severity was classified as severe (group 1), moderate (group 2) or mild (group 3). Open or closed septoplasty procedures were performed. All patients were surveyed twice using the Nasal Obstruction Symptom Evaluation scale and the 36-Item Short Form Health Survey. RESULTS The mean Nasal Obstruction Symptom Evaluation score for group 1 was 15.58 ± 2.34 prior to surgery and 6.61 ± 3.29 following surgery. The corresponding pre- and post-surgery scores in group 2 were 11.9 ± 2.82 and 6.3 ± 3.03, respectively. In group 3, these values were 8.28 ± 2.63 and 7.12 ± 3.18, respectively. The mean 36-Item Short Form Health Survey physical function value for groups 1 and 2 increased after surgery; in group 3, this value decreased after surgery, but the result was not statistically significant. CONCLUSION Septoplasty is very successful for treating moderate or advanced deviations, but great care should be taken when employing septoplasty for mild deviations.
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Affiliation(s)
- N Susaman
- Department of Otolaryngology, Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
| | - H Çetiner
- Department of Otolaryngology, Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
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12
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Youn GM, Shah JP, Wei EX, Kandathil C, Most SP. Revision Rates of Septoplasty in the United States. Facial Plast Surg Aesthet Med 2023; 25:153-158. [PMID: 35394347 PMCID: PMC9986010 DOI: 10.1089/fpsam.2022.0009] [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] [Indexed: 11/13/2022] Open
Abstract
Background: Large-scale studies characterizing septoplasty revision rates are lacking. Objectives: To identify rates of septoplasty revision in the United States. Methods: Patients undergoing initial septoplasty between January 1, 2007 and December 31, 2013 were identified using the IBM® MarketScan® Commercial Database. Patients were excluded if they had nasal vestibular stenosis, rhinoplasty, or costal cartilage grafts for the initial surgery, or did not have either septoplasty, nasal vestibular stenosis, rhinoplasty, and/or costal cartilage grafts for the second surgery. Results: 295,236 patients received an initial septoplasty, and 3213 (1.1%) patients underwent a revision. Among the revision group, 178 (5.4%) patients received a septorhinoplasty, among which 13 (7.3%) required a costal cartilage graft. Older patients were less likely to need revision surgery (RS). Patients in the Northeast and West were significantly more likely than patients in the Midwest to undergo RS. Insurance plans such as comprehensive and point-of-service were associated with greater odds of RS, whereas others such as high-deductible health plans were associated with lower odds. Conclusion: Septoplasty revision rates are relatively low at 1.1% but influenced by age, region, and insurance plan.
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Affiliation(s)
- Gun Min Youn
- Stanford University School of Medicine, Stanford, California, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jay P. Shah
- Stanford University School of Medicine, Stanford, California, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Eric X. Wei
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Cherian Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sam P. Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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Basappa Varun TGS, Dutta A, Naga R, Gupta DK, Mathews S. Evaluation of endoscopic septoplasty outcomes using nasal obstruction symptom evaluation scale. JOURNAL OF MARINE MEDICAL SOCIETY 2023. [DOI: 10.4103/jmms.jmms_1_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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14
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Madani GA, El-Din WAN, Essawy AS, Hussain K, Fattah IOA. Nasal septal anatomical variations among Saudi population and their possible coincidence with sinusitis: a computed tomography scan study. Anat Cell Biol 2022; 55:423-432. [PMID: 36198657 PMCID: PMC9747349 DOI: 10.5115/acb.22.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 01/02/2023] Open
Abstract
The nasal septum is a crucial supporting factor for the nasal cavity and may develop several anatomical variants including septal deviation, spur and pneumatization. These variants could be associated with a higher incidence of sinusitis due to structural and functional alterations. So, the aim of this study was to assess the prevalence of nasal septal deviation (NSD), nasal septal spur (NSS) and nasal septal pneumatization (NSP) among the Saudi adult population and their links with the incidence of sinusitis by using computed tomography (CT). A retrospective study was achieved over a twenty-two months period on 681 adult Saudi subjects (420 males and 261 females) aged 20 years or older, referred for coronal CT evaluation of the paranasal sinuses. NSD and NSS were significantly more prevalent in males than females (80.0% vs. 67.4% respectively for NSD, and 34.5% vs. 24.9% respectively for NSS), while there was no statistical difference in frequency of NSP regarding gender (P=0.670). The incidence of sinusitis was significantly higher in presence of NSD and/or NSS (P<0.001 for both). On the contrary, NSP was not associated with a significant increase in the prevalence of sinusitis (P=0.131). In conclusion, NSD and NSS are more prevalent in males than females among the Saudi population with no statistical difference between both genders regarding the presence of septal pneumatization. Furthermore, sinusitis is more prevalent with the occurrence of NSD and NSS, and not related to the incidence of NSP.
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Affiliation(s)
- Gisma Ahmed Madani
- Department of Anatomy, Faculty of Medicine, The National University, Khartoum, Sudan
| | - Wael Amin Nasr El-Din
- Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain,Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Asmaa S. Essawy
- Department of Human Anatomy and Embryology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Khamrunissa Hussain
- Department of Family and Community Medicine, Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia
| | - Islam Omar Abdel Fattah
- Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt,Corresponding author: Islam Omar Abdel Fattah, Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia 41511, Egypt, E-mail:
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15
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Na Y, Kim YJ, Kim HY, Jung YG. Improvements in airflow characteristics and effect on the NOSE score after septoturbinoplasty: A computational fluid dynamics analysis. PLoS One 2022; 17:e0277712. [PMID: 36395146 PMCID: PMC9671303 DOI: 10.1371/journal.pone.0277712] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022] Open
Abstract
Septoturbinoplasty is a surgical procedure that can improve nasal congestion symptoms in patients with nasal septal deviation and inferior turbinate hypertrophy. However, it is unclear which physical domains of nasal airflow after septoturbinoplasty are related to symptomatic improvement. This work employs computational fluid dynamics modeling to identify the physical variables and domains associated with symptomatic improvement. Sixteen numerical models were generated using eight patients' pre- and postoperative computed tomography scans. Changes in unilateral nasal resistance, surface heat flux, relative humidity, and air temperature and their correlations with improvement in the Nasal Obstruction Symptom Evaluation (NOSE) score were analyzed. The NOSE score significantly improved after septoturbinoplasty, from 14.4 ± 3.6 to 4.0 ± 4.2 (p < 0.001). The surgery not only increased the airflow partition on the more obstructed side (MOS) from 31.6 ± 9.6 to 41.9 ± 4.7% (p = 0.043), but also reduced the unilateral nasal resistance in the MOS from 0.200 ± 0.095 to 0.066 ± 0.055 Pa/(mL·s) (p = 0.004). Improvement in the NOSE score correlated significantly with the reduction in unilateral nasal resistance in the preoperative MOS (r = 0.81). Also, improvement in the NOSE score correlated better with the increase in surface heat flux in the preoperative MOS region from the nasal valve to the choanae (r = 0.87) than in the vestibule area (r = 0.63). Therefore, unilateral nasal resistance and mucous cooling in the preoperative MOS can explain the perceived improvement in symptoms after septoturbinoplasty. Moreover, the physical domain between the nasal valve and the choanae might be more relevant to patient-reported patency than the vestibule area.
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Affiliation(s)
- Yang Na
- Department of Mechanical Engineering, Konkuk University, Gwangjin-gu, Seoul, Korea
| | - Youn-Ji Kim
- Department of Mechanical Engineering, Konkuk University, Gwangjin-gu, Seoul, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
- * E-mail:
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16
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Dutta A, Goyal L. Can Nose Scale Be Used as a Predictor of Successful Surgery in Patients Undergoing Septoplasty. Indian J Otolaryngol Head Neck Surg 2022; 74:785-791. [PMID: 36452672 PMCID: PMC9702102 DOI: 10.1007/s12070-020-01834-9] [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: 11/16/2019] [Accepted: 03/05/2020] [Indexed: 10/24/2022] Open
Abstract
The complaint of nasal obstruction or difficulty in nasal breathing is highly subjective. The benefits of surgery vary depending upon patient perception and satisfaction. Along with objective methods like nasal endoscopy improvement in subjective score of patients symptoms is definitely an important outcome parameter of management. Assessing the disease specific quality of life outcomes of patients undergoing septoplasty by means of a questionnaire using nose scale and correlating it with diagnostic nasal endoscopic findings and clinical examination thirty patients above 17 years of age, with anatomical deviation of the nasal septum as the sole cause of obstruction and symptoms persisting for more than 3 months, underwent septoplasty. Degree of septal deviation was classified as per Mladina classification. Patients Nasal Obstruction & Symptom Evaluation (NOSE) score were documented preoperatively and postoperatively and analysed. In our study it was found that there was significant improvement in nose scores which correlated with the improvement in nasal endoscopic findings. Use of NOSE score will help in letting the patient know his expected outcome following septoplasty and can be used as a predictor of successful surgery/an adjunct to clinical examination and nasal endoscopy in patients undergoing septoplasty. Disease specific health status instruments like Nose scale are needed along with objective outcome measures to compare disease-specific health status and symptom severity in patients before and after treatment. Similarly it could be used to assess differences in outcome when different surgical techniques are used. These subjective scales like nose scale can be used as along with to clinical examination and nasal endoscopy in the management of patients undergoing septoplasty.
