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Dizdar SK, Doğan U, Ece M, Kaya KS, Seyhun N, Turgut S. Effects of submucoperichondrial application of platelet-rich plasma on nasal mucosal healing after septoplasty. Auris Nasus Larynx 2024; 51:437-442. [PMID: 38520974 DOI: 10.1016/j.anl.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/18/2023] [Accepted: 12/13/2023] [Indexed: 03/25/2024]
Abstract
OBJECTIVE(S) Our aim is to investigate the effects of the submucoperichondrial application of Platelet Rich Plasma (PRP) on nasal mucosal healing after septoplasty surgery. METHOD(S) This prospective randomized observational study was conducted between July 2019 and February 2021, with 40 patients aged 18-60 years who underwent closed the only septoplasty operation for similar septal deviations. Patient divided into two group; 21 patients were placed in PRP group to which PRP was applied on all mucosal surface and submucoperichondrial area of septum and 19 patients were placed in control group to which saline solution was applied on same regions. Nasal obstruction score, mucociliary clearance time, presence of nasal crusting, and bleeding time were evaluated on 5th, 10th, 15th day after surgery and compared between groups. RESULTS Intranasal crusting on day 10 was found to be lower in the PRP group (n:13 68.4 %) than control group (n:7 33.3 %) with a statistically significant difference (p = 0.028). The nasal obstruction score on day 10 and 15 were found to be lower in the PRP group (3,33 ± 2,75, 2,07 ± 2,20) (than the control group (5,44 ± 2,26, 3,37 ± 1,92) with a statistically significant difference (p = 0,003,p = 0,009). The mucociliary clearance rate was found to be higher and the bleeding time was found to be lower in the PRP group, but a statistically significant difference was not observed. CONCLUSIONS Application of submucoperichondrial PRP could have beneficial effects on nasal mucosal repair, nasal crusting, and congestion after septoplasty surgery.
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Affiliation(s)
- Senem Kurt Dizdar
- University of Health Science Hamidiye Sisli Etfal Education and Research Hospital, Otorhinolaryngology Department, Demokrasi Street, Huzur Neighbourhood, No:1, Sarıyer, İstanbul, Turkey.
| | - Uğur Doğan
- University of Health Science Hamidiye Sisli Etfal Education and Research Hospital, Otorhinolaryngology Department, Demokrasi Street, Huzur Neighbourhood, No:1, Sarıyer, İstanbul, Turkey
| | - Mehmet Ece
- University of Health Science Hamidiye Sisli Etfal Education and Research Hospital, Otorhinolaryngology Department, Demokrasi Street, Huzur Neighbourhood, No:1, Sarıyer, İstanbul, Turkey
| | - Kerem Sami Kaya
- University of Health Science Hamidiye Sisli Etfal Education and Research Hospital, Otorhinolaryngology Department, Demokrasi Street, Huzur Neighbourhood, No:1, Sarıyer, İstanbul, Turkey
| | - Nurullah Seyhun
- University of Health Science Hamidiye Sisli Etfal Education and Research Hospital, Otorhinolaryngology Department, Demokrasi Street, Huzur Neighbourhood, No:1, Sarıyer, İstanbul, Turkey
| | - Suat Turgut
- University of Health Science Hamidiye Sisli Etfal Education and Research Hospital, Otorhinolaryngology Department, Demokrasi Street, Huzur Neighbourhood, No:1, Sarıyer, İstanbul, Turkey
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Lenze NR, Bharadwaj SR, Baldassari CM, Kirkham EM. Surgical Management of Pediatric Obstructive Sleep Apnea Beyond Adenotonsillectomy: The Nose, Nasopharynx, and Palate. Otolaryngol Clin North Am 2024; 57:421-430. [PMID: 38508883 PMCID: PMC11060425 DOI: 10.1016/j.otc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
While adenotonsillectomy is the primary treatment of pediatric obstructive sleep apnea (OSA), persistent OSA after surgery is common and may be due to residual obstruction at the nose, nasopharynx, and/or palate. Comprehensive evaluation for persistent pediatric OSA ideally includes clinical examination (with or without awake nasal endosocpy) as well as drug-induced sleep endoscopy in order to accurately identify sources of residual obstruction. Depending on the site of obstruction, some of the surgical management options include submucous inferior turbinate resection, septoplasty, adenoidectomy, and expansion sphincter pharyngoplasty.
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Affiliation(s)
- Nicholas R Lenze
- Department of Otolaryngology-Head & Neck Surgery, The University of Michigan, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Suhas R Bharadwaj
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA
| | - Christina M Baldassari
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA
| | - Erin M Kirkham
- Department of Otolaryngology-Head & Neck Surgery, The University of Michigan, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Rüttgers M, Waldmann M, Vogt K, Ilgner J, Schröder W, Lintermann A. Automated surgery planning for an obstructed nose by combining computational fluid dynamics with reinforcement learning. Comput Biol Med 2024; 173:108383. [PMID: 38555704 DOI: 10.1016/j.compbiomed.2024.108383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/26/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Septoplasty and turbinectomy are among the most common interventions in the field of rhinology. Their constantly debated success rates and the lack of quantitative flow data of the entire nasal airway for planning the surgery necessitate methodological improvement. Thus, physics-based surgery planning is highly desirable. In this work, a novel and accurate method is developed to enhance surgery planning by physical aspects of respiration, i.e., to plan anti-obstructive surgery, for the first time a reinforcement learning algorithm is combined with large-scale computational fluid dynamics simulations. The method is integrated into an automated pipeline based on computed tomography imaging. The proposed surgical intervention is compared to a surgeon's initial plan, or the maximum possible intervention, which allows the quantitative evaluation of the intended surgery. Two criteria are considered: (i) the capability to supply the nasal airway with air expressed by the pressure loss and (ii) the capability to heat incoming air represented by the temperature increase. For a test patient suffering from a deviated septum near the nostrils and a bony spur further downstream, the method recommends surgical interventions exactly at these locations. For equal weights on the two criteria (i) and (ii), the algorithm proposes a slightly weaker correction of the deviated septum at the first location, compared to the surgeon's plan. At the second location, the algorithm proposes to keep the bony spur. For a larger weight on criterion (i), the algorithm tends to widen the nasal passage by removing the bony spur. For a larger weight on criterion (ii), the algorithm's suggestion approaches the pre-surgical state with narrowed channels that favor heat transfer. A second patient is investigated that suffers from enlarged turbinates in the left nasal passage. For equal weights on the two criteria (i) and (ii), the algorithm proposes a nearly complete removal of the inferior turbinate, and a moderate reduction of the middle turbinate. An increased weight on criterion (i) leads to an additional reduction of the middle turbinate, and a larger weight on criterion (ii) yields a solution with only slight reductions of both turbinates, i.e., focusing on a sufficient heat exchange between incoming air and the air-nose interface. The proposed method has the potential to improve the success rates of the aforementioned surgeries and can be extended to further biomedical flows.
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Affiliation(s)
- Mario Rüttgers
- Jülich Supercomputing Centre, Forschungszentrum Jülich GmbH, Wilhelm-Johnen-Straße, 52425 Jülich, Germany; Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Wüllnerstraße 5a, 52062 Aachen, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany.
| | - Moritz Waldmann
- Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Wüllnerstraße 5a, 52062 Aachen, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany
| | - Klaus Vogt
- Faculty of Medicine, Center of Experimental Surgery, University of Latvia, 1586 Riga, Latvia
| | - Justus Ilgner
- Department of Otorhinolaryngology, Head and Neck Surgery, Uniklinik RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Wolfgang Schröder
- Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Wüllnerstraße 5a, 52062 Aachen, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany
| | - Andreas Lintermann
- Jülich Supercomputing Centre, Forschungszentrum Jülich GmbH, Wilhelm-Johnen-Straße, 52425 Jülich, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany
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Jomah M, Smith O, Villemure-Poliquin N, Cunningham H. Use of alloplastic implants for correction of deviated nasal septum: Systematic review and meta-analysis. Am J Otolaryngol 2024; 45:104240. [PMID: 38447465 DOI: 10.1016/j.amjoto.2024.104240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE To systematically reviews the safety and effectiveness of alloplastic implants (AI) in septoplasty. METHODS We conducted a comprehensive search in Medline, EMBASE, SCOPUS, CINAHL, and Cochrane Library databases to identify articles on septoplasty using AI. We also manually searched reference lists of included articles. Inclusion criteria involved prospective or retrospective case-series studies of adults with deviated nasal septum (DNS) who underwent septoplasty with AI, with sufficient follow-up data. Two authors independently screened articles, reviewed full manuscripts, and extracted data. RESULTS Out of 5370 articles, 16 met inclusion criteria, encompassing 884 patients from 14 eligible studies. Most studies had fair quality. AI materials included Polydioxanone (PDS), Polycaprolactone (PCL), Titanium, Macropore, and PolyMax. AI usage improved nasal obstruction in most patients, with 95.6 % (84.8 %-100 %) based on physical examination and 96.9 % (89.6 %-100 %) based on symptoms. AI-related complications occurred in 4.3 % (0 %-12.8 %) of cases, mostly non-serious. CONCLUSIONS AI use can be considered as a useful adjunct in septoplasty, with uncommon complications similar to standard procedures. However, due to limited-quality evidence, further prospective controlled studies are needed.
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Affiliation(s)
- Mohammed Jomah
- Department of Otolaryngology - Head & Neck Surgery, Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology - Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia.
| | - Oakley Smith
- Department of Otolaryngology - Head & Neck Surgery, Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Noémie Villemure-Poliquin
- Otorhinolaryngologie et Chirurgie Cervico-Faciale, Faculté de Médecine, Université Laval, Montreal, Quebec, Canada.
| | - Heather Cunningham
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada.
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Bergin K, Estevez SL, Alkon-Meadows T, Nyein E, Cohen N, Hernandez-Nieto C, Gounko D, Lee JA, Copperman AB, Buyuk E. Single Euploid Embryo Transfer Outcomes After Uterine Septum Resection. J Minim Invasive Gynecol 2024; 31:432-437. [PMID: 38360394 DOI: 10.1016/j.jmig.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/28/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
STUDY OBJECTIVE To study pregnancy outcomes after single euploid embryo transfer (SEET) in patients who underwent prior uterine septum resection to those with uteri of normal contour, without Müllerian anomalies or uterine abnormalities including polyps or fibroids, and without a history of prior uterine surgeries. DESIGN Retrospective cohort study. SETTING Single academic affiliated center. PATIENTS 60 cycles of patients with prior hysteroscopic uterine septum resection who underwent an autologous SEET between 2012 and 2020 were used as the investigational cohort. A 3:1 ratio propensity score matched control cohort of 180 single euploid embryo transfer cycles from patients without a history of uterine septa were used as the control group. INTERVENTIONS No interventions administered. MEASUREMENTS AND MAIN RESULTS Pregnancy, clinical pregnancy loss, ongoing clinical pregnancy, and live birth rates in patients with a history of uterine septum resection compared with matched patients without Müllerian anomalies or uterine surgeries. Patients with a prior uterine septum had significantly lower rates of chemical pregnancy (58.33% vs 77.2%, p = .004), implantation (41.67% vs 65.6%, p = .001), and live birth (33.33% vs 57.8%, p = .001) per transfer. No statistical difference in clinical pregnancy loss rates was found when comparing septum patients with controls (8.33% vs 7.8%, p = .89). CONCLUSION Patients with a history of hysteroscopic resection who undergo in vitro fertilization are more susceptible to suboptimal clinical outcomes compared with patients with normal uteri. Early pregnancy loss rates in patients with a uterine septum are higher than in those without; however, after resection, the rates are comparable. Patients born with septate uteri require assessment of surgical intervention prior to SEET, and to optimize their reproductive outcomes.
