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Chien L, Yver CM, Shohat S, Friedman O. Predictors of Success of Endonasal Septal Perforation Repair: A 10-Year Experience. Facial Plast Surg Aesthet Med 2024; 26:117-123. [PMID: 37782906 DOI: 10.1089/fpsam.2022.0162] [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: 10/04/2023] Open
Abstract
Background: There is no consensus on optimal repair technique for nasal septal perforations (NSPs). Objective: To measure success rate and evaluate predictors of success for NSP repair. Methods: Medical records of patients who underwent NSP repair from 2010 to 2020 were reviewed. Included patients had at least 60 days of postsurgical follow-up. Surgical technique involves an endonasal approach; subperichondrial dissection with local flap mobilization; and multilayer closure using cartilage interposition graft, fascia graft, and mucoperichondrial flaps. A chi-squared test or Fisher exact test was used for statistical analysis. Results: Eighty-one repairs were performed with a closure rate of 86%. The median patient age was 46 years (range 13-77); 34.6% of perforations were ≥2 cm. Conchal (77.8%), rib (7.4%), or septal (7.4%) cartilage was used as graft material. A complication rate of 8.6% was reported. Perforation size or graft material had no impact on successful closure rate. Of patients with failed repairs, 55% had perioperative complications or conditions associated with poor healing. Conclusion: An endonasal approach for NSP repair showed a high success rate across diverse presentations; however, NSP repair was significantly more likely to be successful in patients without perioperative complications or pre-existing conditions associated with poor wound healing.
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Affiliation(s)
- Lillian Chien
- Division of Facial Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina M Yver
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shirly Shohat
- Department of Plastic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Oren Friedman
- Division of Facial Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Joo HA, Jang YJ. Factors Affecting the Surgical Outcome in Nasal Septal Perforation Repair. Ann Otol Rhinol Laryngol 2024; 133:14-21. [PMID: 37357889 DOI: 10.1177/00034894231178964] [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] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Nasal septal perforation (NSP) repair is challenging surgery considered in patients with symptomatic NSP intractable to conservative treatments. This study aimed to assess the success rate and identify factors affecting the surgical outcome of NSP by analyzing consecutive series of NSP repairs by a single surgeon. METHODS We enrolled 84 patients diagnosed with NSP and who underwent surgical repair of NSP by a single surgeon (Y.J.J.) between November 2007 and July 2022. Medical records were retrospectively reviewed regarding variables involving preoperative symptoms, rhinologic history, etiology, surgical techniques, and the outcome of surgery. In addition, features of NSP were objectively evaluated using computed tomography scans. RESULTS The overall success rate of NSP repair was 64.3% (54 of 84). Nasal obstruction (79.8%), crusting (34.5%), and epistaxis (27.4%) were frequent preoperative symptoms. Iatrogenic injury from previous nasal surgery (70.2%) was the most common cause. The average size of NSP on preoperative CT was 9.53 ± 6.68 mm. Patients with incomplete NSP closure had significantly larger perforations (12.21 ± 7.92 mm) than those with successful closure (8.04 ± 5.41 mm) preoperatively (P = .005). Patients with smoking history (OR = 2.971, 95% CI 1.170-7.548, P = .020) and NSP repair with combined rhinoplasty (OR = 3.811, 95% CI 1.401-10.370, P = .007) were more likely to experience incomplete closure. Patients whose perforations were reinforced with interposition graft were more likely to result in successful repair (OR = 6.752, 95% CI 2.496-18.262, P < .001). The bilaterality of mucosal flap coverage, surgical approach, types of mucosal flap and interposition graft, perforation shape, mucosal thickness around perforation, and distance from the nasal floor were not significantly related to the surgical outcome. CONCLUSIONS Significant factors affecting the outcome of NSP repair were patient's smoking status, combined rhinoplasty, application of interposition graft, and perforation size.