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Affiliation(s)
- Angshuman Dutta
- Command Hospital Air Force, Old Airport Road, Bengaluru, 560007 India
| | - Lovraj Goyal
- Command Hospital Air Force, Old Airport Road, Bengaluru, 560007 India
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17
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Singh A, Garg LN, Singh G, Singh A, Puri A. To Assess the Effect of Septoplasty on Pulmonary Function Tests: A Prospective Study. Indian J Otolaryngol Head Neck Surg 2022; 74:967-971. [PMID: 36452585 PMCID: PMC9702185 DOI: 10.1007/s12070-020-02041-2] [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: 06/15/2020] [Accepted: 08/08/2020] [Indexed: 11/30/2022] Open
Abstract
To assess the effect of septoplasty on pulmonary function test (PFT). 50 cases were chosen between the age group 18-50. All cases had nasal obstruction due to nasal septum deviation. Demographic data, detailed clinical examination including anterior and posterior rhinoscopy was performed. PFT values (fvc, fev1, fev1/fvc, fef25%, fef50%, fef75%, fif25%, fif50%, fif75%) were taken pre operatively and 1 month after the surgery by using Helios 401 spirometer. All the data were recorded and spss version 20.0 was used to analyse the data. Among 50 patient, most of the patients were males 78% (n = 39) and the rest were females (n = 11) 22%. The patient were in between 18 and 50 age group. The maximum patient belonged to age group 18-27 years (n = 25) 50% of the total patients. 38% (n = 19) were in the age group of 27-37 years. 12% (n = 6) of the patients were in age group of 37-50. Nasal obstruction was present in all patients (n = 50) followed by sneezing (56%), nasal discharge (42%), and headache (26%). Maximum number of patient had deviation of septum to the left (n = 28) 56% and the rest had to the right (n = 22) 44%. After the surgery there was improvement in PFT values in all types of patient with DNS, but statistical significance was seen in type II in fef25% and fif75% values (p < 0.05). In rest of the patients there was no statistical significant improvement seen. A favorable outcome was seen in PFT values after Septoplasty, thus signifying the effect of deviated nasal septum on lower airway.
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Affiliation(s)
- Anshul Singh
- Department of E.N.T, Maharishi Markandeshwar (Deemed to be) University, Mullana, India
| | - Lakshmi Narayan Garg
- Department of E.N.T, Maharishi Markandeshwar (Deemed to be) University, Mullana, India
| | - Gurchand Singh
- Department of E.N.T, Maharishi Markandeshwar (Deemed to be) University, Mullana, India
| | - Anukrati Singh
- Department of Obstetrics and Gynaecology, Teerthanker Mahaveer University, Moradabad, India
| | - Anisha Puri
- Department of Anaesthesia, Maharishi Markandeshwar (Deemed to be) University, Mullana, India
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Dar NH, Altaf S, Patigaroo SA, Ahmad S, Rafiq R. Role of Non-contrast Computed Tomography of Nose and Paranasal Sinus in Preoperative Evaluation of Patients with Symptomatic Deviated Nasal Septum. Indian J Otolaryngol Head Neck Surg 2022; 74:1502-1509. [PMID: 36452690 PMCID: PMC9702050 DOI: 10.1007/s12070-021-02636-3] [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: 12/25/2020] [Accepted: 05/15/2021] [Indexed: 10/21/2022] Open
Abstract
Symptomatic deviated nasal septum is a commonly encountered clinical condition by otorhinolaryngologist. Non-contrast Computed tomography (NCCT) of nose and Paranasal sinuses is a good tool in the preoperative evaluation of symptomatic deviated nasal septum so as to find hidden sinonasal pathologies in addition to deviated nasal septum. The aim of this article is to find the role and scope of preoperative Computed tomography in the management of symptomatic deviated nasal septum. This cross-sectional observational study was conducted on 120 patients with symptomatic deviated nasal septum, out of which 27 had concomitant hypertrophy of inferior turbinate. All were planned for septoplasty with or without turbinoplasty. Non contrast computed tomography (NCCT) scan was done in all cases. Different findings on NCCT were noted. After NCCT was done, 33 (27.5%) out of 120 patients underwent additional surgical procedures. In conclusion, NCCT of Nose and Paranasal sinus surgery should be given due consideration in the evaluation of symptomatic deviated nasal septum so as to avoid second surgery.
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Affiliation(s)
- Nisar Hussain Dar
- Department of ENT and Head & Neck Surgery, Government Medical College, Srinagar, J&K India
| | - Sanam Altaf
- Department of ENT and Head & Neck Surgery, Government Medical College, Srinagar, J&K India
| | - Suhail Amin Patigaroo
- Department of ENT and Head & Neck Surgery, Government Medical College, Srinagar, J&K India
| | - Shabir Ahmad
- Department of Radiodiagnosis, Government Medical College, Srinagar, J&K India
| | - Rashid Rafiq
- Department of ENT and Head & Neck Surgery, Government Medical College, Srinagar, J&K India
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Nasal Septal Deviation After Surgically Assisted Rapid Maxillary Expansion. J Maxillofac Oral Surg 2022; 21:765-771. [PMID: 36274864 PMCID: PMC9475003 DOI: 10.1007/s12663-021-01529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Aim Surgically assisted rapid maxillary expansion (SARME) is a surgical technique widely used to correct deficiency of the transverse maxillary dimension. Although some studies investigated the effect of SARME on nasal and facial alterations, there is no evidence that correlates nasal septal deviation (NSD) to SARME as a possible postoperative sequel. The aim of this study is to address and quantify possible variations in the position of the nasal bony septum after SARME and identify any NSD as a postoperative outcome of this surgical technique. Patients and Methods This is a retrospective study, conducted at the Department of Oral and Maxillofacial Surgery of the University Hospital of Araraquara (Unesp, faculty of dentistry), SP, Brazil. Twenty-nine patients who underwent SARME were studied; every patient was evaluated by cone-beam computerized tomography (CBCT) before (T0) and six months after surgery (T1), and we collected the variation of nasal septal position by measuring the distance between the bony septum and the nasal lateral wall. Our measurements were carried out at the level of the head, midpoint and tail of the inferior turbinate. Results A mean NSD ranging from 0.4 to 1.2 mm was measured, and it is more pronounced at the anterior part of the bony septum. Twenty-seven patients (93.1%) presented minor changes in bony septum position; in 2 cases (6.8%), a significant NSD was found (p < 0.05). Conclusion A variation of bony nasal septum position can be expected in any direction after SARME, and it is more pronounced at anterior portion.
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Greco P, Caccamo G, Tasca I. Algorithm for Management of Nasal Valve Collapse. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00403-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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The Crooked Nose: A Practical Guide to Successful Management. Plast Reconstr Surg 2022; 149:779e-788e. [PMID: 35349547 DOI: 10.1097/prs.0000000000008918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: (1) Preoperatively evaluate the patient with a crooked nose. (2) Develop a comprehensive preoperative plan specific to the patient. (3) Effectively "deconstruct" and rebuild the crooked nose to address both aesthetic and functional concerns. (4) Use postoperative techniques to maximize outcomes. SUMMARY Correction of the crooked nose requires a detailed understanding of the relevant surgical anatomy, identification of the deforming forces-both intrinsic and extrinsic-contributing to the deformity, and knowledge of techniques needed to effect the desired change. This continuing medical education article takes the reader through the evaluation and formulation processes to develop a patient-specific plan and provides surgical pearls necessary to get the best results possible. Most importantly, this article emphasizes the need to treat the crooked nose as a reconstructive rather than routine aesthetic operation.
