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Digilli Ayaş B, Çiçekcibaşı AE, Gökşan AS, Açar G, Aydoğdu D. Clinically relevant morphometric analysis of pterygopalatine fossa and its volumetric relationship with adjacent paranasal sinuses: a CT-based study. Oral Radiol 2024; 40:285-294. [PMID: 38236559 DOI: 10.1007/s11282-023-00735-1] [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: 10/13/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES This study aimed to perform morphometric measurements of the pterygopalatine fossa (PPF), the transition zone to critical neurovascular structures. The second aim was to investigate the relationship between the volumes of the PPF and the paranasal sinuses and the effect of nasal septum deviation (NSD) types on all these measurements. METHODS We performed PPF's morphometry and all volume measurements on the CT images of 260 patients (130 male and 130 female, age range 18-79). RESULTS All volumetric measurements and the angle between foramen rotundum (FR) and pterygomaxillary fissure (PMF) were significantly higher in males than females. In contrast, the distance between sphenopalatine foramen (SPF) and PMF was considerably higher in females than in males. The PPF volume, the distance between the pterygoid canal (PC) and maxillary sinus, and the angle between FR and PMF were significantly higher on the right side than on the left. In contrast, the angle between PC and SPF and between greater palatine canal and PPF were considerably higher on the left side than on the right. The angle between PC and SPF decreased markedly with age. Only sphenoidal sinus volume was significantly smaller on the same side as the septal deviation. There was no correlation between PPF volume with maxillary and sphenoid sinus volumes from adjacent paranasal sinuses. CONCLUSIONS Volumetric and morphometric data obtained from PPF and paranasal sinuses can aid clinicians in diagnosing and treating patients by guiding them in selecting the right surgical approach or tools, especially in endoscopic procedures.
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Affiliation(s)
- Betül Digilli Ayaş
- Department of Anatomy, Faculty of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey.
| | - Aynur Emine Çiçekcibaşı
- Department of Anatomy, Faculty of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey
| | - Ahmet Safa Gökşan
- Department of Anatomy, Faculty of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey
| | - Gülay Açar
- Department of Anatomy, Faculty of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey
| | - Demet Aydoğdu
- Department of Radiology, Faculty of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey
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Houdu J, Jankowski R, Renkes R, Nguyen-Thi PL, Gallet P, Nguyen DT. Minimal clinically important differences on the DyNaChron questionnaire after surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:261-266. [PMID: 37838601 DOI: 10.1016/j.anorl.2023.10.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
OBJECTIVES To determine minimal clinically important differences (MCIDs) for the DyNaChron chronic rhinosinusitis quality-of-life questionnaire. INTRODUCTION MCIDs are the smallest changes in a quality-of-life score that are of clinical relevance for the patient. They allow treatment benefit to be estimated. MCIDs have not previously been determined for DyNaChron. MATERIAL AND METHODS A single-center retrospective study analyzed DyNaChron questionnaires filled out between June 2016 and December 2021 by all patients consulting for chronic nasal dysfunction. Five hundred and thirteen of the 2390 patients were operated on for nasal polyposis (NP; n=282) or septo(rhino)plasty+inferior turbinoplasty (SPIT; n=231). Standard error of measurement was used to determine MCIDs. RESULTS MCID for DyNaChron global score was 60 in NP and 58 in SPIT. MCIDs per symptom domain in NP and SPIT respectively were: 15 and 13 for nasal obstruction, 21 and 21 for anterior rhinorrhea, 20 and 19 for posterior rhinorrhea, and 17 and 17 for olfaction. In agreement with global MCID, 257 NPs (91%) and 149 SPITs (65%) showed clinical improvement. CONCLUSION MCID helps assess response to treatment. In the DyNaChron questionnaire, MCIDs enable global and symptom-specific assessment of chronic nasal dysfunction and its impact on quality of life in a single patient or in groups.
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Affiliation(s)
- J Houdu
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - R Jankowski
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - R Renkes
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - P-L Nguyen-Thi
- Unité d'évaluation médicale, unité de méthodologie, data management et statistique - UMDS, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - P Gallet
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - D-T Nguyen
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
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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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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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Keche PN, Davange NA, Gawarle SH, Ganguly S. A Study of Anatomical Variations in the Nasal Cavity in Cases of Chronic Rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2022; 74:943-948. [PMID: 36452798 PMCID: PMC9702033 DOI: 10.1007/s12070-020-02028-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: 03/01/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022] Open
Abstract
Chronic rhinosinusitis is very common disorder encountered in general population. Anatomical variations in the nasal cavity are mainly responsible for improper drainage and subsequent chronic rhinosinusitis. Present study is crosssectional and observational study undertaken at ENT department of tertiary care hospital. 200 cases of chronic rhinosinusitis fulfilling inclusion criteria were evaluated for various anatomical variations in the nasal cavity using diagnostic nasal endoscopy and computed tomography. Present study of 200 cases showed male preponderance M: F ratio 1:0.56. Most cases (79.5%) belonged to age group 11-50. Nasal obstruction was presenting complaint in 90% cases. 78% cases had septal deviation. 20% had septal spur. 32% cases had enlarged inferior turbinate, 9% had paradoxical middle turbinate, 13% had enlarged middle turbinate, 1% had bifid middle turbinate. 12% had pneumatised middle turbinate. 7% had enlarged uninate process, 1.5% cases had hypoplastic uncinate process and 7% had enlarged ethmoidal bulla. 45% cases showed oval sphenoid ostium while 31% showed circular and 8% slit like opening. Agger nasi cells were present in 82% cases. All 200 cases had anatomical variations in nasal cavity so it can be concluded that these are responsible for chronic rhinosinusitis.
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Affiliation(s)
- Prashant Narayanrao Keche
- Department Of Ent, Government Medical College and Cancer Hospital, Flat No. 501, Adinath Imperial, Ramkrishnanagar, Garkheda, Aurangabad, Maharashtra India
| | | | | | - Subhro Ganguly
- Department of ENT, S.V.N. Government Medical College, Yavatmal, Maharashtra India
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Sharma Y, Mishra G, Pancholi K, Govindarajalu P. Does Degree of Nasal Septal Deviation Measured with CT PNS have a Role in Management of Deviated Nasal Septum? Indian J Otolaryngol Head Neck Surg 2022; 74:1665-1667. [PMID: 36452660 PMCID: PMC9701915 DOI: 10.1007/s12070-021-02831-2] [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: 08/06/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022] Open
Abstract
Deviated nasal septum is one of the most commonly encountered nasal anatomical abnormalities. Various studies showed that deviated nasal septum results in the osteo-meatal complex disease and compensatory turbinate hypertrophy. But only a few studies described the association between type and degree of angle of deviated nasal septum and measured the angle of septal deviation and explore its effect in causation of nasal symptomatology. Hence, this study was undertaken with the aim to study the relation between type and degree of septal deviation with nasal symptomatology and to measure the degree of septal deviation. This was an observational study and data collection was done from August 2017 to August 2019. A total 52 patients with symptomatic deviated nasal septum were studied. Higher septal deviation caused symptoms in 73% of cases and severe degree of angle of septal deviation caused symptoms in 63% of cases. High and severe deviated nasal are more associated with nasal symptoms. Therefore, we could derive a correlation between the cases with higher septal deviation and incidence of nasal symptoms.
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Affiliation(s)
- Yojana Sharma
- Department of ENT, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat 388325 India
| | - Girish Mishra
- Department of ENT, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat 388325 India
| | - Kuldeep Pancholi
- Department of ENT, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat 388325 India
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Alessandri-Bonetti M, Costantino A, Gallo Afflitto G, Carbonaro R, Amendola F, Catapano S, Cottone G, Borelli F, Vaienti L. Reply to "Anxiety and depression in patients with nasal septal deviation: What is the clinical impact?". Am J Otolaryngol 2022; 43:103633. [PMID: 36095889 DOI: 10.1016/j.amjoto.2022.103633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
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Baudouin R, Lechien JR, Maniaci A, Lisan Q, Hans S. Anxiety and depression in patients with nasal septal deviation: What is the clinical impact? Am J Otolaryngol 2022; 43:103632. [PMID: 36108361 DOI: 10.1016/j.amjoto.2022.103632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/03/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Robin Baudouin
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
| | - Jérôme R Lechien
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France; Department of Otolaryngology, Elsan polyclinic of Poitiers, Poitiers, France; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Laryngology & Broncho-Esophagology, EpiCURA Hospital, Baudour, Belgium
| | - Antonino Maniaci
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania 95123, Italy
| | - Quentin Lisan
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Stéphane Hans
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
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Alessandri-Bonetti M, Costantino A, Gallo Afflitto G, Carbonaro R, Amendola F, Catapano S, Cottone G, Borelli F, Vaienti L. Anxiety and depression mood disorder in patients with nasal septal deviation: A systematic review and meta-analysis. Am J Otolaryngol 2022; 43:103517. [PMID: 35714499 DOI: 10.1016/j.amjoto.2022.103517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/01/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nasal septal deviation (NSD) is one of the most prevalent upper airway diseases causing airway obstruction, and it can negatively impact patients' quality of life (QoL). OBJECTIVE The aim of this study was to determine the risk of anxiety and depression mood disorders in patients with NSD. METHODS A systematic review and meta-analysis was performed according to the PRISMA statement. An electronic search was performed on PubMed/MEDLINE, Scopus and Google Scholar. Raw affect size data were pooled comparing standardized between group mean differences. RESULTS A total of 625 patients (males: 53 %, n = 280/525) with a mean age of 32.4 years (n = 375, 95 % CI: 25.3-39.4) were included. The pooled standardized mean differences (SMD) for the prevalence of the anxiety disorder was 1.17 (n = 625, 95 % CI: 0.34-2.0). The pooled SMD for the prevalence of the depression disorder was 0.30 (n = 490, 95 % CI: 0.12-0.48). CONCLUSION Prevalence of anxiety and depression mood disorders is higher in patients with NSD compared to controls. These diseases should be investigated and considered during the diagnostic and therapeutic process to improve the QoL of patients with NSD.
