Endoscopic-assisted correction of the deviated nose

The Morphological and Functional Effects of the Endoscope-Assisted One-Stage Approach for Crooked Nose

BACKGROUND

A crooked nose is an external nose deformity predominantly caused by congenital aplasia or acquired secondary to trauma or surgery, often accompanied by a deviated nasal septum. Patients with crooked nose have dual needs to improve both esthetic and functional problems.

METHODS

The clinical and photographic information of 48 patients diagnosed with a crooked nose and nasal septum deviation treated from January 2018 to January 2022 was acquired. The morphology and functional effects were investigated by evaluating the general condition of the operation, measuring the esthetic indexes of the nose, and subjectively scoring.

RESULTS

For both morphology and function, endoscopy-assisted one-stage correction showed positive results in this study. The external nose deviation distance postoperatively measured 1.28 (0.85, 1.97) mm, which significantly decreased from the preoperative value of 3.96 (3.31, 5.29) mm. The scores of doctors and irrelevant medical students on nose morphology increased significantly from 4.75±1.88 and 3.84±0.76 to 6.48±1.21 and 7.21±0.67, respectively. The rhinoplasty outcome evaluation score and the "nasal obstruction symptom evaluation "score of patients were both significantly improved ( t = -7.508 and t =6.310, respectively, P < 0.001).

CONCLUSION

Endoscope-assisted one-stage correction of the crooked nose can restore nasal morphology, improve the symptoms of nasal obstruction, and achieve patient satisfaction. It is a minimally invasive, safe, effective, and fast recovery approach for patients who need to solve both esthetic and functional problems.

Clinical Efficacy Analysis of Functional Rhinoplasty Assisted by Nasal Endoscopy

OBJECTIVE

To analyze the clinical effect of endoscopy-assisted functional rhinoplasty.

METHODS

Endoscopy-assisted functional rhinoplasty was performed in all patients. Deviated nasal septum was corrected, nasal septum cartilage graft was prepared through open access under the assistance of endoscopy, the nasal frame structure was adjusted with the endoscopy-assisted rhinoplasty combined with middle and inferior turbinoplasty, and the patient's nasal ventilation function and external nose cosmetology were restored. Visual Analogue Scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE), nasal acoustic reflex, and nasal resistance were examined preoperatively and 6 months postoperatively. Rhinoplasty Outcome Evaluation (ROE), nasal appearance deviation value, and morphological measurement of the external nose were used to assess the external nasal appearance. Finally, postoperative satisfaction was used for overall evaluation.

RESULTS

In terms of nasal ventilation evaluation, the VAS and NOSE scores of nasal obstruction decreased significantly at 6 months after the operation compared with that before the operation (1.96 ± 0.84 vs 6.68 ± 1.28, 4.25 ± 1.80 vs 12.25 ± 2.50; P < .05). Among the objective indexes, MCA1, MCA2 and NV5 were significantly increased whereas RT, MCA1a/MCA1b, MCA2a/MCA2b, MD1a/MD1b, and MD2a/MD2b were significantly decreased compared with those before the operation (P < .05). The MD1 and MD2 levels before and after operation had no significant differences (P > .05). In the evaluation of external nose morphology, postoperative ROE was significantly increased, and the deviation value of nasal appearance was significantly decreased [(16.93 ± 2.61 vs 10.64 ± 3.01), (1.46 ± 1.11 mm vs 5.72 ± 2.30 mm), P < .05]. In terms of postoperative patient satisfaction: 26 cases (92.9%) were very satisfied with nasal ventilation function, 2 cases (7.1%) were satisfied with nasal ventilation function, 24 cases (85.7%) were very satisfied with nasal appearance, and 4 cases (14.3%) were satisfied with nasal appearance.

CONCLUSIONS

Nasal endoscopy-assisted functional rhinoplasty can improve the nasal ventilation function and external nasal morphology at the same time. Moreover, its clinical effect is good, and the patient satisfaction is high.

A new approach to nasoseptal fractures: Submucosal endoscopically assisted septoplasty and closed nasal reduction

BACKGROUND

Nasal bone fracture is the most common among facial bone fractures. The prevalence of concomitant septal and nasal bone fractures fluctuates between 34% and 96.2%. An adequate management of such fractures is essential to prevent complications such as post-traumatic nasal obstruction and nasoseptal deformities. The purpose of the present study is to introduce the submucosal endoscopically assisted septoplasty (SEAS) as an alternative approach for acute septal lesions and to report our experience and outcomes.