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22
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Instrum RS, Koch RW, Rocha T, Rohani SA, Ladak H, Agrawal SK, Sowerby LJ. Improving Nasopharyngeal Swab Technique via Simulation for Frontline Workers. Laryngoscope 2022; 133:38-42. [PMID: 35102548 PMCID: PMC9015425 DOI: 10.1002/lary.30034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES/HYPOTHESIS Nasopharyngeal swabs currently remain the gold standard for COVID-19 sample collection. A surge in testing volume has resulted in a large number of health care workers who are unfamiliar with nasal anatomy performing this test, which can lead to improper collection practices culminating in false-negative results and complications. Therefore, we aimed to assess the accuracy and educational potential of a realistic 3D-printed nasal swab simulator to expedite health care workers' skill acquisition. STUDY DESIGN Prospective pre-post interventional study. METHODS A nasal swab task trainer (NSTT) was developed to scale from computed tomography data with a deviated septum. Frontline workers at COVID-19 testing sites in Ontario, Canada, were recruited to use the NSTT for nasopharyngeal swab training. Integrated video recording capability allowed participants to self-evaluate procedure accuracy. A five-point Likert scale was collected regarding the NSTT's educational value and procedural fidelity. RESULTS Sixty-two frontline workers included in the study were primarily registered nurses (52%) or paramedics (16%). Following simulator use, self-assessed accuracy improved in 77% of all participants and 100% of participants who expressed low confidence before training. Ninety-four percent reported that the NSTT provided a complete educational experience, and 82% regarded the system as a more effective training approach than what is currently available. Eighty-one indicated that the simulator should be used at all COVID-19 testing sites, with 77% stating province-wide implementation was warranted. CONCLUSIONS The nasal swab task trainer is an effective educational tool that appears well-suited for improved skill acquisition in COVID-19 testing and may be useful for training other nasal swab applications. LEVEL OF EVIDENCE 3 Laryngoscope, 133:38-42, 2023.
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Affiliation(s)
- Ryan S. Instrum
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Robert W. Koch
- School of Biomedical EngineeringWestern UniversityLondonOntarioCanada
| | - Taciano Rocha
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Seyed Alizera Rohani
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Hanif Ladak
- Department of Electrical and Computer EngineeringWestern UniversityLondonOntarioCanada
| | - Sumit K. Agrawal
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Leigh J Sowerby
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
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Our Septoplasty Results: Evaluation with the Nose Scale. J Craniofac Surg 2021; 33:1775-1781. [PMID: 34743159 DOI: 10.1097/scs.0000000000008361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of septoplasty and septoplasty + bilateral radio frequency ablation of inferior turbinate (b-RFAIT) according to the type of operation, age groups, gender of patients, and the duration of control period by using Nasal Obstruction Symptom Evaluation (NOSE) Scale. MATERIALS AND METHODS Prospective observational study was undertaken in the otolaryngology department of a training hospital. Using the NOSE scale, the study prospectively compared the results of septoplasty only and septoplasty with b-RFAIT in the treatment of nasal obstruction caused by the combination of septal deviation and turbinate hypertrophy. Patients were divided into 2 groups. The first group had only septoplasty and the second group had septoplasty with b-RFAIT. General and local anesthesia were applied in both groups. To review clinical success, all patients were controlled at the 1st week, 1st month, and 3rd month. RESULTS One hundred seventy-eight adult patients (male/female: 127/51) with chronic nasal obstruction complaint were enrolled in this prospective study. Our data demonstrated significant improvement from baseline after 24 months for the NOSE scores in both the septoplasty and septoplasty + b-RFAIT groups. No statistical difference was noted in the amount of postoperative improvement between the 2 treatment groups (P = 0.306). No significant difference was observed between general and local anesthesia with respect to patients' preop and postop mean scores (P > 0.05). There was a significant difference between the age of patients' postoperative mean (P < 0.001). There were 4 postoperative means with respect to control time. There was an 82.29% decrease in the complaints of patients at 0 to 6 months, 80.51% decrease at 7 to 12months, 76.1% decrease at 13 to 18 months, and 59.67% decrease at 19 to 24 months. Only the last group had a significant difference regarding mean change in scores (P < 0.001). CONCLUSIONS This study shows that septoplasty + bilateral turbinate radiofrequency should be applied to patients who suffer from septum deviation with concha hypertrophy. Postoperative NOSE scale shows that the success of operation does not depend on the gender of patients and operation types (general or local anesthesia). We conclude that younger patients (18-40 age) who have obstruction with septal deviation and septum deviation with concha hypertrophy benefit more from operation than older patients do.
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Castle-Kirszbaum M, Uren B, Goldschlager T. Anatomic Variation for the Endoscopic Endonasal Transsphenoidal Approach. World Neurosurg 2021; 156:111-119. [PMID: 34610448 DOI: 10.1016/j.wneu.2021.09.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
Knowledge of anatomy and its variations is the key to safe and efficient surgery. The endoscopic endonasal route to the sella has evolved to become the preferred route to access a wide variety of diseases. We describe the skeletal, vascular, and neural anatomic variations that could be encountered from the nasal phase, through the sphenoid phase, to the sellar phase of the operative exposure. A preoperative checklist is also provided.
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Affiliation(s)
| | - Brent Uren
- Department of Ear, Nose and Throat Surgery, Monash Health, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
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25
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Abou Sleiman R, Saadé A. Effect of septal deviation on nasomaxillary shape: A geometric morphometric study. J Anat 2021; 239:788-800. [PMID: 34148243 PMCID: PMC8450481 DOI: 10.1111/joa.13479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/27/2022] Open
Abstract
Nasal cavities in their primitive stage communicate with the oral cavity until the 8th week of intrauterine life where the posterior palate initiates its development. Hence, starting from the initial growth phases, a significant connection lays between the nasal structures and the maxillary bone and witnessing key functional roles, among which the respiration. Proper nasal breathing has been proven to be a crucial factor for the maturity of the craniofacial complex, and obstruction of the respiratory airway due to nasal septum deviation can generate clinically significant reduction of the nasal airflow. This situation will imply irreversible repercussions that hinders the harmonious development of the craniofacial complex. In order to understand such potential impacts of septal deviation, our first objective was to materialize the relation between septum deviation, and both nasal cavity and maxillary structures. For the second objective, we used Procrustes analysis to assess the shape variation of these two anatomical regions, the bivariate plots of Principal Components to evaluate their shape space, and a two-block Partial Least Square (PLS) to explore their covariation. We analysed, in this cross-sectional study, 62 posteroanterior cephalometric radiographs of adult subjects from both sexes (23 males, 39 females; mean age 25.3 years) collected from the database of the Department of Orthodontics at Lebanese University. Landmarks were plotted and variables were calculated and divided into nasal septum, nasal cavity and maxillary ones. The sample was further divided into two groups based on septal deviation severity (a septal deviation is considered minor if <6). The results suggested that nasal septum deviation was correlated to reduced nasal cavity area and a reduced maxillary area. Moreover, the comparison of the two groups concluded that the difference between all variables was statistically significant with higher scores in the minor septal deviation group. These findings were corroborated with the shape analysis where the mean centroid size of nasal cavity and that of the maxilla in the group of reduced septal deviation were significantly greater than those of the group with increased angle of deviation. Results of PLS analysis concluded to a strong covariation between nasal septum and nasomaxillary complex. These conclusions support the early septoplasty in growing patients as a solution to redirect the normal course of growth and re-establish a good function of the nasomaxillary complex.