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Affiliation(s)
- Keri Bergin
- Reproductive Medicine Associates of New York (all authors); Icahn School of Medicine at Mount Sinai (Drs. Bergin, Estevez, Nyein, Copperman, and Buyuk), New York.
| | - Samantha L Estevez
- Reproductive Medicine Associates of New York (all authors); Icahn School of Medicine at Mount Sinai (Drs. Bergin, Estevez, Nyein, Copperman, and Buyuk), New York
| | | | - Ethan Nyein
- Reproductive Medicine Associates of New York (all authors); Icahn School of Medicine at Mount Sinai (Drs. Bergin, Estevez, Nyein, Copperman, and Buyuk), New York
| | - Natalie Cohen
- Reproductive Medicine Associates of New York (all authors)
| | | | - Dmitry Gounko
- Reproductive Medicine Associates of New York (all authors)
| | - Joseph A Lee
- Reproductive Medicine Associates of New York (all authors)
| | - Alan B Copperman
- Reproductive Medicine Associates of New York (all authors); Icahn School of Medicine at Mount Sinai (Drs. Bergin, Estevez, Nyein, Copperman, and Buyuk), New York
| | - Erkan Buyuk
- Reproductive Medicine Associates of New York (all authors); Icahn School of Medicine at Mount Sinai (Drs. Bergin, Estevez, Nyein, Copperman, and Buyuk), New York
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Benites C, Awan MU, Patel H, Pandit S, Shifchik A, Harmon S, Malisetyan T, Angel S, Goldrich D, Demory ML. An examination of antibiotic administration in septorhinoplasty: A systematic review and meta-analysis. Am J Otolaryngol 2024; 45:104333. [PMID: 38677149 DOI: 10.1016/j.amjoto.2024.104333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Septoplasty and rhinoplasty are common otolaryngological procedures, often combined as septorhinoplasty (SRP), offering aesthetic and functional benefits. These surgeries are believed to potentially risk postoperative infections due to natural bacterial flora in the nares. This study evaluates the effectiveness of prophylactic antibiotics in reducing post-surgical infection complications. MATERIALS AND METHODS A systematic review was conducted using PubMed, Cochrane, and Web of Science, adhering to PRISMA guidelines, focusing on antibiotic use in septoplasty, rhinoplasty, and SRP. The study included randomized control trials, single/double-blind studies, retrospective chart reviews, and prospective cohort studies, excluding pediatric, non-human research, or studies with inaccessible data. Postoperative infection rates were analyzed utilizing R software as a form of Statistic. RESULTS From 697 articles, 15 studies were chosen for meta-analysis, involving 2225 patients, with 1274 receiving prophylactic antibiotics and 951 as controls. The meta-analysis indicated an odds ratio of 0.65 (95 % CI: [0.23, 1.89]), showing no significant protective effect of prophylactic antibiotics. DISCUSSION The study found no significant infection rate reduction with prophylactic antibiotic use. Notable were inconsistencies in study designs, antibiotic administration timing, and varied surgical practices. Antibiotic use risks were considered. Study limitations include potential biases and the retrospective nature of many studies. CONCLUSIONS This review and meta-analysis found no substantial evidence supporting prophylactic antibiotics' effectiveness in reducing postoperative infection rates in septoplasty, rhinoplasty, and SRP, indicating a need to reevaluate practices and develop evidence-based guidelines. Future research should focus on comprehensive, randomized control studies, covering both preoperative and postoperative stages.
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Affiliation(s)
- Cristina Benites
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Muhammad Usman Awan
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Heli Patel
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Saket Pandit
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Anastassia Shifchik
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Skylar Harmon
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Tatevik Malisetyan
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - Samuel Angel
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
| | - David Goldrich
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Pennsylvania State University, United States of America.
| | - Michelle L Demory
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
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Gani K, Castelhano L, Correia F, Reis LR, Escada P. Endoscopic and External Dacryocystorhinostomy: Long Term Result from a Tertiary Center in Portugal. Indian J Otolaryngol Head Neck Surg 2024; 76:1613-1618. [PMID: 38566741 PMCID: PMC10982182 DOI: 10.1007/s12070-023-04368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 04/04/2024] Open
Abstract
Dacryocystorhinostomy is the gold-standard for distal lacrimal obstructions. This study aims to report the demography, clinical presentation, influence of agger nasi opening, uncinectomy and septoplasty, the use of silicone stent tubes, complications and success of endoscopic and external dacryocystorhinostomy over a period of 11 years. Retrospective review of clinical records, from January 2012 to December 2022, at a tertiary center in Portugal. A total of 249 procedures, 6 external and 243 endoscopic, were performed, including 39 revision cases. There was a female predominance (79.9%) with a mean age at diagnosis of 66.4 years. Recurrent acute dacryocystitis, reported by 33.3%, was associated with higher success (p = 0.053). Agger nasi opening, uncinectomy and septoplasty were performed in 17.7%, 6.0% and 15.3% respectively, although associated with higher success rates, no statistically significant difference was found. Minor complication rates for both external and endoscopic approach was 33.3% and 32.1% respectively. Functional and anatomical success was 100% and 83.3%, respectively, for external dacryocystorhinostomy, and 91.4% and 85.1%, respectively, for endoscopic dacryocystorhinostomy. Revision surgery was associated with a worse anatomical success (p = 0.05). Endoscopic dacryocystorhinostomy is an effective and safe alternative to the external approach. Minor procedures can increase the success rate, but multicentre studies need to be performed for a statistically significant result.
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Affiliation(s)
- Kaamil Gani
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | | | | | - Pedro Escada
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Singh AP, Singh S, Malik R, Gupta R, Pandey S. An Analysis of the VELNEZ Nasal Pack's Acceptability and Safety for Use During Nasal Surgery: A Prospective Study. Indian J Otolaryngol Head Neck Surg 2024; 76:1886-1890. [PMID: 38566718 PMCID: PMC10982240 DOI: 10.1007/s12070-023-04437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 04/04/2024] Open
Abstract
The primary function of nasal packs is to modulate the bleeding, prevent adhesions and obstruction, with least discomfort to the subjects without risking secondary infection. However, both packing and removal of the pack is an unpleasant experience, with the latter being extremely painful. Therefore the need of the hour is a dressing which prioritizes subject comfort without compromising other desired nasal pack properties. Twenty subjects were enrolled in this interventional, open label study. The subjects had 10 hospital visits, starting from baseline (Visit 1) to postoperative day 28 (Visit 10), at regular intervals. The proportion of the population with postoperative pain alleviation and bleeding control failure (within 10 min) were the main objectives. Within 10 min of VELNEZ administration, all 20 participants got their bleeding under control. With VELNEZ, the painful nasal pack removal method was totally avoided because it was biodegradable. No moderate/severe pain, infection and adhesions were reported in any of the subjects, but few subjects reported moderate obstruction until Visit 3 (Discharge Day). In the present study, for participants undergoing nasal surgery, VELNEZ proved to be a secure and reliable nasal pack. Trial Registration: CTRI/2021/09/036437, prospectively registered.
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Affiliation(s)
- Akhil Pratap Singh
- Department of ENT and Head Neck surgery Sarojini Naidu Medical College, Moti Katra, Agra, UP India
| | - Saloni Singh
- Department of ENT and Head Neck surgery Sarojini Naidu Medical College, Moti Katra, Agra, UP India
| | - Ridhima Malik
- Department of ENT and Head Neck surgery Sarojini Naidu Medical College, Moti Katra, Agra, UP India
| | - Ritu Gupta
- Department of ENT and Head Neck surgery Sarojini Naidu Medical College, Moti Katra, Agra, UP India
| | - Siddharth Pandey
- Datt Mediproducts Private Limited, 56 Community Centre, East of Kailash, New Delhi, India
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Park C, Reategui Via Y Rada ML, Pandhiri T, Davis S, Shipchandler T, Vernon D. Clinical and surgical factors associated with opioid refill rates following septorhinoplasty. Am J Otolaryngol 2024; 45:104268. [PMID: 38579507 DOI: 10.1016/j.amjoto.2024.104268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Septorhinoplasty is one the most common class of procedures performed worldwide, and opioids are frequently prescribed for post-operative pain [1]. OBJECTIVE The objective of this study was to examine the rate of post-operative opioid prescription refills following septorhinoplasty. METHODS This study was a case-control study of patients who underwent septoplasty and other secondary concomitant procedures. RESULTS Of the 249 patients included in this study, the majority of patients (94.8%) were prescribed 12 tablets of hydrocodone-acetaminophen 5 mg - 325 mg and only 31 patients (13.3%) received refills. The presence of osteotomies and history of prior opioid use were associated with refills. Nasal valve repair type, open versus closed approach, and presence of autologous auricular cartilage graft harvest were not. DISCUSSION Our study highlights factors that surgeons should consider when prescribing opioids after septorhinoplasty. Twelve tablets of an opioid are likely sufficient for the majority of patients, but if osteotomies are performed or the patient has a history of prior opioid use, more may be indicated to avoid the need for refills. Additional narcotics are not necessary for an open approach or for patients in which auricular cartilage is needed.
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Affiliation(s)
- Christopher Park
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN 46204, United States of America.
| | - Maria Laura Reategui Via Y Rada
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN 46204, United States of America
| | - Taruni Pandhiri
- Indiana University School of Medicine, Indianapolis, IN 46204, United States of America
| | - Seth Davis
- Stanford University School of Medicine, Stanford, CA 94304, United States of America
| | - Taha Shipchandler
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN 46204, United States of America
| | - Dominic Vernon
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN 46204, United States of America
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Sun YD, Wu SQ, Wang Z, Zhao ZM, An Y. A Safe Technique for Excising the Perpendicular Plate of the Ethmoid Bone in Patients with Crooked Nose: A Finite Element Analysis. Aesthetic Plast Surg 2024; 48:1084-1093. [PMID: 37932507 DOI: 10.1007/s00266-023-03712-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/10/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Correction of the crooked nose, especially the perpendicular plate of the ethmoid bone, has the potential to cause skull base injury. At present, the safe and effective method for perpendicular plate resection has not been clearly defined through biomechanics. METHOD CT scan data of 48 patients with crooked nose and deviated nasal septum were divided into C-type, angular deformity-type, and S-type based on the morphology of the 3D model. Different types of finite element models of the nasal bony septum and skull base were established. The osteotomy depth, angle, and force mode of the PPE resection were simulated by assembling different working conditions for the models. The von Mises stress of the anterior cranial fossa was observed. RESULTS When the osteotomy line length was 0.5 cm, the angle was at 30° to the Frankfurt plane, and 50 N·mm torque was applied, the von Mises stress of the skull base was minimal in the four models, showing 0.049 MPa (C-type), 0.082 MPa (S-type), 0.128 MPa (angular deformity-type), and 0.021 MPa (control model). The maximum von Mises stress values were found at the skull base when the osteotomy line was 1.5 cm, the angle was 50°, and the force was 10 N along the X-axis, showing 0.349 MPa (C-type), 0.698 MPa (S-type), 0.451 MPa (angular deformity-type), and 0.149 MPa (control model). CONCLUSION The use of smaller resection angle with the Frankfurt plane, conservative resection depth, and torsion force can better reduce the stress value at the skull base and reduce the risk of basicranial fracture. It is a safe and effective technique for perpendicular plate resection of the ethmoid bone in the correction of crooked nose. 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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Affiliation(s)
- Yi-Dan Sun
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Si-Qiao Wu
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Zheng Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Zhen-Min Zhao
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, 100191, China.
| | - Yang An
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, 100191, China.
