Postoperative Comfort Score after Septoplasty among Patients Undergoing Nasal Packing versus Suturing of the Septal Flap by Modified Technique without Packing : A Randomized Controlled Trial

Background : Septal surgery is one of the most common surgical procedures performed by an Otorhinolaryngeal surgeon since ancient times. Various modifications in the approach, changing concept of conserving septal cartilage, use of an endoscope and good antibiotics to control postoperative infection have played a key role in controlling the complication rates but still, one thing which is mostly practiced worldwide is nasal packing in the postoperative period which is a nightmare for many patients, as the pain threshold varies from patient to patient. It also causes dryness of mouth, throat irritation, facial heaviness, headache, excessive watering from eyes, aural fullness. There is a lack of proper evidence to prove whether nasal packing really decreases postoperative hemorrhage as the incision is properly approximated and sutured. The main reason for nasal packing was an approximation of nasal septal flap thereby reducing the chances of septal Haematoma and stabilization of septal flap in the midline. The present study has been taken to study and compare postoperative nasal packing and modified quilting suture of the septal flap without the nasal pack. Material and Methods : This one-year prospective comparative study was conducted on 149 patients who underwent septoplasty with 3 months follow-up. One group had Postoperative nasal packing and the other had only modified septal flap suturing without the nasal pack. Results : Out of the total of 149 patients, 88 underwent nasal packing in the postoperative period and 61 patients had undergone suture of the nasal septal flap without nasal packing. A statistically significant value of VAS score was found in the non-packing group of 61 patients, where the average postoperative VAS score was 1.46 against 3.7 among the packing group of 88 patients. An unpaired t-test was applied and a value of 15.431 was obtained with a pvalue less than 0.001. No cases presented with septal perforation in the postoperative period in patients without a nasal pack and there were 2 cases (2.2%) of septal perforation in the nasal packing group. There was no significant bleeding in the postoperative period in both groups of patients. Conclusion : Stabilization of the nasal septal flap by modified quilting technique is better option after septoplasty with good comfort score.

The Role of Preemptive Infiltration Anesthesia in the Management of Postoperative Pain Following Septoplasty

Abstract Introduction Septoplasty is one of the most common surgical procedures in rhinology practice. Two major problems encountered after septoplasty are pain and bleeding. Preoperative administration of analgesics before the surgical stimulus, which is the main concept of preemptive analgesia, decreases postoperative pain. Objective The present study was designed to investigate whether preincisional lidocaine infiltration to the subperichondrial area during septoplasty surgery reduced or not postoperative pain and analgesic use. Methods The present prospective, randomized, placebo controlled, double-blind trial was conducted on 64 consecutive patients with nasal septum deviation. Patients were randomly divided into 2 groups; the study group received 2% 20 mg lidocaine/cc (n = 31), and the control group received 6 cc 0.9% NaCl (n = 33). A standard questionnaire was given to each patient to mark his or her pain score between 0 and 10 at the 1st, 3rd, 6th, 12th, and 24th hours. Results The mean and the range of visual analogue scale (VAS) scores of the patients in the study group at the 1st, 3rd, 12th, and 24th hours were 4.03 ± 3.08 (0-10); 3.42 ± 2.39 (0-8); 2.97 ± 2.22 (0-8); 2.87 ± 2.61 (0-9); and 1.94 ± 2.06 (0-9) respectively. The mean and the range of VAS scores of the patients in the control group at the 1st, 3rd, 12th, and 24th hours were 4.12 ± 2.7 (0-10); 3.45 ± 2.4 (0-10); 2.94 ± 2.7 (0-10); 2.79 ± 2.34 (0-10); and 1.5 ± 1.8 (0-6), respectively. The statistical analysis revealed no significant difference among the groups. Conclusion The preemptive local anesthetic administration to the incision area and under the mucoperichondrial flap before septoplasty does not decrease the level of postoperative pain.

Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation / Efeito da septoplastia no desempenho miocárdico ventricular esquerdo em pacientes com desvio de septo nasal

Abstract Introduction: Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. Objective: The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. Methods: This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. Results: Significantly higher left ventricular myocardial performance index (0.52 ± 0.06 vs. 0.41 ± 0.04, p < 0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p < 0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p < 0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p = 0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p = 0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p < 0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p =0.224). Conclusion: Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.