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Affiliation(s)
- Hye Ah Joo
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Ju Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Shin CH, Jang YJ. Factors Affecting the Complication Rate of Septoplasty: Analysis of 1,506 Consecutive Cases of Single Surgeon. Facial Plast Surg 2023; 39:387-392. [PMID: 36452993 DOI: 10.1055/a-1990-2818] [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: 12/05/2022] Open
Abstract
Based on the analysis of a single surgeon's consecutive cases, we present the incidence of septoplasty complications and factors that contribute to the increased risk of complications. We retrospectively reviewed the medical records from 1,506 patients diagnosed with deviated nasal septum who underwent septoplasty by a single surgeon from January 2003 until May 2020. The incidence of different complications was investigated. Predisposing factors for specific complications were examined with univariate analysis. The average age of patients was 35 (11-76) years. Out of 1,506 patients, 1,252 were male, and 254 were female. The most frequent complication was insufficient correction (78 cases, 5.2%), and revision septoplasty was performed in 21 cases. We also reported 59 (3.9%), 55 (3.7%), 33 (2.2%), 20 (1.3%), and 18 (1.2%) cases of olfactory dysfunction, hematoma, synechia, abscess, and septal mucosal defect, respectively. Additionally, there were nine (0.6%), six (0.4%), five (0.3%), four (0.3%), and four (0.3%) cases of septal perforation, postoperative bleeding, saddle nose, chondritis, empty nose syndrome, respectively. The proportion of insufficient correction was higher in revision cases than in primary cases. Hematoma formation, abscess formation, and septal mucosal defect occurred more frequently in the bilateral flap elevation group. Olfactory dysfunction was significantly more frequent when the bony batten was inserted, while hematoma, abscess formation, and septal mucosal defect were more frequent when the cartilage batten was used. Septoplasty was associated with the risk of several complications, while complication rates were influenced by choice of surgical techniques and approaches.
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Affiliation(s)
- Chol Ho Shin
- Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Yong Ju Jang
- Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
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Conventional septoplasty complications: A Systematic review and meta-analysis. Am J Otolaryngol 2023. [DOI: 10.1016/j.amjoto.2023.103811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Hom DB, Davis ME. Reducing Risks for Poor Surgical Wound Healing. Facial Plast Surg Clin North Am 2023; 31:171-181. [PMID: 37001921 PMCID: PMC11081059 DOI: 10.1016/j.fsc.2023.01.002] [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] [Indexed: 03/31/2023]
Abstract
This review summarizes common risk factors for poor surgical healing on the face and neck and a generalized approach to treating a delayed healing wound. During the preoperative evaluation patients should be screened for prior irradiation, cigarette or e-cigarette use, chronic steroid use, alcoholism, diabetes, malnutrition, and other chronic medical conditions and medications. Despite the surgeon's best efforts to prevent poor surgical healing, some wounds may display signs of persistent inflammation. The facial plastic surgeon should be astute in recognizing delayed healing and identifying intrinsic and extrinsic risk factors so that timely intervention can be performed.
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Affiliation(s)
- David B Hom
- Department of Otolaryngology Head and Neck Surgery, University of California San Diego School of Medicine.
| | - Morgan E Davis
- Department of Otolaryngology Head and Neck Surgery, University of California San Diego School of Medicine
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Peri-operative complications of sphenopalatine artery ligation: a 10-year series from two secondary care centres. The Journal of Laryngology & Otology 2022; 136:1249-1253. [DOI: 10.1017/s0022215122000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
There is currently limited evidence regarding the potential complications of sphenopalatine artery ligation. The post-operative outcomes at two secondary care centres over a 10-year period were reviewed.
Methods
A retrospective review was undertaken of patients undergoing emergency and elective sphenopalatine artery ligation between January 2011 and January 2021. Their demographics, peri-operative care and post-operative outcomes were recorded. The median follow-up time was 54 days (range, 0–2657 days).
Results
Ninety-one patients were included. Four patients (4.4 per cent) had a septal perforation at post-operative review. Nineteen patients (20.9 per cent) had post-operative bleeding that extended their in-patient stay, with five patients (5.5 per cent) requiring revision surgery. Pre-operative non-dissolvable nasal packing was used a median of 1 time (range, 0–8 times).
Conclusion
Further research on outcomes of sphenopalatine artery ligation is needed. Pre-operative non-dissolvable nasal packing, concurrent septal surgical procedures, surgical techniques, and co-morbidities such as hypertension represent potential confounding factors that could not be further assessed in this small, retrospective study.
