1
|
Carrie S, Fouweather T, Homer T, O'Hara J, Rousseau N, Rooshenas L, Bray A, Stocken DD, Ternent L, Rennie K, Clark E, Waugh N, Steel AJ, Dooley J, Drinnan M, Hamilton D, Lloyd K, Oluboyede Y, Wilson C, Gardiner Q, Kara N, Khwaja S, Leong SC, Maini S, Morrison J, Nix P, Wilson JA, Teare MD. Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT. Health Technol Assess 2024; 28:1-213. [PMID: 38477237 PMCID: PMC11017631 DOI: 10.3310/mvfr4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Background The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking. Objective The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum. Design This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation. Setting The trial was set in 17 NHS secondary care hospitals in the UK. Participants A total of 378 eligible participants aged > 18 years were recruited. Interventions Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190). Main outcome measures The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes - Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements - peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms. Results At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were -20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval -23.6 to -16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively. Limitations COVID-19 had an impact on participant-facing data collection from March 2020. Conclusions Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid. Trial registration This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Sean Carrie
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James O'Hara
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Alison Bray
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jemima Dooley
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michael Drinnan
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly Lloyd
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Wilson
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Quentin Gardiner
- Ear, Nose and Throat Department, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Naveed Kara
- Ear, Nose and Throat Department, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Sadie Khwaja
- Ear, Nose and Throat Department, Manchester Royal Infirmary, Manchester University Foundation NHS Trust, Manchester, UK
| | - Samuel Chee Leong
- Ear, Nose and Throat Department, Aintree Hospital, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sangeeta Maini
- Ear, Nose and Throat Department, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | - Paul Nix
- Ear, Nose and Throat Department, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
2
|
Fageeh YA, Basurrah MA, ALAzwari KD, AlAmri MA, AlJuaid WM, AlHumaidi AA, AlFaqih MH, AlAlyani OM. Prevalence of nasal obstruction and its impact on quality of life in Saudi Arabia. J Family Med Prim Care 2024; 13:572-578. [PMID: 38605785 PMCID: PMC11006041 DOI: 10.4103/jfmpc.jfmpc_482_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 04/13/2024] Open
Abstract
Purpose/Background Nasal obstruction is a significant issue influencing the patient's quality of life. Chronic nasal obstruction is frequently associated with other symptoms such as headache, sleep disturbance, and daytime sleepiness. This study aims to investigate the prevalence of nasal obstruction in Saudi Arabia and examine its effect on patients' quality of life. Methods This is a cross-sectional study conducted in Saudi Arabia. Data were collected using a self-administered combination of two previously validated questionnaires (the NOSE scale and the WHOQOL-BREF) translated into Arabic. The Mann-Whitney test was used to investigate the association between nasal obstruction prevalence and the participants' QOL. Results The study included 1039 participants from different regions of Saudi Arabia. The prevalence of nasal obstruction was 60.3% among the participants. Several factors significantly affected the prevalence of nasal obstruction, including sex, suffering from a chronic disease, having a family member with nasal obstruction, and using medications (P < 0.001 for all factors). A better score was shown in the four domains of the WHOQOL-BREF questionnaire by the participants who had no nasal obstruction: the physical health domain, psychological health, social relationships, and environment (P < 0.001 for all factors). Conclusions Quality of life is affected by nasal obstruction. The subjective assessment is essential in evaluating the severity of nasal obstruction disease. It is recommended that healthcare providers use subjective tools combined with objective tools to assess the degree of nasal obstruction severity.
Collapse
Affiliation(s)
- Yahya Ahmed Fageeh
- Otorhinolaryngology-head and Neck Surgery, College of Medicine, Taif University, Taif, Kingdom of Saudi Arabia
| | - Mohammed Abdullah Basurrah
- Otorhinolaryngology-head and Neck Surgery, College of Medicine, Taif University, Taif, Kingdom of Saudi Arabia
| | | | | | | | | | | | | |
Collapse
|
3
|
Karataş M, Koparal M, Yılmazer C, Kelles M. Correlations between objective and subjective tests of nasal patency in patients undergoing septoplasty. J Laryngol Otol 2023; 137:413-418. [PMID: 35607263 DOI: 10.1017/s002221512200127x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study assessed correlations between pre- and post-operative objective and subjective nasal patency test results in patients undergoing septoplasty to treat nasal septum deviation. METHOD Eighty nasal septum deviation patients who underwent septoplasty were prospectively enrolled. Nasal Obstruction Symptom Evaluation questionnaire scores, anterior rhinomanometry and acoustic rhinometry data were compared pre-operatively and three months after surgery. The left, right and total volume and left, right and total minimum cross-sectional area acoustic rhinometry values were compared. RESULTS The left volume, total volume, left minimum cross-sectional area and total minimum cross-sectional area differed significantly between the two time-points (all p < 0.05). The total resistance, inspiratory total airflow, expiratory total resistance and expiratory total airflow rhinomanometric data did not differ between the two timepoints (all p > 0.05). CONCLUSION This study suggested that subjective tests such as the Nasal Obstruction Symptom Evaluation questionnaire are optimal to identify complaints and assess post-operative satisfaction.
Collapse
Affiliation(s)
- M Karataş
- Department of Otolaryngology, Faculty of Medicine, Adiyaman University, Turkey
| | - M Koparal
- Department of Otolaryngology, Faculty of Medicine, Adiyaman University, Turkey
| | - C Yılmazer
- Department of Otolaryngology, Faculty of Medicine, Adiyaman University, Turkey
| | - M Kelles
- Department of Otolaryngology, Faculty of Medicine, Turgut Özal University, Malatya, Turkey
| |
Collapse
|
4
|
Youn GM, Shah JP, Wei EX, Kandathil C, Most SP. Revision Rates of Septoplasty in the United States. Facial Plast Surg Aesthet Med 2023; 25:153-158. [PMID: 35394347 PMCID: PMC9986010 DOI: 10.1089/fpsam.2022.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Large-scale studies characterizing septoplasty revision rates are lacking. Objectives: To identify rates of septoplasty revision in the United States. Methods: Patients undergoing initial septoplasty between January 1, 2007 and December 31, 2013 were identified using the IBM® MarketScan® Commercial Database. Patients were excluded if they had nasal vestibular stenosis, rhinoplasty, or costal cartilage grafts for the initial surgery, or did not have either septoplasty, nasal vestibular stenosis, rhinoplasty, and/or costal cartilage grafts for the second surgery. Results: 295,236 patients received an initial septoplasty, and 3213 (1.1%) patients underwent a revision. Among the revision group, 178 (5.4%) patients received a septorhinoplasty, among which 13 (7.3%) required a costal cartilage graft. Older patients were less likely to need revision surgery (RS). Patients in the Northeast and West were significantly more likely than patients in the Midwest to undergo RS. Insurance plans such as comprehensive and point-of-service were associated with greater odds of RS, whereas others such as high-deductible health plans were associated with lower odds. Conclusion: Septoplasty revision rates are relatively low at 1.1% but influenced by age, region, and insurance plan.
Collapse
Affiliation(s)
- Gun Min Youn
- Stanford University School of Medicine, Stanford, California, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jay P. Shah
- Stanford University School of Medicine, Stanford, California, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Eric X. Wei
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Cherian Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sam P. Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
5
|
Kasamkattil J, Gryadunova A, Schmid R, Gay-Dujak MHP, Dasen B, Hilpert M, Pelttari K, Martin I, Schären S, Barbero A, Krupkova O, Mehrkens A. Human 3D nucleus pulposus microtissue model to evaluate the potential of pre-conditioned nasal chondrocytes for the repair of degenerated intervertebral disc. Front Bioeng Biotechnol 2023; 11:1119009. [PMID: 36865027 PMCID: PMC9971624 DOI: 10.3389/fbioe.2023.1119009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction: An in vitro model that appropriately recapitulates the degenerative disc disease (DDD) microenvironment is needed to explore clinically relevant cell-based therapeutic strategies for early-stage degenerative disc disease. We developed an advanced 3D nucleus pulposus (NP) microtissues (µT) model generated with cells isolated from human degenerating NP tissue (Pfirrmann grade: 2-3), which were exposed to hypoxia, low glucose, acidity and low-grade inflammation. This model was then used to test the performance of nasal chondrocytes (NC) suspension or spheroids (NCS) after pre-conditioning with drugs known to exert anti-inflammatory or anabolic activities. Methods: NPµTs were formed by i) spheroids generated with NP cells (NPS) alone or in combination with ii) NCS or iii) NC suspension and cultured in healthy or degenerative disc disease condition. Anti-inflammatory and anabolic drugs (amiloride, celecoxib, metformin, IL-1Ra, GDF-5) were used for pre-conditioning of NC/NCS. The effects of pre-conditioning were tested in 2D, 3D, and degenerative NPµT model. Histological, biochemical, and gene expression analysis were performed to assess matrix content (glycosaminoglycans, type I and II collagen), production and release of inflammatory/catabolic factors (IL-6, IL-8, MMP-3, MMP-13) and cell viability (cleaved caspase 3). Results: The degenerative NPµT contained less glycosaminoglycans, collagens, and released higher levels of IL-8 compared to the healthy NPµT. In the degenerative NPµT, NCS performed superior compared to NC cell suspension but still showed lower viability. Among the different compounds tested, only IL-1Ra pre-conditioning inhibited the expression of inflammatory/catabolic mediators and promoted glycosaminoglycan accumulation in NC/NCS in DDD microenvironment. In degenerative NPµT model, preconditioning of NCS with IL-1Ra also provided superior anti-inflammatory/catabolic activity compared to non-preconditioned NCS. Conclusion: The degenerative NPµT model is suitable to study the responses of therapeutic cells to microenvironment mimicking early-stage degenerative disc disease. In particular, we showed that NC in spheroidal organization as compared to NC cell suspension exhibited superior regenerative performance and that IL-1Ra pre-conditioning of NCS could further improve their ability to counteract inflammation/catabolism and support new matrix production within harsh degenerative disc disease microenvironment. Studies in an orthotopic in vivo model are necessary to assess the clinical relevance of our findings in the context of IVD repair.