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Affiliation(s)
- Mario Alessandri-Bonetti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Gabriele Gallo Afflitto
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Riccardo Carbonaro
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Francesco Amendola
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Simone Catapano
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Giuseppe Cottone
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Francesco Borelli
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Luca Vaienti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
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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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Malik J, Spector BM, Wu Z, Markley J, Zhao S, Otto BA, Farag AA, Zhao K. Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation. Laryngoscope 2022; 132:509-517. [PMID: 34125439 PMCID: PMC8669045 DOI: 10.1002/lary.29673] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 02/04/2021] [Revised: 05/06/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS About 260,000 septoplasties are performed annually in the US to address nasal septal deviation (NSD). Yet, we do not consistently understand what aspects of NSD result in symptoms. STUDY DESIGN Blinded cohort study. METHODS Two fellowship-trained surgeons blindly reviewed computerized tomography (CTs) of 10 confirmed NSD patients mixed with 36 healthy controls. All patients were correctly identified, however, 24/36 controls were falsely identified by both surgeons as patients (33.3% specificity), which were grouped as asymptomatic NSD (aNSD), while the remaining controls as non-NSD (healthy). Acoustic rhinometry, rhinomanometry, individual CT-based computational fluid dynamics and nasal sensory testing were applied to address the puzzling questions of why these aNSD had no symptoms and, more fundamentally, what caused symptoms in sNSD patients. RESULTS aNSD reported no nasal symptoms - Nasal Obstruction Symptom Evaluation score (sNSD: 60.50 ± 13.00; aNSD: 5.20 ± 5.41; non-NSD: 6.66 ± 7.17, P < .05); 22-item Sino-Nasal Outcome Test score (sNSD: 32.60 ± 14.13; aNSD: 10.04 ± 10.10; non-NSD: 9.08 ± 12.42, P < .001). No significant differences in measured nasal resistance, minimum cross-sectional area (MCA), degree of septal deviation, and nasal airflow distributions were found between sNSD and aNSD groups. Only three variables differentiate sNSD versus aNSD: anterior averaged heat flux on deviated side, inferior turbinate peak heat flux on non-deviated side, and nasal cool sensitivity measured by menthol lateralization threshold, with no significant differences among these variables found between the two healthy groups (aNSD vs. non-NSD). These variables by themselves or combined can differentiate sNSD from controls with higher specificity than the physicians (ROC area under the curve = 0.84 with 70% sensitivity and 91.6% specificity). CONCLUSIONS This study sheds light on the potential mechanisms of NSD symptomatology: distorted nasal cooling due to NSD exacerbated by poorer nasal mucosal sensitivity. It further supports our previous hypothesis that nasal obstruction complaints do not result directly from obstruction, rather from the capacity of our nose to subjectively sense airflow cooling. LEVEL OF EVIDENCE 3 Laryngoscope, 132:509-517, 2022.
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Affiliation(s)
- Jennifer Malik
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Barak M. Spector
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Zhenxing Wu
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Jennifer Markley
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Songzhu Zhao
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Bradley A. Otto
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Alexander A. Farag
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Kai Zhao
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
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Maniaci A, Lechien JR, Calvo-Henriquez C, Iannella G, Leigh S, Ingrassia A, Merlino F, Bannò V, Cocuzza S, La Mantia I. Long-term stability of outcomes of endoscopic surgery for rhinogenic contact point headache (Sluder''s neuralgia). Am J Otolaryngol 2022; 43:103368. [PMID: 35038648 DOI: 10.1016/j.amjoto.2021.103368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/15/2021] [Accepted: 12/18/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy.
| | - Jerome Rene Lechien
- Research Committee of the Young Otolaryngologists, International Federations of ORL Societies, Paris, France; Department of Human Anatomy and Experimental Oncology, School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital (University of Paris-Saclay), Paris, France
| | - Christian Calvo-Henriquez
- Task Force COVID-19 of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Department of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Sowerby Leigh
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ont. Leigh, Canada.
| | - Angelo Ingrassia
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Federico Merlino
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Vittoria Bannò
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
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Saxon S, Johnson R, Spiegel JH. Laterality and severity of nasal obstruction does not correlate between physicians and patients, nor among physicians. Am J Otolaryngol 2021; 42:103039. [PMID: 33930682 DOI: 10.1016/j.amjoto.2021.103039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/17/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nasal obstruction is a common patient complaint and has a variety of etiologies, and a specific anatomical abnormality can often be found within the nasal cavity on physical examination. In practice, this observed pathology does not always correlate with the laterality, severity, and exact intranasal site of the patients' perceived obstruction. OBJECTIVES We seek to answer the following questions: 1) Does a physician's evaluation of nasal obstruction correlate with subjective patient complaints? 2) Is there reasonable correlation between physicians of similar training in the routine evaluation of nasal obstruction? METHODS First, we asked patients presenting to the otolaryngology clinic with a primary complaint of nasal obstruction to fill out a modified NOSE survey. Nasal endoscopy was performed on all subjects to assess all potential sites of obstruction. We then determined whether there is an association between patient complaints and findings on physical examination. Second, we determined if there is correlation between similarly trained physicians in their interpretation of a basic nasal examination. Otolaryngologists were shown a series of standardized videos of an endoscopic nasal examination that were recorded with a primary complaint of nasal obstruction. Findings were reported in an anonymous online survey focusing on laterality, severity, and specific site of perceived obstruction. RESULTS A total of 38 patients were included in the first part of the study. The Cohen's kappa coefficient was used to determine the interrater agreement between the patient and physician in the degree of nasal obstruction. The kappa coefficient was 0.03 (p value 0.372) for the comparison of the left-sided scores (fair agreement), and 0.16 (p value 0.014) for the right-sided scores (slight agreement). A comparison was also done between the side of the nose the patient felt was most obstructed to the most obstructed side found on physical exam by the otolaryngologist. Thirteen of the 38 patients (34%) had perceived nasal obstruction on the opposite side of that noted to be most obstructed on physical exam. Despite this, the kappa coefficient in this comparison was 0.43 (p value <0.001) revealing moderate agreement between the two groups. Seventeen otolaryngologists participated in the second part of the study. Data extrapolated revealed very little agreement among the physicians in reporting which side of the nose was most obstructed, what anatomical structure contributed to the obstruction the most, and what percentage obstruction was present. DISCUSSION Based on our findings, patients can reasonably determine based on their symptoms which side is most obstructed, but symptoms do not correlate with severity of obstruction when compared to physical exam. There is also very little consistency between otolaryngologists in their assessment of the degree of nasal obstruction on exam. The results of this study may have far-reaching implications for patient management, surgical intervention, and medicolegal documentation as it relates to the current surgical treatment of nasal obstruction.
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Affiliation(s)
- Sarah Saxon
- Facial Plastic Surgery, Austin, TX, United States of America
| | - Romaine Johnson
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern, Dallas, TX, United States of America
| | - Jeffrey H Spiegel
- Boston University School of Medicine, Boston, MA, United States of America.
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Lim ZF, Rajendran P, Musa MY, Lee CF. Nasal airflow of patient with septal deviation and allergy rhinitis. Vis Comput Ind Biomed Art 2021; 4:14. [PMID: 34014417 PMCID: PMC8137764 DOI: 10.1186/s42492-021-00080-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/27/2021] [Indexed: 12/30/2022] Open
Abstract
A numerical simulation of a patient’s nasal airflow was developed via computational fluid dynamics. Accordingly, computerized tomography scans of a patient with septal deviation and allergic rhinitis were obtained. The three-dimensional (3D) nasal model was designed using InVesalius 3.0, which was then imported to (computer aided 3D interactive application) CATIA V5 for modification, and finally to analysis system (ANSYS) flow oriented logistics upgrade for enterprise networks (FLUENT) to obtain the numerical solution. The velocity contours of the cross-sectional area were analyzed on four main surfaces: the vestibule, nasal valve, middle turbinate, and nasopharynx. The pressure and velocity characteristics were assessed at both laminar and turbulent mass flow rates for both the standardized and the patient’s model nasal cavity. The developed model of the patient is approximately half the size of the standardized model; hence, its velocity was approximately two times more than that of the standardized model.