METHODS

Retrospective review including patients with nasal fracture in association with septal fracture (nasoseptal fractures) who underwent to submucosal endoscopically assisted septoplasty and closed nasal reduction. The surgical technique is described and a video is presented.

RESULTS

Ninety patients were included; 23% were female and 77% were male, with a mean age of 40 years. All the cases were workplace accidents or commuting accidents. The mean time elapsed between the accident and surgery was 15 days. There were no technique-related intraoperative complications. Three (3.3%) patients suffered a subsequent nasal obstruction and/or deviation of the nasal axis, requiring subsequent secondary open rhinoseptoplasty.

CONCLUSIONS

Submucosal endoscopically assisted septoplasty and closed nasal reduction for the treatment of nasoseptal fractures is a novel approach that reduces the rate of secondary rhinoseptoplasty as compared to other authors' reports. The technique described is reproducible, cost-effective and has very encouraging outcomes.

LEVEL OF EVIDENCE

IV Therapeutic.

A comparative study of endoscopic septoplasty versus conventional septoplasty

Nasal obstruction due to deviated nasal septum is a common problem encountered by otolaryngologists. A variety of surgical procedures have been tried in the treatment of the same. This study was conducted to evaluate the outcomes and complications of endoscopic and conventional septoplasty. This is a prospective, randomized study. Fifty patients with symptomatic deviated nasal septum were included in the study, 25 of them underwent conventional septoplasty and the rest underwent endoscopic septoplasty. The difference in the functional outcome of both the surgeries was insignificant. There was a significant difference with respect to complications. Endoscopic septoplasty had better outcome with respect to complications. It is easier to correct posterior deviations and isolated spurs with endoscopic septoplasty. Complications are lesser with endoscopic septoplasty.

Endoscopic septoplasty in primary cases using electromechanical instruments: surgical technique, efficacy and results

INTRODUCTION AND OBJECTIVES

The microdebrider is a surgical tool which has been used successfully in many endoscopic surgical procedures in otolaryngology. In this study, we analysed our experience using this powered instrument in the resection of obstructive nasal septum deviations.

SUBJECTS AND METHODS

This was a longitudinal, prospective, descriptive study conducted between January and June 2007 on 141 patients who consulted for chronic nasal obstruction caused by a septal deviation or deformity and underwent powered endoscopic septoplasty (PES).

RESULTS

The mean age was 39.9 years (15-63 years); 60.28% were male (n=85) The change in nasal symptom severity decreased after surgery from 6.12 (preoperative) to 2.01 (postoperative). Patients undergoing PES had a significant reduction of nasal symptoms in the pre- and postoperative period, which was statistically significant (P<.05). There were no statistically significant differences between the results at the 2 nd week, 6th week and 5th year after surgery. The 100% of patients were satisfied with the results of surgery and no patient answered "No" to the question added to compare patient satisfaction after surgery. Minor complications in the postoperative period were present in 4.96% of the cases.

CONCLUSIONS

Powered endoscopic septoplasty allows accurate, conservative repair of obstructive nasal septum deviations, with fewer complications and better functional results. In our experience, this technique offered significant perioperative advantages with high postoperative patient satisfaction in terms of reducing the severity of nasal symptoms.

Comparative evaluation of endoscopic with conventional septoplasty

A study was conducted to assess the merits and demerits of endoscopic septoplasty. Fifty patients having symptomatic DNS were randomly divided into two groups of 25 patients each. One group underwent endoscopic septoplasty and other group underwent conventional septoplasty. The groups were compared regarding the complaints with pack in postoperative period, relief of symptoms after surgery and complications. The symptoms complained by the patients with pack in postoperative period and complications after surgery were significantly less in endoscopic septoplasty group.