Collapse
Affiliation(s)
- Jesil Kasamkattil
- Spine Surgery, University Hospital Basel, Basel, Switzerland,Department of Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Anna Gryadunova
- Spine Surgery, University Hospital Basel, Basel, Switzerland,Department of Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland,World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Raphael Schmid
- Spine Surgery, University Hospital Basel, Basel, Switzerland,Department of Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Max Hans Peter Gay-Dujak
- Spine Surgery, University Hospital Basel, Basel, Switzerland,Department of Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland,Department of Biomedicine, Institute of Anatomy, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Boris Dasen
- Department of Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Morgane Hilpert
- Department of Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Karoliina Pelttari
- Department of Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Ivan Martin
- Department of Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Stefan Schären
- Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Andrea Barbero
- Department of Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Olga Krupkova
- Spine Surgery, University Hospital Basel, Basel, Switzerland,Department of Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland,*Correspondence: Olga Krupkova,
| | - Arne Mehrkens
- Spine Surgery, University Hospital Basel, Basel, Switzerland,Department of Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland
| |
Collapse
|
6
|
Kar M, Bayar Muluk N, Susaman N, Çetiner H, Cingi C. How do different climatic conditions affect the quality of life of patients following septoplasty or septorhinoplasty? J Plast Reconstr Aesthet Surg 2023; 77:54-62. [PMID: 36549123 DOI: 10.1016/j.bjps.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 08/18/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The effects of different climatic conditions on the quality of life (QoL) of patients following septoplasty or septorhinoplasty were investigated. METHODS A total of 89 patients (47 males and 42 females) underwent either septoplasty or septorhinoplasty during the summer (summer group, n = 42) or winter (winter group, n = 47) season. To assess QoL, SinoNasal Outcome Test (SNOT)-22, Nasal Obstruction Symptom Evaluation (NOSE) scale, and Visual Analogue Scale were used. Postoperative (PO) pain, bleeding, and symptoms related to nasal packing (eating and sleep problems) were also evaluated. RESULTS PO pain scores were lower in the winter group than that in the summer group (p<0.05). After pack removal, there was a slight serohemorrhagic nasal discharge in 2.1% of the patients in the winter group, but no patient required intervention. Slight leakage was detected in 47.6% of the patients and 2.4% of the patients called for intervention (p<0.05) in the summer group. The SNOT-22 values did not differ between the groups (p>0.05). NOSE scores in the winter group were higher than that in the summer group (p<0.05). In each group, SNOT-22 (padjusted<0.175) and NOSE scores (p<0.05) were lower at 1 month after surgery. The winter group patients rated headache, facial pain, and nasal crusting higher than those in the summer group did (p<0.05). However, nasal discharge and loss of smell were less troubling in the summer group than that in the winter group (p<0.05). CONCLUSION Regardless of climate or season, septoplasty or septorhinoplasty increases patients' QoL. However, problematic PO bleeding was detected at a higher frequency in patients who underwent surgery in summer. The advantage of surgery in winter is that it leads to less frequent problematic bleeding PO.
Collapse
Affiliation(s)
- Murat Kar
- AlaaddinKeykubat University, Alanya Training and Research Hospital, Department of Otorhinolaryngology, Alanya, Antalya, Turkey
| | - Nuray Bayar Muluk
- Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey.
| | - Nihat Susaman
- Elazig Fethi Sekin City Hospital, ENT Clinics, Elazig, Turkey
| | - Hasan Çetiner
- East Anatolia Hospital, Department of Otorhinolaryngology, Elazıg Turkey
| | - Cemal Cingi
- Eskisehir Osmangazi University, Faculty of Medicine, ENT Department, Eskisehir, Turkey
| |
Collapse
|
7
|
Hellgren J, Lundberg M, Rubek N, von Buchwald C, Steinsvåg S, Mäkitie A. Unmet challenges in septoplasty–nordic studies from a uniform healthcare and geographical area. Front Surg 2022; 9:1061440. [DOI: 10.3389/fsurg.2022.1061440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
PurposeNasal septoplasty is one of the most common surgical procedures in otorhinolaryngology and optimising both patient selection and the surgery is a challenge. The Nordic countries have similar public healthcare systems and comparable populations in terms of size.MethodsThis is a review of studies of outcome and predictors related to septoplasty from Denmark, Finland, Norway and Sweden, published during the last decade. The aim of this review was to identify areas in need of further research to meet the challenges of septoplasty in the Nordic countries with reference to international data.ResultsPostoperative patient satisfaction at 6–12 months was reported in around 2/3 of the patients and well in line with international data. Patients with more severe symptoms had a higher chance of improvement. Lack of standardisation in patient selection, surgical methods and skills, and follow up procedures, still makes it difficult to explain the 25% failure rate in septoplasty surgery.ConclusionThis review of the Nordic studies from the last decade shows that septoplasty in general is effective in relieving nasal obstruction. There is a need for studies addressing the standardisation of diagnostic tools and algorithms and the systematic and continuous implementation of follow-up of the surgical results at both departmental and personal level. This includes an awareness of how surgical skills in septoplasty are obtained and maintained.
Collapse
|
8
|
Causes and management of persistent septal deviation after septoplasty. Sci Rep 2022; 12:19574. [PMID: 36380114 PMCID: PMC9666439 DOI: 10.1038/s41598-022-23772-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Septoplasty is one of the most common otolaryngological surgical procedures. The causes of persistent septal deviation after primary septoplasty vary. The purpose of this study was to identify factors associated with failure of primary septoplasty, operative techniques that correct residual septal deviation, and surgical outcomes. Seventy-four adults who underwent revision septoplasty to treat persistent septal deviations were enrolled. The level of hospital in which primary septoplasty was performed, type of septal deviation, septal portion exhibiting persistent deviation, and techniques used to correct the deviation were evaluated. Outcomes were measured subjectively using a visual analog scale (VAS), and objectively using acoustic rhinometry. The first septoplasties were usually performed in primary and secondary hospitals. C-shaped deviations were more common than S-shaped ones in both the anteroposterior and cephalocaudal dimensions. The most common region of persistent septal deviation was the caudal septum (44.6%), followed by multiple sites (20.3%). The corrective techniques included excision of the remnant deviated portion (70.3%), septal cartilage traction suturing (27.0%), spreader grafting (13.5%), and cross-suturing (6.8%). The VAS score improved significantly 6 months after surgery. The minimal cross-sectional area and nasal cavity volume of the convex side increased significantly after revision septoplasty. Patients who underwent septoplasty in primary and secondary hospitals were more likely to require revision septoplasty. The caudal septum was the most common site of persistent septal deviation. Careful preoperative evaluation of the caudal septal deviation and selection of an appropriate surgical technique may reduce the need for revision septoplasty.
Collapse
|
9
|
Dąbrowska-Bień J, Skarżyński H, Górski SF, Skarżyński PH. Quality of Life in Patients with Nasal Obstruction after Septoplasty: A Single Institution Prospective Observational Study. Int Arch Otorhinolaryngol 2021; 25:e575-e579. [PMID: 34737830 PMCID: PMC8558945 DOI: 10.1055/s-0040-1722162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/25/2020] [Indexed: 10/27/2022] Open
Abstract
Introduction Nasal obstruction is a common symptom in otorhinolaryngological practice. It can impact significantly on the quality of life of the individual. Objective The primary goal of the present study was to evaluate quality of life after septoplasty in adults with nasal obstruction. A secondary goal was to assess the effectiveness of septoplasty. Methods This was a single institution prospective observational study. Patients had experienced septal deviation and symptomatic nasal obstruction with no benefit from medical treatment. There were 51 patients who completed the Nasal Obstruction Symptom Evaluation (NOSE-POL) scale as well as theVisual Analogue Scale (VAS) before undergoing septoplasty, 3 months later, and finally 7 months after surgery. Patients evaluated changes in their nasal obstruction and changes in their quality of life using the Clinical Global Impression Scale (CGI-S). Results There was a significant improvement in nasal obstruction after septoplasty. Before septoplasty, the mean score on NOSE was 60.3 ± 20.4; 3 months after surgery, it was 32.9 ± 16.8; and 7 months after surgery it was 39.6 ± 33.2. The VAS results also proved a significant enhancement in nasal obstruction after septoplasty. Patients reported an improvement in nasal obstruction as well as a positive change in quality of life, confirming the effectiveness of septoplasty. Conclusions In patients with deformed septum, septoplasty contributes to high satisfaction of the patient and a compelling improvement in disease-specific quality of life. The NOSE-POL questionnaire is a useful tool for measuring the outcomes of this procedure.
Collapse
Affiliation(s)
- Justyna Dąbrowska-Bień
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Otorhinolaryngology Surgery Clinic, World Hearing Center, Nadarzyn/Warsaw, Poland
| | - Henryk Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Otorhinolaryngology Surgery Clinic, World Hearing Center, Nadarzyn/Warsaw, Poland
| | - Sebastian Filip Górski
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Otorhinolaryngology Surgery Clinic, World Hearing Center, Nadarzyn/Warsaw, Poland
| | - Piotr Henryk Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Otorhinolaryngology Surgery Clinic, World Hearing Center, Nadarzyn/Warsaw, Poland.,Department of Heart Failure and Cardiac Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.,Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland.,Institute of Sensory Organs, Kajetany/Warsaw, Poland
| |
Collapse
|
10
|
Our Septoplasty Results: Evaluation with the Nose Scale. J Craniofac Surg 2021; 33:1775-1781. [PMID: 34743159 DOI: 10.1097/scs.0000000000008361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of septoplasty and septoplasty + bilateral radio frequency ablation of inferior turbinate (b-RFAIT) according to the type of operation, age groups, gender of patients, and the duration of control period by using Nasal Obstruction Symptom Evaluation (NOSE) Scale. MATERIALS AND METHODS Prospective observational study was undertaken in the otolaryngology department of a training hospital. Using the NOSE scale, the study prospectively compared the results of septoplasty only and septoplasty with b-RFAIT in the treatment of nasal obstruction caused by the combination of septal deviation and turbinate hypertrophy. Patients were divided into 2 groups. The first group had only septoplasty and the second group had septoplasty with b-RFAIT. General and local anesthesia were applied in both groups. To review clinical success, all patients were controlled at the 1st week, 1st month, and 3rd month. RESULTS One hundred seventy-eight adult patients (male/female: 127/51) with chronic nasal obstruction complaint were enrolled in this prospective study. Our data demonstrated significant improvement from baseline after 24 months for the NOSE scores in both the septoplasty and septoplasty + b-RFAIT groups. No statistical difference was noted in the amount of postoperative improvement between the 2 treatment groups (P = 0.306). No significant difference was observed between general and local anesthesia with respect to patients' preop and postop mean scores (P > 0.05). There was a significant difference between the age of patients' postoperative mean (P < 0.001). There were 4 postoperative means with respect to control time. There was an 82.29% decrease in the complaints of patients at 0 to 6 months, 80.51% decrease at 7 to 12months, 76.1% decrease at 13 to 18 months, and 59.67% decrease at 19 to 24 months. Only the last group had a significant difference regarding mean change in scores (P < 0.001). CONCLUSIONS This study shows that septoplasty + bilateral turbinate radiofrequency should be applied to patients who suffer from septum deviation with concha hypertrophy. Postoperative NOSE scale shows that the success of operation does not depend on the gender of patients and operation types (general or local anesthesia). We conclude that younger patients (18-40 age) who have obstruction with septal deviation and septum deviation with concha hypertrophy benefit more from operation than older patients do.
Collapse
|
11
|
Computational Fluid Dynamics Modeling of Nasal Obstruction and Associations with Patient-Reported Outcomes. Plast Reconstr Surg 2021; 148:592e-600e. [PMID: 34550944 DOI: 10.1097/prs.0000000000008328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nasal obstruction is a common problem, with significant impact on quality of life. Accurate diagnosis may be challenging because of the complex and dynamic nature of the involved anatomy. Computational fluid dynamics modeling has the ability to identify specific anatomical defects, allowing for a targeted surgical approach. The goal of the current study is to better understand nasal obstruction as it pertains to disease-specific quality of life by way of a novel computational fluid dynamics model of nasal airflow. METHODS Fifty-three patients with nasal obstruction underwent computational fluid dynamics modeling based on computed tomographic imaging. Nasal resistance was compared to demographic data and baseline subjective nasal patency based on Nasal Obstructive Symptom Evaluation scores. RESULTS Mean Nasal Obstructive Symptom Evaluation score among all patients was 72.6. Nasal Obstructive Symptom Evaluation score demonstrated a significant association with nasal resistance in patients with static obstruction (p = 0.03). There was a positive correlation between Nasal Obstructive Symptom Evaluation score and nasal resistance in patients with static bilateral nasal obstruction (R2 = 0.32) and poor correlation in patients with dynamic bilateral obstruction caused by nasal valve collapse (R2 = 0.02). Patients with moderate and severe bilateral symptoms had significantly higher nasal resistance compared to those with unilateral symptoms (p = 0.048). CONCLUSIONS Nasal obstruction is a multifactorial condition in most patients. This study shows correlation between simulated nasal resistance and Nasal Obstructive Symptom Evaluation score in a select group of patients. There is currently no standardized diagnostic algorithm or gold standard objective measure of nasal airflow; however, computational fluid dynamics may better inform treatment planning and surgical techniques on an individual basis. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, V.