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The Effect of Smoking on Septoplasty and Septorhinoplasty Outcomes. Aesthetic Plast Surg 2022; 46:1378-1384. [PMID: 34988636 DOI: 10.1007/s00266-021-02683-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/14/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND There have been many studies in the literature describing the techniques, the associated comorbidities and the outcomes related to septoplasty and septorhinoplasty, while there have been few studies evaluating the effects of cigarette smoking on septorhinoplasty. The present study evaluates the effect of cigarette smoking on complication and revision rates and compares the functional results of smoking and non-smoking patients. METHOD The data of 598 patients were retrospectively analyzed, and the age, gender, cigarette smoking status, type of operation, NOSE scores, complications and revision rates were recorded. For the purpose of the study, three different patient groups were defined, being those who had never smoked, those who smoked in the past but had quit and active cigarette smokers. The preoperative and postoperative 6th month Nasal Obstruction Symptom Evaluation (NOSE) Questionnaire scores were compared, and the three groups were compared in terms of complications and the need for revision. RESULTS No differences were identified in the complication rates or revision requirements of the three groups with different cigarette smoking statuses (p=0.17 and p=0.74, respectively). The NOSE scores of the surgery groups and cigarette smoking categories improved significantly after the operation (p=0.01). No difference was identified in the NOSE scores of the groups with different cigarette smoking statuses (p>0.05). CONCLUSION Active cigarette smoking has no effect on the functional results and rates of complication/revision after septoplasty or septorhinoplasty operation. That said, surgeons should suggest that patients quit smoking preoperatively in order to minimize the general systematic effects of cigarette smoking. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Analysis of patient- and procedure-related risk factors for nasal septal perforations following septoplasty. Eur Arch Otorhinolaryngol 2021; 279:1357-1361. [PMID: 34028581 DOI: 10.1007/s00405-021-06887-2] [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: 02/06/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess the possible relationship between various predictive factors (patient or surgery related) and the development of nasal septal perforations (NSP) with the help of a large study group. METHODS One hundred and forty-three patients were included in the study. The presence of the following factors was evaluated and compared between the NSP and healthy group: types of surgeries, presence of unilateral or bilateral mucosal tears, concomitant inferior turbinate interventions, smoking, accompanying diabetes mellitus (DM) or allergic rhinitis (AR), types of nasal packings, duration of the surgery (minutes), and the experience of the surgeon (senior/junior). Nasal septal deviations were grouped into two: simple cartilage crests at the septum base and other-more complicated-deviations. RESULTS NSP was detected in six (4.2%) patients after a mean follow-up of 9.3 ± 3.7 (min: 6 max: 14) months. None of these patients suffered from (AR) or DM. Four of these patients had unilateral and one patient had bilateral mucosal tears during the surgeries. None of the above-mentioned factors-including mucosal tears, type of the deviation or experience of the surgeon-had a significant effect on NSP. CONCLUSION Untreated bilateral corresponding mucosal tears are the main cause of NSP. When immediately repaired, unilateral or bilateral tears do not affect the development of NSP significantly. Patient-related factors such as age, DM, smoking, AR, and procedure-related factors such as duration, the complexity of the septal deviation, type of the nasal packing, and experience of the surgeon also do not have a significant effect on NSP.
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9
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Ak S, Kaplama ME. Effects of hookah and cigarette smoking on the recovery after septoplasty. Int J Clin Pract 2021; 75:e13968. [PMID: 33368967 DOI: 10.1111/ijcp.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Hookah is a tobacco product of Middle Eastern origin; however, its popularity increases in Europe and the US. Despite its frequent use, hookah's potentially detrimental effects are underestimated as a result of the scarcity of the relevant research. Since septoplasty is one of the most commonly performed procedures of otolaryngology practice, we aimed to investigate the impact of hookah consumption on recovery after septoplasty. METHODS Patients who underwent septoplasty in Sanliurfa Training and Research Hospital Department of Otolaryngology between January 2017 and December 2019 were divided into four groups based on their history of hookah and cigarette smoking. The patients' prospectively collected data, including demographic features, healing time, and presence or absence of septal perforation during follow-up, were compared between these four groups. RESULTS The entire cohort included 270 patients. The mean patient age was 29.2 ± 5.8 years. One hundred and thirty-two (48.9%) patients were non-smokers, 96 (35.5%) were cigarette smokers, 27 (10%) were hookah smokers and 15 (5.6%) consumed both tobacco products regularly. Mean healing time was 10 days, and septal perforation was encountered in 10 patients (3.7%). A comparison of the groups revealed that cigarette smoking did not impact septal perforation rates (P = .326) but prolonged the healing time. However, hookah smoking with or without cigarette smoking significantly influenced septal perforation rates and healing times. CONCLUSION Patients should be questioned about hookah smoking in addition to cigarette smoking before the septoplasty procedure. Patients with a positive history of hookah smoking should be followed closely in terms of delayed healing and increased septal perforation rates.