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11
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Imbs S, Deyrail B, Nguyen DT, Hossu G, Blum A, Gondim Teixeira PA, Rumeau C, Jankowski R, Gillet R. Olfactory cleft stenosis and obstruction on paranasal sinus CT scan in pre-septo-rhinoplasty patients: normal variants or pathologic findings? Eur Radiol 2024:10.1007/s00330-023-10564-9. [PMID: 38206402 DOI: 10.1007/s00330-023-10564-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/19/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE(S) To determine the frequency of olfactory cleft (OC) stenosis and obstruction on paranasal sinus CT scans in pre-septorhinoplasty of patients who had septal deviation, septopyramidal deformation or nasal obstruction without other sinonasal conditions. METHODS This retrospective study included patients referred to our institution between December 2013 and December 2021 for septorhinoplasty due to nasal obstruction without other sinonasal or neurological conditions. All patients underwent preoperative paranasal sinus CT scan and olfactory testing. OC stenosis was quoted as none, partial, or total (less than 1/3 contact between nasal septum and ethmoid turbinates, 1/3-2/3, more than 2/3, respectively), as well as OC obstruction as none, partial, or complete (obstruction of less than 1/3 of OC, 1/3-2/3, more than 2/3, respectively). Radiologic evaluation was validated by near perfect interobserver agreement. RESULTS A total of 75 patients (32 women, 43 men) with a mean age of 44.2 ± 15.64 (23-74) years were included, of which 36 were normosmic and 39 hyposmic. OC stenosis was partial in 58.7% (n = 44) of the patients, absent in 28% (n = 21), and total in 13.3% (n = 10), without difference between normosmic and hyposmic patients (p = .66). OC obstruction was absent in 52% (n = 39) and partial in 46.7% (n = 35), without difference between normosmic and hyposmic patients (p = .51). Only one normosmic patient had complete OC obstruction. CONCLUSION OC partial stenosis and partial obstruction were frequent findings in pre-septorhinoplasty patients without respiratory mucosa disease and did not influence their olfactory status. Total stenosis and complete obstruction were rarer and require further investigation. CLINICAL RELEVANCE STATEMENT Isolated partial olfactory cleft stenosis and obstruction should be considered normal variants, whereas the impact of complete olfactory cleft stenosis and obstruction on patient's olfactory status remains to be determined. KEY POINTS • The incidence of olfactory cleft stenosis and obstruction in asymptomatic patients remains unknown, even though it is encountered in clinical practice. • Partial and total olfactory cleft stenosis occurred in 58.7% and 13.3% of the patients; partial obstruction occurred in half of the cases, but complete obstruction was extremely rare. • There are frequent findings of partial olfactory cleft obstruction and stenosis, but complete obstruction and total stenosis should be further investigated.
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Affiliation(s)
- Sara Imbs
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France
| | - Baptiste Deyrail
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
| | - Duc Trung Nguyen
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
| | - Gabriela Hossu
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Cécile Rumeau
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, DevAh, Nancy, France
| | - Roger Jankowski
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, DevAh, Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France.
- Université de Lorraine, INSERM, IADI, Nancy, France.
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France.
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12
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De Luca P, La Mantia I, Gioacchini FM, Re M, Radici M, Camaioni A, Di Stadio A. Fitostimoline® in fibro-endoscopic and trans-nasal trans-speculum septoplasty as a beneficial tool to improve post-surgical outcome: Preliminary results of a case-control study. Am J Otolaryngol 2024; 45:104107. [PMID: 37948825 DOI: 10.1016/j.amjoto.2023.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Topic treatment can be useful to improve short and long-term nasal outcomes after nasal surgery, reducing discomfort and risk of synechia. This study aimed at evaluating the effect on clinical outcomes of nasal packaging using Fitostimoline® gauze in FESS and septoplasty. METHODS A case-control study on hospitalized patients was performed in a tertiary referral center. The control group included 20 patients treated with the standard surgical protocol for septoplasty and standard nasal packaging; treatment group included 21 patients underwent same surgical procedure but in whom the nasal tampon was wrapped with a gauze containing Fitostimoline® before being placed into the nose. RESULTS Patients in treatment group had better outcomes than control; nasal mucosa showed better healing - recovery of normal color- in those patients in whom we applied the Fitostimoline® gauze around tampons. Moreover, 100 % patients in the treatment group did not refer discomfort during at tampon removal versus 60 % subjects in the control group who referred pain, tension or tearing during the same action. CONCLUSION Our results, although preliminary because of the small cohort of subjects included, suggest that the apposition of a gauze with Fitostimoline® after nasal surgery might improve the mucosal healing with consequent reduction of patients discomfort during the post-surgical period.
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Affiliation(s)
- Pietro De Luca
- Otolaryngology Department, Fatebenefratelli Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Ignazio La Mantia
- GF Ingrassia Department, Otolaryngology Unit, University of Catania, Catania, Italy
| | - Federico Maria Gioacchini
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Massimo Re
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Marco Radici
- Otolaryngology Department, Fatebenefratelli Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Angelo Camaioni
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Arianna Di Stadio
- GF Ingrassia Department, Otolaryngology Unit, University of Catania, Catania, Italy.
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Karaoğullarından A, Erkan SO, Ekici NY. Is transoral sphenopalatine ganglion blockade more effective on postoperative pain than endoscopic sphenopalatine ganglion blockade? Eur Arch Otorhinolaryngol 2024; 281:193-199. [PMID: 37697038 DOI: 10.1007/s00405-023-08174-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/31/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE In this study, we aimed to examine and compare the effects of endoscopic SPGB and transoral SPGB on postoperative pain control and patient satisfaction in patients undergoing septoplasty. METHODS Participants were randomly divided into three groups, no blockade (n:20), endoscopic SPGB (n:20), and transoral SPGB (n:20). Those who had no blockage were included in the control group. Demographic data of patients, such as age and sex, VAS (visual analogue scale) and postoperative pain scores (PPS) [determined at arrival in the post-anesthesia care unit (PACU) and after 2, 6, 12, and 24 h], general analgesic use (24 and 168 h after surgery) and postoperative Quality of Recovery (QoR-15) values were recorded and compare them. RESULTS The PPS PACU of 2 h, 6 h, 12 h, and 24-h values of the transoral group were lower than the endoscopic and control groups (p < 0.001).The values of 24 h and 168 h of analgesic use in the transoral group were lower than in the control and endoscopic groups (p < 0.001).The average recovery QoR-15 scores at 12 h and 24 h differed according to the groups (p < 0.001) and the highest values were in the transoral group (p < 0.001). CONCLUSION Transoral SPGB is more effective in postoperative pain control than endoscopic SPGB, it decreases the use of postoperative analgesics and improves postoperative recovery scores.
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Affiliation(s)
- Ayşe Karaoğullarından
- ENT Specialist in Adana City Training and Research Hospital ENT Department, 01060, Yüreğir, Adana, Turkey.
| | - Sanem Okşan Erkan
- ENT Specialist in Adana City Training and Research Hospital ENT Department, 01060, Yüreğir, Adana, Turkey
| | - Nur Yücel Ekici
- ENT Specialist in Adana City Training and Research Hospital ENT Department, 01060, Yüreğir, Adana, Turkey
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Mandour YMH, El Hamshary A, Abdel-Elhay SA, Abdel-Hamid MS, Gomaa M. Laryngeal Changes After Septoplasty and Turbinectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:3242-3247. [PMID: 37974822 PMCID: PMC10645820 DOI: 10.1007/s12070-023-03951-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/08/2023] [Indexed: 11/19/2023] Open
Abstract
Studies found only a little amount of evidence about the impact of septoplasty on the mechanism of voice production, as well as vocal cord and laryngeal mucosal changes. Nasal obstruction is a common medical issue that is linked to changes in the quality of resonance of voice. To assess patients with deviated nasal septum and inferior turbinate hypertrophy's voice alterations using laryngeal stroboscope before and after septoplasty and turbinectomy. In this prospective case-control study, patients in group A had inferior turbinate hypertrophy and a nasal septal deviation, while participants in group B were healthy controls who were matched for age and gender. All of the included patients had their laryngeal stroboscope and acoustic voice characteristics evaluated both preoperatively and three months after surgery. Only the baseline evaluation of healthy controls was done. We included 30 patients with mean age 24.43 ± 7.81 years, and males accounted for two thirds of the included cases, speech testing showed that Amplitude perturbation significantly improved post septoplasty with p values < 0.05, while Fundamental frequency and NHR parameters didn't show statistically significant improvement compared to preoperative measurements and control groups. Paired comparison of laryngeal erythema, mucosal edema and mucosal waves showed significant improvement compared to preoperative laryngeal stroboscopic findings with p values < 0.001 each. Significant improvements were made to septal deviation following surgery nasal obstruction caused by nasal septal deviation and inferior turbinate hypertrophy is associated with amplitude perturbation, laryngeal erythema, mucosal edema, and mucosal waves in the patients.
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Rajpurohit R, Salaria N, Garg U. Comparative Arterial Blood Gas Analysis in Post Septoplasty Patients with Conventional Nasal Packs Versus Nasal Packs with Airway. Indian J Otolaryngol Head Neck Surg 2023; 75:2802-2808. [PMID: 37974710 PMCID: PMC10645705 DOI: 10.1007/s12070-023-03847-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/03/2023] [Indexed: 11/19/2023] Open
Abstract
To evaluate levels of arterial blood gases in patients undergoing septoplasty, with conventional nasal packing versus those with nasal packing with airway. The current prospective comparative study was conducted on 68 patients undergoing septoplasty, who were divided randomly into two groups-conventional nasal packs (ANP) and nasal packs with airway (ANP-A). Arterial blood gas analysis alongwith objective symptoms of patients were recorded and evaluated. The difference between pre and post operative values of SpO2 (ANP = 6.73 ± 1.17, ANP-A = 2.84 ± 0.91) and pO2 (ANP = 15.09 ± 4.34, ANP-A = 3.46 ± 1.49) between the two groups was statistically significant (p = 0.001). Differences in post operative pH, pCO2 and HCO3 between the two groups was not statistically significant. Significant difference between the two groups was observed in patients' objective symptoms as well. Nasal packs with airway have lesser perturbing effects on septoplasty patients as compared to conventional nasal packs.
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Affiliation(s)
- Ramya Rajpurohit
- Department of ENT, BPS Government Medical College for Women Khanpur Kalan, Sonepat, Haryana India
| | - Neha Salaria
- Department of ENT, BPS Government Medical College for Women Khanpur Kalan, Sonepat, Haryana India
- Department of Otorhinolaryngology, G Block, 1st Floor OPD Block, BPS Government Medical College for Women Khanpur Kalan, Sonepat, Haryana 131305 India
| | - Uma Garg
- Department of ENT, BPS Government Medical College for Women Khanpur Kalan, Sonepat, Haryana India
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Gryskiewicz J, Alameddine KO. Invited Discussion on: Video-Assisted Septo-Rhinoplasty, the Future of Endonasal Rhinoplasty-A Technical Note. Aesthetic Plast Surg 2023; 47:2658-2660. [PMID: 37474821 DOI: 10.1007/s00266-023-03497-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023]
Abstract
This discussion critically evaluates the paper "Video-assisted septo-rhinoplasty, the future of endonasal rhinoplasty-A Technical Note." This discussion recognizes the substantial advantages offered by the novel endoscopic technique, such as improved visibility and the facilitation of surgical teaching. However, it also explores the inherent obstacles including potential restrictions in achieving full visibility of all nasal structures, a steeper learning curve for young surgeons due to the need to master endoscope manipulation, and difficulties in precision and accuracy during suture and graft placements in the confined operational field. This discussion underscores the importance of surgical adaptability as well as tailoring techniques to meet the specific anatomical and esthetic considerations of each patient. Even as the limitations of the endoscopic method are highlighted, its potential for advancing the field of rhinoplasty is affirmed. The inventiveness and dedication of the original authors are applauded, and we look forward to their continued innovation in this rapidly evolving discipline.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Joe Gryskiewicz
- School of Dentistry Cleft Palate/Craniofacial Clinics, University of Minnesota Academic Health Center, Minneapolis, MN, USA.
| | - Khaled O Alameddine
- Division of Plastic Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Moon JW, Choi SY, Kim SJ, Shin JM, Park IH. Wedge resection combined with 3D-printed polycaprolactone mesh for caudal septal deviation. J Otolaryngol Head Neck Surg 2023; 52:69. [PMID: 37876017 PMCID: PMC10599004 DOI: 10.1186/s40463-023-00677-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 10/18/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Biocompatibility and stability of three-dimensional printed polycaprolactone mesh grafts for nasal surgery are proven in both animal and human models. However, their safety and durability as batten grafts for caudal septal deviation has not been documented. This study was designed to investigate the efficacy and safety of three-dimensional printed polycaprolactone mesh batten graft in septoplasty using the wedge resection technique for the correction of caudal septal deviation. METHODS This retrospective study reviewed the medical records of 20 patients aged ≥ 18 years with caudal septal deviation who underwent septoplasty with wedge resection and three-dimensional printed polycaprolactone mesh graft from a tertiary medical center in South Korea, between December 1, 2019 and May 31, 2021. Those without nasal obstruction before surgery or with a short follow-up period (< 28 days) were excluded from the survey analysis. RESULTS Of the 20 patients (mean age, 48.0 [range, 19-65] years), 17 (85.0%) were male, and three (15.0%) were female. A significant change was noted in the mean nasal obstruction symptom evaluation score (68.2 vs. 15.0, P < .001) in the 17 patients included in the analysis. Postoperative endoscopic evaluation revealed a straight septum in 19/20 (95.0%) patients, and no complications were noted in the postoperative follow-up period of up to 364 days. CONCLUSIONS The three-dimensional printed polycaprolactone nasal mesh is safe and provides adequate support to resist the intrinsic memory of the cartilage of the caudal septum. In addition to nasal surgeries, it has great potential as a graft in other reconstructive surgeries. Trial registration Retrospectively registered.