Collapse
|
12
|
Kastyro IV, Popadyuk VI, Reshetov IV, Kostyaeva MG, Dragunova SG, Kosyreva TF, Khamidulin GV, Shmaevsky PE. Changes in the Time-Domain of Heart Rate Variability and Corticosterone after Surgical Trauma to the Nasal Septum in Rats. DOKL BIOCHEM BIOPHYS 2021; 499:247-250. [PMID: 34426921 DOI: 10.1134/s1607672921040098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/22/2022]
Abstract
The aim of the work was to study changes in the time range of heart rate variability (HRV) against the background of changes in the concentration of corticosterone in blood plasma in rats after surgical trauma to the nasal septum. Septoplasty was simulated in 30 mature male Wistar rats weighing 210-290 g. ECG was recorded with subsequent analysis of the time domain of HRV, as well as blood sampling to estimate changes in the concentration of corticosterone in the blood plasma was performed. As a result, SDNN significantly increased in comparison with the control on days 2 and 3 (p < 0.001) but decreased on days 4-5 (p < 0.001) and 6 (p < 0.01). rMSSD changed in waves with two irregular peaks on days 1 and 6. SDNN/rMSSD, in comparison with the 1st day of the postoperative period, increased on the 2nd day, continued to increase (p < 0.05), and then began to decrease on day 4 (p < 0.01). The total HRV power of was low throughout the postoperative period (p < 0.001), except for day 3, when it was equal to the control data. The increase in the total power index fell on day 3 after the operation (p <0.01), after which its decline was observed again. The concentration of corticosterone in the blood plasma in rats was significantly higher than before (p < 0.001). On postoperative day 2 to 4, its plateau was determined. Simulation of septoplasty leads to changes in the time range of HRV, an increase in the concentration of corticosterone in the blood plasma in rats with its maximum at the time of surgery and 24 h later, and the formation of a "plateau" on postoperative days 2 to 4, which coincides with the changes in HRV.
Collapse
Affiliation(s)
- I V Kastyro
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia.
| | - V I Popadyuk
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - I V Reshetov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M G Kostyaeva
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - S G Dragunova
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - T F Kosyreva
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - G V Khamidulin
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - P E Shmaevsky
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| |
Collapse
|
13
|
Rhinoplasty Assisted by Endoscopic Septoplasty: Precise Job and an Educational Tool. J Craniofac Surg 2020; 31:847-850. [PMID: 32168123 DOI: 10.1097/scs.0000000000006117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Septoplasty is a crucial step during rhinoplasty to correct the nose function and nasal aesthetics. The idea is not investigated regarding the educational purposes. Objective of the study is to evaluate the efficiency of endoscopic septoplasty during full job rhinoplasty and to observe its educational benefit. METHODS Twenty-seven patients who submitted for prospective study of endoscopic septorhinoplasty operation; the analysis involves 16 female patients and 11 males. RESULTS Endoscopic septoplasty during rhinoplasty showed an efficient illumination and visualization, which improved the precision and has an educational benefit during the reform of the posterior septum, isolated septal spurs, anterior septum, and middle turbinate attachments. CONCLUSION The procedure allows a precise septal job with excellent visualization of the anterior and posterior septum. It also has an intraoperative educational benefit and helps to soothe the time down of patient's recovery.
Collapse
|
14
|
Abstract
The authors aimed to evaluate quality of life after septal surgery with Short Form-36 survey, and the effectiveness of the survey. Nasal symptoms (nasal obstruction, facial pain, catarrh), and general quality of life (using the Turkish version of the Short Form-36 questionnaire) were assessed preoperatively and at 1st and 6th postoperative months. Acoustic rhinometry and rhinomanometry were assessed preoperatively and at 6th postoperative month. Data from 78 patients were analyzed. This prospective clinical study was conducted on patients complaining of nasal obstruction with nasal septal deviation. Seventy-eight patients were included in the study. Fourty-two patients (53.8%) were male and 36 patients (46.2%) were female. At 1st postoperative month, nasal obstruction, facial pain and catarrh scores significantly improved in all, 46, 18 patients, respectively (P < 0.0001). At 6th postoperative month, scores nonsignificantly worsened by 1 point in 12, 6, 12 patients, respectively. Nasal volume significantly increased and total resistance significantly decreased at 6th month (P < 0.0001). Compared to preoperative values, all items except social function and bodily pain significantly increased at 1st postoperative month. Compared to values at 1st postoperative month, only bodily pain score decreased at 6th postoperative month. One patient presented with septal perforation. Septoplasty is a well-established technique to reduce nasal obstruction and improve quality of life. SF-36 may be used as a reliable measure of changes in quality of life after septal surgery.
Collapse
|
15
|
Menapace DC, Carlson KD, Dragomir-Daescu D, Matsumoto J, Hamilton GS. Finite Element Analysis of the Septal Cartilage L-Strut. Facial Plast Surg Aesthet Med 2020; 23:90-97. [PMID: 32721238 DOI: 10.1089/fpsam.2019.0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Importance: Septoplasty is one of the most commonly performed operations in the head and neck. However, the reasons for septoplasty failure and the additional stress of performing a chondrotomy on the septal cartilage are not well understood. Design, Setting, and Participants: A finite element model of the nasal septum was created using a microcomputed tomography scan of the nasoseptal complex that was reconstructed into a three-dimensional model in silico. Testing included four common chondrotomy designs: traditional L-strut, double-cornered chondrotomy (DCC), curved L-strut, and the C-curve. Tip displacement was applied in a vector parallel to the caudal strut to simulate nasal tip palpation. Main Outcomes and Measures: With finite element analysis, the maximum principal stress (MPS), von Mises stress (VMS), harvested cartilage volume, and surface area were recorded. Results: The highest MPS for the L-strut, DCC, curved L-strut, and C-curve was identified at the corner of the chondrotomy. The MPS at the corner of the chondrotomy was reduced 44% when comparing the C-curve with the traditional L-strut. The VMS patterns showed compressive stress along the caudal septum in all models, but at the corner, the stresses were highest in the chondrotomies designed with sharp-angled corners. The VMS showed a 76% decrease when comparing the C-curve with the traditional L-strut. The stress across the anterior septal angle is also higher in models with sharp-angled corners. Cartilage harvest volumetric and surface area assessments did not show meaningful differences between shapes. Conclusions and Relevance: The highest area of stress is near the transition of the dorsal to caudal septum in all models. Stresses are relatively higher in chondrotomy shapes that contain sharp-angled corners. The relative reduction in MPS and VMS utilizing a C-curve instead of an L-strut may decrease the likelihood that the septum will deform or fail in this region. The volume and surface area of the C-curve are similar to that of the L-strut technique. Avoiding sharp-angled corners reduces the stresses at the corner of the chondrotomy and across the anterior septal angle. Using a C-curve may be an improved septoplasty design.
Collapse
Affiliation(s)
- Deanna C Menapace
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent D Carlson
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Minnesota, USA
| | - Dan Dragomir-Daescu
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Minnesota, USA
| | - Jane Matsumoto
- Department of Diagnostic Radiology, Mayo Clinic Rochester, Minnesota, USA
| | - Grant S Hamilton
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
16
|
Campbell DA, Moghaddam MG, Rhee JS, Garcia GJM. Narrowed Posterior Nasal Airway Limits Efficacy of Anterior Septoplasty. Facial Plast Surg Aesthet Med 2020; 23:13-20. [PMID: 32471319 DOI: 10.1089/fpsam.2020.0081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Predicting symptomatic relief after septoplasty has been difficult. Minimal cross-sectional area (mCSA) measured by acoustic rhinometry and airflow resistance (R) measured by rhinomanometry have been used to select surgical candidates with mixed success. An important assumption is that mCSA and resistance are tightly coupled, but studies have reported weak or no correlation. Recently, we proposed the Bernoulli Obstruction Theory as an explanation, where tight coupling between mCSA and R is only predicted below a critical mCSA (Acrit). Methods: The nasal airway and septum of 10 healthy subjects were reconstructed from computed tomography scans. Simulated anterior septal deviations of increasing severity were created. Computational fluid dynamics simulations were performed to quantify mCSA, resistance, and flow in the healthy septum model and four simulated septal deviation models for each subject (total of 50 models). Results: A tighter coupling between mCSA and resistance was found below Acrit, estimated to be 0.20 cm2 (a very severe deviation). Above Acrit, enlarging the mCSA had a smaller effect in patients with narrower cross-sectional area in the postvalve region (CSAPV). Conclusions: Two patterns of flow increase are expected with septoplasty. Below Acrit, enlarging mCSA predictably increases flow. Above Acrit, the effect size of increasing mCSA depends on CSAPV. Unrecognized small CSAPV may explain persistent sensation of nasal obstruction after septoplasty. Our data suggest that inferior turbinate reduction ipsilateral to a septal deviation may amplify airflow benefits after septoplasty in patients with a narrow CSAPV.
Collapse
Affiliation(s)
- David A Campbell
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Masoud Gh Moghaddam
- Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Guilherme J M Garcia
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
17
|
Physiological changes in the size of the septal swell body correlate with changes in inferior turbinate size. The Journal of Laryngology & Otology 2020; 134:323-327. [PMID: 32241312 DOI: 10.1017/s0022215120000675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The nasal septal swell body is a normal anatomical structure located in the superior nasal septum anterior to the middle turbinate. However, the impact of the septal swell body in nasal breathing during normal function and disease remains unclear. This study aimed to establish that the septal swell body varies in size over time and correlates this with the natural variation of the inferior turbinates. METHOD Consecutive patients who underwent at least two computed tomography scans were identified. The width and height of the septal swell body and the inferior turbinates was recorded. A correlation between the difference in septal swell body and turbinates between the two scans was performed using a Pearson's coefficient. RESULTS A total of 34 patients (53 per cent female with a mean age of 58.3 ± 20.2 years) were included. The mean and mean difference in septal swell body width between scans for the same patient was 1.57 ± 1.00 mm. The mean difference in turbinate width between scans was 2.23 ± 2.52 mm. A statistically significant correlation was identified between the difference in septal swell body and total turbinate width (r = 0.35, p = 0.04). CONCLUSION The septal swell body is a dynamic structure that varies in width over time in close correlation to the inferior turbinates. Further research is required to quantify its relevance as a surgical area of interest.