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Affiliation(s)
- Semih Ak
- Department of Otorhinolaryngology, Sanliurfa M. Akif Inan Education and Research Hospital, University Of Health Sciences, Sanliurfa, Turkey
| | - Mehmet Erkan Kaplama
- Department of Otorhinolaryngology, Sanliurfa M. Akif Inan Education and Research Hospital, University Of Health Sciences, Sanliurfa, Turkey
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10
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Hunter BG. Cartilage Sparing Septal Perforation Repair using Rotation Flaps and a Collagen Interposition Graft: A Case Series. Ann Otol Rhinol Laryngol 2020; 130:745-751. [PMID: 33158375 DOI: 10.1177/0003489420970592] [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: 11/17/2022]
Abstract
OBJECTIVE Septal Perforations may be asymptomatic or can cause significant problems including nasal obstruction, crusting, bleeding, whistling and in severe cases a change in nasal shape and even pain. METHOD The author would like to present a single surgeon case series of septal perforation repairs, managed using an endo-nasal technique, with no external scars. There were 54 consecutive cases between 2011 and 2017. The repair was carried out using mucosal rotation flaps with an interposition graft of porcine collagen matrix. Patients were grouped according to the size of the perforation as measured at the time of the surgery. The patients were then clinically followed up for 1 year, and the recorded outcome measures were: the success of the surgical repair and the patient reported symptoms. RESULTS Surgical success was 70% up to 1 cm diameter, 77% from 1 to 2 cm and 82% in perforations from 2 to 3 cm in diameter. No perforation over 3 cm in diameter was successfully closed. Patients were rendered asymptomatic even if the perforation was not closed in between 81% and 91% of patients up to perforations 3 cm in size. Over 3 cm in size 50% of patients reported being asymptomatic. CONCLUSIONS This technique is an effective and low morbidity option for patients with small to medium sized septal perforations. For perforations over 3 cm in diameter other options may be more suitable.
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Affiliation(s)
- Benjamin G Hunter
- St Georges Hospital NHS Trust, London, UK.,Hals-Nasen-Ohren Klinik, Kantosspital St Gallen, St Gallen, Switzerland
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11
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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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Shin JM, Park JH, Yang HW, Lee HM, Park IH. Cigarette smoke extract inhibits cell migration and contraction via the reactive oxygen species/adenosine monophosphate-activated protein kinase pathway in nasal fibroblasts. Int Forum Allergy Rhinol 2020; 10:356-363. [PMID: 31693801 DOI: 10.1002/alr.22479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/15/2019] [Accepted: 10/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Fibroblast migration plays a significant role in wound healing after endoscopic sinonasal surgery. Cigarette smoke extract (CSE) is a potent inhibitor of fibroblast functions including cell proliferation and migration. The purpose of the study was to determine the influence of CSE on migration and collagen gel contraction in nasal fibroblasts and investigate its underlying mechanisms. METHODS Fibroblast migration was evaluated using wound healing assay and transwell migration assay. Contractile activity was assessed by collagen gel contraction assay. Reactive oxygen species (ROS) were quantified by 2',7'-dichlorofluorescein diacetate. Fibroblasts were treated with CSE and N-acetylcysteine (NAC), metformin, compound C, or transfected with small interfering RNA (siRNA) to suppress adenosine monophosphate-activated protein kinase (AMPK) expression. AMPK activation was determined by Western blot. RESULTS CSE and metformin were found to significantly reduce the migration and collagen gel contraction activity of nasal fibroblasts. Conversely, pretreatment with NAC and compound C significantly enhanced the migration and collagen gel contraction activity of fibroblasts. ROS production and AMPK phosphorylation were found to be significantly induced by CSE treatment, whereas the activity was inhibited on treatment with NAC, metformin, compound C, or AMPK siRNA. Silencing of AMPK expression was found to significantly reverse the suppressive effect of CSE in nasal fibroblasts. CONCLUSION CSE has an inhibitory effect on cell migration and collagen gel contraction activity via the ROS/AMPK signaling pathway in nasal fibroblasts.