Resumo Introdução: O desvio do septo nasal é a principal causa de obstrução das vias aéreas superiores. A obstrução crônica das vias aéreas superiores pode causar lesão miocárdica devido à hipóxia crônica. Os efeitos da septoplastia nas funções diastólica e sistólica do ventrículo esquerdo não são bem conhecidos. O índice de desempenho miocárdico é um parâmetro confiável e fácil de aplicar que reflete as funções cardíacas sistólica e diastólica. Objetivo: Investigar o efeito da septoplastia nasal no índice de desempenho miocárdico em pacientes com desvio de septo nasal. Método: Este estudo prospectivo consistiu em 50 pacientes consecutivos submetidos a septoplastia devido a desvio de septo nasal significativo sintomático em S ou C. A ecocardiogarfia transtorácica foi feita em todos os pacientes antes e 3 meses após a septoplastia. Os índices de desempenho miocárdico calculados foram comparados. Resultados: Um valor de indice de desempenho miocárdico ventricular esquerdo significantemente maior (0,52 ± 0,06 vs. 0,41 ± 0,04, p < 0,001), tempo mais longo de relaxamento isovolumétrico (95,0 ± 12,5 vs. 78,0 ± 8,6 ms, p < 0,001), tempo mais longo de contração isovolumétrica (45,5 ± 7,8 vs. 39,5 ± 8,6 ms, p < 0,001), tempo de desaceleração mais longo (184,3 ± 32,5 vs. 163,6 ± 45,4 ms, p = 0,004), maior razão de pico de velocidade transmitral precoce e tardia (E / A) (1,42 ± 0,4 vs. 1,16 ± 0,2, p = 0,006) e menor tempo de ejeção (270,1 ± 18,3 vs. 286,5 ± 25,8 ms, p < 0,001) foram observados antes da septoplastia quando comparados aos valores obtidos 3 meses após a septoplastia. A fração de ejeção sistólica do ventrículo esquerdo foi semelhante antes e após a septoplastia (63,8 ± 2,8% vs. 64,6 ± 3,2%, p = 0,224). Conclusão: A cirurgia de septoplastia não apenas reduz os sintomas em pacientes com desvio de septo nasal, mas também pode melhorar o desempenho ventricular esquerdo. Assim, o tratamento precoce do desvio de septo nasal é sugerido para prevenir possíveis eventos cardiovasculares futuros.

PRE & POST OPERATIVE ASSESSMENT OF NASAL AIRFLOW BY ACTIVE ANTERIOR RHINOMANOMETRY IN OBSTRUCTIVE NASAL PATHOLOGIES

Nasal obstruction is a common symptom seen across various nasal pathologies, the objective way of measuring nasal obstruction is active rhinomanometry. To measure the difference in the nasal air?ow of cases of nasal pathology with nasal obstruction, a prospective study was undertaken to compare the pre and post-operative rhinomanometry ?ndings in cases presenting with nasal obstruction

The effects of intraday operation time on pain and anxiety of patients undergoing septoplasty / Os efeitos do tempo de cirurgia intradia na dor e ansiedade de pacientes submetidos à septoplastia

Abstract Introduction Anxiety and pain levels of septoplasty patients may vary according to intraday operation time. Objective To investigate the effects of septoplasty operation and intraday operation time on anxiety and postoperative pain. Methods Ninety-eight voluntary patients filled out the hospital anxiety and depression scale to measure the anxiety level three weeks before, one hour before and one week after surgery. Forty-nine patients were operated at 8:00 am (morning group); other 49 were operated at 03:00 pm (afternoon group). We used a visual analogue scale to measure postoperative pain. Preoperative and postoperative scores were compared, as were the scores of the groups. Results Median hospital anxiety and depression scale scores one hour before the operation [6 (2-10)] were significantly higher compared to the median scores three weeks before the operation [3 (1-6)] (p < 0.001), and one week after the operation [2 (1-6)] were significantly lower compared to the median scores three weeks before the operation [3 (1-6)] (p < 0.001). Hospital anxiety and depression scale scores one hour before the operation were significantly greater in the afternoon group [8 (7-10)], compared to the morning group [4 (2-6)] (p < 0.001). Postoperative first, sixth, twelfth and twenty-fourth-hour pain visual analogue scale scores were significantly higher in the afternoon group compared to the morning group (p < 0.001). Conclusion Septoplasty might have an increasing effect on short-term anxiety and postoperative pain. Performing this operation at a late hour in the day might further increase anxiety and pain. However, the latter has no long-term effect on anxiety.