Collapse
|
18
|
Rennie KJ, O’Hara J, Rousseau N, Stocken D, Howel D, Ternent L, Drinnan M, Bray A, Rooshenas L, Hamilton DW, Steel A, Fouweather T, Hynes AM, Holstein EM, Oluboyede Y, Abouhajar A, Wilson JA, Carrie S. Nasal Airway Obstruction Study (NAIROS): a phase III, open-label, mixed-methods, multicentre randomised controlled trial of septoplasty versus medical management of a septal deviation with nasal obstruction. Trials 2020; 21:179. [PMID: 32054508 PMCID: PMC7020359 DOI: 10.1186/s13063-020-4081-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/16/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Septoplasty (surgery to straighten a deviation in the nasal septum) is a frequently performed operation worldwide, with approximately 250,000 performed annually in the US and 22,000 in the UK. Most septoplasties aim to improve diurnal and nocturnal nasal obstruction. The evidence base for septoplasty clinical effectiveness is hitherto very limited. AIMS To establish, and inform guidance for, the best management strategy for individuals with nasal obstruction associated with a deviated septum. METHODS/DESIGN A multicentre, mixed-methods, open label, randomised controlled trial of septoplasty versus medical management for adults with a deviated septum and a reduced nasal airway. Eligible patients will have septal deflection visible at nasendoscopy and a nasal symptom score ≥ 30 on the NOSE questionnaire. Surgical treatment comprises septoplasty with or without reduction of the inferior nasal turbinate on the anatomically wider side of the nose. Medical management comprises a nasal saline spray followed by a fluorinated steroid spray daily for six months. The recruitment target is 378 patients, recruited from up to 17 sites across Scotland, England and Wales. Randomisation will be on a 1:1 basis, stratified by gender and severity (NOSE score). Participants will be followed up for 12 months post randomisation. The primary outcome measure is the total SNOT-22 score at 6 months. Clinical and economic outcomes will be modelled against baseline severity (NOSE scale) to inform clinical decision-making. The study includes a recruitment enhancement process, and an economic evaluation. DISCUSSION The NAIROS trial will evaluate the clinical effectiveness and cost-effectiveness of septoplasty versus medical management for adults with a deviated septum and symptoms of nasal blockage. Identifying those individuals most likely to benefit from surgery should enable more efficient and effective clinical decision-making, and avoid unnecessary operations where there is low likelihood of patient benefit. TRIAL REGISTRATION EudraCT: 2017-000893-12, ISRCTN: 16168569. Registered on 24 March 2017.
Collapse
Affiliation(s)
- Katherine J. Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, NE2 4AE UK
| | - James O’Hara
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
- Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
| | - Nikki Rousseau
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Deborah Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Laura Ternent
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Mike Drinnan
- Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
- Northern Medical Physics and Clinical Engineering, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH UK
| | - Alison Bray
- Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
- Northern Medical Physics and Clinical Engineering, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH UK
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle upon Tyne, NE2 4HH UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, BS8 2PS UK
| | - David W. Hamilton
- Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
| | - Alison Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, NE2 4AE UK
| | - Tony Fouweather
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Ann-Marie Hynes
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, NE2 4AE UK
| | - Eva-Maria Holstein
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, NE2 4AE UK
| | - Yemi Oluboyede
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Alaa Abouhajar
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, NE2 4AE UK
| | - Janet A. Wilson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
- Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
| | - Sean Carrie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
- Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
| |
Collapse
|
19
|
Jiang R, Wang G, Zhang J, Zhang X, Zhou L, Xu T. Three-dimensional bioprinting of auricular cartilage: A review. MEDICINE IN DRUG DISCOVERY 2019. [DOI: 10.1016/j.medidd.2020.100016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
20
|
Zaman SU, Zakir I, Faraz Q, Akhtar S, Nawaz A, Adeel M. Effect of single-dose intravenous tranexamic acid on postoperative nasal bleed in septoplasty. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:435-438. [PMID: 31204198 DOI: 10.1016/j.anorl.2018.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 05/22/2018] [Accepted: 10/07/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Postoperative nasal bleeding is a common complication of septoplasty and may lead to painful procedure of nasal packing to stop bleeding. Since Tranexamic acid (TXA) has been reported to reduce bleeding, the purpose of this study is to investigate the effect of single dose of intravenous TXA on postoperative nasal bleed associated with septoplasty. MATERIALS AND METHODS This prospective randomized, double-blinded clinical trial consisted of 176 patients aged 18-55 years who underwent septoplasty for symptomatic deviated nasal septum. These participants were randomly divided into 2 groups; 88 patients were given normal saline (Control group) and 88 patients were administered a single shot of intravenous TXA 10mg/kg (TXA group). Operative technique applied was same in all cases. At the end of surgery nasal packs, nasal splints or trans-septal suturing were not done. Nasal bleeding was monitored after surgery and up to 2 weeks postoperatively. RESULTS Patients receiving TXA showed significantly less postoperative nasal bleeding compared with controls. Extensive bleeding in terms of number of gauze pads used and duration was also higher in placebo with a statistically significant difference (all P=<0.05). Seven patients required nasal packing in control group to stop bleeding as compared to one patient in TXA group. Adverse reactions to TXA were minimal, and these were easily managed conservatively. CONCLUSION Single intravenous dose of TXA is shown to be effective and safe agent in preventing postoperative nasal bleeding after septoplasty therefore avoiding additional techniques of nasal packing, intranasal splint or trans-septal suturing during surgery.
Collapse
Affiliation(s)
- S U Zaman
- Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat National Hospital & Medical College, Karachi, Pakistan.
| | - I Zakir
- Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Q Faraz
- Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - S Akhtar
- Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - A Nawaz
- Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - M Adeel
- Department of Head & Neck Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| |
Collapse
|
21
|
A new technique of revision septoplasty using semi-penetrating straight and circular incisions of the nasal septum. The Journal of Laryngology & Otology 2019; 133:494-500. [PMID: 31142392 DOI: 10.1017/s0022215119000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to investigate endoscopic revision septoplasty with semi-penetrating straight and circular incisions in patients for whom septoplasty was unsuccessful. METHOD Patients in this study (n = 14) had a deviation of the nasal septum after septoplasty. Pre-operative and post-operative assessments were performed using a visual analogue scale and nasal endoscope. Semi-penetrating straight and circular incisions in front of the caudal septum and at the margin of the nasal septal cartilage-bone defect, respectively, were made. The mucoperichondrium and mucoperiosteum were bilaterally dissected until interlinkage with the cartilage-bone defect was achieved. Mucous membranes within the circular incision as well as the right mucoperichondrium and mucoperiosteal flaps were protected by pushing them to the right. This exposed the osteocartilaginous framework and allowed correction of the residual deviation. The patients were followed up for 30-71 months. RESULTS For nasal obstruction and headaches, a significant improvement was noted in post-operative compared to pre-operative visual analogue scale scores. No patients had septal deviations, saddle nose, false hump nose or contracture of the nasal columella. CONCLUSION The technique allowed exposure of the septal osteocartilaginous framework and a broad operational vision, which enabled successful correction of various deformities of the nasal septum.
Collapse
|
22
|
Endoscopic septoplasty: literature review, surgical techniques and retrospective analysis at the University Hospitals Leuven. The Journal of Laryngology & Otology 2019; 133:262-268. [PMID: 30967166 DOI: 10.1017/s0022215119000665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Endoscopic septoplasty is an alternative approach for a deviated nasal septum. Since its introduction, numerous techniques have been developed, each with its own advantages and limitations. A literature review is presented, along with our experience with endoscopic spur resection. METHODS The Medline and Google Scholar databases were searched for relevant literature, and the records of all patients undergoing endoscopic spur resection at the University Hospitals Leuven between 2001 and 2015 were reviewed.Results and conclusionEndoscopic septoplasty offers improved visualisation and the option of limited flap dissection, which are particularly helpful when dealing with isolated spurs, posterior deviations and revision septoplasty. It enhances teaching and improves surgical transition to endoscopic sinus surgery. Reported success and complication rates are comparable to those seen in traditional approaches. Endoscopic spur resection, as conducted at the University Hospitals Leuven, was shown to be a quick, safe and efficient technique when dealing with isolated septal spurs, especially when combined with endoscopic sinus surgery.
Collapse
|
23
|
Assessment of non-response in quality control of nasal septal surgery. The Journal of Laryngology & Otology 2019; 133:208-212. [PMID: 30813978 DOI: 10.1017/s002221511900032x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study evaluated the effect of mail non-response on the validity of the results of nasal septal surgery. METHOD Six months post-operatively, questionnaires with both prospective and retrospective ratings were mailed to patients. Patients who did not respond (non-responders) were contacted by telephone. This study compared two cohorts of patients using different interviewers (a nurse and a surgeon). Cohort one consisted of 182 patients (with 67 per cent mail response), and cohort two consisted of 454 patients (with 64.8 per cent mail response). RESULTS In both cohorts, the improvement in obstruction scores was significantly better among mail responders than among non-responders (telephone interviewees) using prospective ratings, but worse using retrospective ratings. CONCLUSION Mail responders had better improvement in nasal obstruction after septoplasty than non-responders. Therefore, low response rates may cause an overestimation of the results. The retrospective ratings obtained through telephone interviews are less reliable because they are influenced by memory and the patients' tendency to give socially acceptable answers.
Collapse
|
24
|
Lee YH, Chang JS, Jung JH, Kim ST, Kang IG. Usefulness of Unilateral Nasal Packing for Recurred Septal Deviation within a Month after Septoplasty: Preliminary Study. JOURNAL OF RHINOLOGY 2019. [DOI: 10.18787/jr.2019.26.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yoon Hee Lee
- Student, Gachon University School of Medicine, Incheon, Korea
| | - Jin Soon Chang
- Department of Otolaryngology-Head and Neck Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Joo Hyun Jung
- Department of Otolaryngology-Head & Neck Surgery, Medical Faculty, Gil Medical Center, Gachon University, Incheon, Korea
| | - Seon Tae Kim
- Department of Otolaryngology-Head & Neck Surgery, Medical Faculty, Gil Medical Center, Gachon University, Incheon, Korea
| | - Il Gyu Kang
- Department of Otolaryngology-Head & Neck Surgery, Medical Faculty, Gil Medical Center, Gachon University, Incheon, Korea
| |
Collapse
|
25
|
Valsamidis K, Titelis K, Karkos P, Markou K, Constantinidis J, Triaridis S. Predictive factors of patients' general quality of life after nasal septoplasty. Eur Arch Otorhinolaryngol 2018; 276:429-438. [PMID: 30511105 DOI: 10.1007/s00405-018-5229-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/28/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Although septoplasty is considered to be the definitive treatment of septal deviation and is associated with an increase of nasal patency, patients are not always satisfied with the surgical outcome as assessed by its effect on their general Quality of Life (QOL).The aim of this study was to identify the predictive factors that influence the patients' QOL after surgery. METHODS 60 patients with nasal obstruction and septal deviation were enrolled in this prospective study, and they all completed the follow-up survey of 6 postoperative months. Symptom severity (Nasal Obstruction Symptom Evaluation-NOSE, Sino nasal outcome test 22-SNOT-22), sleep quality (Epworth Sleepiness Scale-ESS), olfactory function (Threshold Discrimination Identification-TDI score), voice quality (Nasalance score and Voice Handicap Index-VHI), stress (SQ test) and emotional status (Beck Depression Index-BDI) were evaluated as predictive factors of patients' QOL (Glasgow Benefit Inventory-GBI) postoperatively. We also analyzed age, gender, smoking, socioeconomic status, type of septal deviation and changes of nasal patency (with the use of rhinomanometry, acoustic rhinometry, and peak nasal inspiratory flow). RESULTS From all the analyzed parameters, the nasal obstruction symptom severity, the sleep quality, and stress levels were only significantly associated with patients' overall QOL (p < 0.05; univariate analysis). However, on multiple regression, positive changes in NOSE score (OR 15.09, 95% CI 1.47-22.64, p < 0.05) and SQ test (OR 4, 95% CI 1.12-14.3, p < 0.05) were only related with higher likelihood of participants' QOL improvement after surgery. CONCLUSIONS Thorough preoperative evaluation of the symptom severity and stress levels is critical as these two factors are predictive of patient's satisfaction after septoplasty.