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Affiliation(s)
- Zi Fen Lim
- School of Aerospace Engineering, Universiti Sains Malaysia, 11800, Pulau Pinang, Malaysia
| | - Parvathy Rajendran
- School of Aerospace Engineering, Universiti Sains Malaysia, 11800, Pulau Pinang, Malaysia. .,Faculty of Engineering & Computing, First City University College, 47800, Selangor, Malaysia.
| | - Muhamad Yusri Musa
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, 11800, Pulau Pinang, Malaysia
| | - Chih Fang Lee
- School of Aerospace Engineering, Universiti Sains Malaysia, 11800, Pulau Pinang, Malaysia
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15
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Sari H, Atar Y, Kumral TL, Uygan U, Karaketir S, Karaketir ŞG, Uyar Y. Effects of nasal packing and transseptal suturing on swallowing after septoplasty. Eur Arch Otorhinolaryngol 2021; 279:267-273. [PMID: 33973085 DOI: 10.1007/s00405-021-06854-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: 01/23/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This clinical trial aimed to investigate the effects of different nasal packing methods and transseptal suture technique on swallowing after septoplasty. METHODS This randomized prospective study consists of 180 consecutive patients with septal deviation. All the patients underwent septoplasty. All the patients were randomly assigned to three groups. In group A, transseptal sutures were used for septal stabilization. In group B, both nasal passages were packed with Merocel tampons for septal stabilization. In group C, both nasal passages were packed with Doyle silicone splints for septal stabilization. For the evaluation of swallowing, the Eating Assessment Tool (EAT-10) questionnaire and a visual analog scale (VAS) were administered to all the patients preoperatively and on the second and seventh postoperative days. RESULTS One hundred and twenty two of the patients (67.7%) were female and 58 of them (32.2%) were male. The mean age was 32.41 ± 12.37 years (range: 18-57 years). Both EAT-10 and VAS scores on the second postoperative day were significantly higher than the preoperative scores in all the groups (p < 0.05). The transseptal suture group had significantly lower EAT-10 and VAS scores on the second postoperative day than the Merocel packing and silicone packing groups (p < 0.05). Both EAT-10 and VAS scores on the postop 7th day significantly decreased in all groups compared to the postop second day (p < 0.05). CONCLUSIONS Septoplasty affects swallowing, regardless of whether a tampon is applied. Transeptal suturing has a lesser effect on swallowing than other techniques. Although silicone packing is a less invasive method, it negatively affects swallowing, similar to Merocel packing. The transseptal suture technique is more comfortable than the other techniques in terms of swallowing function in the postoperative period.
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Affiliation(s)
- Hüseyin Sari
- Otorhinolaryngology Department, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Yavuz Atar
- Otorhinolaryngology Department, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Tolgar Lütfi Kumral
- Otorhinolaryngology Department, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ugur Uygan
- Otorhinolaryngology Department, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Semih Karaketir
- Department of Otorhinolaryngology-Head and Neck Surgery, Bulanik State Hospital, Zafer Mahallesi, Yeni Hastane Caddesi, 49530, Bulanık, Muş, Turkey.
| | - Şeyma Gorcin Karaketir
- Director of Malazgirt District Health Directorate, Public Health Specialist, Istanbul, Turkey
| | - Yavuz Uyar
- Otorhinolaryngology Department, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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Maniaci A, Merlino F, Cocuzza S, Iannella G, Vicini C, Cammaroto G, Lechien JR, Calvo-Henriquez C, La Mantia I. Endoscopic surgical treatment for rhinogenic contact point headache: systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2021; 278:1743-53. [PMID: 33677741 DOI: 10.1007/s00405-021-06724-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
Purpose This meta-analysis study was designed to analyze endoscopic surgery’s role in treating rhinogenic contact point headache. Methods We performed a comprehensive review of the last 20 years’ English language regarding Rhinogenic contact point headache and endoscopic surgery. We included the analysis papers reporting post-operative outcomes through the Visual Analogue Scale or the Migraine Disability Assessment scale. Results We provided 18 articles for a total of 978 RCPH patients. While 777 (81.1%) subjects underwent functional nasal surgery for RCPH, 201 patients (20.9%) were medically treated. A significant decrease from the VAS score of 7.3 ± 1.5 to 2.7 ± 1.8 was recorded (p < 0.0001). At quantitative analysis on 660 patients (11 papers), surgical treatment demonstrated significantly better post-operative scores than medical (p < 0.0001). Conclusion At comparison, surgical treatment in patients with rhinogenic contact points exhibited significantly better values at short-term, medium-term, and long term follow up. Endoscopic surgery should be proposed as the choice method in approaching the symptomatic patient.
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Kang ET. Septal deviation correction methods and surgical considerations in turbinoplasty. Arch Plast Surg 2020; 47:522-7. [PMID: 33238338 DOI: 10.5999/aps.2020.02033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/08/2022] Open
Abstract
Nasal septoplasty is often required to correct a cosmetic deformity, which is a common reason for patients to present to a plastic surgeon. If nasal septoplasty is insufficient, a residual deformity or nasal obstruction may remain after surgery. Even if the nasal septum is corrected to an appropriate position, nasal congestion could be exacerbated if the turbinate on the other side is not also corrected. Therefore, appropriate treatment is required based on the condition of the turbinates. Herein, we survey recent trends in treatment and review previous research papers on turbinoplasty procedures that can be performed alongside nasal septoplasty.
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Depeyre A, Schlund M, Delmotte C, Dupuch V, Pham Dang N, Barthélémy I. Extracorporeal septorhinoplasty: Technical note. J Stomatol Oral Maxillofac Surg 2020; 121:579-584. [PMID: 32171966 DOI: 10.1016/j.jormas.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 11/28/2022]
Abstract
Severe nasal septal deformities can be responsible for functional and aesthetic impairments. Correction of these deformities can be difficult and restoring perfect nasal shape and function is still challenging. Classical techniques can, sometimes, lead to disappointing results or relapse. In this article, the aim was to describe the different techniques of extracorporeal septorhinoplasty and fixation of the neoseptum. Three techniques are mainly used: "crisscross" suture, "U-shaped" suture and anterior septal reconstruction to fix the neoseptum after extracorporeal remodeling. All these techniques are technically demanding, especially concerning keystone area management; but, if well performed, could give satisfactory functional and aesthetic outcomes. We therefore think that extracorporeal septorhinoplasty should really improve our results concerning functional and aesthetic aspects in case of severe anterior or caudal septum deviation.
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Affiliation(s)
- A Depeyre
- Oral and Maxillofacial Department, Estaing Hospital, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; Faculty of Medicine, université d'Auvergne, 63001 Clermont-Ferrand cedex 1, France; Laboratoire CROC EA 3847, Faculty of Dental Surgery, université d'Auvergne, 63100 Clermont-Ferrand, France; Inserm, U1008-Controlled Drug Delivery Systems and Biomaterials, University Lille, CHU de Lille, 59000 Lille, France; Ramsay GDS, hôpital privé de la Loire, 39, boulevard de la Palle, 42100 Saint-Étienne, France.