Resumo Introdução Os níveis de ansiedade e dor em pacientes submetidos à septoplastia podem variar de acordo com o tempo de cirurgia intradia. Objetivo Investigar os efeitos da cirurgia de septoplastia e do tempo de cirurgia intradia na ansiedade e dor pós-operatória. Métodos Noventa e oito pacientes voluntários preencheram a Hospital Anxiety and Depression Scale (HADS) para medir o nível de ansiedade três semanas antes, uma hora antes e uma semana após a cirurgia. Quarenta e nove pacientes foram operados às 8h (grupo da manhã) e 49 foram operados às 15h (grupo da tarde). Usamos a Escala Visual Analógica para medir a dor pós-operatória. Os escores pré e pós-operatórios foram comparados, assim como os escores dos grupos. Resultados As medianas dos escores da HADS uma hora antes da operação [6 (2-10)] foram significativamente mais altas em comparação com as medianas dos escores da HADS três semanas antes da operação [3 (1-6)] (p < 0,001) e as medianas dos escores da HADS uma semana após a operação [2 (1-6)] foram significativamente mais baixas em comparação com as medianas dos escores três semanas antes da operação [3 (1-6)] (p < 0,001). Os escores da HADS uma hora antes da operação foram significativamente mais altos no grupo da tarde [8 (7-10)], em comparação ao grupo da manhã [4 (2-6)] (p < 0,001). Os escores da EVA para dor na primeira, sexta, 12ª segunda e 24ª hora do pós-operatório foram significativamente mais altos no grupo da tarde em comparação com o grupo da manhã (p < 0,001). Conclusão A septoplastia pode ter um efeito crescente sobre a ansiedade em curto prazo e na dor pós-operatória e a feitura dessa cirurgia em hora mais tardia pode aumentar ainda mais a ansiedade e a dor. No entanto, isso não tem efeito em longo prazo na ansiedade.

Significance of Inner Nasal Valve In Septoplasty

Background: Nasal obstruction due to deviated septum is commonly treated with conventional septoplasty. This surgery however is inadequate in cases of compromised nasal valves and leads to persistent symptoms. Hence, we stressed the evaluation of nasal valves before septal surgery & studied the outcome of the patients with valve area correction. Aim:To prove the signi?cance of inner nasal valve in nasal surgery. Objective: To analyse the outcome of Open septoplasty. Methodology:A retrospective review of our patients undergoing Open septoplasty was analyzed from April 2016 to January 2021. The preoperative and post-operative evaluations were calculated & statistically analysed. Results :A total of 400 patients underwent Open septoplasty, out of which 392(98%)showed symptomatic improvement in breathing dif?culty. Also, 220 patients out of total 400 underwent cosmetic correction along with open septoplasty & 209 (95%) out of these220 were completely happy with the asthetic improvement. Conclusion:Open septoplasty and Spreader grafts is best solution to improve Internal Nasal valve angle. Rim graft to improve external valve collapse. Spreader graft also gives asthetic along with functional improvement.

Early clinical outcomes of ınferior turbinate radiofrequency and lateralization combined with septoplasty / Resultados clínicos iniciais da utilização de radiofrequência e lateralização das conchas nasais inferiores combinadas à septoplastia

Abstract Introduction: Mechanical obstruction is the most common form of nasal obstruction. Among the types of mechanical obstructions, septum deviation and inferior turbinate hypertrophy are the most prevalent. Objective: This study evaluated the early clinical outcomes of inferior turbinate radiofrequency and inferior turbinate lateralization combined with septoplasty in the treatment of nasal obstruction symptoms. Methods: The research retrospectively evaluated data from 33 patients (24 male, nine female) undergoing septoplasty and inferior turbinate radiofrequency (RF group) and 32 patients (24 male, eight female) treated with septoplasty and inferior turbinate lateralization (LAT group), who were admitted, with complaints of nasal obstruction, to the University of Health Sciences, Department of Otorhinolaryngology, between January 1, 2017 and January 1, 2018. The patients' preoperative and 6-month postoperative symptoms were evaluated via the Nasal Obstruction Symptom Evaluation, the NOSE scale. Results: The mean preoperative NOSE scores were 10.3 ± 4.2 in the RF group and 10.9 ± 4.9 in the LAT group, and the mean six-month postoperative scores were 1.09 ± 1.3 in the RF group and 1.2 ± 1.3 in the LAT group. There was no significant difference in NOSE scores between the two groups (p > 0.05). Conclusion: The data obtained in this study show that both methods result in similar outcomes in terms of relieving nasal obstruction symptoms in patients requiring inferior turbinate intervention. Therefore, the researchers believe that, in each case, the intervention method should be selected at the discretion of the patient and surgeon(s).