Collapse
Affiliation(s)
- Konstantinos Valsamidis
- Department of Otorhinolaryngology, Georgios Gennimatas General Hospital, Ethinikis Amynis 41 str, 54635, Thessaloniki, Greece.
| | - Konstantinos Titelis
- Department of Otorhinolaryngology, Georgios Gennimatas General Hospital, Ethinikis Amynis 41 str, 54635, Thessaloniki, Greece
| | - Petros Karkos
- 1st University Department of Otorhinolaryngology, AHEPA University Hospital, Aristotle University of Thessaloniki, Kiriakidi 1 str, 54621, Thessaloniki, Greece
| | - Konstantinos Markou
- 2nd University Department of Otorhinolaryngology, Papageorgiou General Hospital, Agiou Pavlou 76 str, Pavlos Melas, 56429, Thessaloniki, Greece
| | - Jiannis Constantinidis
- 1st University Department of Otorhinolaryngology, AHEPA University Hospital, Aristotle University of Thessaloniki, Kiriakidi 1 str, 54621, Thessaloniki, Greece
| | - Stefanos Triaridis
- 1st University Department of Otorhinolaryngology, AHEPA University Hospital, Aristotle University of Thessaloniki, Kiriakidi 1 str, 54621, Thessaloniki, Greece
| |
Collapse
|
26
|
Jin HR, Kim DW, Jung HJ. Common Sites, Etiology, and Solutions of Persistent Septal Deviation in Revision Septoplasty. Clin Exp Otorhinolaryngol 2018; 11:288-292. [PMID: 30021415 PMCID: PMC6222185 DOI: 10.21053/ceo.2017.01788] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/06/2018] [Accepted: 05/18/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the common causes of persistent septal deviation in revision septoplasty and to report the surgical techniques and results to correct them. METHODS A total of 100 consecutive patients (86 males) who had revision septoplasty due to persistent septal deviation from 2008 and 2014 were included in the study. Their mean age was 35.6 years and the mean follow-up duration was 9.1 months. Presenting symptoms, sites of persistent septal deviation, techniques used to correct the deviation, and surgical results were reviewed. RESULTS The mean interval between primary and revision surgery was 6.2 years. Forty-eight patients received revision septoplasty and 52 received revision septoplasty combined with rhinoplasty. Nasal obstruction was the most presenting symptom in almost all patients. The most common site of persistent septal deviation was middle septum (58%) followed by caudal septum (31%). Correcting techniques included further chondrotomy and excision of deviated portion in 76% and caudal batten graft in 39%. Rhinoscopic and endoscopic exams showed straight septum in 97% and 92 patients had subjective symptom improvement postoperatively. CONCLUSION Middle septum and caudal septum were common sites of persistent deviation. Proper chondrotomy with excision of deviated middle septum and correction of the caudal deviation with batten graft are key maneuvers to treat persistent deviation.
Collapse
Affiliation(s)
| | - Dae Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hahn Jin Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| |
Collapse
|
27
|
Lee E, Lee SJ, Kim HJ, Shin JM, Choi JH, Lee JY. Incidence of re-deviated nasal septum after septoplasty in adolescent and adult patients. Acta Otolaryngol 2018; 138:909-912. [PMID: 30016905 DOI: 10.1080/00016489.2018.1484564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Re-deviation of the nasal septum may occur after septoplasty. Because the cartilaginous septum grows until the age of 16-17 years, septoplasty is usually recommended thereafter. However, severely deviated septum may necessitate septoplasty in younger adolescents. OBJECTIVES To compare the incidence of re-deviated nasal septum in patients who underwent septoplasty at ≤18 versus ≥19 years of age. MATERIALS AND METHODS The medical records and endoscopic photographs of patients who underwent septoplasty between 2005 and 2015 were retrospectively reviewed. Re-deviation of the nasal septum was defined as >50% narrowing of one side of the nasal cavity compared to immediately after septoplasty. RESULTS The inclusion criteria were met by 52 adolescent patients and 549 adult patients. Re-deviation of the septum occurred in 11 (21.2%) and 39 (7.1%) patients, respectively; the difference was significant. Most patients had caudal and upper cartilaginous deviations. Four adolescent and 14 adult patients underwent revisional septoplasty. CONCLUSIONS AND SIGNIFICANCE Adolescent patients who underwent septoplasty had a significantly higher incidence of re-deviation of the nasal septum than adult patients. Therefore, when septoplasty is deemed necessary in adolescent patients, they and their parents should be informed about the possibility of re-deviation and the need for revisional septoplasty.
Collapse
Affiliation(s)
- Eunsang Lee
- Department of Otorhinolaryngology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Seung Jae Lee
- Department of Otorhinolaryngology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyo Jun Kim
- Department of Otorhinolaryngology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Min Shin
- Department of Otorhinolaryngology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ji Ho Choi
- Department of Otorhinolaryngology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Yong Lee
- Department of Otorhinolaryngology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| |
Collapse
|
28
|
Manteghi A, Din H, Bundogji N, Leuin SC. Pediatric septoplasty and functional septorhinoplasty: A quality of life outcome study. Int J Pediatr Otorhinolaryngol 2018; 111:16-20. [PMID: 29958602 DOI: 10.1016/j.ijporl.2018.05.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE This study assessed disease-specific quality-of-life outcomes among pediatric patients undergoing septoplasty or functional septorhinoplasty. The Nasal Obstruction Symptom Evaluation (NOSE) score was obtained pre- and post-operatively. Additional analyses determined whether demographics, nasal trauma, prior nasal surgery, or allergic rhinitis history affected NOSE scores. METHODS Patients undergoing septoplasty or functional septorhinoplasty were evaluated prospectively at a tertiary children's hospital. NOSE scores were assessed pre- and post-operatively. Change in NOSE score was analyzed using the Wilcoxon Signed Rank test, while multiple regression analysis evaluated factors associated with NOSE score change. RESULTS 136 patients (mean age 15.7 ± 2.1 years) were evaluated; 52 (38.2%) underwent septoplasty while 84 (61.8%) underwent functional septorhinoplasty. Mean follow-up was 3.6 ± 5.1 months. There was a statistically significant decrease in NOSE score from pre-operative septoplasty and functional septorhinoplasty: median = 75 to post-operative septoplasty: median = 20 (z = -5.9, p < 0.001) and functional septorhinoplasty: median = 15 (z = -7.9, p < 0.001). Gender, age, nasal trauma, prior nasal surgery, and allergic rhinitis did not have a significant effect on NOSE score change for either group. Additional surgery at the time of procedure was not a confounding variable in the relationship between surgery type and NOSE score. A NOSE Scale reliability analysis demonstrated high internal consistency with Cronbach's α of 0.83 across septoplasty and functional septorhinoplasty patients. CONCLUSION There was significant improvement in disease-specific quality-of-life in pediatric patients undergoing septoplasty or functional septorhinoplasty. Gender, nasal trauma, prior nasal surgery, and allergic rhinitis did not significantly affect NOSE scores in either group.
Collapse
Affiliation(s)
- Alexander Manteghi
- Division of Pediatric Otolaryngology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, 9500 Gilman Drive, San Diego, CA 92093, USA.
| | - Hena Din
- Division of Pediatric Otolaryngology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
| | - Nour Bundogji
- Division of Pediatric Otolaryngology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
| | - Shelby C Leuin
- Division of Pediatric Otolaryngology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, 9500 Gilman Drive, San Diego, CA 92093, USA
| |
Collapse
|
29
|
Savović S, Paut Kusturica M, Kljajić V, Buljčik Čupić M, Jovančević L, Pavlović V, Rašković A. The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal. Braz J Otorhinolaryngol 2018; 85:685-689. [PMID: 30017873 PMCID: PMC9443054 DOI: 10.1016/j.bjorl.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/22/2018] [Accepted: 05/02/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction After post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections. Objective The aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections. Methods The study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination. Results The group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients’ assessment (p < 0.001) and by nasal endoscopic examination (p = 0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required. Conclusion The use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.
Collapse
Affiliation(s)
- Slobodan Savović
- University of Novi Sad, Faculty of Medicine, Clinical Centre of Vojvodina, Ear, Nose and Throat Clinic, Novi Sad, Serbia
| | - Milica Paut Kusturica
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Pharmacology Toxicology and Clinical Pharmacology, Novi Sad, Serbia.
| | - Vladimir Kljajić
- University of Novi Sad, Faculty of Medicine, Clinical Centre of Vojvodina, Ear, Nose and Throat Clinic, Novi Sad, Serbia
| | - Maja Buljčik Čupić
- University of Novi Sad, Faculty of Medicine, Clinical Centre of Vojvodina, Ear, Nose and Throat Clinic, Novi Sad, Serbia
| | - Ljiljana Jovančević
- University of Novi Sad, Faculty of Medicine, Clinical Centre of Vojvodina, Ear, Nose and Throat Clinic, Novi Sad, Serbia
| | | | - Aleksandar Rašković
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Pharmacology Toxicology and Clinical Pharmacology, Novi Sad, Serbia
| |
Collapse
|
30
|
Clark DW, Del Signore AG, Raithatha R, Senior BA. Nasal Airway Obstruction: Prevalence and Anatomic Contributors. EAR, NOSE & THROAT JOURNAL 2018; 97:173-176. [DOI: 10.1177/014556131809700615] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Surgical treatments for nasal airway obstruction (NAO) are commonly offered as part of otolaryngology practice. Anatomic causes include septal deviation, inferior turbinate hypertrophy, and nasal valve collapse (NVC). This study was performed to determine the prevalence of anatomic contributors to NAO. A total of 1,906 patients with sinonasal complaints were surveyed by 50 otolaryngologists in varying U.S. geographic regions. Patients were first evaluated using the Nasal Obstruction Symptom Evaluation (NOSE) instrument to assess the NAO symptoms and their severity. Physicians then examined patients for the presence of the three anatomic contributors. Presence of septal deviation and turbinate hypertrophy was assessed through an internal nasal exam with direct or endoscopic visualization based on the physician's standard methodology for diagnosis. Presence of NVC was determined by the modified Cottle maneuver. Among all patients surveyed, prevalence was 67% for NVC, 76% for septal deviation, and 72% for inferior turbinate hypertrophy. We found that 64% of the patients (n = 1,211) had severe/extreme NOSE scores (≥55), representing the most likely nasal obstruction candidates for intervention. In these patients, the prevalence of NVC, septal deviation, and inferior turbinate hypertrophy was 73, 80, and 77%, respectively. Eighty-two percent of the 236 patients with severe/extreme NOSE scores who reported prior septoplasty and/or inferior turbinate reduction had NVC. Our study revealed a comparable prevalence of all three anatomic contributors across all patients and the subset with severe/extreme NOSE scores, highlighting the importance of evaluating the lateral nasal wall as a component of NAO treatment strategy.