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Affiliation(s)
- Roni Abou Sleiman
- Department of Orthodontics and Dentofacial OrthopedicsLebanese UniversityBeirutLebanon
| | - Antoine Saadé
- Department of Orthodontics and Dentofacial OrthopedicsLebanese UniversityBeirutLebanon
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The Impact of Septoplasty on Cardiopulmonary Functions in Patients With Nasal Septal Deviation: A Prospective Comprehensive Analysis of Echocardiographic Outcome and Serum N-Terminal Pro BNP Levels. J Craniofac Surg 2021; 33:35-40. [PMID: 34267121 DOI: 10.1097/scs.0000000000007801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT This study was designed to evaluate the impact of septoplasty on cardiopulmonary functions in patients with nasal septal deviation (NSD). A total of 30 consecutive adult patients (mean [standard deviation] age: 33.7 [10.9] years, 56.7% were males) who underwent septoplasty due NSD were included. Visual analog scale scores, nose obstruction symptom evaluation scale scores, serum N-terminal Pro BNP levels, and cardiologic examination findings on electrocardiogram, transthoracic echocardiography, and exercise treadmill testing were evaluated both 7 days before and 3-months after septoplasty operation. A significant decrease was noted in mean (standard deviation) visual analog scale scores (8.27 [0.83] versus 1.87 [0.73], P < 0.001), and nose obstruction symptom evaluation scores (83.7 [4.9] versus 12.7 [(5.4], P < 0.001) from preoperative to postoperative period, while maximum effort capacity was improved significantly (11.8 [1.9] versus 13.1 [2.1], P = 0.010) after septoplasty. Echocardiography findings at 3rd postoperative month revealed significant decrease in pulmonary artery systolic pressure (22.2 [3.2] versus 19.0 [3.6], P = 0.001), whereas significant increase in trans-mitral early diastolic rapid filling (E wave, 0.82 [0.14] versus 0.87 [0.13], P = 0.011), peak systolic velocity (S, 0.11 [0.02] versus 0.12 [0.02], P = 0.002), tricuspid annular plane systolic excursion (22.6 [3.2] versus 24.9 [2.9], P = 0.002), and right ventricle stroke volume (0.14 [(0.02] versus 0.15 [0.02], P = 0.013). In conclusion, our findings indicate favorable outcome of septoplasty in NSD patients not only in terms of improved nasal airflow but also cardiopulmonary functions, particularly the exercise capacity, pulmonary artery pressure, and right ventricular systolic functions. In this regard, our findings emphasize the important role of treating NSD patients without delay, given the likelihood of septoplasty to reverse the changes in the pulmonary artery system and to prevent onset of permanent cardiopulmonary dysfunction via amelioration of chronic obstruction of the upper respiratory tract.
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27
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A unified resource and configurable model of the synapse proteome and its role in disease. Sci Rep 2021; 11:9967. [PMID: 33976238 PMCID: PMC8113277 DOI: 10.1038/s41598-021-88945-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/15/2021] [Indexed: 02/03/2023] Open
Abstract
Genes encoding synaptic proteins are highly associated with neuronal disorders many of which show clinical co-morbidity. We integrated 58 published synaptic proteomic datasets that describe over 8000 proteins and combined them with direct protein-protein interactions and functional metadata to build a network resource that reveals the shared and unique protein components that underpin multiple disorders. All the data are provided in a flexible and accessible format to encourage custom use.
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Galluzzi F, Garavello W, Dalfino G, Castelnuovo P, Turri-Zanoni M. Congenital bony nasal cavity stenosis: A review of current trends in diagnosis and treatment. Int J Pediatr Otorhinolaryngol 2021; 144:110670. [PMID: 33706014 DOI: 10.1016/j.ijporl.2021.110670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/31/2021] [Accepted: 03/02/2021] [Indexed: 10/22/2022]
Abstract
Congenital bony nasal cavity stenosis is caused by alterations of the normal embryological development of the nasal cavity. Depending on the site of the obstruction, the most important types of stenosis are: choanal atresia and stenosis, congenital nasal pyriform aperture stenosis, congenital midnasal stenosis, arhinia and nasal septum deviation. Although they are uncommon, they could be potentially life-threatening conditions that require early diagnosis and proper treatment. In case of neonatal nasal obstruction, appropriate differential diagnosis with other causes, such as rhinitis and sinonasal masses, are performed by nasal endoscopy and radiological exams. Treatment strategy consisting of medical nasal therapies and endoscopic or open nasal surgery should be tailored according to the types and the degree of the stenosis. When indicated, endoscopic endonasal approach is considered the most effective technique in neonates warranting minimal surgical invasiveness and maximum effect. In order to promote the management of these rare yet clinically relevant neonatal nasal breath disorders, we review the current trends in diagnosis and treatment of congenital bony nasal cavity stenosis.
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Affiliation(s)
| | - Werner Garavello
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianluca Dalfino
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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29
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Öztürk G. Combination of Crossbar and Let-Down Techniques for Dorsal Hump and Septal Correction in Rhinoplasty. Ann Plast Surg 2021; 86:501-507. [PMID: 33939652 DOI: 10.1097/sap.0000000000002818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Rhinoplasty is one of the most common and challenging surgeries in aesthetic plastic surgery. Among rhinoplasty operations, dorsal hump reduction and septal deviation surgeries are quite common. In the present research, the author describes new approaches in which let-down and crossbar techniques are used in patients with simultaneous dorsal hump and septal deviation deformations. The records of the patients were accessed from a private practice. According to the inclusion and exclusion criteria, 36 patients were included. Two approaches were defined according to patients' needs. Patients were evaluated using the "Rhinoplasty Outcome Evaluation" (ROE) questionnaire before and 12 months after surgery. The follow-up periods ranged between 14 and 21 months. The ROE scores ranged between 80 and 100 points after 1 year. The initial median ROE score was 55.5, and it increased to 90.5 points at 12 months after surgery (P < 0.001). Patient satisfaction was excellent for 90% of the included patients. The present research is the first to demonstrate the successful results of the combination of crossbar and let-down techniques in patients with septal deviation and nasal hump. Plastic surgeons will be able to solve these challenging problems without relapse with the combination of crossbar and let-down techniques.
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Affiliation(s)
- Güncel Öztürk
- From the Nisantasi University, Nisantasi, İstanbul, Turkey
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30
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Shetty SR, Al Bayatti SW, Al-Rawi NH, Marei H, Reddy S, Abdelmagyd HA, Narasimhan S, Al Kawas S, Mathew A. Analysis of inferior nasal turbinate width and concha bullosa in subjects with nasal septum deviation: a cone beam tomography study. BMC Oral Health 2021; 21:206. [PMID: 33894757 PMCID: PMC8066481 DOI: 10.1186/s12903-021-01576-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background In individuals with nasal septal deviation (NSD), compensatory hypertrophy of the nasal turbinates occurs as a protective mechanism of the nasal passage from dry and cold air. NSD associated nasal turbinate hypertrophy is usually recurrent, requiring repetitive imaging. Therefore, a multiplanar imaging modality with a low radiation dose is best suited for long-term follow-up of this condition. This study aimed to evaluate the association of width of inferior turbinates and presence of concha bullosa with the degree of NSD using Cone beam computed tomography (CT). Methods The CBCT scans of 100 patients with NSD were selected as per convenience sampling and were evaluated by two maxillofacial radiologists. The width of the non-hypertrophied inferior turbinate (NHT) on the convex side of the NSD, and hypertrophic inferior turbinates (HT) on the concave side of the NSD were measured at three locations. The septal deviation angle (SDA) and the presence of concha bullosa (CB) were determined. Results A significant difference was observed in the anterior, middle, posterior, and mean widths between HT and NHT (p < 0.001). There was a significant difference in the widths of the HT and NHT among different types of NSD. A strong positive correlation (r = 0.71, p < 0.001) was found between SDA and the mean width of the HT. Age (P = 0.71) and gender (P = 0.65) had no significant difference among different types of NSD. Regression analysis revealed that the presence of CB (p = 0.01) and middle width of the HT (p < 0.001) are significant predictors of SDA and type of NSD. Conclusion The results of the present study reveal that the middle width of the HT and the presence of CB influence the degree of NSD. The present study results recommend the use of CBCT as a substitutive low radiation dose imaging modality for evaluation of NSD, CB, and associated inferior turbinate hypertrophy.