Resumo Introdução: A obstrução mecânica é a forma mais comum de obstrução nasal. Entre os tipos de obstruções mecânicas, o desvio do septo e a hipertrofia de conchas inferiores são os mais prevalentes. Objetivo: Avaliar os resultados clínicos iniciais da aplicação de radiofrequência nas conchas inferiores e a lateralização delas combinada com septoplastia no tratamento dos sintomas de obstrução nasal. Método: O estudo avaliou retrospectivamente dados de 33 pacientes (24 homens, nove mulheres) que foram submetidos a septoplastia e aplicação de radiofrequência no concha inferior (grupo RF) e 32 pacientes (24 homens, oito mulheres) submetidos a septoplastia e lateralização de concha inferior (grupo LAT), que foram admitidos com queixas de obstrução nasal na University of Health Sciences, Departamento de Otorrinolaringologia, entre 1° de janeiro de 2017 e 1° de janeiro de 2018. Os sintomas pré-operatórios e pós-operatórios de 6 meses dos pacientes foram avaliados pela escala NOSE, do inglês Nasal Obstruction Symptom Evaluation. Resultados: Os escores médios pré-operatórios da escala NOSE foram 10,3 ± 4,2 no grupo RF e 10,9 ± 4,9 no grupo LAT e os escores médios pós-operatórios de seis meses foram 1,09 ± 1,3 no grupo RF e 1,2 ± 1,3 no grupo LAT. Não houve diferença significante nos escores da escala NOSE entre os dois grupos (p > 0,05). Conclusão: Os dados obtidos neste estudo mostram que ambos os métodos têm resultados semelhantes em termos de alívio dos sintomas de obstrução nasal em pacientes que necessitam de intervenção nas conchas inferiores. Portanto, os pesquisadores acreditam que, em cada caso, o método de intervenção deve ser selecionado a critério do paciente e do cirurgião.

Understanding the use of polycaprolactone in East Asian Structural Rhinoplasty: Questions and Answers

@#Surgery as an art in rhinoplasty involves grafting techniques wherein materials (usually autologous) are taken from the septum and supplemented by conchal cartilage. However, not all noses have adequate cartilage material. The quest for materials as possible replacement for human tissue have led to invention of synthetic (e.g. silicone, e-PTFE, porous polyethelene) and non-synthetic products (e.g. processed homograft and xenograft). In this era of advanced medical science, tissue engineering has started the use polycaprolactone (PCL) as a template and scaffold for tissue growth. Because of this characteristic feature, PCL as a mesh has a significant role in structural rhinoplasty.

Comparison of septoplasty with three high / 中南大学学报(医学版)

OBJECTIVES@#To compare the operation time, subjective and objective outcomes of septoplasty with three high-tension line resection and two high-tension line resection.@*METHODS@#A prospective randomized controlled study was conducted to identify patients with septal deviation and symptomatic nasal obstruction. The patients were classified into a three high-tension line resection and senior physician group (Group A), a two high-tension line resection and senior physician group (Group B), a three high-tension line resection and junior physician group (Group C), a two high-tension line resection and junior physician group (Group D). In addition, according to whether there were the anterior deviation, some of patients were also divided into a three high-tension line resection and anterior deviation group (Group E) and a two high-tension line resection and anterior deviation group (Group F). The operation time was recorded. The patients completed the Nasal Obstruction Symptom Evaluation (NOSE) Scale (subjective symptom), nasal endoscopy (bodily sign) and rhinomanometry (objective examination) before and 6 months after septoplasty. The operation time and the efficacy were compared between three high-tension line resection operation and two high-tension line resection operation.@*RESULTS@#There was no significant difference in the operation time between the Group A and the Group B (@*CONCLUSIONS@#The effect of septoplasty with two high-tension line resection is as good as septoplasty with three high-tension line resection. The septoplasty with two high-tension line resection is more suitable to junior physician because it is easier and the operation time is shorter.

Síndrome de Tapia posterior a cirugía nasal

Resumen El síndrome de Tapia es una complicación poco frecuente secundaria a la manipulación de la vía aérea. Se caracteriza por haber una lesión concomitante de los pareas craneales X (nervio vago) y XII (nervio hipogloso), usualmente por compresión o sobredistensión de estos. Inicialmente puede hacernos sospechar una lesión central, al haber compromiso de dos nervios craneales bajos en forma simultánea, pero la gran mayoría de los casos descritos son lesiones periféricas. De los procedimientos asociados a esta complicación, los que lideran en frecuencia son los de cabeza y cuello, por lo que es de gran importancia tenerlo en conocimiento en el desarrollo de nuestra práctica clínica. Nuestro paciente presentó esta complicación tras una septoplastía con turbinectomía sin complicaciones en el sitio operatorio, ni anestésicas. Se manejó con fonoaudiología y corticoides orales, con recuperación completa a los cuatro meses de posoperatorio.