The crooked nose: the use of medial iliac crest bone graft as a supporting framework

The crooked nose is one that the vertical axis of the nose inclines from the midline. As a rule, a major septal deformity almost always accompanies to impairing breathing and aesthetic appearance. To achieve total straightening of the crooked nose, the septum must become the target of the treatment. To prevent redeviation, we used rigid bone grafts instead of flexible and relatively weak cartilage to maintain the support of the corrected deformity. Between February 2005 and July 2007, 9 patients (all male) with crooked noses underwent corrective surgery. The mean age of the patients was 21 years (range, 19-23 years). The source of the bone graft was medial side of iliac crest in all patients. The mean follow-up was 18 months, ranging from 10 to 26 months. All patients had both functional and cosmetic problems. Mean operation time was 4 hours. Airway patency was improved in all cases. The grafts did not shift in any case and did not develop unsightly irregularities over time. Absorption of the grafts was not seen in the follow-up. There were no cases of extrusion or infection. No donor site complication occurred. None of the patient required secondary surgery. A residual deviation can be obvious despite all attempts, which has no deleterious effect on patient satisfaction. This article introduces a novel technique for the correction of the crooked nose.

Rhinoplasty and endoscopic surgery for functional and inflammatory nasal/sinus disorders

The rhinoplastic surgeon when faced with nasal sinusitis has traditionally delayed aesthetic treatment of the nose, referring the patient to the ear, nose, and throat consultant until complete resolution of the inflammatory condition. Often, under such a scenario, the patient found the ear, nose, and throat procedure to be a traumatic experience that discouraged further surgery of an aesthetic nature. The advent of functional endoscopic sinus surgery has significantly modified the management of paranasal sinus disorders. This minimally invasive, sophisticated procedure can easily be combined with rhinoplasty. More recently, an endoscopic approach has been advocated for management of the septum and lower/middle turbinates. The authors call this functional endoscopic nasal surgery. Functional endoscopic nasal surgery allows a clearer view of the operative field (septum and turbinates), a more accurate correction of nasal obstruction, and better control of bleeding. Thus, endoscopic techniques permit the treatment of functional and inflammatory nasal disorders in a single stage, along with aesthetic improvement. Only the patient with severe sinusitis is unsuitable for combined therapy. The authors present their experience based on 72 consecutive cases of combined functional endoscopic sinus surgery/functional endoscopic nasal surgery with aesthetic rhinoplasty. Complications were minimal and functional failures were limited to 4 percent, whereas aesthetic outcomes remained uncompromised.

Endoscopy-assisted rhinoplasty

In nasal surgery some surgical steps are done without the aid of direct vision. In these situations, surgeons must use their experience and judgment. I have adapted techniques used in endoscopic sinus surgery to perform some of the surgical steps of functional and aesthetic rhinoplasty. Between September 1999 and February 2000, 11 patients underwent endoscopic-assisted septorhinoplasty, and 18 patients underwent traditional closed rhinoplasty. The following parameters were compared: surgical bleeding, postoperative edema and ecchymosis, dorsum irregularity, and operative time for each technique. The following steps were clearly visualized with the endoscope: raising the periosteum from the nasal bone, resecting the nasal hump, and rasping the nasal bones. The use of endoscopic instruments does not change the surgical steps required. Rather, it allows direct vision of steps previously not viewable.

Endoscopically assisted, intraorally approached corrective rhinoplasty

In the field of facial surgery, operations that require guesswork can result in unexpected complications. One example of such "blind" facial surgery is the lateral osteotomy procedure in corrective rhinoplasty. In most conventional corrective rhinoplasties, the postoperative results of a lateral osteotomy can be controlled by the surgeon's visual perception or manual dexterity; therefore, an experienced surgeon is indispensable in such elaborate operations. Until now, reports have focused on the endoscopic approach through the nasal dorsum or septum through the nostril. However, because of the difficulty in handling the endoscope with osteotomy instruments, it is considered difficult to perform a precise lateral osteotomy procedure using that approach. The authors think the intraoral endoscopic approach should be considered a viable alternative in corrective rhinoplasty. Through small, bilateral gingivobuccal incisions, both the piriform apertures and nasal bones can be easily exposed, and the exact level of the lateral osteotomy can be confirmed directly under the endoscope. The lateral osteotomy is made simply with a reciprocating saw, and symmetrical cutting can be ascertained during the operation. Sometimes, a particular osteotomy level or the proper repositioning of osteotomed segments can be readily evaluated with assistance from the endoscope during the operation. Eleven cases using this procedure were performed over the past 3 years. These endoscopic repairs for a deviated nose were quite helpful for visual confirmation and accurate correction. No complications occurred when using the endoscope with this procedure.