| | - M Schlund
- Inserm, U1008-Controlled Drug Delivery Systems and Biomaterials, University Lille, CHU de Lille, 59000 Lille, France; Oral and Maxillofacial Surgery Department, University Lille, CHU de Lille, 59000 Lille, France
| | - C Delmotte
- Oral and Maxillofacial Department, Estaing Hospital, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; Faculty of Medicine, université d'Auvergne, 63001 Clermont-Ferrand cedex 1, France; Oral and Maxillofacial Surgery Department, University Lille, CHU de Lille, 59000 Lille, France
| | - V Dupuch
- Cabinet ORL du Zénith, 63800 Cournon-d'Auvergne, France
| | - N Pham Dang
- Oral and Maxillofacial Department, Estaing Hospital, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; Faculty of Medicine, université d'Auvergne, 63001 Clermont-Ferrand cedex 1, France; Inserm U1107 Neuro-Dol, Trigeminal Pain and Migraine, Faculty of Dental Surgery, 63100 Clermont-Ferrand, France
| | - I Barthélémy
- Oral and Maxillofacial Department, Estaing Hospital, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; Faculty of Medicine, université d'Auvergne, 63001 Clermont-Ferrand cedex 1, France; Inserm U1107 Neuro-Dol, Trigeminal Pain and Migraine, Faculty of Dental Surgery, 63100 Clermont-Ferrand, France
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Ng CL, Rival R, Solomon P. Anterior Nasal Spine Relocation for Caudal Septal Deviation: A Case Series and Discussion of Common Scenarios. Aesthetic Plast Surg 2020; 44:501-7. [PMID: 31820063 DOI: 10.1007/s00266-019-01568-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Deviation of the anterior nasal spine (ANS) is a common cause of caudal nasal septal deviation. In our experience, relocation of the deviated ANS is a useful technique in the correction of the caudal septal deviation. OBJECTIVES To describe our experience with the ANS relocation technique in isolation and in combination with other techniques for correction of caudal septal deviation. METHODS A retrospective chart review was performed on cases of ANS relocation. RESULTS A total of 378 patients underwent ANS relocation over 4 years. Complete straightening of the septum occurred in 312 cases (82.5%), and significant improvement with mild remnant deviation occurred in 66 cases (17.5%). No patients had severe remnant deviation. None of the patients requested for revision surgery. A total of 351 patients (92.9%) experienced significant subjective improvement in bilateral nasal airflow, while 27 patients (7.1%) experienced mild improvement in bilateral nasal airflow. None of the patients had worsened airflow after surgery. CONCLUSION The ANS relocation technique is a useful and effective technique which can be used in isolation or in combination of other techniques for the correction of caudal septal deviation. 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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Sazgar AA, Kheradmand A, Razfar A, Hajialipour S, Sazgar AK. Different techniques for caudal extension graft placement in rhinoplasty. Braz J Otorhinolaryngol 2019; 87:188-192. [PMID: 31585700 PMCID: PMC9422556 DOI: 10.1016/j.bjorl.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/06/2019] [Accepted: 08/10/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The caudal extension graft is usually a cartilage graft that overlaps the caudal margin of the nasal septum. A combination of the caudal extension graft and the tongue-in-groove technique is used to stabilize the nasal base, set tip projection, and refine the alar-columellar relationship. OBJECTIVES In this study we present some new modifications to the placement of caudal extension grafts in rhinoplasty. METHODS This study is a retrospective review of a prospectively collected database of 965 patients who underwent septorhinoplasty from June 2011 to July 2015. Of these, 457 patients required a caudal extension graft and were included in the study. Minimum follow-up was 13.2 months with a mean follow-up time of 17.4 months. RESULTS In most cases, comparison of photographs before and after surgery were satisfactory and showed improved contour. Minor deformity was detected in 41 patients and 11 patients needed revision surgery. CONCLUSION With these modifications the surgeon can employ the caudal extension graft even in angulated caudal septal deviations. A variety of methods have been proposed for correction of caudal nasal deviation.
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Affiliation(s)
- Amir Arvin Sazgar
- Tehran University of Medical Sciences, Vali-Asr Hospital, Department of Otolaryngology Head and Neck Surgery, Tehran, Iran.
| | - Azadeh Kheradmand
- Tehran University of Medical Sciences, Vali-Asr Hospital, Department of Otolaryngology Head and Neck Surgery, Tehran, Iran
| | - Ali Razfar
- University of California, Los Angeles Medical Center, Department of Otolaryngology Head and Neck Surgery, Los Angeles, United States
| | - Shabnam Hajialipour
- Tabriz University of Medical Sciences, Imam Reza Hospital, Department of Otolaryngology Head and Neck Surgery, Tehran, Iran
| | - Amir Keyvan Sazgar
- Tehran University of Medical Sciences, Vali-Asr Hospital, Department of Otolaryngology Head and Neck Surgery, Tehran, Iran
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Hyman AJ, Fastenberg JH, Stupak HD. Orientation of the premaxilla in the origin of septal deviation. Eur Arch Otorhinolaryngol 2019; 276:3147-51. [PMID: 31486935 DOI: 10.1007/s00405-019-05618-y] [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: 07/18/2019] [Accepted: 08/24/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION While most people believe the nasal septum to have intrinsic deviation and overgrowth in patients seeking rhinoplasty, an alternative concept is that a mal-oriented premaxilla causes extrinsic septal buckling and external extrusion of the septal cartilage. In this sense, the premaxillary bone plays a significant role in the pathogenesis of septal deviation. This study was performed to determine if non-traumatically acquired septal/nasal functional and aesthetic pathology or septal deviation may be related to the orientation of the premaxilla relative to the skullbase. METHODS A retrospective, single-center study of patients in the general population who underwent maxillofacial CT scans and presented for the evaluation of nasal obstruction. CT scans were used to measure features of both pathologic and non-pathologic nasal septums. RESULTS A total of 68 subjects were evaluated. When comparing patients with a premaxillary-skullbase angle of greater than 81° (the mean of the study group) to those of less than 81°, and a more obtuse nasolabial angle was observed (p = 0.0269). When comparing the extremes of premaxillary rotation, specifically, greater than 87° (mean 91.7°, SD 5.1) and less than 77° (mean 70.7°, SD 3.6), the differences were more pronounced with regard to caudal septal excess (p = 0.0451) and septal deviation in the axial plane (p = 0.0150). CONCLUSION Septal developmental changes may involve an overly rotated or more vertically oriented premaxillary bone relative to the skull base. An understanding of the cause of septal deformity may provide insight into the design of improved treatments.
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Ramalingam V, Venkatesan R, Somasundaram S, Kandasamy K, Rajeswari M. A Comparative Study Between Septal Quilting Sutures Without Nasal Packing and Only Nasal Packing Post-septal Correction. Indian J Otolaryngol Head Neck Surg 2020; 72:169-74. [PMID: 32551273 DOI: 10.1007/s12070-019-01730-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022] Open
Abstract
Septal correction is the commonest surgery by rhinologists worldwide. We aimed at studying the comfort level of the patient with standard postoperative nasal packing with Merocel and placing quilting sutures in septum leaving the nose unpacked in the postoperative period. We conducted the study in the tertiary care centre enrolling 82 patients in a quasi-randomised method of odd and even numbers placing them in the nasal packing group and the quilting group respectively. We used analogue scoring method for subjective assessment of comfort level in the postoperative period and the surgeon objectively assessed the patient on follow up. The results were tabulated and analysed. Postoperative pain, headache and sleep disturbance was significantly more in the nasal packing group. We found that the crusting is commonly seen in patients in the nasal packing group. Quilting the nasal septum and leaving the nasal cavity unpacked increases the comfort level of the patient in the postoperative period. The resultant pain, headache and sleep disturbance caused by nasal packing can be significantly avoided by using quilting the septum without nasal packing. We also observed that by avoiding nasal packing postoperatively, the patients were more comfortable and compliant with the treatment regimen and follow-up.
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Cantone E, Ricciardiello F, Oliva F, De Corso E, Iengo M. Septoplasty: is it possible to identify potential "predictors" of surgical success? ACTA ACUST UNITED AC 2019; 38:528-535. [PMID: 30623898 PMCID: PMC6325657 DOI: 10.14639/0392-100x-2072] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/27/2018] [Indexed: 11/23/2022]
Abstract
Septoplasty is one of the most frequent surgical procedures performed by otolaryngologists. Despite successful surgical correction, many patients are not satisfied with their outcomes. So far, in clinical practice there is no consensus of opinion about the reliability of objective measurements of nasal patency and the correlation between objective measurements and subjective nasal patency symptoms. This study aims to assess the reasons for patient dissatisfaction after septoplasty and optimise pre-operative diagnostic management to predict surgical outcomes. We analysed 494 patients undergoing septoplasties with turbinoplasty by subjective Nasal Obstruction Symptom Evaluation questionnaire (NOSE) and objective active anterior rhinomanometric measurements before surgery and after 6 months. In our series, 17% had postoperative septal re-displacement; all patients had an anterior deviations at baseline. We found that the type of septal deviation, anterior vs posterior, was a significant predictor of postoperative functional improvement, whereas demographic characteristics as age, gender and smoke habit were not. Our data suggest that the anterior segment of the nasal septum was the most critical area for nasal airway resistance and more difficult to manage because it is likely to re-displace vs the posterior one and for this reason it represents a negative predictor of postoperative satisfaction.