Abstract Tapia's Syndrome is a rare complication secondary to airway manipulation. It is characterized by a concurrent lesion of cranial nerve pairs X (vagus nerve) and XII (hypoglossal nerve), usually attributed to compression or stretching of these nerves. Initially, it may lead us to suspect a central lesion, as there is simultaneous involvement of two low cranial nerves, but the vast majority of cases described are peripheral lesions. The procedures most frequently associated with this complication are head and neck surgery, which is why it is very important to bear this in mind in the development of our clinical practice. Our patient showed Tapia's syndrome following septoplasty with turbinectomy without complications in the operative site nor under anesthesia. He was treated with phoniatric and oral corticoids, recovering completely four months after surgery.

Rinoplastía y rinoseptoplastía funcional: mejorando la función nasal más allá de la cirugía del tabique y los cornetes nasales / Functional rhinoplasty and septorhinoplasty: improving nasal function beyond septal and turbinate surgery

Resumen La obstrucción nasal es una de las causas más frecuentes de consulta otorrinolaringológica general. Diversas estructuras juegan un rol en la mantención de una adecuada función respiratoria nasal, incluyendo el tabique, los cornetes, las paredes laterales y las alas nasales. La cirugía del tabique y de los cornetes inferiores son los procedimientos más comúnmente realizados y aunque son efectivos en un gran porcentaje de los casos, en ocasiones se deben intervenir otras estructuras nasales para corregir adecuadamente la obstrucción. La cirugía con fines primariamente funcionales de las válvulas nasales externa e interna, de la punta y/o de la pirámide ósea se ha denominado "rinoplastía funcional". Dada la importancia de estas estructuras para la recuperación de una adecuada permeabilidad nasal estática y dinámica, el diagnóstico y manejo quirúrgico de estas condiciones debe ser de dominio del otorrinolaringólogo.

Abstract Nasal obstruction is one of the most frequent complaints in general otorhinolaryngology practice. Different structures have a role in maintaining an adequate nasal breathing function, including the septum, turbinates, lateral sidewalls and nasal alae. Surgery of the nasal septum and inferior turbinates are the most commonly performed procedures and, although effective in most cases, occasionally other nasal structures must be intervened to correctly address the sites of obstruction. The term "functional rhinoplasty" has been coined for surgery of the external and internal nasal valves, nasal tip and/or bony pyramid, with primarily functional objectives. Given the importance of these structures for restoring an adequate static and dynamic nasal patency, diagnosis and management of these conditions must be dominion of the otorhinolaryngologist.

The Impact of Olfactory Dysfunction on the Psychological Status and Quality of Life of Patients with Nasal Obstruction and Septal Deviation

Abstract Introduction Olfactory dysfunctionmay be present in patients with nasal obstruction and septal deviation. The impact of olfactory dysfunction on the psychological profile and quality of life (QoL) of these patients remains unexplored. Objective The present study aimed to investigate the emotional status and QoL of patients with olfactory dysfunction and septal deviation and to identify predictors associated with clinically significant improvement of psychological status and QoL, focusing mainly on the role of olfactory recovery after septoplasty. Methods The olfactory function was quantitatively assessed using the ''Sniffin' sticks'' test (Burghart Messtechnik GmbH, Wedel, Germany) in 60 patients and 25 controls enrolled in this prospective study. The participants completed validated questionnaires specific for general health (Short Form-36), nasal-symptom related QoL (SinoNasal Outcome Test-22), olfaction-associated QoL (Questionnaire of Olfactory Deficits) and for assessing their psychological state (Short Anxiety Screening Test and Beck Depression Inventory) preoperatively and 6 months postoperatively. The patients used the Glasgow Benefit Inventory to evaluate their personal benefit after septoplasty with. Results Septoplasty led to significantly improved olfactory function. Patients with olfactory impairment had significantly lower nasal-symptom related QoL, higher stress levels, andmore depressivemood compared with normosmics and controls before and after septoplasty. Postoperatively, personal benefit from surgery was higher in normosmic patients. Improvement of nasal-symptom related QoL was significantly associated with higher likelihood of clinically significant improvement of patients' psychological profile and more personal benefit from surgery. Olfactory dysfunction was negatively correlated with the emotional status of the patients. Conclusion Olfactory dysfunction appears to significantly affect the psychological status of patients with nasal obstruction, and olfactory recovery improves the patients' perception of personal benefit from septoplasty.