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Affiliation(s)
- Shishir Ram Shetty
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates. .,Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.
| | | | | | - Hesham Marei
- College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
| | - Sesha Reddy
- College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
| | | | - Sangeetha Narasimhan
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Sausan Al Kawas
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Asok Mathew
- University of Science and Technology of Fujairah, Fujairah, United Arab Emirates
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31
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Bruno G, Stefani AD, Benetazzo C, Cavallin F, Gracco A. Changes in nasal septum morphology after rapid maxillary expansion: a Cone-Beam Computed Tomography study in pre-pubertal patient. Dental Press J Orthod 2020; 25:51-56. [PMID: 33206829 PMCID: PMC7668057 DOI: 10.1590/2177-6709.25.5.051-056.oar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/18/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction: Nasal septum deviation (NSD) is the most common structural cause of nasal obstruction, affecting around 65-80% of the adult population. Rapid maxillary expansion (RME) is currently used for treatment of maxillary transverse deficiency, but can also influence nasal cavity geometry. Objective: The present study aimed at evaluating the changes in NSD by using Cone-Beam Computed Tomography (CBCT) scans in pre-pubertal patients treated with RME. Methods: This retrospective exploratory study evaluated 20 pre-pubertal patients (mean age 10 ± 2 years) who were treated for transverse maxillary constriction with RME and presented mild/moderate NSD as an incidental finding. The outcome measures were NSD tortuosity and area. These measures were obtained from transverse and coronal views of records taken before and after RME treatment. Intra-rater reliability was also assessed with intraclass correlation coefficient. Results: NSD was mild in thirteen patients (65%) and moderate in seven (35%). NSD tortuosity index did not significantly change over time (mean difference 0.002 mm/year, 95% CI; p = 0.58). NSD area did not significantly change over time (mean difference 2.103 mm2/year, 95% CI; p = 0.38). Intraclass correlation coefficient was 0.73 (95% CI) for NSD tortuosity and 0.84 (95% CI) for NSD area. Conclusions: NSD tortuosity and area suggested potential changes in NSD with small clinical relevance in pre-pubertal patients who were treated with RME. Additional studies using CBCT scans in larger samples are required to clarify the role of RME in NSD treatment.
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Affiliation(s)
- Giovanni Bruno
- Università di Padova, Faculty of Dentistry (Padova, Italy)
| | | | | | | | - Antonio Gracco
- Università di Padova, Faculty of Dentistry (Padova, Italy)
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32
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Kang XR, Chen B, Chen YS, Yi B, Yan X, Jiang C, Wang S, Lu L, Shi R. A prediction modeling based on SNOT-22 score for endoscopic nasal septoplasty: a retrospective study. PeerJ 2020; 8:e9890. [PMID: 32974101 PMCID: PMC7489239 DOI: 10.7717/peerj.9890] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background To create a nomogram prediction model for the efficacy of endoscopic nasal septoplasty, and the likelihood of patient benefiting from the operation. Methods A retrospective analysis of 155 patients with nasal septum deviation (NSD) was performed to develop a predictive model for the efficacy of endoscopic nasal septoplasty. Quality of life (QoL) data was collected before and after surgery using Sinonasal Outcome Test-22 (SNOT-22) scores to evaluate the surgical outcome. An effective surgical outcome was defined as a SNOT-22 score change ≥ 9 points after surgery. Multivariate logistic regression analysis was then used to establish a predictive model for the NSD treatment. The predictive quality and clinical utility of the predictive model were assessed by C-index, calibration plots, and decision curve analysis. Results The identified risk factors for inclusion in the predictive model were included. The model had a good predictive power, with a AUC of 0.920 in the training group and a C index of 0.911 in the overall sample. Decision curve analysis revealed that the prediction model had a good clinical applicability. Conclusions Our prediction model is efficient in predicting the efficacy of endoscopic surgery for NSD through evaluation of factors including: history of nasal surgery, preoperative SNOT-22 score, sinusitis, middle turbinate plasty, BMI, smoking, follow-up time, seasonal allergies, and advanced age. Therefore, it can be cost-effective for individualized preoperative assessment.
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Affiliation(s)
- Xue-Ran Kang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Bin Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Yi-Sheng Chen
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Yi
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Xiaojun Yan
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Chenyan Jiang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Shulun Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Lixing Lu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Runjie Shi
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
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33
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Samarei R, Mabarian S. A randomised trial comparing the subjective outcomes following septoplasty with or without inferior turbinoplasty. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:277-283. [PMID: 32482570 DOI: 10.1016/j.anorl.2020.01.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/27/2019] [Accepted: 01/06/2020] [Indexed: 11/27/2022]
Abstract
AIMS The surgical management of contralateral inferior turbinate hypertrophy in patients with deviated nasal septum is controversial. In this randomised clinical trial, we aimed to investigate the subjective improvement of nasal symptoms postoperatively in patients undergoing septoplasty with or without inferior turbinoplasty. MATERIAL AND METHODS One hundred and thirty-seven patients with nasal obstruction, who had unilateral septal deviation and compensatory contralateral inferior turbinate enlargement, were randomised into either septoplasty alone arm (n=66) or septoplasty combined with turbinoplasty arm (n=71). Preoperative symptom scores and the subjective perception of the nasal obstruction were compared between two groups of the study using Nasal Obstruction Symptom Evaluation Scale (NOSE) and Visual analog scale (VAS) respectively. The measurements were repeated 6 months after surgery as well as at 1, 2, and 4 years postoperatively. RESULTS With regard to the findings obtained from both scales, both interventions successfully relieved the patients' complaints of nasal obstruction at almost all postoperative visits when compared with the baseline measurements (P˂0.005 for most comparisons). However, the relief of nasal obstruction was more pronounced in patients undergoing combined intervention at all postoperative visits, except at the 1st follow-up session (P˂0.005). Nasal symptoms of septoplasty alone group began to deteriorate over the period between month 24 and month 48. In contrast, patients undergoing the combined surgery steadily showed symptomatic improvement over the whole period of study. CONCLUSIONS A turbinate reduction surgery should be conducted along with septoplasty to achieve better results in cases suffering from deviated nasal septum with concomitant hypertrophied inferior turbinate.
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Affiliation(s)
- R Samarei
- Department of Otolaryngology, Urmia University of Medical Sciences, Urmia, Iran.
| | - S Mabarian
- Department of Otolaryngology, Urmia University of Medical Sciences, Urmia, Iran
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34
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Gokce G, Veli I, Yuce YK, Isler Y. Efficiency evaluation of rapid maxillary expansion treatment on nasal septal deviation using tortuosity ratio from cone-beam computer tomography images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 188:105260. [PMID: 31862681 DOI: 10.1016/j.cmpb.2019.105260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/12/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE This study aims to assess the effect of Rapid Maxillary Expansion (RME) on Nasal Septal Deviation (NSD) changes from three-dimensional (3D) images. METHODS In this study, cone-beam computed tomography (CBCT) images from 15 patients with maxillary constriction (mean age 12 ± 1.6 years) were included. RME treatment with Hyrax appliance was performed in all patients. CBCT scans were taken at three different times; before appliance insertion (T0), after active expansion (T1) and 3 months after appliance insertion (T2). We developed a novel Matlab-based application to quantify NSD based on the tortuosity ratio by dividing the actual length of the septum by the ideal length in the mid-sagittal plane by using this application. RESULTS Tortuosity ratio (TR) values were found as 1.03 ± 0.03 (T0), 1.02 ± 0.02 (T1), and 1.02 ± 0.02 (T2). Differences of TR values among these groups were evaluated using the statistical method of ANOVA (ANalysis Of VAriance) for repeated measures with the significance level of p ≤ .05. Results showed significant reductions in TR values between T0-T1 (p ≤ .05) and between T0-T2 (p ≤ .05). Nonetheless, a significant difference between T1-T2 was not determined (p > .05). CONCLUSIONS As a result, we can conclude that the NSD degree is affected by the RME treatment. The developed application can be used for both educational and research purposes.
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Affiliation(s)
- Gokcenur Gokce
- Faculty of Dentistry, Department of Orthodontics, Izmir Katip Celebi University, Cigli, Izmir, Turkey
| | - Ilknur Veli
- Faculty of Dentistry, Department of Orthodontics, Izmir Katip Celebi University, Cigli, Izmir, Turkey
| | - Yilmaz Kemal Yuce
- Rafet Kayis Faculty of Engineering, Department of Computer Engineering, Alanya Alaaddin Keykubat University, Alanya, Antalya, Turkey
| | - Yalcin Isler
- Faculty of Engineering and Architecture, Department of Biomedical Engineering, Izmir Katip Celebi University, Cigli, Izmir, Turkey.