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Affiliation(s)
- Jae-Min Shin
- Upper Airway Chronic inflammatory Diseases Laboratory, Korea University, College of Medicine, Seoul, Korea
- Medical Devices Clinical Trials Laboratory, Korea University, College of Medicine, Seoul, Korea
- IVD Support Center Korea University, Korea University, College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University, College of Medicine, Seoul, Korea
| | - Joo-Hoo Park
- Upper Airway Chronic inflammatory Diseases Laboratory, Korea University, College of Medicine, Seoul, Korea
- Medical Devices Clinical Trials Laboratory, Korea University, College of Medicine, Seoul, Korea
- IVD Support Center Korea University, Korea University, College of Medicine, Seoul, Korea
| | - Hyun-Woo Yang
- Upper Airway Chronic inflammatory Diseases Laboratory, Korea University, College of Medicine, Seoul, Korea
- IVD Support Center Korea University, Korea University, College of Medicine, Seoul, Korea
| | - Heung-Man Lee
- Upper Airway Chronic inflammatory Diseases Laboratory, Korea University, College of Medicine, Seoul, Korea
- IVD Support Center Korea University, Korea University, College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University, College of Medicine, Seoul, Korea
| | - Il-Ho Park
- Upper Airway Chronic inflammatory Diseases Laboratory, Korea University, College of Medicine, Seoul, Korea
- Medical Devices Clinical Trials Laboratory, Korea University, College of Medicine, Seoul, Korea
- IVD Support Center Korea University, Korea University, College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University, College of Medicine, Seoul, Korea
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Use of Neutrophil, Eosinophil, Basophil, and Platelet to Lymphocyte Ratio to Predict Patient Satisfaction After Septoplasty Plus Inferior Turbinate Reduction. J Craniofac Surg 2019; 30:1022-1026. [PMID: 30908446 DOI: 10.1097/scs.0000000000005527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM Investigation of the predictive value of neutrophil, platelet, eosinophil, and basophil to lymphocyte ratio (NLR, PLR, ELR, and BLR) in evaluation of patients' satisfaction of septoplasty + inferior turbinate reduction operations. PATIENTS AND METHODS Seventy-six patients who were operated because of nasal obstruction were enrolled in the study. They were invited to the hospital and asked to answer a modified nasal obstruction symptom evaluation (NOSE) survey to determine their degree of satisfaction. Patients were divided into 2 groups according to their modified NOSE survey results, dissatisfied and satisfied groups. The 2 groups were compared in terms of demographic data, surgery, and hematological values. In addition, correlation analysis was performed between NLR, PLR, ELR, BLR, and modified NOSE scores. RESULTS There were 29 patients in the dissatisfied group and 47 patients in the satisfied group. Both groups were similar in terms of mean age, gender, surgery type, septal deviation type, smoking, hemoglobin, neutrophil, and white blood count (P > 0.05). There were significant differences between the 2 groups in terms of ELR and BLR (P < 0.05). In addition, there were negative and statistically significant correlations between modified NOSE scores and ELR and BLR. As ELR and BLR values increased, the satisfaction rate decreased. CONCLUSION Eosinophil to lymphocyte ratio and BLR could be used to predict patient satisfaction after septoplasty and inferior turbinate reduction and for selection of patients.