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Affiliation(s)
- Jee Won Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 08308, Seoul, South Korea
| | - Seok-Youl Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 08308, Seoul, South Korea
| | - Su-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 08308, Seoul, South Korea
| | - Jae-Min Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 08308, Seoul, South Korea
- Upper Airway Chronic Inflammatory Diseases Laboratory, Korea University, College of Medicine, Seoul, South Korea
| | - Il-Ho Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 08308, Seoul, South Korea.
- Upper Airway Chronic Inflammatory Diseases Laboratory, Korea University, College of Medicine, Seoul, South Korea.
- Medical Device Usability Test Center, Korea University, College of Medicine, Seoul, South Korea.
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Bhardwaj H, Kalsotra G, Kalsotra P, Singh P, Saraf A. Surgical Outcomes of Endoscopic Versus Conventional Septoplasty. Indian J Otolaryngol Head Neck Surg 2023; 75:1724-1730. [PMID: 37636711 PMCID: PMC10447728 DOI: 10.1007/s12070-023-03720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
The most common cause of nasal obstruction is a deviated nasal septum. It causes breathing difficulties and may eventually also cause sinusitis, epistaxis, sleep disturbances and snoring. The traditional surgeries of the nasal septum improve the nasal airway but do not fulfil the essential criteria in most instances. Endoscopic septoplasty is a fast-developing concept and gaining popularity as it provides a direct targeted approach to the septal anatomic deformity allowing a minimally invasive procedure under excellent visualization. The aim of this study is to compare the post-operative morbidity among conventional and endoscopic septoplasty. The present prospective study was conducted on 50 patients having deviated nasal septum. Patients were randomly divided into two groups of 25 each. Out of 50 patients, in 25 patients (Group A) Conventional septoplasty was done, whereas in other 25 patients (Group B) endoscopic septoplasty was done. The patients were followed up post-operatively at 2 weeks, 4 weeks and 8 weeks. Study Design: comparative study. The mean of operating time (min) in Group A was 60.47 ± 8.16 which was significantly higher as compared to Group B (39.7 ± 6.73). (p value < .0001). The Mean of blood loss (mL) was significantly higher in Group A (88.67 ± 8.77) as compared to Group B. (54.6 ± 7.18). (p value < .0001). Post-operative NOSE score at one month was 7.33 ± 1.5 in group A which was significantly higher as compared to Group B (5 ± 1.41). (p value = 0.0007) whereas post-operative NOSE score at 3 months in Group A was 6.53 ± 1.25 which was significantly higher as compared to Group B (4.4 ± 1.78). Proportion of post-operative complications was comparable in Group A and Group B (No complication 80% vs. 92% respectively). According to the present study, both the conventional and endoscopic septoplasty procedures were effective in relieving nasal obstruction in the patients. Endoscopic septoplasty showed significantly better result than conventional septoplasty in terms of time taken for surgery, blood loss during the surgery, post-operative complications and in terms of quality of life as assessed by NOSE Score.
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Affiliation(s)
- Heemani Bhardwaj
- Department of ENT and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir India
| | - Gopika Kalsotra
- Department of ENT and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir India
| | - Parmod Kalsotra
- Department of ENT and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir India
| | - Padam Singh
- Department of ENT and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir India
| | - Aditiya Saraf
- Department of ENT and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir India
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Sedaghat K, Hosseinpoor M, nasirai E, yousefi R, Akbari S, Rasoulian B. Evaluation of the Effect of Antibiotics and Splints on the Result of Septal Mucosal Culture After Septoplasty. Indian J Otolaryngol Head Neck Surg 2023; 75:1586-1590. [PMID: 37636722 PMCID: PMC10447870 DOI: 10.1007/s12070-023-03665-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/03/2023] [Indexed: 03/29/2023] Open
Abstract
Purpose Post operation infection after septoplasty is very rare, possibly due to excessive nasal blood supply. Most otorhinolaryngologists recommend antibiotics after septoplasty; however, controversial results were available. Therefore, this study was designed to investigate the effect of antibiotics after septoplasty. Methods In this study, 90 patients who were candidates for septoplasty were entered the study and divided into three groups. The first group did not receive any oral antibiotics after septoplasty. The second group took 500 mg of oral cephalexin. The third group, for whom splints were used, also received cephalexin. The culture of the nasal mucosa was prepared before and two weeks after surgery and compared between groups. Then, the amount and types of mucosa microorganisms were reported. Data were analyzed using SPSS16. Results The growth significantly increased in the first group (p = 0.051) and reduced in the second group (p < 0.001). While a decreased growth rate was observed in the third group, it was not statistically significant (p = 0.12). Conclusion The present study highlighted the beneficial role of prophylactic antibiotics administration in patients without splints on bacterial growth, while it had no effect in patients with splints. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03665-w.
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Affiliation(s)
- Kianoosh Sedaghat
- Otorhinolaryngology department, Mashhad University of Medical Sciences, Otorhinolaryngologist, Mashhad, MD Iran
| | - Masoumeh Hosseinpoor
- Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan nasirai
- Otorhinolaryngology department, Mashhad University of Medical Sciences, Otorhinolaryngologist, Mashhad, MD Iran
- Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Shadi Akbari
- Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bashir Rasoulian
- Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Jamil A, Hameed HA, Sidiqqui AH, Farrukh MS. Comparison of complete nasal packing with and without integrated airways. Pak J Med Sci 2023; 39:1317-1320. [PMID: 37680792 PMCID: PMC10480746 DOI: 10.12669/pjms.39.5.7478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 09/09/2023] Open
Abstract
Objective To compare the effects of nasal packing using a Nasopore nasal packing with and without an airway tube on postoperative pain, SpO2, nasal obstruction, and difficulty in breathing complaints. Methods This comparative study was conducted at Dow University of Health Sciences (DUHS), DMC Civil Hospital Karachi between September 18, 2021, to May 19, 2022. A total of 70 patients who underwent septoplasty for septal deviation and chronic hypertrophic rhinitis were equally divided into two groups. Group-A patients received nasal packing using a Nasopore nasal packing with an airway tube, and Group-B patients received nasal packing using a Nasopore nasal packing without an airway tube. Post-operation Nasal pain sensations were measured using the Wong-Baker Faces Pain Rating Scale at 2 and 12 hours. SpO2 was measured at 30 minutes pre-operatively with an O2 saturation monitor and 12 hours post-operatively during sleep. Results The postoperative pain at two hours and 12 hours was compared between the two groups, and a significant difference was observed. In Group-A, the average SpO2 decreased > 4% from baseline in 5.7% patients, and 37% in Group-B. A significant difference was observed in the severity of nasal obstruction and difficulty breathing, P-value < 0.05. Conclusion It is concluded that septoplasty followed by applying nasal packing with integrated airway reduces postoperative pain and improves oxygen saturation compared to nasal packing without integrated airways.
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Affiliation(s)
- Afifa Jamil
- Afifa Jamil, MBBS. ENT Unit-1, Dr Ruth K.M. PFAU, Civil Hospital, DUHS, Karachi, Pakistan
| | - Hira Abdul Hameed
- Hira Abdul Hameed, DLO, RMO. ENT Unit-1, Dr Ruth K.M. PFAU, Civil Hospital, DUHS, Karachi, Pakistan
| | - Atif Hafeez Sidiqqui
- Atif Hafeez Sidiqqui, FCPS. ENT Unit-1, Dr Ruth K.M. PFAU, Civil Hospital, DUHS, Karachi, Pakistan
| | - M. Shuja Farrukh
- M. Shuja Farrukh, FCPS. ENT Unit-1, Dr Ruth K.M. PFAU, Civil Hospital, DUHS, Karachi, Pakistan
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Shafiee A, Arabzadeh Bahri R, Teymouri Athar MM, Beiky M, Rostaii O, Golpayegani G, Soltani Abhari F. Pain management following septorhinoplasty surgery: evidence from a systematic review. Eur Arch Otorhinolaryngol 2023; 280:3931-3952. [PMID: 37272951 DOI: 10.1007/s00405-023-08044-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE We investigated recent evidence on the analgesics available for postoperative pain management among patients undergoing septoplasty or rhinoplasty surgery. METHODS Studies were retrieved from MEDLINE (through PubMed), Web of Science, and Embase up to 3 August 2022. RESULTS Forty-seven studies including 3717 patients were included. There were 45 randomized clinical trials and 2 observational cohort studies. Most of the studies were recently published and conducted in Turkey (n = 27). The majority of the studies performed the intervention preoperatively (n = 26), 11 studies postoperatively, 6 studies intraoperative, 2 studies preoperative plus intraoperative, and 2 studies performed the intervention with preoperative plus postoperative timing. The most evaluated medication was lidocaine (n = 10), followed by levobupivacaine (n = 4), and gabapentin (n = 4). Regarding post-operative pain assessment, the most used scale was the visual analog scale (VAS) (n = 36). Compared to controls, almost all interventions showed a significant benefit in managing post-operative pain. Although it should be mentioned regarding the comparison between opioids and NSAIDs consumption after surgery for pain management, most studies did not show a significant difference between the groups. No major side effects except nausea and vomiting were observed among the reviewed studies. CONCLUSION This study summarized the most recent options that are available to manage pain following septorhinoplasty surgery. Recent investigations showed local interventions vs pre/post-operative analgesic medications are highly suggested to be replaced with opioids and NSAIDs as they have shown prominent efficacy with no significant adverse events. Future research is advised to determine the best dosage and administration techniques.
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Affiliation(s)
- Arman Shafiee
- Department of Psychiatry and Mental Health, Alborz University of Medical Sciences, Karaj, Iran.
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
| | | | | | - Maryam Beiky
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Omid Rostaii
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Golshid Golpayegani
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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22
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Park DY, Cho JH, Jung YG, Choi JH, Kim DK, Kim SW, Kim HJ, Kim HY, Park SK, Park CS, Yang HC, Lee SH, Cho HJ. Clinical Practice Guideline: Clinical Efficacy of Nasal Surgery in the Treatment of Obstructive Sleep Apnea. Clin Exp Otorhinolaryngol 2023; 16:201-216. [PMID: 36791806 PMCID: PMC10471902 DOI: 10.21053/ceo.2022.01361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 02/16/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway obstruction during sleep. To reduce the morbidity of OSA, sleep specialists have explored various methods of managing the condition, including manifold positive airway pressure (PAP) techniques and surgical procedures. Nasal obstruction can cause significant discomfort during sleep, and it is likely that improving nasal obstruction would enhance the quality of life and PAP compliance of OSA patients. Many reliable studies have offered evidence to support this assumption. However, few comprehensive guidelines for managing OSA through nasal surgery encompass all this evidence. In order to address this gap, the Korean Society of Otorhinolaryngology-Head and Neck Surgery (KORL-HNS) and the Korean Society of Sleep and Breathing designated a guideline development group (GDG) to develop recommendations for nasal surgery in OSA patients. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. The types of nasal surgery included septoplasty, turbinate surgery, nasal valve surgery, septorhinoplasty, and endoscopic sinus surgery. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians' grading system. The GDG developed 10 key action statements with supporting text to support them. Three statements are ranked as strong recommendations, three are only recommendations, and four can be considered options. The GDG hopes that this clinical practice guideline will help physicians make optimal decisions when caring for OSA patients. Conversely, the statements in this guideline are not intended to limit or restrict physicians' care based on their experience and assessment of individual patients.