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35
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De Virgilio A, Pellini R, Mercante G, Ferreli F, Petruzzi G, Spriano G. Who should perform the rhinopharyngeal swab in COVID-19 positive patients? Head Neck 2020; 42:1250-1251. [PMID: 32329138 PMCID: PMC7264563 DOI: 10.1002/hed.26194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Armando De Virgilio
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Mercante
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Fabio Ferreli
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Cellina M, Gibelli D, Cappella A, Martinenghi C, Belloni E, Oliva G. Nasal cavities and the nasal septum: Anatomical variants and assessment of features with computed tomography. Neuroradiol J 2020; 33:340-347. [PMID: 32193968 DOI: 10.1177/1971400920913763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The nasal cavities are complex anatomical structures with high inter-individual variability that relates to different functions. Different anatomic variants may manifest at this site, mainly belonging to the nasal septum and turbinates. Precise knowledge of the anatomy and variants is fundamental for both radiologists and ENT surgeons. This article provides an overview of the main anatomic variants and their frequency, according to the existing literature, as well as ongoing research on nasal cavity segmentation in order to obtain personal 3D models and to predict post-surgical results.
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Affiliation(s)
| | - Daniele Gibelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy
| | - Annalisa Cappella
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy
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Patel PN, Kandathil CK, Most SP. Outcomes of Combined Anterior Septal Reconstruction and Dorsal Hump Reduction. Laryngoscope 2020; 130:E803-E810. [PMID: 32163185 DOI: 10.1002/lary.28611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/22/2020] [Accepted: 02/15/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Deviations of the caudal nasal septum can impact airflow and aesthetics. The anterior septal reconstruction (ASR) technique, a modification of extracorporeal septoplasty, addresses this issue while preserving a segment of the dorsal septum. When ASR is combined with dorsal hump reductions and osteotomies, the keystone may be destabilized. This study evaluates the outcomes of this intervention. STUDY DESIGN Retrospective chart review. METHODS This is a retrospective study evaluating the functional and aesthetic outcomes of 58 patients who underwent ASR combined with dorsal hump reductions (with or without osteotomies). The Nasal Obstruction Symptom Evaluation (NOSE) and Standardized Cosmesis and Health Nasal Outcomes Survey Obstructive/Cosmetic (SCHNOS-O, SCHNOS-C) scores were measured and compared pre- and postoperatively. Linear regression analysis was performed to determine the impact of sex, gender, osteotomies, and trauma on outcomes. RESULTS Mean improvement in NOSE, SCHNOS-O, and SCHNOS-C scores within the first 3 months after surgery were -41.8, -32.6, and -51.5 respectively (P < .05). At follow-up >9 months, these improvements were also significant for NOSE and SCHNOS-O scores and approached significance (P = .06) for SCHNOS-C scores. A subanalysis of patients who underwent osteotomies yielded functional and aesthetic improvements across all follow-up periods, all of which were significant with the exception of SCHNOS-O scores at >9 months (P = .1). In a multiple linear regression analysis, osteotomies contributed significantly to change in SCHNOS-C scores (β = -64.09, P = .001) at 3- to 9-month follow-up. CONCLUSIONS The combination of ASR, hump take down, and osteotomies is safe and efficacious with implications for patients who seek correction of caudal septal deviations in conjunction with changes in external contour deformities. LEVEL OF EVIDENCE 3 Laryngoscope, 2020.
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Affiliation(s)
- Priyesh N Patel
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Cherian K Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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Spataro EA, Saltychev M, Kandathil CK, Most SP. Outcomes of Extracorporeal Septoplasty and Its Modifications in Treatment of Severe L-Strut Septal Deviation: A Systematic Review and Meta-analysis. JAMA FACIAL PLAST SU 2020; 21:542-550. [PMID: 31621791 DOI: 10.1001/jamafacial.2019.1020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance While extracorporeal septoplasty (ECS) and its modifications have been previously studied, to our knowledge, no systematic review of surgical outcomes and complications of this technique has been performed. Objective To evaluate the evidence of surgical outcomes and complications of ECS (including modified techniques) to treat severe L-strut septal deviation defined as deviation within 1.0 cm of the caudal or dorsal septum. Data Sources MEDLINE, Embase, CINAHL, CENTRAL, Scopus, and Web of Science databases and reference lists were searched from inception to April 2018 for clinical and observational studies. Search terms included extracorporeal, septoplasty, and septum. Study Selection Selection criteria were defined according to the population, intervention, comparison, and outcome framework. Relevant studies were selected by 2 independent reviewers based on abstracts and full texts. Data Extraction and Synthesis Data were extracted using standardized lists chosen by the authors according to Cochrane Collaboration guidelines. Data were collected and synthesized with ranges reported, as well as assessment of bias and heterogeneity when applicable. Analysis started in February 2019. Main Outcomes and Measures Outcomes assessed included functional nasal airway improvement by objective measurements and subjective measurements (Nasal Obstruction Symptom Evaluation [NOSE] and visual analog scale scores); complications including bleeding, infection, dorsal irregularities, and other functional or cosmetic deficits; and as revision surgery rates. Results Of 291 records initially obtained, 31 were considered relevant after review according to PRISMA guidelines. All studies except 1 randomized clinical trial (3.2%) were observational in nature, with 21 retrospective studies (67.7%) and 9 prospective studies (29.0%). Conventional ECS was performed in 16 studies (51.6%), and modified ECS was performed in 15 studies (48.4%). The sample size varied from 10 to 567, and the mean age varied from 22.5 to 46 years. Of 31 studies, 14 (45%) were of good methodology. Meta-analysis was performed on 5 studies reporting change in NOSE scores, with pooled effect of -60.0 (95% CI, -67.8 to -52.2) points, but heterogeneity was high, with I2 = 96%. When comparing complications between modified and conventional ECS, the relative risk for infections was 0.95 (95% CI, 0.34-2.7); for bleeding, 0; for nasal dorsal irregularities, 0.29 (95% CI, 0.16-0.53); for other cosmetic complications, 4.3 (95% CI, 0.87-21.1); for other functional complications, 0.47 (95% CI, 0.20-1.1); and for revision operations, 1.4 (95% CI, 0.83-2.3). Conclusions and Relevance Of the 31 studies included in this systematic review, less than half were of good methodology, and a significant level of heterogeneity was found regarding type of outcome measure used and reporting of complications. To improve the level of evidence, better study methodology, standardization of surgical outcomes measures, and reporting of complications are needed.
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Affiliation(s)
- Emily A Spataro
- Division of Facial Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Mikhail Saltychev
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Cherian K Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
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Fertuzinhos A, Teixeira MA, Ferreira MG, Fernandes R, Correia R, Malheiro AR, Flores P, Zille A, Dourado N. Thermo-Mechanical Behaviour of Human Nasal Cartilage. Polymers (Basel) 2020; 12:polym12010177. [PMID: 31936593 PMCID: PMC7023433 DOI: 10.3390/polym12010177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to undergo a comprehensive analysis of the thermo-mechanical properties of nasal cartilages for the future design of a composite polymeric material to be used in human nose reconstruction surgery. A thermal and dynamic mechanical analysis (DMA) in tension and compression modes within the ranges 1 to 20 Hz and 30 °C to 250 °C was performed on human nasal cartilage. Differential scanning calorimetry (DSC), as well as characterization of the nasal septum (NS), upper lateral cartilages (ULC), and lower lateral cartilages (LLC) reveals the different nature of the binding water inside the studied specimens. Three peaks at 60–80 °C, 100–130 °C, and 200 °C were attributed to melting of the crystalline region of collagen matrix, water evaporation, and the strongly bound non-interstitial water in the cartilage and composite specimens, respectively. Thermogravimetric analysis (TGA) showed that the degradation of cartilage, composite, and subcutaneous tissue of the NS, ULC, and LLC take place in three thermal events (~37 °C, ~189 °C, and ~290 °C) showing that cartilage releases more water and more rapidly than the subcutaneous tissue. The water content of nasal cartilage was estimated to be 42 wt %. The results of the DMA analyses demonstrated that tensile mode is ruled by flow-independent behaviour produced by the time-dependent deformability of the solid cartilage matrix that is strongly frequency-dependent, showing an unstable crystalline region between 80–180 °C, an amorphous region at around 120 °C, and a clear glass transition point at 200 °C (780 kJ/mol). Instead, the unconfined compressive mode is clearly ruled by a flow-dependent process caused by the frictional force of the interstitial fluid that flows within the cartilage matrix resulting in higher stiffness (from 12 MPa at 1 Hz to 16 MPa at 20 Hz in storage modulus). The outcomes of this study will support the development of an artificial material to mimic the thermo-mechanical behaviour of the natural cartilage of the human nose.