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14
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Saadi R, Loloi J, Schaefer E, Lighthall JG. Outcomes of Cadaveric Allograft versus Autologous Cartilage Graft in Functional Septorhinoplasty. Otolaryngol Head Neck Surg 2019; 161:779-786. [PMID: 31385746 DOI: 10.1177/0194599819866812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our goal was to elucidate the efficacy and outcome profile of cadaveric allografts (homograft costal cartilage) in functional septorhinoplasty as compared with autografts (quadrangular cartilage, conchal cartilage, and autologous costal cartilage). STUDY DESIGN Retrospective chart review. SETTING Otolaryngology division of the Penn State Health Milton S. Hershey Medical Center. SUBJECTS AND METHODS A chart review of a single surgeon's practice was conducted with Current Procedural Terminology codes for septorhinoplasty (30410, 30420, 30430, 30435, 30450, 30465) from August 1, 2014, to August 1, 2017. All patients underwent functional septorhinoplasty for a chief complaint of nasal obstruction. Outcomes were collected up to 12 months following the operation and included the validated Nasal Obstruction Symptom Evaluation (NOSE), infection rate, malposition/warping of the graft, need for revision surgery, and graft loss. RESULTS A total of 171 cases were included in our data analysis. On multivariate analysis, there were no significant differences between patients who had autografts and those who had allografts in 3-, 6-, or 12-month postoperative NOSE score. Preoperative NOSE score was the only covariate to demonstrate a significant positive relationship to postoperative NOSE score. Regarding outcomes between autograft and allograft, no significant differences were found in rate of graft resorption (3.4% vs 5.6%, P = .680), graft warping (3.4% vs 0%, P = .309), infection (0% vs 1.9%, P = .316), or need for revision surgery (4.3% vs 5.6%, P = .709). CONCLUSION Autologous grafting is often the first choice in septorhinoplasty because of its presumed resistance to infection and resorption. Similar to autologous grafts, allografts are resistant to infection and resorption and demonstrate prolonged efficacy following functional septorhinoplasty.
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Affiliation(s)
- Robert Saadi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Justin Loloi
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Eric Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Risk factors for nasal septal perforation after septoplasty operation. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.567210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cavada MN, Orgain CA, Alvarado R, Sacks R, Harvey RJ. Septal Perforation Repair Utilizing an Anterior Ethmoidal Artery Flap and Collagen Matrix. Am J Rhinol Allergy 2018; 33:256-262. [PMID: 30525903 DOI: 10.1177/1945892418816959] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nasal septal perforation repair remains a challenge with no standard technique for repair recognized. OBJECTIVE To describe the combination of an anterior ethmoidal artery flap with a collagen matrix inlay as a successful technique for nasal septal perforation repair. METHODS A case series of consecutive patients who underwent nasal septal perforation repair with an anterior ethmoidal artery flap with an inlay collagen graft was conducted. Demographic data, preoperative features of the perforation (size, location, and presence of chondritis), and postoperative outcomes were analyzed; closure rate, mucosalization rate (of the contralateral side at 21 and 90 days), and complications (crusting, bleeding, obstruction, infection, and rehospitalization <30 days) were documented. RESULTS Thirteen patients (age: 49 ± 15 years, 30.8% women) were assessed. The perforation size was 1.6 ± 0.9 cm (range: 0.3-3.5 cm) and located 1.2 ± 0.5 cm (range: 0.5-2.0 cm) posterior to the columella. Chondritis was present in 69.2%. The closure rate was 100% (95% confidence interval [CI]: 77%-100%) at both 21 and 90 days. One patient required a free mucosa graft to an area of persistent crusting on the contralateral side (7.7%). Complications were low; bleeding 0%, obstruction 7.7% (requiring corticosteroid injection of anterior ethmoidal artery flap), and 0% infection/rehospitalization. CONCLUSION Anterior ethmoidal artery flap with an inlay collagen matrix is a reliable technique to repair nasal septal perforation. This technique, with robust vascularity and wide angle of rotation, enables the closure of perforations both large (<50% total septum) and with anterior locations.
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Affiliation(s)
- Marina N Cavada
- 1 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,2 Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Carolyn A Orgain
- 2 Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Raquel Alvarado
- 2 Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Raymond Sacks
- 1 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,2 Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.,3 Faculty of Medicine, University of Sydney, Sydney, Australia.,4 Department of Otolaryngology, Concord General Hospital, Sydney, Australia
| | - Richard J Harvey
- 1 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,2 Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
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Zanation AM. Delving into the unknown in rhinology and allergy. Am J Rhinol Allergy 2017; 31:1-2. [PMID: 28234136 DOI: 10.2500/ajra.2017.31.4419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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