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Affiliation(s)
- Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Hoon Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk 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
| | - Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Sang-Wook Kim
- Department of Otorhinolaryngology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyun Jun Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chan Soon Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Chae Yang
- 9Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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23
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Bruintjes TD, Bleys RLAW. The clinical significance of the human vomeronasal organ. Surg Radiol Anat 2023; 45:457-460. [PMID: 36759365 PMCID: PMC10039832 DOI: 10.1007/s00276-023-03101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To find out whether the vomeronasal organ (VNO) can be identified in the nose as a mucosal pit in the anterior nasal septum, to elucidate its function in man and to determine whether it is important to preserve the VNO during septal surgery. METHODS Literature review. RESULTS AND CONCLUSION The VNO is histologically present in almost all humans, but a macroscopically visible septal pit does not necessarily correspond with the actual VNO. The human VNO is probably a vestigial organ with a non-operational sensory function. It is not necessary to take particular care not to damage the VNO during septal surgery.
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Affiliation(s)
- Tjasse D Bruintjes
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Otorhinolaryngology, Gelre Hospital Apeldoorn, Apeldoorn, The Netherlands.
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
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24
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Tremp M, Schneider J, Raghu RBN, Goksel A, Saban Y. A Systematic Analysis of the Nasal Septum in Crooked Noses and Suggested Treatment Algorithm According to Preservation Rhinoplasty (PR) Principles. Aesthetic Plast Surg 2023:10.1007/s00266-023-03293-3. [PMID: 36826521 PMCID: PMC10390351 DOI: 10.1007/s00266-023-03293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/28/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND A deviated nose is a common problem among patients for both cosmetic and functional reasons. The correction remains a major challenge for the rhinoplasty surgeon. Unrecognized nasal septal deviations stand as the primary reason for failed rhinoplasty outcomes. There is a paucity of data in the literature about septoplasty classifications and technical details in preservation rhinoplasty (PR) for various crooked noses. MATERIALS AND METHODS The aim of this article is to provide a comprehensive overview of the various septum deviations according to the nasal axis. Moreover, a treatment algorithm is suggested with technical details based on PR principles. RESULTS The directions and curvature of the cartilaginous deviation of crooked nose such as C-shaped, reverse C-shaped, straight axis deviations (I-shaped), and S-shaped are described. According to the deviation, a septoplasty classification (Type 1-Type 4) is suggested. CONCLUSIONS On the basis of septal deviation, different PR techniques are proposed to achieve the desired straight nasal dorsum with an optimal functional outcome. Compared to the classical L-strut concept, the quadrangular cartilage remains preserved in the swinging door technique. The cartilage might be further used in the future for grafting in the hybrid structural/preservation technique if needed, ultimately saving rib cartilage and/or conchal cartilage. Finally, surgery time is reduced, and patient's morbidity remains minimal. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mathias Tremp
- Faculty of Medicine, University of Basel, Basel, BS, Switzerland. .,Private Practice, Hirslanden Private Hospital Group, Dorfplatz 1, 6330, Cham, Switzerland.
| | - Jonas Schneider
- Faculty of Medicine, University of Basel, Basel, BS, Switzerland
| | | | | | - Yves Saban
- Rhinoplasty Private Practice, Nice, France
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Arslan E, Tulaci KG, Canakci H, Arslan S, Yazici H. Effects of nasal septum deviation and concha bullosa surgery on the frequency and financial burden of acute rhinosinusitis. Ir J Med Sci 2023; 192:341-7. [PMID: 36098946 DOI: 10.1007/s11845-022-03156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nasal septum deviation/concha bullosa (DNS)/(CB) are known to be predisposing factors in the pathophysiology of acute rhinosinusitis (ARS). However, the effects of surgical treatment of these pathologies on ARS have not been adequately investigated. AIMS To reveal the effects of the surgical treatment of DNS and CB on the frequency of the ARS, the use of antibiotics (ABs), and the direct cost incurred. METHODS Medical records of the patients who had undergone successful surgery for DNS/CB and were diagnosed with ARS in the preoperative and postoperative 3-year period were retrospectively analyzed. The average annual number of ARS examinations of the patients, the number of ABs prescribed, and prescription, examination, and total health system costs were compared. RESULTS Fifty-three patients (33 men (62%) and 20 women (38%)) were included in the study. There was a statistically significant decrease in the mean annual number of examinations for ARS, the number of ABs prescribed, prescription, examination, and total health system costs (p < 0.05) in the postoperative period compared with the preoperative period. CONCLUSIONS The present study determined that successful surgeries performed in patients with DNS/CB resulted in a significant decrease in the average annual number of examinations performed for ARS, number of AB prescriptions, and prescription, examination, and total health system costs. With these results, it seems beneficial to direct patients to surgery within the framework of the health policies of countries to reduce the frequency and financial burden of ARS in DNS/CB patients.
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26
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Kar M, Bayar Muluk N, Susaman N, Çetiner H, Cingi C. How do different climatic conditions affect the quality of life of patients following septoplasty or septorhinoplasty? J Plast Reconstr Aesthet Surg 2023; 77:54-62. [PMID: 36549123 DOI: 10.1016/j.bjps.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 08/18/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The effects of different climatic conditions on the quality of life (QoL) of patients following septoplasty or septorhinoplasty were investigated. METHODS A total of 89 patients (47 males and 42 females) underwent either septoplasty or septorhinoplasty during the summer (summer group, n = 42) or winter (winter group, n = 47) season. To assess QoL, SinoNasal Outcome Test (SNOT)-22, Nasal Obstruction Symptom Evaluation (NOSE) scale, and Visual Analogue Scale were used. Postoperative (PO) pain, bleeding, and symptoms related to nasal packing (eating and sleep problems) were also evaluated. RESULTS PO pain scores were lower in the winter group than that in the summer group (p<0.05). After pack removal, there was a slight serohemorrhagic nasal discharge in 2.1% of the patients in the winter group, but no patient required intervention. Slight leakage was detected in 47.6% of the patients and 2.4% of the patients called for intervention (p<0.05) in the summer group. The SNOT-22 values did not differ between the groups (p>0.05). NOSE scores in the winter group were higher than that in the summer group (p<0.05). In each group, SNOT-22 (padjusted<0.175) and NOSE scores (p<0.05) were lower at 1 month after surgery. The winter group patients rated headache, facial pain, and nasal crusting higher than those in the summer group did (p<0.05). However, nasal discharge and loss of smell were less troubling in the summer group than that in the winter group (p<0.05). CONCLUSION Regardless of climate or season, septoplasty or septorhinoplasty increases patients' QoL. However, problematic PO bleeding was detected at a higher frequency in patients who underwent surgery in summer. The advantage of surgery in winter is that it leads to less frequent problematic bleeding PO.
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Affiliation(s)
- Murat Kar
- AlaaddinKeykubat University, Alanya Training and Research Hospital, Department of Otorhinolaryngology, Alanya, Antalya, Turkey
| | - Nuray Bayar Muluk
- Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey.
| | - Nihat Susaman
- Elazig Fethi Sekin City Hospital, ENT Clinics, Elazig, Turkey
| | - Hasan Çetiner
- East Anatolia Hospital, Department of Otorhinolaryngology, Elazıg Turkey
| | - Cemal Cingi
- Eskisehir Osmangazi University, Faculty of Medicine, ENT Department, Eskisehir, Turkey
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27
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Lepley TJ, Frusciante RP, Malik J, Farag A, Otto BA, Zhao K. Otolaryngologists' radiological assessment of nasal septum deviation symptomatology. Eur Arch Otorhinolaryngol 2023; 280:235-240. [PMID: 35768701 PMCID: PMC10229233 DOI: 10.1007/s00405-022-07528-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/24/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Nasal Septal Deviation (NSD) is one of the most common causes of nasal obstruction. This study aims to further examine the clinical utility of imaging assessment in the workup and management of symptomatic nasal septal deviation, across all levels of medical training. STUDY DESIGN Cross-sectional survey. METHODS CT scans of 10 confirmed NSD patients and 36 healthy controls (HC) were mixed and emailed through anonymous REDCap surveys to otolaryngologists in the US. The HC had no reported sinonasal obstruction symptoms-NOSE (NSD: 62.2 ± 12.5; HC: 5.69 ± 5.99, p < 0.05); SNOT-22 (NSD: 31.4 ± 14.5; HC: 9.72 ± 10.76, p < 0.05). The images consisted of a coronal slice at each subject's most deviated location. Participants were instructed to choose the patients suspected to present with symptoms of sinonasal obstruction. RESULTS 88 otolaryngologists responded to the survey. 18 were excluded due to incomplete responses. On average, they identified 64.2 ± 29.8% of symptomatic NSD subjects correctly, but misidentified 54.6 ± 34.6% of HC as symptomatic. Their decisions were strongly correlated to degree of NSD (r = 0.69, p < 0.05). There exists a significant degree of NSD among HC (38.7 ± 17.2%), which does not significantly differ from symptomatic subjects (51.0 + 18.7%, p = 0.09). Residents and fellows performed similarly, with responses correlated between levels of training (r = 0.84-0.96, p < 0.05). CONCLUSIONS The incorporation of a substantial number of otolaryngologists, large patient sample, and blind mixing with HC gives us greater insight to the relative contribution of the extent of septal deviation to symptoms of nasal obstruction. Although NSD is a common factor contributing to nasal obstruction, the results of this study suggest that it is difficult to reliably infer obstructive symptoms based on degree of NSD on CT. LEVEL OF EVIDENCE Three.
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Affiliation(s)
- Thomas J Lepley
- Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH, 43212, USA
| | | | - Jennifer Malik
- Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH, 43212, USA
| | - Alexander Farag
- Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH, 43212, USA
| | - Bradley A Otto
- Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH, 43212, USA
| | - Kai Zhao
- Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH, 43212, USA.
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28
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Raghavendra Prasad KU, Divya CT, Ramitha TS. Unilateral Blindness in Post Septoplasty Due to Homocysteinemia: A Rare Presentation. Indian J Otolaryngol Head Neck Surg 2022; 74:4784-4787. [PMID: 36742842 PMCID: PMC9895241 DOI: 10.1007/s12070-021-03066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
Septoplasty is a common operative procedure in ENT for correction of nasal septal deformity. Rarely it may result into devastating complication like vision loss. This may be related to other causes apart from septoplasty. The author presents a 27 yrs old male admitted to our hospital for septoplasty, 1 h after septoplasty the patient suffered from unilateral vision loss. After thorough examination and investigation the vision loss was found to be due to homocysteinemia. Hence homocysteinemia is one of the rare cause of vision loss in post septoplasty. Thus this is a rare presentation.
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Affiliation(s)
| | - C. T. Divya
- Department of ENT, Hassan Institute of Medical Sciences, Hassan, India
| | - T. S. Ramitha
- Department of ENT, Hassan Institute of Medical Sciences, Hassan, India
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Haque M, Mukhopadhyay S. Objective and Subjective Analysis for Efficaciousness of Nasal Airway in Patients Undergoing Conventional and Endoscopic Septoplasty: A Comparative Study. Indian J Otolaryngol Head Neck Surg 2022; 74:4816-4823. [PMID: 36742918 PMCID: PMC9895268 DOI: 10.1007/s12070-022-03120-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/06/2022] [Indexed: 02/07/2023] Open
Abstract
Deviated nasal septum is the most common cause of nasal obstruction and is one of the common problems encountered by otolaryngologists. Although there are different methods to surgically correct a deviated nasal septum which can give qualitative relief to the patient, less emphasis is put on the quantitative assessment of airway after a septal correction surgery. Institution based Case Control study was undertaken at Medical College and Hospital Kolkata between January 2019 to March 2020 to subjectively and objectively assess and compare the nasal airway status preoperatively and postoperatively in patients undergoing conventional and endoscopic septoplasty. A total of 250 patients were taken in this study and divided into two groups A and B. Group A consisted of patients undergoing Conventional Septoplasty (Control arm) and Group B consisted of patients undergoing Endoscopic Septoplasty (Case arm). Patients were followed up and the readings of NOSE score and PNIF value were recorded at the end of 6 weeks and 6 months (24 weeks). The Mean NOSE score post operatively at the end of 6 weeks was 36.32 in GROUP A (Control arm) and 33.08 in GROUP B (Case arm). t-Test revealed insignificant results with a p-value of 0.08. The mean NOSE score post operatively at the end of 6 months was 29.96 in GROUP A (Control arm) and 22.16 in GROUP B (Case arm). t-Test revealed significant results with a p-value of 0.00. Similarly, Mean PNIF value post operatively at the end of 6 weeks was 57.24 in GROUP A (Control arm) and 73.88 in GROUP B (Case arm). t-Test revealed significant results with p-value of 0.00. The mean PNIF value post-operatively at the end of 6 months was 59.44 in GROUP A (Control arm) and 80.08 in GROUP B (Case arm). t-Test revealed significant results with p-value of 0.00. Endoscopic Septoplasty is a very effective way to treat septal deviations especially with deviations based on the posterior aspect of the septum. It provides a superior edge in terms of nasal airway improvement as compared to conventional method of septoplasty. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03120-2.