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Affiliation(s)
- Aureliano Fertuzinhos
- CMEMS-UMinho, Departamento de Engenharia Mecânica, Universidade do Minho, Campus de Azurém, 4804-533 Guimarães, Portugal; (A.F.); (P.F.)
| | - Marta A. Teixeira
- 2C2T—Centro de Ciência e Tecnologia Têxtil, Universidade do Minho, Campus de Azurém, 4804-533 Guimarães, Portugal; (M.A.T.); (A.Z.)
| | - Miguel Goncalves Ferreira
- Department of Otolaryngology, Head and Neck Surgery, Santo António Hospital, 4099-001 Porto, Portugal;
| | - Rui Fernandes
- HEMS—Histology and Electron Microscopy, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal; (R.F.); (R.C.); (A.R.M.)
- IBMC—Instituto de Biologia Molecular e Celular, University of Porto, 4200-135 Porto, Portugal
| | - Rossana Correia
- HEMS—Histology and Electron Microscopy, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal; (R.F.); (R.C.); (A.R.M.)
- Ipatimup—Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135 Porto, Portugal
| | - Ana Rita Malheiro
- HEMS—Histology and Electron Microscopy, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal; (R.F.); (R.C.); (A.R.M.)
- IBMC—Instituto de Biologia Molecular e Celular, University of Porto, 4200-135 Porto, Portugal
| | - Paulo Flores
- CMEMS-UMinho, Departamento de Engenharia Mecânica, Universidade do Minho, Campus de Azurém, 4804-533 Guimarães, Portugal; (A.F.); (P.F.)
| | - Andrea Zille
- 2C2T—Centro de Ciência e Tecnologia Têxtil, Universidade do Minho, Campus de Azurém, 4804-533 Guimarães, Portugal; (M.A.T.); (A.Z.)
| | - Nuno Dourado
- CMEMS-UMinho, Departamento de Engenharia Mecânica, Universidade do Minho, Campus de Azurém, 4804-533 Guimarães, Portugal; (A.F.); (P.F.)
- Correspondence:
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Wang Y, Bonaparte JP. Diagnosis and management of septal deviation and nasal valve collapse - a survey of Canadian otolaryngologists. J Otolaryngol Head Neck Surg 2019; 48:71. [PMID: 31842991 PMCID: PMC6916251 DOI: 10.1186/s40463-019-0394-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/05/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Management of nasal valve collapse (NVC) in patients with a septal deviation can be challenging. Our objective was to determine the opinions of Canadian Otolaryngologists regarding the diagnosis and management of nasal obstruction in patients with septal deviation and NVC. METHODS A twenty-question survey was developed for the purpose of our study. Questions were divided into the following areas: diagnosis, management and prognosis. We included all otolaryngologists who were members of the Canadian Society of Otolaryngology. RESULTS The response rate to our survey was 18%. The most commonly identified cause of a failed septoplasty was incomplete septoplasty (41.9%), followed by nasal valve collapse (25.6%). The Cottle manoeuvre (62.8%) and visual inspection (39.5%) were noted to be the most important diagnostic tools for external and internal NVC respectively. However, physicians often rely on a variable number of different examinations when making a diagnosis of nasal valve collapse. When evaluating which patients with a septal deviation also required nasal valve surgery, 27.9% of responders believed the current physical examination methods provided a high accuracy, while 55.8% indicated moderate accuracy and 16.3% indicated low accuracy. Compared to other subspecialties in Otolaryngology, Facial Plastic and Reconstruction Surgeons noted higher septoplasty failure rates in patients with co-morbid NVC. CONCLUSIONS NVC is an important concern for otolaryngologists performing septoplasty. Although most physicians believe that the physical exam provides a moderate effectiveness when predicting who requires a functional rhinoplasty, diagnostic methods used for NVC is varied and inconsistent.
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Affiliation(s)
- Yiqiao Wang
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - James P Bonaparte
- Department of Otolaryngology - Head and Neck Surgery, Senior Clinical Investigator, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
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Outcome of Septoplasty with Inferior Turbinectomy as an In-patient or Out-patient Procedure. Sci Rep 2019; 9:7573. [PMID: 31110327 PMCID: PMC6527848 DOI: 10.1038/s41598-019-44107-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 05/09/2019] [Indexed: 11/08/2022] Open
Abstract
The study aimed to compare the surgical outcomes of septoplasty with inferior turbinectomy between in-patient and out-patient groups. A total of 152 patients who underwent septoplasty with inferior turbinectomy between May 2012 and February 2013 were retrospectively reviewed and divided into in-patient group and out-patient group. The two groups were compared in three aspects: (i) consumption of medical resources, including National Health Insurance payments, patient surcharges, and total surgical expenses; (ii) prognostic indicators; and (iii) post-operative complications. There were no statistically significant differences between the prognostic indicators or post-operative complications in the 2 study groups except for "duration of nasal decongestant use". The in-patient group had higher medical resource consumption in all categories. In conclusion, septoplasty with inferior turbinectomy can be performed cost-effectively as an out-patient procedure with satisfactory quality and adequate safety.
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Caglar O, Guclu O, Oymak S, Derekoy S. The Effects of Different Types of Nasal Packing on Odor Function and Mucociliary Function After Septum Surgery. EAR, NOSE & THROAT JOURNAL 2019; 98:486-489. [PMID: 31032654 DOI: 10.1177/0145561319843074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In this study, we evaluated how the Merocel and nasal splint packing placed in the nose after septoplasty surgery affects the olfactory and mucociliary functions of the nose in the early period, and compared the 2 packing with each other. MATERIAL AND METHOD The study included 60 patients with isolated septal deviation and 30 patients in the control group. The patients were randomly divided into 2 groups. Nasal splint was inserted after septoplasty in group A (n = 30). Merocel was inserted in group B (n = 30). The Sniffin sticks test and saccharin test were applied to the patients before surgery and 15 days after the surgery. The same tests were applied to the control group consisting of 30 patients and the results were compared. RESULTS No complications, such as postoperative bleeding, submucoperichondrial hematoma, or abscess formation, were found in both groups. Mucociliary function was improved after septoplasty, and it was statistically significant, but there was no statistically significant difference between both packing groups. A statistically significant difference was found for the odor test in patients who used nasal splint packing in comparison with patients who used Merocel in the early period. CONCLUSION The odor test showed significant differences between the 2 groups and this was statistically significant in the early period. Mucociliary function was better after surgery, but there was no statistical difference in the different nasal packing groups.
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Affiliation(s)
- Ozge Caglar
- Otorhinolaryngology Department, University Medical School, Canakkale Onsekiz Mart Universitesi, Canakkale, Turkey
| | - Oguz Guclu
- Otorhinolaryngology Department, University Medical School, Canakkale Onsekiz Mart Universitesi, Canakkale, Turkey
| | - Sibel Oymak
- Public Health Department, University Medical School, Canakkale Onsekiz Mart Universitesi, Canakkale, Turkey
| | - Sefa Derekoy
- Otorhinolaryngology Department, University Medical School, Canakkale Onsekiz Mart Universitesi, Canakkale, Turkey
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Abstract
PURPOSE OF REVIEW To examine the recent literature on extracorporeal septoplasty. RECENT FINDINGS The literature suggests that extracorporeal septoplasty is an effective approach for both functional and cosmetic treatment of moderate to severe deformities of the caudal and dorsal septum. The procedure can be performed via an endonasal or external approach based on the nature of the deformity and the experience of the surgeon, although recent literature highlights various advantages of an external approach. The use of polydioxanone foil as a scaffold for septal reconstruction is widely accepted, and can enhance the technical performance of this technique. Although reported complication rates are low, tip deprojection and rotation have been observed in cases where extracorporeal septoplasty is performed without simultaneous rhinoplasty. SUMMARY Extracorporeal septoplasty is a useful technique in the armamentarium of surgeons addressing deviations of the dorsal and caudal septum.
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Polysomnographic and pulmonary function changes in patients with sleep problems after septoplasty with turbinectomy. Am J Otolaryngol 2019; 40:187-190. [PMID: 30558896 DOI: 10.1016/j.amjoto.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 11/21/2022]
Abstract
OBJECT To compare Polysomnography and Pulmonary function tests before and after Septoplasty with Turbinectomy in patients complaining of nasal obstruction and sleep problems due to deviated septum with hypertrophic inferior turbinate. METHODS 90 patients underwent Septoplasty with Turbinectomy due to nasal obstruction and sleep problems involved in this study, their sleep quality evaluated by polysomnography before and after the surgery, their pulmonary functions assessed by spirometry before and after the operation. RESULTS The postoperative pulmonary function values; FVC, FEV1, PEFR and postoperative polysomonographic values; AHI, Snoring index/hour, SpaO2 were higher than the preoperative values, and the results were statistically significant (p-values <0.001). CONCLUSION Septoplasty with partial inferior turbinectomy might be a useful operation in the management of nasal obstruction and sleep problems that caused by a deviated nasal septum and hypertrophied inferior turbinate.