A comparative study of endoscopic and conventional septoplasty

Objective: Nasal obstruction due to deviated nasal septum is a common problem encountered by otolaryngologist. The standard surgical treatment for symptomatic deviated septum is septoplasty which has gone through several modifications since its inception. Study objectives were to compare the endoscopic and conventional septoplasty and to evaluate the advantage, disadvantage and complication of both the procedures. Materials and Methods: Prospective observational study was conducted in department of ENT and Head-Neck-Surgery of a tertiary care teaching hospital. Sixty patients undergoing either endoscopic septoplasty or conventional septoplasty were studied prospectively for a period of 3 months to compare the efficacy of both the techniques. Objective assessment was done by doing nasal endoscopy 90 days after the operation to note the following points- (1) Persistence of deviation (2) Spur (3) Formation of synechiae (4) Septal perforation. Result: In this study the endoscopic approach showed better overall clinical result as compared to conventional technique with lesser complication. It was noted that endoscopic septoplasty group had minimum blood loss and shorter operative time than conventional method, but difference was not statistically significant. Conclusion: Endoscopic septoplasty was founded with distinct advantage over conventional method due to better illumination, improve accessibility to remote area was founded. Further surgical experience and larger similar studies will help in coming to a greater consensus.

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal / A influência do extrato de folha de hera seca na secreção nasal após remoção de tampão nasal pós-septoplastia

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.

Resumo Introdução: Após a remoção do tampão nasal pós-septoplastia, ocorre produção de secreção nasal, predispondo infecções locais e, por vezes, sistêmicas. Objetivo: O objetivo foi determinar se a aplicação do extrato padronizado de folhas de hera seca após a remoção do tampão nasal influencia a redução da secreção nasal e diminui a ocorrência de infecções locais. Método: O estudo incluiu 70 pacientes pós-septoplastia (divididos em dois grupos iguais) cujo tampão nasal foi retirado no terceiro dia após o procedimento. O grupo I foi tratado com xarope padronizado de extrato de folha seca de hera juntamente com irrigação nasal regular por cinco dias após a remoção do tamponamento nasal, enquanto ao grupo II foi recomendado apenas lavagem nasal. No sexto dia após a remoção do tampão nasal, a quantidade de secreção nasal foi determinada pela escala EVA (escala visual analógica) e pelo exame endoscópico nasal. Resultados: O grupo tratado com xarope de extrato seco de folhas de hera apresentou secreção nasal significativamente menor tanto pela avaliação subjetiva dos pacientes (p < 0,001) quanto pelo exame endoscópico nasal (p = 0,003). O exame de acompanhamento pós-cirúrgico no sexto dia após a remoção do tampão nasal não mostrou desenvolvimento de infecção local nos pacientes do grupo I, enquanto que no grupo II, cinco apresentaram sinais de infecção local (14,29%) com necessidade de antibioticoterapia. Conclusão: O uso do extrato padronizado de folhas secas de hera após a remoção do tampão nasal reduz significativamente a produção de secreção nasal.

A Comparative Study of Conventional Septoplasty Verses Endoscopic Septoplasty

Introduction: A deviated septum can be asymptomatic or cancause functional and cosmetic abnormality. Different studieshave been proposed for correction of deviated septum butseptoplasty has been the treatment of choice. Septoplasty is amore conservative surgery and endoscopic septoplasty hasbecome increasingly popular over the last few decades.Methods: The study was carried out to compare thepostoperative results among patients of conventional andendoscopic septoplasty and to assess the efficacy ofendoscopic septoplasty with other surgeries. The present studywas conducted among 40 patients of deviated nasal septumadmitted in the department of otolaryngology of Adesh Instituteof Medical Sciences and Research, Bathinda. Patients wereselected by simple random sampling and were divided intogroup A and B, with 20 patients in each group. Group Aunderwent conventional septoplasty and group B underwentendoscopic septoplasty.Results: The male to female ratio in the present study was 3:1.Deviated nasal septum was commonly associated with inferiorturbinate hypertrophy (45%) and concha bullosa (27.5%).Postoperatively, a significant relief from the symptoms ofnasal obstruction (85%), nasal discharge (25%), headache(30%) and post nasal drip (55%) was observed in endoscopicseptoplasty. Complication rate was higher in conventionalseptoplasty. The endoscopic approach facilitates properalignment by limited and precise resection of pathologicalareas.Conclusion: Endoscopic Septoplasty provides preciseresection of the pathological areas and better illumination withlimited flap dissection and exposure.