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Affiliation(s)
- Misbahul Haque
- Department of ENT and Head Neck Surgery, Medical College and Hospital, Kolkata, West Bengal India
| | - Subrata Mukhopadhyay
- Department of ENT and Head Neck Surgery, Medical College and Hospital, Kolkata, West Bengal India
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30
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Schell A, Wassmer F, Zaubitzer L, Kramer B, Sadick H, Rotter N, Häussler D. The effect of complementary music intervention on the patients' quality of life after septoplasty and rhinoplasty. BMC Complement Med Ther 2022; 22:282. [PMID: 36320025 PMCID: PMC9624046 DOI: 10.1186/s12906-022-03761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/14/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Quality of life (QoL) assessment has emerged as an important evaluation tool for therapeutic treatments. The positive impact of complementary music interventions on QoL has been demonstrated in the literature, particularly in chronic and malignant diseases. However, its benefits during the perioperative period in head and neck patients have not been investigated thus far. METHODS Head and neck patients undergoing septoplasty and rhinoplasty were prospectively randomized and consecutively included in the trial. Passive music intervention (60 min per day) was applied to the intervention group. QoL was assessed using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and the Functional Rhinoplasty Outcome Inventory 17 (FROI-17) questionnaire at three visits during the postoperative phase. Pain was measured using a visual analogue scale. RESULTS Forty-four patients were enrolled in the study. The NOSE score between the control group and the intervention group in the septoplasty arm differed significantly at visit #2 (p < 0.001) and visit #3 (p < 0.015). For the rhinoplasty study arm, significant differences in the FROI-17 score were also found at visit #2 and visit #3 (p = 0.04). CONCLUSION Complementary music interventions can considerably improve patients' QoL during the postoperative period. Furthermore, passive music interventions may be easily implemented in clinical practice as an additional cost-effective treatment with ubiquitous availability.
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Affiliation(s)
- Angela Schell
- grid.411778.c0000 0001 2162 1728Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Medical Faculty of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Felix Wassmer
- grid.411778.c0000 0001 2162 1728Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Medical Faculty of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Lena Zaubitzer
- grid.411778.c0000 0001 2162 1728Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Medical Faculty of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Benedikt Kramer
- grid.411778.c0000 0001 2162 1728Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Medical Faculty of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Haneen Sadick
- grid.411778.c0000 0001 2162 1728Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Medical Faculty of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Nicole Rotter
- grid.411778.c0000 0001 2162 1728Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Medical Faculty of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Daniel Häussler
- grid.411778.c0000 0001 2162 1728Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Medical Faculty of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
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Kumar M, Panneerselvam E, Prabhu K, Ganesh SK, Vb KKR. Prospective cohort study on short-term evaluation of septoplasty as early management of naso-septal fractures - A correlation of clinical outcomes with computational fluid dynamic parameters. J Stomatol Oral Maxillofac Surg 2022; 123:639-644. [PMID: 35853555 DOI: 10.1016/j.jormas.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/12/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Post-traumatic deviated nasal septum (PTDNS) leads to impaired breathing and poor esthetics. The aim of this study was to assess treatment outcomes of early septoplasty for correction of PTDNS and correlate it with computational fluid dynamic (CFD) parameters. METHODS This prospective cohort study included patients who underwent early septoplasty for PTDNS. Outcome variables were clinical (pain, nasal symmetry, and nasal obstruction) and computational (velocity, pressure, wall shear stress and Reynold's number). The cohort consisted of two groups: patients with history of closed reduction for nasal fractures (CR) and patients without (NCR). The primary outcome measure was response to treatment. Correlation between clinical and computational parameters, and influence of closed reduction on septoplasty outcomes were the secondary and tertiary outcomes, respectively. Descriptive and inferential statistics were performed to analyze data. Level of significance was fixed at 5% (α = 0.05). RESULTS The sample included 12 patients, of which 5 underwent CFD analysis. Pain score reduced from a pre-operative mean of 7.3 to 0.5 post-operatively (p<0.001). All patients demonstrated reduction of nasal obstruction (p<0.001) and deviation (p<0.001) post-operatively. CFD analysis revealed post-operative reduction of velocity (p = 0.005) and Reynold's number (p = 0.007), with positive correlation between nasal obstruction and CFD parameters. Though patients in the CR group demonstrated reduced nasal deviation and obstruction before septoplasty, as compared to the NCR group, their outcomes were comparable following septoplasty. CONCLUSION Early septoplasty improves functional and esthetic outcomes in patients with PTDNS. CFD simulation is a predictable method to objectively evaluate nasal function.
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Affiliation(s)
- Muthu Kumar
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Elavenil Panneerselvam
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India.
| | - Komagan Prabhu
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Sriraam Kasi Ganesh
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Krishna Kumar Raja Vb
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
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Mandal S, Tripathi Ashwin N, Sharma A, Bhardwaj R. Trans-septal Suturing Versus Merocel Nasal Packing: A Post Septoplasty Comparison. Indian J Otolaryngol Head Neck Surg 2022; 74:937-942. [PMID: 36452623 PMCID: PMC9702412 DOI: 10.1007/s12070-020-02013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022] Open
Abstract
It has been observed that nasal packing following septoplasty contributes to co-morbidities like post-operative pain, bleeding and increased duration of hospital stay. Trans-septal suturing has been suggested as a safe and effective alternative with a view to obviate the need for nasal packing and the hence avoid the discomfort associated with it. To compare the outcome of trans-septal suturing technique with merocel nasal packing after septoplasty. This was a prospective comparative study done on 60 patients who underwent septoplasty. The patients were divided randomly into 2 groups, while Group A comprised of patients undergoing Post-operative nasal packing with poly vinyl alcohol sponge (also commercially called Merocel), Group B included patients who underwent nasal septal suturing after surgery. The postoperative pain, hemorrhage and duration of hospital stay were the main parameters that were assessed and a comparison was drawn between the post-operative outcome of two techniques. Post-operative global pain score was 62.18 ± 4.75 in the group A (patients with nasal packing) and 24.73 ± 4.29 (patients with trans-septal suturing) in group B ('p'value was < 0.0001). Post-operative bleeding was noticed in 19 patients (out of 30) in group A, and in 2 patients of group B ('p'value was < 0.0001). 27 out of 30 patients of Group A were discharged on day 2 whereas 24 out of 30 patients of Group B required only 1 day of hospital stay after the surgery ('p' value was < 0.0001). Trans-septal suturing technique reduces the duration of hospital stay, causes lesser post-operative bleeding and pain and is a relatively less painful technique than merocel nasal packing.
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Affiliation(s)
- Shantanu Mandal
- Department of Otorhinolaryngology, Safdarjung Hospital and Vardhman Mahavir Medical College, Ansari Nagar, New Delhi, 110029 India
| | - N. Tripathi Ashwin
- Department of Otorhinolaryngology, Safdarjung Hospital and Vardhman Mahavir Medical College, Ansari Nagar, New Delhi, 110029 India
| | - Akriti Sharma
- Department of Otorhinolaryngology, SGT Medical College, Hospital & Research Institute, Village Budhera, Gurugram, Haryana 122505 India
| | - Rohit Bhardwaj
- Department of Otorhinolaryngology, Safdarjung Hospital and Vardhman Mahavir Medical College, Ansari Nagar, New Delhi, 110029 India
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Majeed SA, Saeed BMN. The Efficacy of Septal Quilting Sutures Versus Nasal Packing in Septoplasty. Indian J Otolaryngol Head Neck Surg 2022; 74:1713-1717. [PMID: 36452783 PMCID: PMC9702136 DOI: 10.1007/s12070-021-02865-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022] Open
Abstract
Nasal packing is the classic method adopted by many otolaryngologists to stabilize the nasal septum and decrease the occurrence of postoperative bleeding and septal hematoma after septoplasty. However, because of its associated postoperative morbidity, many surgeons started to adopt alternative methods. This study aimed to assess the outcome and benefits of septal quilting sutures in comparison to nasal packing after septoplasty. A prospective non-randomized comparative interventional study was carried out at two teaching hospitals in Mosul city from January 2020 to January 2021. A total of 60 patients who were candidates for septoplasty, were included in the study. According to the surgeon's preference; 30 patients had placement of septal quilting sutures (group A), and in the other 30 patients nasal packing was performed (group B). Patients were assessed for postoperative morbidity and early outcome in the first 24 h, 1 week and 1 month postoperatively. In the first 24 h after septoplasty, patients in group B had significantly higher levels of nasal/facial pain, headache, sleep disturbance, breathing difficulties and swallowing difficulties compared to group A (p < 0.001). Over the follow up period of 1 month, no significant differences were recorded regarding postoperative bleeding, hematoma, infection, adhesions formation and septal perforation between the two groups (p > 0.05). Septal quilting sutures technique is more favorable in the early period in terms of patient discomfort after septoplasty, better nasal block and nasal/facial pain, the absence of misery on pack removal, with minimal bleeding after surgery.
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Affiliation(s)
- Sinan Ahmed Majeed
- Department of Otorhinolaryngology, Aljumhori Teaching Hospital, Mosul, Iraq
- College of Medicine, University of Mosul, Mosul, Iraq
| | - Basil M. N. Saeed
- Department of Surgery, College of Medicine, University of Mosul, Mosul, Iraq
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bora A, Aslan Y, Durmuş K, Demirkıran BB, Altuntas EE. Do Mean Values of the Peak Inspiratory Nasal Flowmeter Vary According to the Severity, Direction and Type of Nasal Septum Deviation? Indian J Otolaryngol Head Neck Surg 2022; 74:1675-1682. [PMID: 36452731 PMCID: PMC9702492 DOI: 10.1007/s12070-021-02809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/08/2021] [Indexed: 11/28/2022] Open
Abstract
The aim is to investigate the contribution of the PNIF test in daily clinical practices in the objective evaluation of the early postoperative functional results of septoplasty and the effect of the severity, direction, and type of nasal septum deviation on mean PNIF values. Nasal septum deviation (NSDs) of the cases were grouped according to the Mladina classification and the severity of NSDs. An objective evaluation of the nasal airway was conducted via a peak flowmeter device in the preoperative and postoperative first month. When examining the mean PNIF values according to genders, it was observed that the values determined in male cases in the preoperative and postoperative period were higher. In the intragroup evaluation performed according the Mladina classification, a statistically significant increase was observed in the preoperative and postoperative PNIF values of the cases in Types 1-4. In the intragroup evaluation performed according to the severity of NSD, there was a significant increase in the preoperative and postoperative PNIF values of the mild and moderate cases. When comparing the preoperative and postoperative PNIF values of the groups in terms of the severity of NSD, it was observed that there was a significant difference. The PNIF can be used in routine clinical practices to evaluate the septoplasty results objectively. In the evaluation of functional results, the change in the mean PNIF values may also vary according to the direction and severity of septum deviation and the Mladina classification other than age, gender and ethnic origin.