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Affiliation(s)
- E Cantone
- Department of Neuroscience, ENT Section, "Federico II" University, Naples, Italy
| | - F Ricciardiello
- Department of Otorhinolaryngology, "Cardarelli" Hospital, Naples, Italy
| | - F Oliva
- Department of Otorhinolaryngology, "Cardarelli" Hospital, Naples, Italy
| | - E De Corso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Iengo
- Department of Neuroscience, ENT Section, "Federico II" University, Naples, Italy
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Benavides G, Villate P, Malaver C. Caudal Septal Extension Graft Sutured with Absorbable Material and Not Fixed to the Nasal Spine Region Compared with the Conventional Fixation Method: A Retrospective Study. Aesthetic Plast Surg 2019; 43:759-67. [PMID: 30815733 DOI: 10.1007/s00266-019-01330-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The caudal septal extension graft (CSEG) is a predictable method for positioning the tip and columella during rhinoplasty, and it is commonly performed using permanent sutures and in some cases fixating the graft to the nasal spine region (NSR) (conventional method). Whether this predictability is preserved when using absorbable sutures has yet to be determined. METHODS We performed a retrospective assessment of 1146 patients who underwent rhinoplasty performed by the same surgeon using the CSEG method from 2008 through 2017 in an academic setting. We utilized a computer-based patient record system for automatic data collection comparing outcomes of two groups: a group of patients who were operated on using the conventional fixation method (2008-2011) (group 1) with a second group in which absorbable sutures were used without fixation to the NSR (2011-2017) (group 2). The average follow-up period was 33.2 months. Patients operated on using a combination of methods and patients with less than 6 months of follow-up were excluded. All cases had the same septum-to-extension graft suturing technique with either permanent or absorbable suture material. This technique was side-to-side fixation with simple interrupted stitches. RESULTS Outcomes were measured in terms of reoperation rates and complication rates grouped in 10 categories. There were no statistical differences in complication or reoperation rates between group 1 and group 2 except for suture extrusion and/or foreign body reaction (3.9% and 0.2%, respectively, P < 0.0001). Tip deprojection was of rare and similar occurrence in both groups (0.9% and 0.8%, respectively, P 0.88). CONCLUSION Suturing CSEG with absorbable material and not fixing it to the NSR is a reliable variation in the conventional technique. 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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Dell'Aversana Orabona G, Romano A, Abbate V, Salzano G, Piombino P, Farina F, Pansini A, Iaconetta G, Califano L. Effectiveness of endoscopic septoplasty in different types of nasal septal deformities: our experience with NOSE evaluation. ACTA ACUST UNITED AC 2019; 38:323-330. [PMID: 30197423 PMCID: PMC6146582 DOI: 10.14639/0392-100x-1067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/06/2017] [Indexed: 11/23/2022]
Abstract
Septal deviations are the most frequent cause of nasal obstruction, and represent a common complaint in rhinologic practice. Since the first description of Lanza et al. in 1991, the use of the endoscope for the correction of septal deformities is increasingly more frequent. The purpose of this study is to evaluate the effectivenes of the endoscopic septoplasty for the correction of each of the 7 types of septal deformities according to the Mladina’s classification. A retrospective chart review was performed in 59 consecutive patients presenting to our Department for Endoscopic Septoplasty from February 2012 to August 2014. For each deviation, descriptive statistics (mean and standard deviation, significant increase/decrease) was used to asses the corrective capacity and time-dependent effects at follow-up. This study shows that the corrective power of endoscopic septoplasty is different according to the type of deviation. To our knowledge this is the first study that evaluates the corrective capacity of this technique for each deviation by analysing pre- and postoperative objective outcomes as well as subjective outcomes gathered from the validated NOSE questionnaire. Even if endoscopic septoplasty may now be considered a reliable alternative to the classic technique, it is essential to identify the right deformity preoperatively in order to provide the correct therapeutic choice.
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Affiliation(s)
| | - A Romano
- Department of Maxillofacial Surgery, University of Naples Federico II, Naples, Italy
| | - V Abbate
- Department of Maxillofacial Surgery, University of Naples Federico II, Naples, Italy
| | - G Salzano
- Department of Maxillofacial Surgery, University of Naples Federico II, Naples, Italy
| | - P Piombino
- Department of Otorhinolaryngology, University of Naples SUN, Naples, Italy.,Present address: Department of Otorhinolaryngology, University Luigi Vanvitelli of Naples, Italy
| | - F Farina
- Department of Economy and Business, University of Sannio, Benevento, Italy
| | - A Pansini
- Department of Maxillofacial Surgery, University of Naples Federico II, Naples, Italy
| | - G Iaconetta
- Department of Neurosurgery, University of Salerno, Italy
| | - L Califano
- Department of Maxillofacial Surgery, University of Naples Federico II, Naples, Italy
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Garzaro M, Dell'Era V, Riva G, Raimondo L, Pecorari G, Aluffi Valletti P. Endoscopic versus conventional septoplasty: objective/subjective data on 276 patients. Eur Arch Otorhinolaryngol 2019; 276:1707-11. [PMID: 30895435 DOI: 10.1007/s00405-019-05393-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Endoscopic approach represents a valid alternative to conventional septoplasty. The aim of this study is to analyze the objective and subjective data on 276 patients, who underwent traditional (147) or endoscopic (129) septoplasty. METHODS This is a prospective observational study on 276 consecutive patients affected by deviated nasal septum (DNS), who underwent isolated septoplasty between 2011 and 2018. 147 of them were treated using an "open" approach, while 129 were treated with an endoscopic approach. The two groups were compared 3 months after surgery: the objective results (complications such as bleeding, hematoma, pain, synechiae, septal tears and incomplete correction), objective (rhinomanometric data) and subjective measurements (NOSE questionnaires). RESULTS Both techniques are effective in decreasing nasal obstruction and discharge. Complications such as pain, synechiae, early postoperative bleeding, septal tears and incomplete correction are less frequent in the endoscopic group (p < 0.05). The rhinomanometric analysis reveal improvement in both groups without statistical differences. Subjective questionnaires show a good symptoms relief with an improved quality of life in all 276 patients without statistical difference between the two gropus. CONCLUSIONS Both techniques are effective in reducing nasal obstruction and related symptoms with fewer overall complications in the endoscopic approach. The endoscope provides improved field of view, less mucosal damages and a more anatomic dissection. Finally, such approach can be a valuable teaching tool for assistants, residents and students.
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Kokubo LCP, Carvalho TBO, Fornazieri MA, Gomes EMC, Alves CMF, Sampaio ALL. Effects of septorhinoplasty on smell perception. Eur Arch Otorhinolaryngol 2019; 276:1247-50. [PMID: 30806808 DOI: 10.1007/s00405-019-05356-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess whether significant changes in smell perception occur after septorhinoplasty, and evaluate whether septum deviation, allergic rhinitis, and surgical technique affect postoperative smell perception. METHODS Thirty-four patients (> 18 years old) awaiting septorhinoplasty were included, while those with previous severe hyposmia or anosmia were excluded. The participants self-assessed their smell perception using a 100-mm visual analogue scale (VAS), where 0 mm indicated the inability to smell and 100 mm indicated normal smell perception. The University of Pennsylvania Smell Identification Test (UPSIT) was applied before the procedure, and 4 and 12 weeks after surgery. RESULTS The UPSIT score showed no significant changes at 4 (p = 0.59; 95% CI - 0.35 to + 2) or 12 weeks (p = 0.16; 95% CI - 1.13 to + 0.66). A comparison of the VAS scores before and 4 weeks after surgery (p = 0.62; 95% CI - 0.63 to + 0.39) yielded similar results. However, the average VAS scores improved 12 weeks after surgery (p = 0.007; 95% CI + 0.22 to + 1.30). Olfactory function, measured using the UPSIT, was not influenced by open or closed surgical techniques (p ≥ 0.10), the presence or absence of rhinitis (p ≥ 0.15), or obstructive septum deviation (p ≥ 0.38). Twelve weeks after surgery, self-evaluated smell perception was better in patients who underwent a closed procedure rather than an open procedure (p = 0.006; 95% CI: -1.39 to -0.37). CONCLUSION A validated test demonstrates that septorhinoplasty does not compromise smell perception 4 and 12 weeks after surgery. However, it might improve smell perception by the self-report observation.
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Abstract
This article provides a review of modern techniques in the surgical management of the deviated septum with emphasis on the comparison of traditional versus endoscopic septoplasty approaches. Relevant anatomy and physiology of the nasal septum are discussed. A brief history of the evolution of the surgical approaches for the correction of a deviated septum is provided. Traditional and endoscopic septoplasty techniques are reviewed; the indications, advantages, and limitations of each approach are highlighted. Potential complications of septoplasty, with a focus on prevention and management, are also discussed.
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Affiliation(s)
- Janki Shah
- Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA
| | - Christopher R Roxbury
- Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA.
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Abstract
Nasal airway obstruction (NAO) is a common otolaryngic complaint with many potential causes, frequently structural or inflammatory in nature. Patients typically have multiple coexisting factors leading to symptoms. Good patient outcomes require careful preoperative evaluation, including nasal endoscopy, to accurately identify sources of obstruction and tailor intervention appropriately. Common structural causes of NAO include inferior turbinate hypertrophy, nasal septal deviation, and narrowing or collapse of the internal or external nasal valves. The internal nasal valve has the narrowest cross-sectional area within the nasal airway and is thus most sensitive to changes in dimension due to anatomic variation or surgical intervention.
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Affiliation(s)
- Theodore A Schuman
- Rhinology, Allergy, and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, Suite 12-313, PO Box 980146, Richmond, VA 23298, USA
| | - Brent A Senior
- Division of Rhinology, Allergy, and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Chapel Hill, NC 27599-7070, USA.