Long-Term Evaluation of Nasal Septoplasty Followed by Inferior Turbinate Cauterization for the Treatment of Nasal Obstruction Using Objective and Subjective Methods

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 36months 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.

The effect of different nasal irrigation solutions following septoplasty and concha radiofrequency: a prospective randomized study / Efeito de diferentes soluções para irrigação nasal após septoplastia e radiofrequência das conchas nasais: estudo prospectivo e randomizado

Abstract Introduction Nasal irrigation solutions are widely used following endonasal surgery. These irrigation solutions remove infective debris and crusts, reducing the probability of synechia formation, and accelerate mucosal healing. Objective The aim of the present study was to compare the effects of nasal irrigation solutions with different contents following septoplasty and concha radiofrequency. Methods The present study was a prospective, randomized, controlled simple blind study of 120 patients who underwent septoplasty and bilateral concha radiofrequency. Patients were divided into four groups according to the nasal irrigation solution used: tap water, buffered isotonic saline, saline with xylitol, and hypertonic sea water. Patients were examined on the 7th and 15th postoperative days. A saccharine test was applied to determine mucociliary activity preoperatively and on the 7th and 15th postoperative days. Patients were asked about drying and obstruction using a 10 cm visual analog scale. In addition, patients were examined to determine the crusting score. Results There was no significant difference found in the preoperative and 7th and 15th postoperative days' mucociliary clearance times among the four groups. The crusting score was found to be significantly lower in the hypertonic sea water group (p < 0.001). Drying and obstruction on the 7th and 15th postoperative days were found to be significantly more comfortable in the hypertonic sea water group (p < 0.001). Conclusion Hypertonic sea water is the recommended irrigation solution, as it is associated with less crusting, drying, and obstruction in the nose for the postoperative period following septoplasty and concha radiofrequency.

Resumo Introdução Soluções para irrigação nasal são amplamente usadas após cirurgias endonasais. Essas soluções removem os resíduos e crostas, reduzem a probabilidade de formação de sinéquias e aceleram a cicatrização da mucosa. Objetivo O objetivo do presente estudo foi comparar os efeitos das soluçoes para irrigaçao nasal com diferentes conteudos apos septoplastia e turbinoplastia com radiofrequencia. Método O presente estudo foi um estudo cego simples, randomizado, controlado e prospectivo de 120 pacientes submetidos a septoplastia e turbinoplastia bilateral com radiofrequencia. Os pacientes foram divididos em quatro grupos de acordo com a soluçao nasal utilizada: agua da torneira, soluçao salina isotonica tamponada, soluçao salina com xilitol e agua do mar hipertonica. Os pacientes foram examinados no 7° e 15° dias do pos-operatorio. O teste de sacarina foi utilizado para determinar a atividade mucociliar pre-operatoria e no 7° e 15° dias do pos-operatorio. Os pacientes foram questionados sobre a sensaçao de secura e obstruçao nasais utilizando uma escala visual analógica de 10 cm. Alem disso, os pacientes foram examinados para determinar o escore em relaçao a crostas. Resultados Não houve diferença significativa entre o pré-operatório e o sétimo e 15° dias do pós-operatório dos tempos de clearance mucociliar entre os quatro grupos. Verificou-se que o escore em relação a crostas foi significativamente menor no grupo que usou água do mar hipertônica (p < 0,001). As sensações de secura e obstrução nasais no sétimo e 15° dias do pós-operatório mostraram-se significativamente mais confortáveis no grupo água do mar hipertônica (p < 0,001). Conclusão A água de mar hipertônica é a solução de irrigação recomendada, pois está associada a menor incidência de crostas, secura e obstrução nasais no pós-operatório de cirurgia de septoplastia e das conchas nasais com radiofrequência.