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Affiliation(s)
- Adem Bora
- Department of Otolaryngology, Faculty of Medicine, Sivas Cumhuriyet University, 58140 Sivas, Turkey
| | - Yasin Aslan
- Department of Otolaryngology, Faculty of Medicine, Sivas Cumhuriyet University, 58140 Sivas, Turkey
| | - Kasım Durmuş
- Department of Otolaryngology, Faculty of Medicine, Sivas Cumhuriyet University, 58140 Sivas, Turkey
| | - Berat Baturay Demirkıran
- Department of Otolaryngology, Faculty of Medicine, Sivas Cumhuriyet University, 58140 Sivas, Turkey
| | - Emine Elif Altuntas
- Department of Otolaryngology, Faculty of Medicine, Sivas Cumhuriyet University, 58140 Sivas, Turkey
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Kajal P, Aarya R, Singh G, Davessar JL, Kaur K. Changes in Voice After Septoplasty: A Pilot Study. Indian J Otolaryngol Head Neck Surg 2022; 74:1831-1835. [PMID: 36452526 PMCID: PMC9701994 DOI: 10.1007/s12070-020-01860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/11/2020] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to evaluate changes in voice after septoplasty in adults using the Dr.Speech assessment module in conjunction with subjective evaluation using Voice Handicap Index (VHI). A total of 50 consecutive patients with symptomatic Deviated Nasal Septum (DNS) undergoing septoplasty were included in the study. Patients fit for surgery underwent septoplasty by standard technique. Voice assessment was done by subjective voice evaluation and Acoustic voice analysis preoperatively, 1 week after surgery and 1 month after surgery. Mean values of both males and females for Fundamental frequency (F0) were within the normal range at all the three times of assessment. No- significant differences were obtained at all the three times of assessment in males and females respectively. Significant results were obtained while comparing the preoperative and postoperative SNR dB values. Mean VHI score at preoperative, 1 week postoperative and 1 month postoperative was 23.2, 22 and 21.5 respectively. No statistical difference was obtained while comparing the mean VHI score at different time intervals. The scores between 0 and 30 are in the mild category, i.e. minimal amount of handicap. The scores of all the patients were less than 30 at all times of assessment. To conclude, post-operative changes in the voice parameters were minimal and not significant, they were indicative of greater acoustical quality of voice and lesser nasalized speech, thus reflecting the positive outcome of surgery.
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Affiliation(s)
- Puneet Kajal
- Guru Gobind Singh Medical College and Hospital, BFUHS, Faridkot, Punjab India
| | - Richa Aarya
- Guru Gobind Singh Medical College and Hospital, BFUHS, Faridkot, Punjab India
| | - Gurbax Singh
- Guru Gobind Singh Medical College and Hospital, BFUHS, Faridkot, Punjab India
| | - Jai Lal Davessar
- Guru Gobind Singh Medical College and Hospital, BFUHS, Faridkot, Punjab India
| | - Kanwalpreet Kaur
- Guru Gobind Singh Medical College and Hospital, BFUHS, Faridkot, Punjab India
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Vobilisetty RK, Tiwari D. Comparative Study Between Crushing Technique and Lateral Laminectomy of Middle Turbinate as Auxiliary Management in Patients Who Underwent Septoplasty with Concha Bullosa. Indian J Otolaryngol Head Neck Surg 2022; 74:1153-1156. [PMID: 36452635 PMCID: PMC9702221 DOI: 10.1007/s12070-020-02222-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022] Open
Abstract
The aim is to compare two commonly performed surgical techniques, lateral resection and crushing for Concha Bullosa (CB) as auxiliary management in patients who underwent septoplasty. In Patients diagnosed with DNS and CB, using endoscopy and Computerized Tomography, NOSE score was calculated. All patients underwent septoplasty and depending upon the surgical method followed for CB, patients allotted in two groups. In group A, crushing of middle turbinate was performed using Blakesley forceps and in group B, lateral resection of CB was done. Postoperative NOSE scores were calculated at 6 months and outcomes were compared. Both the surgical methods were highly effective in the management of CB. All patients had significant improvement in the NOSE score when compared with the preoperative values. Two patients in group B developed synechia between the turbinate and lateral wall. However, the superiority of one method over the other could not be established statistically. CB is a common anomaly in anatomy of nose and paranasal sinus. It frequently coexists with DNS and may cause sinus problems if it is over-pneumatised. In such cases, surgical correction is warranted. Crushing of MT and lateral resection are two commonly performed methods, both are equally effective, but the crushing technique has an advantage of mucosal preservation and less postoperative complications.
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Affiliation(s)
| | - Devendra Tiwari
- Mahatma Gandhi Medical College and Research Institute, Pillyarkuppam, Pondicherry India
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Parab SR, Khan MM, Rana AK. Rhinogavel™: A Precise and Perfect Hammer for Rhinoplasty. Indian J Otolaryngol Head Neck Surg 2022; 74:849-852. [PMID: 36452599 PMCID: PMC9702153 DOI: 10.1007/s12070-020-01911-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 12/01/2022] Open
Abstract
Nose is very important in standards of beauty because of its central location on face, making any slightest alteration in its appearance vulnerable to appreciation as well as criticism. Osteotomy is one of main steps of rhinoplasty which brings appreciably drastic change in the appearance of the individual after appropriate correction. Many approaches and instruments have since been used for proper correction of width of nasal bridge. Sometimes wrong use of force can even result in comminuted fracture of nasal bones leading to undesired surgical outcome. We have designed a hammer (gavel) made of hylam or bakelite for its precision role and use in rhinoplasty.
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Affiliation(s)
| | - Mubarak Muhamed Khan
- Sushrut ENT Hospital and Dr. Khan’s ENT Research Center, Talegaon Dabhade, India
| | - Amit Kumar Rana
- Shri Ram Murti Smarak Institute of Medical Sciences (SRMS IMS), Bareilly, India
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Sheik-Ali S, Ellis S, Bondin D. Scarring of the Eustachian tube: an unusual presentation following septoplasty and inferior turbinate reduction. Ann R Coll Surg Engl 2022; 104:e236-e238. [PMID: 35446169 PMCID: PMC9433198 DOI: 10.1308/rcsann.2021.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 09/03/2023] Open
Abstract
Septoplasty and inferior turbinate reduction is a common operation performed by ear, nose and throat surgeons for obstructive nasal symptoms. We present a case of complete unilateral scarring of the Eustachian tube orifice, a previously unreported complication, following septoplasty and inferior turbinate reduction for nasal obstruction. It is important to consider this differential diagnosis in patients presenting with unilateral middle ear effusion postoperatively.
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Affiliation(s)
| | - S Ellis
- Tameside and Glossop Integrated Care NHS Foundation Trust, UK
| | - D Bondin
- Tameside and Glossop Integrated Care NHS Foundation Trust, UK
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Zhao R, Chen K, Tang Y. Effects of Functional Rhinoplasty on Nasal Obstruction: A Meta-Analysis. Aesthetic Plast Surg 2022; 46:873-85. [PMID: 35099579 DOI: 10.1007/s00266-021-02741-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/18/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Functional rhinoplasty (FRP) is used to improve nasal ventilation by correcting problems with the nasal valves. It has not been systematically reviewed on a large scale. METHODS A comprehensive literature search was conducted in the PubMed, EMBASE, and Cochrane Library databases to identify studies evaluating nasal obstruction before and after functional rhinoplasty in patients with nasal valve problems. RESULTS A total of 57 cohorts from 43 studies involving 2024 patients were included in the current meta-analysis. The Nasal Obstruction Symptom Evaluation (NOSE) scores indicated significant improvement in nasal obstruction at the 1-month follow-up (WMD = 38.12; 95% CI, 29.15-47.10; I2 = 83.6%; P = 0.00), 3-month follow-up (WMD = 48.40; 95% CI, 43.16-53.64; I2 = 69.1%; P = 0.00), 6-month follow-up (WMD = 44.35; 95% CI, 36.65-52.04; I2 = 96.6%; P = 0.00), 12-month follow-up (WMD=43.07; 95% CI, 26.56-59.58; I2 = 97.9%; P = 0.00), and the last follow-up (WMD = 46.90; 95% CI, 43.92-49.88; I2 = 95.9%; P = 0.00) with respect to the preoperative baseline. The Visual Analogue Scale (VAS) scores indicated a similar trend at the 1-month follow-up (WMD = 4.68; 95% CI, 3.79-5.57; I2 = 86.8%; P = 0.00), 3-month follow-up (WMD = 4.46; 95% CI, 3.19-5.74; I2 = 93.3%; P = 0.00), 6-month follow-up (WMD = 4.91; 95% CI, 4.04-5.78; I2 = 88%; P = 0.00) and last follow-up (WMD = 4.22; 95% CI, 3.12-5.32; I2 = 97.1%; P = 0.00). Nasal obstruction was obviously relieved through rhinomanometry (SMD=0.56; 95% CI, 0.27-0.84; I2 = 0.0%; P = 0.00) but not through peak nasal inspiratory flow (PNIF) (SMD=-1.51; 95% CI, -3.10 to 0.07; I2 = 98.9%; P = 0.09). CONCLUSION FRP may have a positive effect on nasal obstruction caused by nasal valve problems. Broader and well-designed studies are needed to shed more light on the relationships in this area. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Lee IH, Kim DH, Kim SW, Kim SW. Changes in symptoms of Eustachian tube dysfunction after nasal surgery. Eur Arch Otorhinolaryngol 2022. [PMID: 35352146 DOI: 10.1007/s00405-022-07344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the effects of nasal surgery including endoscopic sinus surgery (ESS) and/or septoplasty on Eustachian tube dysfunction (ETD) symptoms using the Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7). METHODS Patients who underwent ESS and/or septoplasty between April 2020 and October 2021 were retrospective reviewed. The patients were divided into 3 groups according to the type of surgery: group A, septoplasty alone (76 patients); group B, ESS alone (209 patients); and group C, septoplasty + ESS (74 patients). Responses to the ETDQ-7, SNOT-22, and NOSE questionnaires were collected preoperatively and at 3 months after surgery and compared between groups. RESULTS A total of 359 patients were included in the study. The prevalence of ETD was 28.9% (22 patients) in group A, 27.3% (57 patients) in group B, and 31.1% (23 patients) in group C. The ETDQ-7 score decreased significantly after surgery: total patient population, 12.47 ± 7.0 to 8.2 ± 2.48 (p < 0.001); group A, 12.76 ± 6.62 to 8.47 ± 2.66 (p < 0.001); group B, 12.05 ± 6.89 to 8.35 ± 2.73 (p < 0.001); and group C, 13.24 ± 7.72 to 7.55 ± 1.25 (p < 0.001). Both SNOT-22 and NOSE scores also decreased significantly after surgery in the total patient population and in all three groups. There was a strong correlation between ETDQ-7 and SNOT-22 scores (r = 0.56, p < 0.001) and a moderate correlation between ETDQ-7 and NOSE scores (r = 0.33, p < 0.001). CONCLUSION Patients with CRS and/or NSD suffered from ETD, and showed significant improvement after surgery. In addition, ETD symptoms were shown to be affected by nasal obstruction as well as CRS symptoms.
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Letzel J, Darbinjan A, Hummel T. The nasal cycle before and after nasal septoplasty. Eur Arch Otorhinolaryngol 2022; 279:4961-4968. [PMID: 35286439 DOI: 10.1007/s00405-022-07322-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Septoplasty is one of the most frequently performed operations in patients with septal deviation of the nose. The aim of this surgical intervention is to reduce nasal obstruction and to achieve a physiological nasal breathing. The nasal cycle plays a crucial role in this. The aim of this study was to investigate nasal breathing and the nasal cycle after septoplasty over a long period of time and under everyday conditions. METHODS We examined 22 healthy subjects and 19 patients with nasal septal deviation. They participated in two sessions separated by an interval of three months. Shortly after the first session patients received nasal septoplasty. Testing included multiple questionnaires regarding nasal breathing and olfactory function, anterior rhinoscopy, rhinomanometry, acoustic rhinometry, and long-term rhinoflowmetry over 24 h. RESULTS Nasal septoplasty was associated with subjectively improved nasal breathing and nasal patency comparable to that in healthy subjects. The severity of nasal obstruction was reduced. Nasal airflow and the hydraulic diameter increased on the deviated side of the nose while the inspiratory resistance did not significantly change. In addition, the number of phases of the nasal cycle decreased on the nondeviated side. Hence, the surgery was associated with a more even distribution of phases on both sides of the nose. CONCLUSION Nasal septoplasty leads to a subjectively satisfactory result in patients with pathological septal deviation of the nose. In particular, septoplasty appears to be accompanied by a more even distribution of the nasal cycle across the two nasal cavities.