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Alakärppä AI, Koskenkorva TJ, Koivunen PT, Alho OP. Predictive factors of a beneficial quality of life outcome in patients undergoing primary sinonasal surgery: a population-based prospective cohort study. Eur Arch Otorhinolaryngol 2018; 275:1139-1147. [PMID: 29492664 DOI: 10.1007/s00405-018-4918-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 11/20/2017] [Accepted: 02/26/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess predictive factors of a beneficial quality of life (QoL) outcome after primary sinonasal surgery. METHODS A population-based prospective cohort study among 160 adult patients undergoing primary sinonasal surgery (76 septoplasties, SP; 84 endoscopic sinus surgeries, ESS) was conducted. We collected QoL data using the Sinonasal Outcome Test-22 (SNOT-22) before and after surgery. A beneficial QoL outcome was defined as a SNOT-22 score change ≥ 9 points 12 months after surgery. Various demographic, clinical and symptom-related factors predicting a beneficial QoL outcome were sought using binary logistic regression analysis. RESULTS The mean age of the patients was 39 years (range 18-61) and 82 (51%) were males. The SNOT-22 score change varied markedly after SP (range - 17 to + 80) and ESS (range - 20 to + 58), but on average it improved (median + 15 after SP and + 16 after ESS). 41 patients (64%) achieved beneficial QoL outcome after SP and 46 (66%) after ESS. In a multivariate analysis, poor QoL before surgery (preoperative SNOT-22 ≥ 20 points) predicted a beneficial QoL outcome after SP and ESS (adjusted odds ratio 10; 95% confidence interval 1.6-64 and 12; 2.5-55, respectively) and a senior surgeon operating after SP (9.9; 1.5-67). On receiver operating characteristic curve analysis, the integer threshold value for the preoperative SNOT-22 score that gave the highest sensitivity (74%) and specificity (70%) was 30. CONCLUSIONS QoL change after primary SP and ESS varies. A preoperative SNOT-22 score of at least 30 best predicted a beneficial QoL outcome after both procedures.
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Affiliation(s)
- Antti I Alakärppä
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, OYS, P.O. Box 21, 90029, Oulu, Finland. .,PEDEGO Research Unit, University of Oulu, Oulu, Finland.
| | - Timo J Koskenkorva
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, OYS, P.O. Box 21, 90029, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Petri T Koivunen
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, OYS, P.O. Box 21, 90029, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Olli-Pekka Alho
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, OYS, P.O. Box 21, 90029, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland
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Abstract
Nasal trauma is a common consequence of athletic competition. The nasal bones are the most commonly fractured facial bone and are particularly at risk during sports participation. Acute management of trauma to the nose includes thorough evaluation of all injuries and may require immediate management for repair of facial lacerations, epistaxis control, or septal hematoma drainage. Nasal fractures can often be addressed with closed reduction techniques; however, in the setting of complex nasal trauma, an open approach may be indicated. Using appropriate treatment techniques, posttraumatic nasal sequelae can be minimized; most patients report satisfactory long-term nasal form and function.
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Özyazgan İ. Septal Deviation Treatment Using Bone or Cartilage Grafts Fixed with Cyanoacrylate Tissue Adhesive. Aesthetic Plast Surg 2017; 41:618-27. [PMID: 28341952 DOI: 10.1007/s00266-017-0836-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND This paper presents a method in which bone or cartilage grafts are fixed to the septal cartilage with cyanoacrylate-based tissue adhesive for the treatment of septal deviation. A prospective study was designed to show the effectiveness of the technique. METHODS Cyanoacrylate-based tissue adhesive was used to fix the cartilage or bone grafts onto the septal cartilage to straighten deviated septal cartilage in 77 patients. Regarding the patients' preoperative and postoperative nasal respiration, the following were assessed: (1) Nasal Obstruction Symptom Evaluation (NOSE) scales, (2) patient satisfaction with postoperative nasal respiration using visual analog scoring, and (3) computerized tomographic images. RESULTS The patients were followed up for 29 months on average. Patients' respiration-related problems resulting from septal deviation were relieved in all but four patients. Clinically and radiologically, the straightened septums preserved their new forms, and it was detected with computerized tomography that the bone grafts had acquired permanency. In addition, the NOSE scores improved significantly compared to their preoperative levels. CONCLUSIONS In cases in which the use of bone or cartilage grafts is chosen to straighten the deviated septal cartilage, fixation of grafts with cyanoacrylate (CA) tissue adhesive is a quick, instantly effective, and reliable method. CA, which enables the subsurface of the graft to have complete contact with the septal cartilage, provides extra benefit by transferring all of the reformative forces of the grafts to the septal cartilage. LEVEL OF EVIDENCE II 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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Mariño-Sánchez F, Valls-Mateus M, Cardenas-Escalante P, Haag O, Ruiz-Echevarría K, Jiménez-Feijoo R, Lozano-Blasco J, Giner-Muñoz MT, Plaza-Martin AM, Mullol J. Influence of nasal septum deformity on nasal obstruction, disease severity, and medical treatment response among children and adolescents with persistent allergic rhinitis. Int J Pediatr Otorhinolaryngol 2017; 95:145-154. [PMID: 28576524 DOI: 10.1016/j.ijporl.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/24/2017] [Accepted: 02/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the impact of different types of nasal septum deformity (NSD) on nasal obstruction, rhinitis severity and response to medical treatment among pediatric persistent allergic rhinitis (PER) patients. METHODS In a prospective, real-life study, 150 children and adolescents (mean age 13 ± 2.8 years, females 32.6%) diagnosed with PER according to ARIA guidelines were assessed by nasal endoscopy for NSD according to Mladina's classification, their response to medical treatment (intranasal steroids and antihistamines or antileucotriens), the presence of comorbidities, rhinitis severity (modified-ARIA criterion) and nasal obstruction visual analog scale score (VAS). RESULTS Most patients (87%) had 1 of the 7 types of septal deformities. There was a high prevalence of bilateral (types 4 and 6; 46%) and anterior unilateral (types 1 and 2; 25%) NSD in patients not responding to medical treatment. Type 4 (OR = 6.4; p = 0.005) or type 6 (OR = 4.4; p = 0.03) NSD increased the risk of lack of improvement with medical treatment. Coexistence of anterior unilateral or bilateral NSD with severe turbinate enlargement increased >20-fold the risk of lack of improvement. Patients with bilateral NSD presented greater rhinitis severity. Non-responder adolescents displayed higher prevalence of bilateral NSD than children (53% vs. 23%; p = 0.02). Nasal obstruction VAS was higher for patients with anterior than posterior NSD, and greater for patients with bilateral NSD than any other type of septal morphology. CONCLUSION Nasal endoscopy shows that bilateral and unilateral anterior nasal septum deformities are strongly associated with a poor response to medical treatment, greater rhinitis severity and higher nasal obstruction VAS. Consequently, nasal endoscopy is necessary in the PER patients to understand the disease severity as well as to plan a specific surgical treatment in order to improve nasal obstruction, disease severity, and patient's quality of life.
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Affiliation(s)
- Franklin Mariño-Sánchez
- Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain; Unidad de Rinología, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Immunoal lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain.
| | - Meritxell Valls-Mateus
- Immunoal lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain; Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | | | - Oliver Haag
- Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Karen Ruiz-Echevarría
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rosa Jiménez-Feijoo
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jaime Lozano-Blasco
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - María T Giner-Muñoz
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ana M Plaza-Martin
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Joaquim Mullol
- Immunoal lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain; Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain.
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Lara-Sánchez H, Álvarez Nuño C, Gil-Carcedo Sañudo E, Mayo Iscar A, Vallejo Valdezate LÁ. Assessment of nasal obstruction with rhinomanometry and subjective scales and outcomes of surgical and medical treatment. Acta Otorrinolaringol Esp 2016; 68:145-150. [PMID: 27780551 DOI: 10.1016/j.otorri.2016.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/27/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Prospective study of patients with nasal obstruction (NO) in order to measure therapeutic success by anterior active rhinomanometry (AAR), Nasal Obstruction Symptom Evaluation (NOSE) scale and Visual Analogue Scale (VAS) and to establish the correlation between these tests. METHODS Patients with NO, on whom we performed an AAR, NOSE and VAS scales at baseline and after medical treatment (topical nasal steroid) or surgery (septoplasty, turbinoplasty or septoplasty and turbinoplasty). The nasal flow obtained by the AAR and the score of both subjective scales (NOSE and VAS) were compared and analyzed. RESULTS A total of 102 patients were included in the study. Surgical treatment resulted in statistically significant differences with the AAR and the subjective scales. While in patients with medical treatment there was an increase in the AAR nasal flow but without statistical significance (P=.1363). The correlation between the AAR, the NOSE and VAS scales was measured finding a strong correlation between the NOSE and VAS scales only (r=.83327). CONCLUSIONS The patients with NO treated surgically have better results when these are evaluated by AAR or with subjective scales. There is no significant correlation between AAR, NOSE and VAS scales, this is considered to be because the AAR and subjective scales are complementary and measure different aspects of NO. The AAR and subjective scales are useful tools to be used together for the follow up of patients with NO.