The seroprevalence of hepatitis B, hepatitis C, and human immunodeficiency virus in patients undergoing septoplasty / Soroprevalência de hepatite B, hepatite C e vírus da imunodeficiência humana em pacientes submetidos a septoplastia

Abstract Introduction Worldwide, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus are major health problems. Healthcare workers are at risk of transmitting blood-borne viruses, and surgeons have a higher risk of exposure to blood and higher rates of percutaneous injury than other healthcare workers. Septoplasty is among the 3 most commonly performed otolaryngological surgeries worldwide. Objective To determine the seroprevalence of Hepatitis B surface antigen, Hepatitis C virus antibody, and Human Immunodeficiency Virus antibody in patients undergoing septoplasty with and without turbinate surgery under general anesthesia, and to determine if preoperative testing should be performed in such patients. Methods This retrospective cross-sectional study included 3731 patients that underwent septoplasty with and without turbinate surgery between January 2005 and July 2015. HBsAg, anti-HCV, and anti-HIV seropositivity in the patients was evaluated retrospectively. Results Mean age of the patients was 36 years (range: 11-81 years). In all, 117 (3.6%) patients were positive for HBsAg, 12 (0.3%) were positive for anti-HCV, and 7 (0.2%) were positive for anti-HIV. Conclusions Education of healthcare workers combined with routine preoperative serological testing in patients undergoing septoplasty under general and local anesthesia are needed to increase awareness of hepatitis B and C, and HIV infection among healthcare workers and patients in order to decrease the transmission rate.

Resumo Introdução No mundo todo, os vírus da hepatite B (VHB), da hepatite C (VHC) e da imunodeficiência humana (HIV) são problemas de saúde importantes. Os profissionais de saúde correm o risco de contrair vírus transmitidos pelo sangue e os cirurgiões têm um maior risco de exposição ao sangue e taxas mais elevadas de lesões percutâneas do que os outros profissionais de saúde. A septoplastia está entre as três cirurgias otorrinolaringológicas mais comumente feitas em todo o mundo. Objetivo Determinar a soroprevalência de anticorpos HBsAg, anti-HCV e anti-HIV em pacientes submetidos a septoplastia com e sem cirurgia de concha nasal sob anestesia geral e determinar se deve ser feito teste pré-operatório nesses pacientes. Método Este estudo transversal retrospectivo incluiu 3.731 pacientes submetidos à septoplastia com e sem cirurgia de concha nasal entre janeiro de 2005 e julho de 2015. A soropositividade para HBsAg, anti-HCV e anti-HIV nos pacientes foi avaliada retrospectivamente. Resultados A idade média dos pacientes foi de 36 anos (intervalo: 11-81); 117 (3,6%) foram positivos para HBsAg, 12 (0,3%) para anti-HCV e sete (0,2%) para anti-HIV. Conclusões A educação de profissionais de saúde combinada com testes sorológicos rotineiros pré-operatórios em pacientes submetidos a septoplastia sob anestesia geral e local é necessária para aumentar a conscientização sobre a hepatite B e C e a infecção pelo HIV entre profissionais de saúde e pacientes para diminuir a taxa de transmissão.

Common Sites, Etiology, and Solutions of Persistent Septal Deviation in Revision Septoplasty

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.

Effectiveness of Polyvinyl Acetate Sheeted with Carboxymethyl Cellulose as a Packing Material after Septoplasty

BACKGROUND AND OBJECTIVES: Although polyvinyl acetate (Merocel®) has been widely used as a packing material after septoplasty, removable nasal packing can increase patient discomfort, local pain, and pressure. Furthermore, the removal of nasal packing has been described as the most uncomfortable and distressing feature associated with septoplasty. The purpose of this study was to investigate the efficacy of polyvinyl acetate with carboxymethyl cellulose sheet (Rhinocel®) nasal packing on patient subjective symptoms, degree of bleeding, hemostasis, and wound healing following septoplasty. SUBJECTS AND METHOD: Forty patients with nasal septum deviation requiring septoplasty were included. Following surgery, one nasal cavity was packed with Rhinocel® and the other one with Merocel®. Patient subjective symptoms while the packing was in situ, hemostatic properties, pain on removal, degree of bleeding on removal, duration of hemostasis after removal, postoperative wound healing, and the cost of the pack were evaluated. RESULTS: Although the two types of packing materials were equally effective in controlling postoperative bleeding after septoplasty, Rhinocel® was significantly more comfortable while in situ and less painful on removal than Merocel®, which was associated with significantly more bleeding on removal and so more time was needed to control hemorrhage. There was no significant difference in postoperative wound healing or pack cost. CONCLUSIONS: The use of Rhinocel® after septoplasty has less discomfort, greater patient satisfaction, and less bleeding on removal with no adverse reactions compared to Merocel® packing. Therefore, Rhinocel® may be a useful packing material after septoplasty.