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Affiliation(s)
- Justus Letzel
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Alexander Darbinjan
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Thomas Hummel
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Uzun S, Keskin S, Kavvasoğlu C. A new approach for crooked nose: Separated spreader graft "puzzle graft". Am J Otolaryngol 2022; 43:103335. [PMID: 35007978 DOI: 10.1016/j.amjoto.2021.103335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/11/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The nasal septum takes an important role in nasal shape and function. The term "crooked nose" is commonly used for all of the clinical conditions involving deviation of the nasal axis from the midline. This situation leads to both aesthetic concerns and breathing problems. In this study, we describe a new method in order to nasal dorsum on the midline and improving airway function in crooked nose patients, that will be contribute to the literature. MATERIALS AND METHODS This study enrolled 50 (fifty) patients who had undergone open septorhinoplasty operation were included in our study. The puzzle graft, which was prepared as a spreader graft consisting of three separate parts, was used to correct crooked nose in all patients. Anterior rhinoscopic examination, photographs and Nasal Obstruction and Septoplasty Effectiveness (NOSE) scores for the pre-operative and post-operative 1 year were compared and evaluated in this study. RESULTS The new approach was used successfully in all of the patients. Anterior rhinoscopic and 1 year photographic evaluations revealed a significantly correction of external appearance post-operatively. None of the patients had any additional complaints and complications during the post-operative period. We observed that NOSE scores, with which the post-operative nasal obstruction was evaluated, were significantly better in all 50 patients. CONCLUSION Crooked nose deformity is one of the most difficult problems in rhinoplasty. There is no absolute true technique for solving this situation. Each method works properly in appropriate cases. Sometimes we should use more than one technique in the same operation to correct the pathology. Our purpose is to present a new option to help surgeons in "crooked nose"; to provide a new method that can work safe and effective in convenient conditions.
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Affiliation(s)
- Selami Uzun
- Gaziantep Nizip State Hospital, Ear Nose Throat Clinic, Gaziantep, Turkey
| | - Serhan Keskin
- Sancaktepe Sehit Prof Dr. Ilhan Varank Training and Research Hospital, Ear Nose Throat Clinic, Sancaktepe, İstanbul, Turkey.
| | - Cem Kavvasoğlu
- Fatih Sultan Mehmet Training and Research Hospital, Ear Nose Throat Clinic, Ataşehir, İstanbul, Turkey
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Abstract
INTRODUCTION Pediatric septoplasty has been a historically controversial topic in the field of otolaryngology. Past recommendations avoided reconstruction during development because of the potential for growth changes after intervention that may require later revision surgery. Recent studies have considered early operation to avoid further growth complications, pointing at changing trends in the field. METHODS A retrospective study was conducted using the ACS NSQIP-P database to identify patients under 18 years of age who underwent a septoplasty between 2012 and 2019. Cases were identified using CPT code 30520 for 'septoplasty' and grouped by primary procedure as follows: cleft lip repair, sinus surgery, rhinoplasty/reconstruction/other, and septoplasty as primary procedure. Variables of interest included patient demographics, comorbidities, perioperative risk factors and complications. RESULTS 2290 patients were included with a mean age of 14.2 years at time of surgery. Patients undergoing cleft lip repair were significantly younger than patients in the other procedure groups (mean age 9.3 years, p < .001), with 28% of the patients under 1 year of age. The most common comorbidity was congenital malformation (20.0%) followed by asthma (10.2%). Significantly longer total length of hospital stay was associated with younger age (p < .001), female gender (p = .007), and perioperative comorbidities (p < .001). 8 (0.3%) patients were readmitted within 30 days for reasons related to the primary septoplasty surgery and 15 patients (0.7%) had related reoperations within 30 days. CONCLUSION Septoplasty is currently being performed on children of all ages. Children undergoing cleft lip repair account for the youngest demographic of pediatric septoplasty patients. General complications such as readmission and length of stay are more common in younger children undergoing septoplasty, however the number of readmissions and reoperations is relatively low. Further study is needed to describe the association between pediatric septoplasty and long term health outcomes.
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Affiliation(s)
- Maya Raghavan
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, 955 Main St, Buffalo, NY, 14203, USA.
| | - Michele Carr
- Department of Otolaryngology - Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA.
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Guven SG, Gorgulu Y. The impact of preoperative psychological characteristics on postoperative satisfaction and quality of life in patients undergoing septoplasty and inferior turbinate ablation surgery. Eur Arch Otorhinolaryngol 2022; 279:4007-4015. [PMID: 35122128 DOI: 10.1007/s00405-022-07286-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the effect of preoperative mental state on postoperative satisfaction and quality of life in patients undergoing septoplasty and inferior turbinate ablation surgery. METHODS A total of 41 patients who underwent septoplasty and inferior turbinate ablation surgery due to nasal congestion were included in the study. Patients were asked to complete the Mental Symptoms Checklist Revised (SCL-90 R), World Health Organization Quality of Life Scale-Short Form (WHOQoL-BREF-TR), and Visual Analogue Scale (VAS) tests before and after their surgery. The surgical procedure for all patients was performed by a single ear-nose-throat physician. The preoperative and postoperative test results were then compared. RESULTS A significant decrease was noted in the postoperative SCL-90 R somatization (p < 0.001), additional items (p = 0.001), and global severity index (GSI) (p = 0.002) scores; a significant increase was observed in the postoperative WHOQoL-BREF-TR physical health score (p = 0.029); and a significant decrease was seen in the postoperative VAS scores (p < 0.001). The preoperative SCL-90 R GSI showed a negative correlation with the postoperative WHOQoL-BREF-TR total score and a significant positive correlation with the postoperative VAS scores (p < 0.05 for all). There was a significant difference between those with a postoperative VAS score of ≤ 2 and > 2 in terms of GSI and all preoperative SCL-90 R subscale scores, except for the additional items subscale. Increased preoperative psychological symptoms reported by the patients were associated with a lower perception of postoperative quality of life. CONCLUSION The preoperative mental state of patients undergoing septoplasty and inferior turbinate ablation surgery affects postoperative satisfaction and quality of life. In addition, the recognition of this parameter may contribute to the treatment management of these patients and the legal protection of physicians.
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Affiliation(s)
- Selis Gulseven Guven
- Department of Otorhinolaryngology, Head and Neck Surgery, Çorlu State Hospital, Çorlu, Tekirdağ, Turkey. .,Department of Otorhinolaryngology, Head and Neck Surgery, Trakya University Faculty of Medicine, 22030, Edirne, Turkey.
| | - Yasemin Gorgulu
- Department of Psychiatry, Trakya University Faculty of Medicine, Edirne, Turkey
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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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Tillis RT, Shah R, Martin HL, Allori AC, Marcus JR, Frank-Ito DO. A systematic analysis of surgical interventions for the airway in the mature unilateral cleft lip nasal deformity: a single case study. Int J Comput Assist Radiol Surg 2022; 17:41-53. [PMID: 34080126 DOI: 10.1007/s11548-021-02396-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/30/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Individuals with unilateral cleft lip nasal deformity (uCLND) often require rhinoplasty in adolescence to correct nasal obstruction. The intent of this study is to identify sites of greatest nasal obstruction and evaluate the effects of isolated and combinations of simulated surgical procedures on these sites using computational fluid dynamics (CFD). METHODS Computed tomography imaging of an adolescent subject with uCLND was converted to an anatomically accurate three-dimensional nasal airway model. Initial analysis was performed to identify anatomic sites of obstruction based on CFD computed resistance values. Virtual surgery procedures corresponding to common uCLND surgical interventions were simulated. Resulting airspace models were then analyzed after conducting airflow and heat transfer simulations. RESULTS The preoperative model had 21 obstructed sites with a nasal resistance of 0.075 Pa s/mL. Following simulated surgical procedures with functional interventions alone and in combinations, the three virtual surgery models with most improved nasal airflow were inferior turbinate reduction (ITR) with posterior septoplasty (resistance = 0.054 Pa s/ml, reduction in 14 of 21 obstructed sites), ITR with anterior septoplasty (resistance = 0.058 Pa s/ml, reduction in 8 of 21 obstructed sites), and ITR with both anterior and posterior septoplasty (resistance = 0.052 Pa s/ml, reduction in 17 of 21 obstructed sites). CONCLUSION This study introduces a new technique for analysis of the impact of different simulated surgical interventions on uCLND-induced nasal obstruction. In this subject, simulated septoplasty with ITR on the non-cleft side provided maximal relief of nasal obstruction. The proposed technique can be further studied for possible utility in analyzing potential surgical interventions for optimal relief of nasal obstruction in patients with uCLND.
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Pacheco Coronel ER, Muñoz Cordero G, Lostau Ull L, Arias Marzan F, Salom Lucena C, Macias Rodriguez D, López Campos D, Pérez Orribo A, de Lucas Carmona G. Quilting sutures compared with sponge packing in septolplasty and turbinoplasty. Acta Otorrinolaringol Esp (Engl Ed) 2021; 72:370-374. [PMID: 34844675 DOI: 10.1016/j.otoeng.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 09/02/2020] [Indexed: 10/19/2022]
Abstract
INTRODUCTION There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications. OBJECTIVE The purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty. MATERIAL AND METHODS Seventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients' pain and bleeding on removal of the packing were evaluated. RESULTS Both techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal. CONCLUSION The use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty.
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Affiliation(s)
| | - Gabriela Muñoz Cordero
- Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | | | - Francisco Arias Marzan
- Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - Cecilia Salom Lucena
- Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - Diego Macias Rodriguez
- Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - Daniel López Campos
- Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - Alicia Pérez Orribo
- Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - Gemma de Lucas Carmona
- Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
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Vicory J, Garcia GJM, Rhee JS, Enquobahrie A. Toward automatic atlas-based surgical planning for septoplasty. Int J Comput Assist Radiol Surg 2021. [PMID: 34837564 DOI: 10.1007/s11548-021-02524-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Surgery for nasal airway obstruction (NAO) has a high failure rate, with up to 50% of patients reporting persistent symptoms postoperatively. Virtual surgery planning has the potential to improve surgical outcomes, but current manual methods are too labor-intensive to be adopted on a large scale. This manuscript introduces an automatic atlas-based approach for performing virtual septoplasties. METHODS A cohort of 47 healthy subjects and 26 NAO patients was investigated. An atlas of healthy nasal geometry was constructed. The automatic virtual septoplasty method consists of a multi-stage registration approach to fit the atlas to a target NAO patient, automatically segment the patient's septum and airway, and deform the patient image to have a non-deviated septum. RESULTS Our automatic virtual septoplasty method straightened the septum successfully in 18 out of 26 NAO patients (69% of cases). In these cases, the ratio of the higher to the lower airspace cross-sectional areas in the left and right nasal cavities improved from 1.47 ± 0.45 to 1.16 ± 0.33 in the region surrounding the septal deviation, showing that the nasal airway became more symmetric after virtual septoplasty. CONCLUSION This automated virtual septoplasty technique has the potential to greatly reduce the effort required to perform computational fluid dynamics (CFD) analysis of nasal airflow for NAO surgical planning. Future studies are needed to investigate if virtual surgery planning using this method is predictive of subjective symptoms in NAO patients after septoplasty.
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Abstract
Nasal airway obstruction is a very common phenomenon that can significantly decrease patients' quality of life. This review article summarizes in an evidence-based fashion the diagnosis and treatment of nasal airway obstruction. The nasal airway may be obstructed at the level of the nasal valve, septum, nasal turbinates, sinonasal mucosa, or nasopharynx. Nasal valve obstruction and septal deviations are usually treated surgically depending on the level of valve obstruction. Isolated turbinate hypertrophy is usually managed medically as part of the treatment of rhinitis, with surgery reserved for cases refractory to medical care. Sinonasal and nasopharyngeal conditions are treated according to the diagnosis.
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