Collapse
Affiliation(s)
- David W. Clark
- Department of Otolaryngology–Head and Neck Surgery, Baylor Scott & White Health, and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Anthony G. Del Signore
- Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Beth Israel, New York, N.Y
| | | | - Brent A. Senior
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, N.C
| |
Collapse
|
31
|
Busaba NY, Hossain M. Clinical Outcomes of Septoplasty and Inferior Turbinate Reduction in the Geriatric Veterans’ Population. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240401800601] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients older than 65 years constitute an increasingly large percentage of the patient population that presents to an adult otolaryngology practice due to the increase in life expectancy. The objective of this study is to assess the clinical outcomes of septoplasty with or without inferior turbinate reduction in patients who are 65 years or older. Methods This is a prospective nonrandomized longitudinal study of 40 patients aged 65 years or more and who underwent septoplasty with or without inferior turbinate reduction. Patients received Nasal Health Survey (NHS) and General Health Status Short Form (SF-12) questionnaires before and 6 months after surgery. Statistical analysis was performed using the paired t-test. Results The preoperative NHS score was 52.3, while the postoperative score was 76.6 (p < 0.001). The reported benefit reflected improvement in symptoms (p < 0.001) and reduction in medication usage (p < 0.001). In addition, the SF-12 score improved after the surgery but the difference did not reach statistical significance (p = 0.055). Conclusion and Significance Septoplasty and inferior turbinate reduction is beneficial in the veterans’ population for patients 65 years or older who present with nasal obstruction and are noted on physical examination to have septal deviation and inferior turbinate hypertrophy.
Collapse
Affiliation(s)
- Nicolas Y. Busaba
- Division of Otolaryngology, VA Boston HealthCare System, the Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, and Department of Otology and Laryngology, Harvard Medical School; Boston, Massachusetts
| | - Monir Hossain
- Department of Research and Development, VA Boston HealthCare System, Boston, Massachusetts
| |
Collapse
|
32
|
Abstract
Background Prior studies on the relationship between computed tomography scan findings and patient-based quality of life in chronic rhinosinusitis (CRS) have found very low correlations. Whereas surprising, similar findings have been noted in other diseases. Methods We performed a cross-sectional analysis of the association between objective and subjective findings in nasal septal deformity and a systematic review and synthesis of the literature on CRS and other diseases. Results We found no association between objective anatomic findings and subjective symptoms in nasal obstruction (R = 0.03; Kruskal–Wallis test, p = 0.97). Multiple studies in CRS and other diseases—sleep apnea, hearing loss, asthma, etc.—have found similarly low correlations between objective and subjective testing. Conclusion For nasal septal deviation and CRS, the patient's subjective perception of disease severity has, at best, a very weak association with objective assessment of severity. Patient-based outcomes assessment remains important; these instruments apparently quantify an aspect of disease not detected by objective testing.
Collapse
Affiliation(s)
- Michael G. Stewart
- The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Texas
| | - Timothy L. Smith
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
33
|
Abstract
Background This article evaluates the prevalence of hyperventilation syndrome (HVS) in patients who continue to complain of ongoing nasal congestion, despite an apparently adequate surgical result and appropriate medical management. Methods Prospective case series of 14 patients from June 2002 to October 2003 was performed. Patients, who presented complaining of nasal congestion after previous nasal surgery and who appeared to have an adequate nasal airway with no evidence of nasal valve collapse, were evaluated for HVS. When appropriate, nasal steroids and oral antihistamines also had been tested without success. Three patients had end-tidal PCO2 levels measured and five patients underwent breathing reeducation. Results All patients had an elevated respiratory rate (>18 breaths/minute) with an upper thoracic breathing pattern. Twelve of the 14 patients complaining of nasal obstruction had an elevated Nijmegen score indicative of HVS. An average number of 2.5 procedures had been performed on each patient. End-tidal PCO2 levels were ≤35 mmHg in the three patients who had expired PCO2 levels measured. Breathing retraining was successful in correcting the nasal congestion in two of five patients. Conclusion HVS should be included in the differential diagnosis of patients presenting with nasal congestion, particularly after failed nasal surgery. One possible explanation is increased nasal resistance secondary to low arterial PCO2 levels. Another possible explanation is reduced alae nasae muscle activity secondary to the reduced activity of serotonin-containing raphe neurons. Additional surgery may not necessarily be the answer in HVS patients complaining of nasal congestion.
Collapse
Affiliation(s)
- Jim Bartley
- Waitemata District Health Board, Auckland, New Zealand
| |
Collapse
|
34
|
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] [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.
Collapse
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
| |
Collapse
|
35
|
Valsamidis K, Titelis K, Rachovitsas D, Konstantinidis I, Markou K, Triaridis S. Long-Term Evaluation of Nasal Septoplasty Followed by Inferior Turbinate Cauterization for the Treatment of Nasal Obstruction using Objective and Subjective Methods. Int Arch Otorhinolaryngol 2018; 22:284-290. [PMID: 29983770 PMCID: PMC6033599 DOI: 10.1055/s-0037-1613688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 09/30/2017] [Indexed: 12/02/2022] Open
Abstract
Introduction
Nasal septoplasty is considered the treatment of choice for nasal obstruction due to septal deviation. An ongoing discussion among rhinologists is whether it is reasonable to perform objective measurements of nasal patency pre or postoperatively routinely.
Objective
The primary aim of this study was to identify the short- and long-term functional benefits for patients undergoing septal surgery, as assessed by acoustic rhinometry (AR). The secondary goal was to evaluate the short- and long-term perception of symptom relief and disease-specific quality of life (QoL) outcomes on the part of the patients.
Methods
This was a prospective observational study in which AR was utilized for the assessment of nasal patency preoperatively and 1, 6 and 36 months after septoplasty. Total 40 patients who underwent septoplasty filled out the Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire and the Glasgow Benefit Inventory (GBI) to assess their subjective improvement in nasal obstruction symptoms and the changes in their QoL.
Results
There were statistically significant improvements in nasal patency, mean postoperative NOSE and GBI scores postoperatively. However, there was no correlation between the mean NOSE and GBI scores and the AR measurements. Furthermore, the GBI scores tended to decrease as the postoperative period increased.
Conclusion
The present study confirms that septoplasty significantly increases nasal patency and causes a significant subjective improvement in nasal obstruction symptoms. The absence of a statistically significant correlation among the objective measurements, the symptom scores, and the patients' low GBI scores indicates that factors other than the anatomical findings may also contribute to the patients' perception of QoL.
Collapse
Affiliation(s)
- Konstantinos Valsamidis
- Department of Otorhinolaryngology, Georgios Gennimatas General Hospital, Thessaloniki, Greece
| | - Konstantinos Titelis
- Department of Otorhinolaryngology, Georgios Gennimatas General Hospital, Thessaloniki, Greece
| | - Dimitrios Rachovitsas
- 1st University Department of Otorhinolaryngology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Iordanis Konstantinidis
- 2nd University Department of Otorhinolaryngology, Geniko Nosokomeio Thessalonikis Papageorgiou, Thessaloniki, Greece
| | - Konstantinos Markou
- 2nd University Department of Otorhinolaryngology, Geniko Nosokomeio Thessalonikis Papageorgiou, Thessaloniki, Greece
| | - Stefanos Triaridis
- 1st University Department of Otorhinolaryngology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
36
|
Tsang CLN, Nguyen T, Sivesind T, Cervin A. Long-term patient-related outcome measures of septoplasty: a systematic review. Eur Arch Otorhinolaryngol 2018; 275:1039-1048. [PMID: 29332171 DOI: 10.1007/s00405-018-4874-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/08/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Septoplasty is a common rhinological procedure intended to relieve symptoms of chronic nasal obstruction. However, there remains a question as to whether patients obtain symptom improvement and are satisfied with surgical outcomes in the months and years after septoplasty. This review aims to evaluate the long-term efficacy of functional septoplasty for nasal septal deviation. METHODS A systematic review of the literature was conducted from November 2014 to March 2016 using the Cochrane, EMBASE, and PubMed databases. Prospective trials concerning functional septoplasty, which assessed subjective outcomes and included long-term follow-up data (≥ 9 month post-septoplasty) were included. RESULTS 2189 articles were screened with seven meeting the criteria for inclusion. Patient satisfaction was assessed in six studies, with rates of satisfaction provided in three of these, ranging from 69 to 100%. Two studies assessed the degree of patient satisfaction, with one study indicating that 88% of patients were moderately satisfied or better at 1 year post-op, and the other reporting that 50% of patients were satisfied. In assessing symptom relief, several methods were used, including validated questionnaires, with varying degrees of improvement in nasal obstruction reported. CONCLUSIONS Septoplasty appears to be a far from perfect treatment for nasal obstruction due to septal deviation. However, given the heterogeneity of data and lack of randomized controlled trials (RCTs), future RCTs and use of validated questionnaires would enable generation of superior levels of evidence. We suggest future prospective trials evaluating prognostic factors in septoplasty, to better inform patients and facilitate the development of guidelines for surgical intervention.
Collapse
Affiliation(s)
- Chi Lap Nicholas Tsang
- Royal Brisbane Clinical Unit, Faculty of Medicine, University of Queensland, Level 9, Health Sciences Building, Brisbane, QLD, Australia.
| | - Theresa Nguyen
- Royal Brisbane Clinical Unit, Faculty of Medicine, University of Queensland, Level 9, Health Sciences Building, Brisbane, QLD, Australia
| | - Torunn Sivesind
- Royal Brisbane Clinical Unit, Faculty of Medicine, University of Queensland, Level 9, Health Sciences Building, Brisbane, QLD, Australia
| | - Anders Cervin
- Royal Brisbane Clinical Unit, Faculty of Medicine, University of Queensland, Level 9, Health Sciences Building, Brisbane, QLD, Australia
| |
Collapse
|
37
|
Age and Unplanned Postoperative Visits Predict Outcome after Septoplasty: A National Swedish Register Study. Int J Otolaryngol 2018; 2018:2379536. [PMID: 29487623 PMCID: PMC5816872 DOI: 10.1155/2018/2379536] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/23/2017] [Accepted: 12/07/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To study predictors of symptom relief six months after septoplasty using data from the Swedish National Septoplasty Register. Participants This is a retrospective register study of adult patients undergoing septoplasty in Sweden in 2003–2012. Outcome Relief of nasal symptoms was analysed in relation to age, gender, size of hospital performing the surgery, addition of turbinoplasty, and unplanned postoperative visits to the hospital due to pain, bleeding, or infection. Results In all, 76% of the patients (n = 5,865) rated their symptoms as “almost gone” or “gone” six months after septoplasty. With every 10-year increase in the age of the patients, the OR was 1.19, 95% CI 1.15–1.23, for a better result and 1.54, 95% CI 1.38–1.71, if the septoplasty was performed at a county hospital versus a university hospital. If there was no unplanned postoperative visit due to pain, bleeding, or infection, the OR for a better result was 1.6, 95% CI 1.39–1.85. Conclusion In this large national cohort of septoplasties, most of the patients felt that their symptoms had gone or almost gone six months after septoplasty. Higher age, surgery at smaller hospitals, and no unplanned visits to the hospital postoperatively predicted a better outcome.