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Affiliation(s)
- Hugo Lara-Sánchez
- Servicio de Otorrinolaringología, Hospital Universitario Río Hortega, Valladolid, España.
| | - Candelas Álvarez Nuño
- Servicio de Otorrinolaringología, Hospital Universitario Río Hortega, Valladolid, España
| | | | - Agustín Mayo Iscar
- Departamento de Estadística e Investigación Operativa, Universidad de Valladolid, Valladolid, España
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Abstract
Correction of a crooked nose is one of the most common requests from patients presenting for rhinoplasty. Both esthetic and functional issues are typically present in patients with this deformity. Rhinoplasty for the crooked nose is particularly challenging because multiple nasal structures, both external and internal, are commonly involved. A major septal deformity is almost always a component of severely deviated noses. The crooked nose results from extrinsic and intrinsic forces that produce distortion of the nasal structures and nasal deviation. The open approach is particularly useful and is the focus of this article.
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Abstract
The management and diagnosis of nasal airway obstruction requires an understanding of the form and function of the nose. Nasal airway obstruction can be structural, physiologic, or a combination of both. Anatomic causes of airway obstruction include septal deviation, internal nasal valve narrowing, external nasal valve collapse, and inferior turbinate hypertrophy. Thus, the management of nasal air obstruction must be selective and carefully considered. The goal of surgery is to address the deformity and not just enlarge the nasal cavity.
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Hsiao YC, Chang CS, Chuang SS, Kolios G, Abdelrahman M. Forty-five degree cutting septoplasty. Plast Surg (Oakv) 2016; 24:199-203. [PMID: 28439511 DOI: 10.4172/plastic-surgery.1000977] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The crooked nose represents a challenge for rhinoplasty surgeons, and many methods have been proposed for management; however, there is no ideal method for treatment. Accordingly, the 45° cutting septoplasty technique, which involves a 45° cut at the junction of the L-shaped strut and repositioning it to achieve a straight septum is proposed. METHODS From October 2010 to September 2014, 43 patients underwent the 45° cutting septoplasty technique. There were 28 men and 15 women, with ages ranging from 20 to 58 years (mean, 33 years). Standardized photographs were obtained at every visit. Established photogrammetric parameters were used to describe the degree of correction: Correction rate = (preoperative total deviation - postoperative residual deviation)/preoperative total deviation × 100% was proposed. RESULTS The mean follow-up period for all patients was 12.3 months. The mean preoperative deviation was 64.3° and the mean postoperative deviation was 2.7°; the overall correction rate was 95.8%. One patient experienced composite implant deviation two weeks postoperatively and underwent revision rhinoplasty. There were no infections, hematomas or postoperative bleeding. CONCLUSION Based on the clinical observation of all patients during the follow-up period, the 45° cutting septoplasty technique was shown to be effective for the treatment of crooked nose.
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Affiliation(s)
- Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Chun-Shin Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Shiow-Shuh Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Georgios Kolios
- Department of Plastic and Reconstructive Surgery, Agaplesion Diakonie Klinikum Hamburg, Germany
| | - Mohamed Abdelrahman
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan.,University of Khartoum, Sudan
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Akgül MH, Muluk NB, Burulday V, Kaya A. Is there a relationship between sphenoid sinus types, septation and symmetry; and septal deviation? Eur Arch Otorhinolaryngol 2016; 273:4321-4328. [PMID: 27300298 DOI: 10.1007/s00405-016-4138-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 03/07/2016] [Accepted: 06/08/2016] [Indexed: 11/28/2022]
Abstract
In the present study, we investigated whether there is a relationship between sphenoid sinus (SS) types, septation (lobulation) and symmetry; and septal deviation (SD) by multidetector computed tomography (MDCT). Paranasal MDCT images of 202 subjects (131 males, 71 females), between 10- and 88-year-old, were included into the study. SS type (conchal, presellar or sellar), SS symmetry, SS septation (lobulation) and SD were evaluated by MDCT images. In the present study, in both males (83.2 %) and females (85.9 %); and in all age groups (80.4-85.7 %), sellar type sphenoid sinus were more detected. Conchal type was detected in two cases of the males (1.5 %) and none of the females. SS was detected mainly as multi-septated (multi-lobulated) (51.9 % in males and 56.3 % in females; in all age groups as 51.0-56.8 %; and both SD (+) and SD (-) groups as 51.2-56.8 %). In subjects with SD, asymmetric SS was detected in 80.2 %. Whereas in SD (-) subjects, asymmetric SS was detected in 50.6 %. Sellar type SS pneumatization is the most detected type in our cases. Presence of SD was related to the higher SS asymmetry values. In SD (-) subjects, SS was detected as symmetric. Nasal septal deformities such as SD may influence the development of the SS pneumatization and asymmetric septation. For well anatomic orientation of the surgeons, good anatomy knowledge and preoperative detailed examination of the CT scans are very important.
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Affiliation(s)
- Mehmet Hüseyin Akgül
- Neurosurgery Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Nuray Bayar Muluk
- ENT Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey. .,, Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 blok, No: 6-3/43, 06610, Çankaya, Ankara, Turkey.
| | - Veysel Burulday
- Radiology Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Ahmet Kaya
- Radiology Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
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Gregurić T, Baudoin T, Tomljenović D, Grgić M, Štefanović M, Kalogjera L. Relationship between nasal septal deformity, symptoms and disease severity in chronic rhinosinusitis. Eur Arch Otorhinolaryngol 2016; 273:671-7. [PMID: 25827442 DOI: 10.1007/s00405-015-3615-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
The objective of this study was to evaluate the interaction of nasal septal deformity (NSD), including the contribution of septal spurs, with the severity of subjective symptoms, impairment of health-related quality of life (HRQoL) and sinus mucosal hyperplasia in patients with chronic rhinosinusitis (CRS). One hundred seventeen patients with CRS were assigned to three groups with mild, moderate or severe NSD, according to the measured nasal septal angle, including the presence of contact septal spurs. All CRS patients completed the visual analog scale (VAS) symptom severity score and the Sino-Nasal Outcome Test (SNOT-22) questionnaire. Symptoms scores, SNOT-22 and Lund-Mackay (LM) scores among the three NSD groups were compared. Related anatomy from the study group was compared with 100 control patients. VAS score for postnasal discharge in CRS patients was significantly higher in patients with mild NSD. There was a significantly higher LM score in CRS patients with severe NSD, compared to those with mild (P = 0.001) or moderate NSD (P = 0.005). CRS patients with a contact spur demonstrated a significantly higher LM score (P = 0.006) compared to those without a contact spur, and no differences in VAS symptom scores or HRQoL scores. There was a similar prevalence of septal deformities in CRS patients and in the non-ENT population. Our results support the conclusion that in patients with CRS, associated NSD or contact septal spur do not contribute significantly to CRS symptom severity or HRQoL impairment, but may have an impact on sinus mucosal hyperplasia.
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Thomassin JM, Radulesco T, Bardot J. [Twisted noses]. ANN CHIR PLAST ESTH 2014; 59:498-507. [PMID: 25174875 DOI: 10.1016/j.anplas.2014.07.022] [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: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
Abstract
Correction of a twisted or crooked nose can be very complex and require the use of a broad range of surgical techniques. Patient needs are often mixed--aesthetic and functional--particularly in post-trauma cases. The quality of postoperative breathing is therefore as important as correction of the nasal deviation. Extracorporeal septoplasty or spreader grafts are very effective not only in correction of the nasal pyramid deformation, but also in resolution of functional respiratory issues. Reconstruction and proper support of the septum are necessary components for a straight nose. Aesthetic deformation can be difficult to correct owing to the memory of the bone and cartilage. Although minor deformations can be corrected with simple techniques, a more aggressive procedure is often necessary in the most complex cases. Despite attempts to correct deformation thanks to the various techniques described here, a postoperative deviation can persist. Preoperative discussion is very important and enables the surgeon to explain to the patient that it is very difficult to obtain a perfectly straight nose.