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Evaluation of Heart Functions With Detailed Echocardiogram in Patients With Septum Deviation. J Craniofac Surg 2019; 29:2148-2152. [PMID: 30028402 DOI: 10.1097/scs.0000000000004742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND One of the most important reasons for nasal congestion is septum deviation. Nasal septal deviation increases airway resistance and can cause systemic problems. In this study, echocardiographic findings were compared with the normal population to see how cardiac function was affected in patients with obstructive nasal septum deviation. METHODS This study included a young patient group with 44 obstructive septum deviation patients and 30 healthy individuals with no nasal-related problems. Echocardiography was performed by the same cardiologist and results were compared with normal patients. The authors got permission from the ethics committee of faculty for the study (E. 116795). RESULTS In the patient group with septum deviation, pulmonary artery pressure was high. In addition, the size of the right heart chambers was also increased. TAPSE, pulmonary acceleration time, ejection fraction, and right ventricular outflow tract-fractional shortening were found to be lower than the normal group. CONCLUSION Patients with obstructive septum deviations should be evaluated early for cardiologic functions.
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Lawlor CM, Grant M, Levy J, Ananth A, Guarisco JL. Neonatal nasal septal deviation: Two cases of successful early surgical intervention. EAR, NOSE & THROAT JOURNAL 2018; 96:E20-E23. [PMID: 28846795 DOI: 10.1177/014556131709600806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Neonatal nasal septal deviations can occur as a result of trauma in utero or during birth. They are associated with significant clinical implications, including respiratory distress and failure to thrive. The incidence and classification of these deformities are varied in the otolaryngology literature. Some authors advocate conservative observation, but no consensus on management has been reached. We present 2 cases of neonatal septal deviation that occurred during difficult deliveries. We repaired the defects with closed reduction in the operating room within the first 2 weeks of life to good effect.
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Affiliation(s)
- Claire M Lawlor
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, 1430 Tulane Ave., SL-59, New Orleans, LA 70112-2699, USA.
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Does Septoplasty Improve Heart Functions of Patients With Septum Deviation in Terms of Echocardiography Findings? J Craniofac Surg 2018; 28:1803-1805. [PMID: 28857985 DOI: 10.1097/scs.0000000000003814] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The authors aimed to determine pulmonary artery pressure and right heart functions in patients with nasal septum deviation (NSD) with echocardiography (EchoCG) and compare the postoperative changes of EchoCG parameters with preoperative findings. METHODS Seventy-six patients who underwent septoplasty composed the study group. Average age of patients was 23.50 ranging between 18 and 48 years of age. There were 53 males (69.7%) and 23 females (30.3%). Mean pulmonary artery pressure, tricuspid annular-plane systolic excursion, right ventricular diameter, and e/a ratio were measured by EchoCG preoperatively and same parameters were reobtained 3 months after surgery. RESULTS Mean pulmonary artery pressure reduced from 23.88 ± 6.36 to 19.80 ±3.95 mm Hg and tricuspid annular-plane systolic excursion increased from 22.36 ±3.85 to 23.57±3.00 3 months after surgery. It represented statistically significant improvement at right heart functions postoperatively (P < 0.001). Although they were not statistically significant, there was also some improvement in right ventricular diameter and e/a ratio values postoperatively. CONCLUSION Nasal septum deviation was associated with higher PAP values, which were improved after surgery. Although at a lower extent, a negative effect of NSD on right heart functions was also suspected. Thus, treatment of NSD without delay was proposed, not only to treat the nasal symptoms but possible future cardiovascular complications as well.
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Tasca I, Ceroni Compadretti G. Immediate Correction of Nasal Septum Dislocation in Newborns: Long-Term Results. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240401800110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The authors present the results of a long-term follow-up after an immediate reduction of nasal septum luxation in newborn infants. Methods Forty-nine children, who underwent a treatment for septal dislocation within 48 hours after birth, were reexamined in 2002 at a mean age of 13.2 years (range, 10–17 years). The examination was performed through inspection of the nasal pyramid, anterior rhinoscopy, nasal endoscopy, rhinomanometry, and acoustic rhinometry. Results Anatomic and functional findings showed satisfactory results for all children affected by septal dislocation. Three patients presenting irreplaceable septal-pyramidal deformity had no spontaneous reduction at 7-, 10-, and 11-year follow-ups and thus required surgical intervention. Conclusions Considering the simplicity and the safety of the reduction maneuver, the importance of early detection and treatment of neonatal septal dislocations is stressed. This is the longest follow-up study reported in international literature to date.
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Affiliation(s)
- Ignazio Tasca
- Ear, Nose, and Throat Department–AUSL Imola, Castel San Pietro Terme (BO), Italy
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Suonpää JT, Sipilä JI, Laippala PJ. Do Rhinomanometric Findings Predict Subjective Postoperative Satisfaction? Long-term follow-up after Septoplasty. ACTA ACUST UNITED AC 2018. [DOI: 10.2500/105065893781976500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Eighty-eight septoplasty patients were controlled with rhinomanometry 6 months after surgery and their subjective satisfaction was re-evaluated with a questionnaire 3–5 years after surgery. A slight but not statistically significant tendency for a decreasing level of subjective satisfaction was evident. The results show that patients whose nasal airways resistance was high preoperatively and patients who were normalized surgically were the most satisfied. The number of symptom-free patients was lower among those who were operated on with normal resistance, and in these cases it is suggested that the positive response is mainly a result of the spontaneous course of the chronic disease of nasal mucosa (e.g., allergic rhinitis), not a result of the operation. Preoperative rhinomanometry helps to select patients who benefit most from the surgery and thus, saves operative resources.
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Affiliation(s)
- Jouko T. Suonpää
- Department of Otorhinolaryngology, Turku University Central Hospital, Turku
| | - Jukka I. Sipilä
- Department of Otorhinolaryngology, Turku University Central Hospital, Turku
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Holton NE, Piche A, Yokley TR. Integration of the nasal complex: Implications for developmental and evolutionary change in modern humans. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2018; 166:791-802. [PMID: 29566424 DOI: 10.1002/ajpa.23466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/12/2018] [Accepted: 03/06/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Assessing the strength of integration among different regions of the modern human nasal complex is important for developing a more thorough understanding of the determinants of nasal morphology. Given the morphogenetic influence of cartilage on adjacent intramembranous growth sites, the interaction between chondrocranial- versus intramembranous-derived nasal structures may have a significant influence on patterns of nasal variation. The purpose of this study is to examine integration between the chondrocranial- and intramembranous-derived regions of the nasal complex. MATERIALS AND METHODS Using computed tomograph (CT) scans, we collected three-dimensional coordinate landmark data from a static adult sample (n = 62). First, using centroid size, and the symmetric and asymmetric components of shape variation, we examined the strength of integration between landmarks representing chondrocranial-derived structures (e.g., ethmoid, external nasal cartilages) and landmarks representing intramembranous-derived structures (nasal floor, anterior nasal aperture, etc.). Second, given that the strength of integration is a relative measure, we compared integration between chondrocranial- and intramembranous-derived structures to the more modularized external and internal regions of the nasal complex. RESULTS There was significant moderate morphological integration between chondrocranial- versus intramembranous-derived regions of the nasal complex. Moreover, integration between chondrocranial- versus intramembranous-derived structures was consistently stronger when compared to external versus internal regions for both the symmetric and asymmetric components of variation. Thus, more covariation within the nasal complex could be explained by the relationship between chondrocranial- and intramembranous-derived structures. CONCLUSIONS Our results suggest that the interaction between chondrocranial- and intramembranous-derived structures may be an important determinant in the patterning of nasal complex variation.
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Affiliation(s)
- Nathan E Holton
- Department of Orthodontics, The University of Iowa, Iowa.,Department of Anthropology, The University of Iowa, Iowa
| | - Amanda Piche
- College of Dentistry, The University of Iowa, Iowa
| | - Todd R Yokley
- Department of Sociology and Anthropology, Metropolitan State University, Denver
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