Collapse
|
38
|
Vascular Endothelial Growth Factor Sequestration Enhances In Vivo Cartilage Formation. Int J Mol Sci 2017; 18:ijms18112478. [PMID: 29160845 PMCID: PMC5713444 DOI: 10.3390/ijms18112478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/01/2017] [Accepted: 11/15/2017] [Indexed: 12/17/2022] Open
Abstract
Autologous chondrocyte transplantation for cartilage repair still has unsatisfactory clinical outcomes because of inter-donor variability and poor cartilage quality formation. Re-differentiation of monolayer-expanded human chondrocytes is not easy in the absence of potent morphogens. The Vascular Endothelial Growth Factor (VEGF) plays a master role in angiogenesis and in negatively regulating cartilage growth by stimulating vascular invasion and ossification. Therefore, we hypothesized that its sole microenvironmental blockade by either VEGF sequestration by soluble VEGF receptor-2 (Flk-1) or by antiangiogenic hyperbranched peptides could improve chondrogenesis of expanded human nasal chondrocytes (NC) freshly seeded on collagen scaffolds. Chondrogenesis of several NC donors was assessed either in vitro or ectopically in nude mice. VEGF blockade appeared not to affect NC in vitro differentiation, whereas it efficiently inhibited blood vessel ingrowth in vivo. After 8 weeks, in vivo glycosaminoglycan deposition was approximately two-fold higher when antiangiogenic approaches were used, as compared to the control group. Our data indicates that the inhibition of VEGF signaling, independently of the specific implementation mode, has profound effects on in vivo NC chondrogenesis, even in the absence of chondroinductive signals during prior culture or at the implantation site.
Collapse
|
39
|
Sen I, Dutta M, Haldar D, Sinha R. Estimation of partitioning of airflow in septal surgery: A prospective study with reference to the NOSE scale. EAR, NOSE & THROAT JOURNAL 2017; 96:E6-E12. [PMID: 28231369 DOI: 10.1177/014556131709600212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Improper patient selection for septal surgery often has been found to result in therapeutic failure, and there needs to be an objective assessment of nasal obstruction before the surgery and for postoperative follow-up that can be applied in the routine otolaryngology practice. The purpose of this study is to assess the usefulness of a cost-effective device for objective measurement of the nasal airway partitioning in selecting patients for septal surgery and for postoperative outcome evaluation. A hospital-based, prospective, observational study was carried out in a tertiary-care teaching institution involving 74 patients waiting for septal surgery. Each patient was exposed to subjective assessment of nasal obstruction by the Nasal Obstruction Symptom Evaluation (NOSE) scale and objective measurement by Nasal Partitioning Ratio (NPR) using a new device, Nasal Airway Partition Meter (NAPM), once before and twice after surgery. Overall, average NOSE score and NPR values were 66.42 ± 9.42 and 0.57 ± 0.18, respectively, at preoperative assessment (correlation coefficient 0.441). Sixty of the 74 patients had high values for both NPR and NOSE scores (Group 1), but in the remaining 14, NPR values were found to be lower despite high NOSE scores (Group 2). Postsurgery, the NOSE score and NPR values were significantly reduced in Group 1. In contrast, participants in Group 2 showed no alteration in the values of both the parameters after the same operative maneuver. However, 2 patients in Group 1 had NOSE score and NPR values unaltered, while 1 patient in Group 2 had a reduced NOSE score after surgery. Therefore, the validity of the new equipment was calculated to be 96.7% sensitive and 92.9% specific to identify patients who needed to undergo septal surgery for their nasal obstruction. It can be deduced from the present study that NAPM can be a cost-effective device for clinicians to objectively measure nasal airway obstruction and screen patients for septal surgery.
Collapse
Affiliation(s)
- Indranil Sen
- Department of Otorhinolaryngology and Head-Neck Surgery, Midnapore Medical College and Hospital, Midnapore, India
| | | | | | | |
Collapse
|
40
|
Radulesco T, Penicaud M, Santini L, Thomassin JM, Dessi P, Michel J. Outcomes of septorhinoplasty: a new approach comparing functional and aesthetic results. Int J Oral Maxillofac Surg 2017; 47:175-179. [PMID: 28967532 DOI: 10.1016/j.ijom.2017.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/16/2017] [Accepted: 09/08/2017] [Indexed: 01/09/2023]
Abstract
The aim of this study was to compare objective and subjective functional results of septorhinoplasty with subjective aesthetic results. A prospective study was performed including global and subgroup analyses (primary versus secondary septorhinoplasty). Three instruments were used to evaluate pre- and postoperative results: rhinomanometry for the objective functional analysis, the Nasal Symptom Obstruction Evaluation (NOSE) scale for the subjective functional analysis, and the Rhinoplasty Outcome Evaluation (ROE) scale for the subjective aesthetic analysis. A septorhinoplasty was performed in all cases. Thirty-five patients were included (22 female), of whom 74% underwent primary septorhinoplasty. The correlation between rhinomanometry, NOSE and ROE scores was analysed. Mean resistance of the two nasal cavities was 4.9 (standard deviation (SD) 8.35) sPa/ml before surgery and 0.8 (SD 0.7) sPa/ml after surgery. NOSE and ROE scores were, respectively, 72.5/100 (SD 21.7) and 7.5/24 (SD 11.3) before surgery and 22/100 (SD 20.6) and 18/24 (SD 17.3) after surgery. Patients complaining of postoperative nasal obstruction had a worse aesthetic evaluation. Correction of the functional disease appears to be as important as aesthetic correction. This study comparing functional and aesthetic results after septorhinoplasty could provide a basis for future studies.
Collapse
Affiliation(s)
- T Radulesco
- Department of Otorhinolaryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille, France; Aix-Marseille Univ, Marseille, France.
| | - M Penicaud
- Department of Otorhinolaryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille, France
| | - L Santini
- Department of Otorhinolaryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille, France
| | - J-M Thomassin
- Department of Otorhinolaryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille, France; Aix-Marseille Univ, Marseille, France
| | - P Dessi
- Department of Otorhinolaryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille, France; Aix-Marseille Univ, Marseille, France
| | - J Michel
- Department of Otorhinolaryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille, France; Aix-Marseille Univ, Marseille, France
| |
Collapse
|
41
|
Preoperative Signs and Symptoms as Prognostic Markers in Nasal Septoplasty. Int J Otolaryngol 2017; 2017:4718108. [PMID: 28883833 PMCID: PMC5572615 DOI: 10.1155/2017/4718108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/13/2017] [Indexed: 11/25/2022] Open
Abstract
Identification of preoperative signs and symptoms that may predict the outcome of surgery is important, for both patient selection and the development of interventions for improving outcomes. The purpose of this study was to assess the value of some selected preoperative signs and symptoms for predicting outcomes of nasal septoplasty. Patients undergoing septoplasty with or without turbinoplasty responded to the Nasal Surgical Questionnaire (NSQ) preoperatively and six months postoperatively. The questionnaire contains visual analogue scales (VAS) for nasal obstruction during the day and at night. We compared preoperative and postoperative VAS scores in patients with unilateral versus bilateral septal deviation and patients with low versus high preoperative scores. Of 446 patients undergoing septoplasty from September 2014 to December 2015 who had responded to the preoperative NSQ, 286 (64.1%) also returned the postoperative version. There was greater improvement in obstruction in patients with preoperative unilateral compared to bilateral septal deviation (day scores, p = 0.04). The grade of deviation and the presence of concomitant bony conchal hypertrophy did not influence results. Patients with lower preoperative VAS scores obtained better end results than those with higher scores (p = 0.04). Type of septal deviation and preoperative VAS scores may aid in predicting outcome of nasal surgery.
Collapse
|
42
|
Acute Palatal Perforation and Peroperative Repair Method During Septoplasty Operation. J Craniofac Surg 2017; 27:e559-60. [PMID: 27526239 DOI: 10.1097/scs.0000000000002865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Septoplasty is a frequent and relatively low-risk procedure in otolaryngology practice. Palatal perforation complication is very rare in the literature and only a few patients have been reported. In this clinical report, a patient with palatal perforation that has been developed and noticed during the septoplasty operation with no anatomical abnormality and alternative repair method are reported with video of the procedure.
Collapse
|
43
|
Sari K, Gul AI, Kantekin Y, Karaaslan O, Gencer ZK. Transseptal Suturing Reduce Patient Anxiety after Septoplasty Compared to Nasal Packing. ACTA MEDICA (HRADEC KRÁLOVÉ) 2017; 59:133-136. [PMID: 28440216 DOI: 10.14712/18059694.2017.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND We measured postoperative anxiety in patients who underwent transseptal suturing or nasal packing after septoplasty. MATERIALS AND METHODS Transseptal suturing was performed on Group 1 patients and nasal splints with airway were placed after septoplasty in Group 2 patients. Postoperative 48-h anxiety levels of both groups were measured using the State-Trait Anxiety Inventory (STAI) clinical assessment scale, prior to removal of nasal packing in Group 2. RESULTS Transseptal suturing was performed after septoplasty in 28 patients and nasal packing in 34 patients. The State-Trait Anxiety Inventory clinical assessment state (STAI-S) and trait (STAI-T) instruments were used to measure postoperative anxiety. The STAI-S scores were found 35.00 in the transseptal suturing group and 43.8 in the nasal packing group; the difference was found significant (p < 0.05). The STAI-T scores were found 42.6 in the transseptal suturing group and 45.7 in the nasal packing group; the difference was not found significant (p > 0.05). The rate of minor hemorrhage was found 10.7% in Group 1 patients. CONCLUSIONS Transseptal suturing is simple and reliable when performed after septoplasty. The technique is painless and comfortable, and reduces patient anxiety (compared to that associated with nasal packing) with only a minor increase in operating time and hemorrhage.
Collapse
Affiliation(s)
- Kamran Sari
- Bozok University School of Medicine, Ear Nose & Throat Department, Yozgat, Turkey.
| | - Ali Irfan Gul
- Bozok University School of Medicine, Psychiatry Department, Yozgat, Turkey
| | - Yunus Kantekin
- Bozok University School of Medicine, Ear Nose & Throat Department, Yozgat, Turkey
| | - Ozgul Karaaslan
- Bozok University School of Medicine, Psychiatry Department, Yozgat, Turkey
| | | |
Collapse
|
44
|
Pelttari K, Mumme M, Barbero A, Martin I. Nasal chondrocytes as a neural crest-derived cell source for regenerative medicine. Curr Opin Biotechnol 2017; 47:1-6. [PMID: 28551498 DOI: 10.1016/j.copbio.2017.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/08/2017] [Indexed: 12/18/2022]
Abstract
Cells deriving from neural crest are generally acknowledged during embryonic development for their multipotency and plasticity, accounting for their capacity to generate various cell and tissue types even across germ layers. At least partial preservation of some of these properties in adulthood makes neural crest derived cells of large interest for regenerative purposes. Chondrocytes from fully mature nasal septum cartilage in adults are also derivatives of neural crest cells and were recently demonstrated to be able not only to maintain functionality across serial cloning, as surrogate self-renewal test, but also to respond and adapt to heterotopic transplantation sites. Based on these findings, cartilage grafts engineered by nasal chondrocytes were clinically used to reconstitute the nasal alar lobule and to repair articular cartilage defects. This article discusses further perspectives of potential clinical utility for nasal chondrocytes in musculoskeletal regeneration. It then highlights the need to derive deeper understanding of their biological properties in order to inform on possible therapeutic modes of action. This acquired knowledge will help to optimise manufacturing conditions to guarantee defined functional traits associated with safety and therapeutic potency of nasal chondrocytes in regenerative medicine.