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Affiliation(s)
- J-M Thomassin
- Service d'ORL et chirurgie cervico-faciale, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - T Radulesco
- Service d'ORL et chirurgie cervico-faciale, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - J Bardot
- Service de chirurgie plastique, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
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Mundra RK, Gupta Y, Sinha R, Gupta A. CT Scan Study of Influence of Septal Angle Deviation on Lateral Nasal Wall in Patients of Chronic Rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2014; 66:187-90. [PMID: 24822160 DOI: 10.1007/s12070-014-0713-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 02/28/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022] Open
Abstract
The nasal septum is an important physiological and support structure of the nose. The nasal septal deviation causes alteration in air flow, mucociliary clearance and effects structures of the lateral nasal wall causing various nasal symptoms and other sinonasal disease. A systematic analysis was performed to measure the angle of septal deviation on CT scan PNS coronal section and to evaluate the influence of increasing septal angle deviation on the severity of lateral nasal wall abnormalities. A total of 61 patients with clinical evidence of chronic rhinosinusitis refractory to medical therapy for minimum three months were included in this study. After preliminary anterior & posterior rhinoscopic examination, all patients were evaluated with nasal endoscopy & CT scan PNS coronal view. There was statistically significant increase in hypertrophy of the middle turbinates and prominence of bulla ethmoidalis with OMC impingement on the side opposite to the direction of septal deviation. No apparent statistically significant difference between ipsilateral and contra lateral side OMC disease and anterior sinus mucosal disease in relation to direction of septal deviation in various groups was seen. We concluded that there is a strong association of increasing angles of septal deviation with corresponding patterns of disease in ostiomeatal complex. The result of the present study reemphasized the fact that, obstruction at ostiomeatal complex and anterior ethmoids secondary to septal deviation is the key factor for causation of chronic sinusitis.
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Affiliation(s)
- R K Mundra
- Department of Otorhinolaryngology and Head & Neck Surgery, MGM Medical College & MY Hospitals, 2 Kanchan Vihar, 2 Kanchan Bagh, Indore, 452001 Madhya Pradesh India
| | - Yamini Gupta
- Department of Otorhinolaryngology and Head & Neck Surgery, MGM Medical College & MY Hospitals, 2 Kanchan Vihar, 2 Kanchan Bagh, Indore, 452001 Madhya Pradesh India
| | - Richi Sinha
- Department of Otorhinolaryngology and Head & Neck Surgery, MGM Medical College & MY Hospitals, 2 Kanchan Vihar, 2 Kanchan Bagh, Indore, 452001 Madhya Pradesh India
| | - Alaknanda Gupta
- Department of Otorhinolaryngology and Head & Neck Surgery, MGM Medical College & MY Hospitals, 2 Kanchan Vihar, 2 Kanchan Bagh, Indore, 452001 Madhya Pradesh India
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Mohebbi S, Salehi O, Ebrahimpoor S. Ectopic supernumerary tooth in nasal septum: a case study. Iran J Otorhinolaryngol 2013; 25:183-6. [PMID: 24303439 PMCID: PMC3846227] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 10/27/2012] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Nasal teeth eruption is a rare phenomenon. The variability of symptoms and generic history makes the diagnosis difficult. This difficulty is more challenging when the tooth is placed in the depth of septum. CASE REPORT Our case is an example of this problem. Herein, we present a case of intraseptal tooth with nasal obstruction and septal deviation and recurrent sinusitis. We present preoperative imaging. CONCLUSION Great suspicion may helpful for preoperative diagnosis and good deciding.
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Affiliation(s)
- Saleh Mohebbi
- Department of Otorhinolaryngology.Tehran University of Medical Sciences,Tehran,Iran. ,Corresponding Author: Department of Otolaryngology. Tehran University of Medical Sciences,Tehran,Iran. E-mail:
| | - Oveis Salehi
- Department of Otorhinolaryngology.Hormozgan University of Medical Sciences,Bandarabbas,Iran.
| | - Sedighe Ebrahimpoor
- Cell and molecular biology,biochemistMsc,Research center of otolaryngology –head and neck surgery,Iran university of medical sciences,Tehran,Iran.
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Murthy VA, Reddy RR, Pragadeeswaran K. Internal nasal valve and its significance. Indian J Otolaryngol Head Neck Surg 2013; 65:400-1. [PMID: 24427685 DOI: 10.1007/s12070-013-0618-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 10/20/2012] [Accepted: 01/12/2013] [Indexed: 11/28/2022] Open
Abstract
UNLABELLED Internal nasal valve (INV) is the narrowest area, of the nose where turbulence of the inspiratory and expiratory current takes place. This study analysis the significance of INV with respect to health and disease. STUDY DESIGN Descriptive study/Prospective study. Study Centre: Tertiary Centre. 150 students were followed for 2 years after noting the endoscopic anatomic details of INV. The students who reported due to sinus/ear disease during this follow up period were again noted. The type of INV in health and disease were analysed. Septal deviation at the INV is noted in most of the cases of sinus/ear disease. It is advisable to correct the abnormality of INV if present simultaneously while clearing the ear/sinus pathology.
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Affiliation(s)
- V Ashok Murthy
- Department of ENT, PES Institute of Medical Science and Research, Kuppam, 517 425 India
| | - R Raghavendra Reddy
- Department of ENT, PES Institute of Medical Science and Research, Kuppam, 517 425 India
| | - K Pragadeeswaran
- Department of ENT, PES Institute of Medical Science and Research, Kuppam, 517 425 India
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Naeimi M, Garkaz M, Naeimi MR. Comparison of sinonasal symptoms in patients with nasal septal deviation and patients with chronic rhinosinusitis. Iran J Otorhinolaryngol 2013; 25:11-6. [PMID: 24303413 PMCID: PMC3846238] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 09/05/2012] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Disorders of the nose and paranasal sinuses are among the most common chronic illnesses. Although considerable progress has been made in the medical and surgical control of these diseases, a large number of questions relating to the diagnosis, evaluation, and treatment of these conditions remain unanswered. The aim of the present study was to evaluate differences in the frequency of symptoms and disease severity in patients with nasal septal deviation (NSD) compared with chronic rhinosinusitis (CRS). MATERIALS AND METHODS A total of 156 patients, divided into NSD and CRS groups, were studied in relation to symptoms and disease severity. Patients were selected from those referred to the Ear, Nose, and Throat (ENT) Wards of the Imam Reza and Ghaem Hospitals, who had not responded to a variety of treatments. Depending on the type of disease, patients were candidates for either septoplasty or endoscopic sinus surgery. The Rhinosinusitis Symptom Inventory was administered to measure the severity of symptoms, with scores assigned based on the answers given by patients (Likert scale). Scores were compared between the CRS and NSD groups. RESULTS A total of 156 patients (78 with NDS and 78 with CRS) entered the study in overall sinonasal symptoms were more prevalent in CRS group. Nasal congestion, runny nose, earache, toothache, and smelling disorder were significantly more common in the CRS group (P<0.001); while there were no significant differences in symptoms such as facial pressure, fever, or headache between the two groups (P>0.05). CONCLUSION Patients with CRS manifested statistically significantly greater sinonasal symptom scores than patients with NSD.
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Affiliation(s)
- Mohammad Naeimi
- Ear,Nose,Throat, Head and Neck Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. ,Corresponding Author: Ghaem Hospital, Mashhad University of Medical Sciences,Mashhad, Iran. Tel:+985118413492, E-mail:
| | - Maria Garkaz
- Departmen of Otorhinolaryngology, Mashhad University of Medical Sciences, Mashhad, Iran.
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Sakallıoğlu O, Düzer S, Kapusuz Z, Soylu E. The evaluation of nasal mucociliary activity after septoplasty and external septorhinoplasty. Indian J Otolaryngol Head Neck Surg 2012; 65:360-5. [PMID: 24427677 DOI: 10.1007/s12070-012-0532-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 01/13/2012] [Accepted: 02/26/2012] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to evaluate the nasal mucociliary activity after septoplasty (SP) and external septorhinoplasty (eSRP). Twenty patients who had SP operation (group 1) and 15 patients who had eSRP operation (group 2) were enrolled in the study. On each case, mucociliary clearance (MCC) measurement was performed by saccharine test before surgery, and on the first and third months of postoperative period. Saccharine clearance time (SCT) of 28 healthy volunteers were measured to establish control values. The mean SCT in control group was 8.79 ± 2.63 min, in group 1 patients before surgery was 14.03 ± 1.68 min, in group 2 patients before surgery was 14.34 ± 1.70 min. The preoperative SCT values of the group 1 and group 2 were significantly higher than healthy controls (p < 0.05). While there were statistically significant differences between preoperative and postoperative third month SCT values of group 1 patients, and postoperative first month and postoperative third month SCT values of group 1 patients (p < 0.05), there was no statistically significant difference between preoperative and postoperative first and third months SCT values of group 2 patients. Nasal septal deviation impairs the nasal mucociliary activity. Septoplasty operation positively affects the MCC mechanism. On the other hand, we observed no significant effect of eSRP operation on mucociliary activity on the first and third months of postoperative period as compared with preoperative.
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Affiliation(s)
- Oner Sakallıoğlu
- Otorhinolaryngology Clinic, Elazığ Training and Research Hospital, Elazig, Turkey
| | - Sertaç Düzer
- Otorhinolaryngology Clinic, Elazığ Training and Research Hospital, Elazig, Turkey
| | - Zeliha Kapusuz
- Otorhinolaryngology Department, Bozok University, Yozgat, Turkey
| | - Erkan Soylu
- Otorhinolaryngology Clinic, Elazığ Training and Research Hospital, Elazig, Turkey
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