Collapse
Affiliation(s)
- Karoliina Pelttari
- Department of Biomedicine, University of Basel, University Hospital of Basel, Switzerland
| | - Marcus Mumme
- Department of Biomedicine, University of Basel, University Hospital of Basel, Switzerland; Clinic for Orthopedics and Traumatology, University Hospital of Basel, Switzerland
| | - Andrea Barbero
- Department of Biomedicine, University of Basel, University Hospital of Basel, Switzerland
| | - Ivan Martin
- Department of Biomedicine, University of Basel, University Hospital of Basel, Switzerland.
| |
Collapse
|
45
|
Hong CJ, Monteiro E, Badhiwala J, Lee J, de Almeida JR, Vescan A, Witterick IJ. Open versus endoscopic septoplasty techniques: A systematic review and meta-analysis. Am J Rhinol Allergy 2017; 30:436-442. [PMID: 28124656 DOI: 10.2500/ajra.2016.30.4366] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Septal deviation is a condition of high prevalence, which ranges from 22% in newborns to 90% in adults. Surgical intervention is frequently considered in the management of patients with symptoms. Although many surgeons prefer either the endoscopic or the open approach to septoplasty, there is an ongoing debate regarding comparative outcomes between the two approaches. OBJECTIVE The purpose of this study was to systematically review the literature and provide pooled summary estimates to evaluate the efficacy and safety of open versus endoscopic septoplasty techniques. METHODS This study was registered with PROSPERO (CRD42014010730). MEDLINE, EMBASE, Google Scholar, CINAHL, Web of Science, and The Cochrane Central Registry for Randomized Trials were searched for relevant studies by using the following keywords in varying combinations: "nasal septum," "nasal obstruction," "nasal cartilages," "nose," "nose diseases," "surgery," "nasal/septal deviation," and "septoplasty." All the studies that compared open versus endoscopic septoplasty techniques for the management of symptomatic septal deviation were considered. Two reviewers independently extracted data by using a preestablished extraction form and performed quality assessment by using the Jadad and Newcastle Ottawa Scales. Weighted pooled estimates were calculated and reported, along with relative risks and 95% confidence intervals. RESULTS Fourteen studies met our inclusion criteria. When comparing open versus endoscopic septoplasty techniques, there was significant improvement in postoperative symptoms (i.e., nasal obstruction, headaches) (p < 0.05) in the endoscopic septoplasty group. There also were significantly fewer complications associated with the endoscopic septoplasty technique (p < 0.05). Based on the quality assessment, included studies were deemed at a moderate-to-high risk of bias. CONCLUSION Our analysis indicated that endoscopic septoplasty may have some advantages over open septoplasty. However, our findings should be taken with caution given the poor quality of included studies.
Collapse
Affiliation(s)
- Chris J Hong
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
46
|
Ziai H, Bonaparte JP. Determining a Successful Nasal Airway Surgery: Calculation of the Patient-Centered Minimum Important Difference. Otolaryngol Head Neck Surg 2017; 157:325-330. [PMID: 28418779 DOI: 10.1177/0194599817701719] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Determine whether the patient-identified minimum important difference (MID) in Nasal Obstruction Symptom Evaluation (NOSE) score differs from a statistically calculated estimate of MID in patients with septal deviation undergoing nasal airway surgery. Study Design Prospective cohort. Setting Tertiary academic referral center. Subjects Patients with nasal obstruction due to septal deviation. Methods Patients completed the NOSE questionnaire preoperatively and indicated the change from their baseline score that they would consider the minimum improvement required to define the septoplasty with turbinate reduction as successful. A previously published distribution-based approach was used to estimate the MID based on baseline NOSE scores. Scores were reported both as a raw score and as a percentage of patients' baseline scores. One-sample t test was used to compare the statistically estimated MID to the patient-reported MID. Results Seventy-six patients were included. The mean (SD) baseline NOSE score was 12.9 (4.03). The mean (SD) patient-identified MID was 5.3 (2.1), corresponding to a 41.1% change (95% confidence interval, 37.2-41.3) from baseline. The statistically estimated MID was 5.2 points (40.3% reduction from baseline scores). The estimated MID was not significantly different from the patient-identified MID ( P = .4). Conclusion In patients with septal deviation, an improvement of approximately 40% in their nasal obstructive symptoms as assessed by the NOSE questionnaire is required to define a nasal airway surgery as successful. The patient-identified and the statistically calculated MIDs were similar. Furthermore, this MID can be used to guide research, improving the ability to use the NOSE score as a dichotomous scoring measure (treatment success/failure) and estimating sample size.
Collapse
Affiliation(s)
- Hedyeh Ziai
- 1 Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - James P Bonaparte
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
47
|
Evaluation of Patient Satisfaction After Nasal Septoplasty Operation Using Peak Nasal Inspratuar Flow and Nasal Obstruction Symptom Score Questionare. J Craniofac Surg 2017; 27:1289-91. [PMID: 27391500 DOI: 10.1097/scs.0000000000002748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the usefulness of the peak nasal inflamatuar flow (PNIF) and Nasal Obstruction Symptom Score (NOSE) questionnaire in the diagnosis and follow-up of nasal septum deviation surgery. METHODS Sixty patients diagnosed with nasal septum deviation were included in the study. Nasal Obstruction Symptom Score scales of patients, PNIF and is measured preoperatively and 14 days after surgery. RESULTS Preoperative NOSE scores were 14.9 ± 2.7 and PNIF scores were 129.6 ± 15.5 L/min in study group. Postoperatively NOSE scores were 7.9 ± 1.8 and PNIF scores were 154.2 ± 9.2 L/min in study group. Nasal Obstruction Symptom Score scores were 3.3 ± 2.3 and PNIF scores were 169.3 ± 13.5 L/min in control group. CONCLUSION Anterior and anteroposteriorly located nasal septum deviation (NSD) had statistically higher degrees of NOSE scores and lower levels of PNIF scores. Posterior located NSD PNIF scores changed postoperatively but NOSE scores do not change statistically. There was a statistically significant correlation in Pearson correlation analysis between NOSE and PNIF scores. The authors recommend using PNIF and NOSE scores in NSD patients.
Collapse
|
48
|
Jeong JI, Hong SD, Kim SJ, Dhong HJ, Chung SK, Kim HY. Temporal differences in improvement of nasal obstruction between primary and revision septoplasty. Am J Rhinol Allergy 2017; 30:134-8. [PMID: 27456589 DOI: 10.2500/ajra.2016.30.4334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Septoplasty is one of most frequently performed surgeries in otorhinolaryngologic clinics to improve nasal obstruction by correcting nasal septal deformities. Many patients require revision surgery for persistent nasal obstruction. However, the outcomes and sources of revision septoplasty are unclear. OBJECTIVE We investigated the discrepancy between patient's subjective and objective improvements after septoplasty by comparing primary and revision procedures. METHODS Patients who underwent septoplasty from January 2012 to December 2014 were enrolled. All the subjects were questioned regarding subjective nasal symptoms before surgery and 1 month and every 3 months after surgery, with responses rated on a 7-point Likert scale. Nasal endoscopic evaluation and acoustic rhinometry were also performed with the same schedule. RESULTS One hundred seventy-nine patients were analyzed. Subjective nasal obstruction scores of both the primary (n = 161) and revision (n = 18) groups were significantly improved at 1 month after surgery and showed no difference between the two groups. However, this improvement was sustained to the last follow-up only in the primary group. The symptom improvement rate of the primary group (85.5% [n = 109]) was significantly higher than that of the revision group (58.8% [n = 10]) at the last follow-up. There was no difference in the degree of improvement in objective findings between the two groups, including the difference and the ratio of the minimal cross-sectional area between the wider and narrower sides, and in endoscopic findings, even at the last follow-up. CONCLUSION Compared with primary septoplasty, the long-term efficacy of revision septoplasty may not be clear, and there are discrepancies between the subjective and objective outcomes.
Collapse
Affiliation(s)
- Jong In Jeong
- Department of Otolaryngology, Keimyung University School of Medicine, Daegu, Korea
| | | | | | | | | | | |
Collapse
|
49
|
Floyd EM, Ho S, Patel P, Rosenfeld RM, Gordin E. Systematic Review and Meta-analysis of Studies Evaluating Functional Rhinoplasty Outcomes with the NOSE Score. Otolaryngol Head Neck Surg 2017; 156:809-815. [PMID: 28168892 DOI: 10.1177/0194599817691272] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To provide aggregate data regarding the ability of functional rhinoplasty to improve nasal obstruction as measured by the Nasal Obstruction Symptom Evaluation (NOSE) score. Data Sources PubMed, EMBASE, Cochrane databases. Review Methods A search was performed with the terms "nasal obstruction" and "rhinoplasty." Studies were included if they evaluated the effect of functional rhinoplasty on nasal obstruction with the NOSE score. Case reports, narratives, and articles that did not use the NOSE score were excluded. Functional rhinoplasty was defined as surgery on the nasal valve. This search resulted in 665 articles. After dual-investigator independent screening, 16 articles remained. Study results were pooled with a random effects model of meta-analysis. Change in NOSE score after surgery was assessed via the mean difference between baseline and postoperative results and the standardized mean difference. Heterogeneity was assessed and reported through the I2 statistic. Results Patients in the included studies had moderate to severe nasal obstructive symptoms at baseline. The NOSE scores were substantially improved at 3-6, 6-12, and ≥12 months, with absolute reductions of 50 points (95% CI, 45-54), 43 points (95% CI, 36-51), and 49 points (95% CI, 39-58), respectively. All of these analyses showed high heterogeneity. Conclusions Nasal obstruction as measured by the NOSE survey is reduced by 43 to 50 points (out of 100 points) for 12 months after rhinoplasty. Our confidence in these results is limited by heterogeneity among studies, large variability in outcomes beyond 12 months, and the inherent potential for bias in observational studies.
Collapse
Affiliation(s)
| | - Sandra Ho
- 1 State University of New York, Brooklyn, New York, USA
| | - Prayag Patel
- 1 State University of New York, Brooklyn, New York, USA
| | | | - Eli Gordin
- 1 State University of New York, Brooklyn, New York, USA
| |
Collapse
|
50
|
Palatal Perforation as a Rare Complication of Nasal Septoplasty. Aesthetic Plast Surg 2016; 40:850-853. [PMID: 27631545 DOI: 10.1007/s00266-016-0693-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Nasal septoplasty is one of the most commonly performed surgical procedures by otolaryngologists or plastic surgeons and is generally performed to improve the quality of life. Although nasal surgeries are generally safe and effective procedures, various complications have been described in the literature. METHODS In this article, we present a rare case of fracture of a part of the hard palate resulting in palatal perforation after nasal septoplasty surgery early diagnosed and successfully treated. RESULTS Patient follow-up 1 year after oronasal closure revealed complete healing of the hard palate without the presence of fistula. CONCLUSIONS Palatal perforation during septoplasty is extremely rare and, even though it is not a life-threatening complication, has potentially annoying effects; according to its size, it can result in nasal speech, oral health problems, and nasal regurgitation of liquids and is sometimes related with reconstructive challenging problems. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A5 online Instructions to Authors. www.springer.com/00266 .
Collapse
|