Evaluation of the Results of Septum Extension Batten Graft in Patients Referred for Septorhinoplasty

Abstract Introduction Correction of caudal septal deviations has always been a challenging subject in septorhinoplasty. The septum batten extension graft (SBEG) is a new graft that has potential properties in rhinoplasty. However, few reports have evaluated the surgical outcomes of this technique. Objective The purpose of this study was to evaluate the effectiveness of SBEG in correcting caudal septal deviation. Methods This cross-sectional study was conducted on patients with caudal septal deviation undergoing septorhinoplasty using SBEG at 2 different hospitals in 2019. We then retrospectively reviewed medical records and photographs of 50 patients at the preoperative period, as well as at 1-month, and 12-month postoperatively. Gross changes in nasolabial angle, columellar show, nasal tip projection, and dorsal nasal deviation were evaluated by a photographic analysis method, and nasal obstruction was assessed by patient satisfaction with breathing. Results There was a significant difference between the mean nasolabial angle and columellar show at 1 and 12-months postoperatively, compared with the previous values (p < 0.0001). The nasolabial angles were in a favorable position with an increase of 12 to 15 degrees compared with the preoperative state. The columellar show also improved by an average of 1.2 mm and was in good condition. The postoperative dorsal nasal deviation was significantly reduced, and projection was significantly increased (3.521 ± 0.087 mm vs. 0.719 ± 0.028; p < 0.0001; p < 0.001 ). Moreover, this method had a significant favorable effect on nasal obstruction (p = 0.049). Conclusion Our results showed that septorhinoplasty using SBEG is useful for correcting caudal septal deviation, with favorable surgical outcomes, and it has responded well to all five aforementioned criteria.

Influence des facteurs épidémio-cliniques dans le résultat fonctionnel de la septoplastie: étude de 250 cas / Epidemiological and clinical predictive factors of success in septoplasty: Study of 250 patients

to describe the epidemiological and clinical aspects, to evaluate the surgical result and to identify the prognostic factors for the success of septoplasty. Methods: It was a retrospective study including 250 patients operated on for a septoplasty collected over a 6-yearperiod. The evaluation of our results was made using 2 tools: NOSE scale and the visual satisfaction scale. Results: In our series, there was a male predominance with a sex ratio of 1.4. The mean age of the patients was 32.7 years. The medical history was dominated by allergic rhinitis in 38.4% of cases. Nasal trauma was noted in 45.2% of cases. A subjective quantification of respiratory discomfort by the NOSE score made it possible to divide them into 3 groups:Group 1: Severe ON: 65.2% of cases; Group 2: Moderate ON: 31.6% of cases; Group 3: Mild ON: 3.2% of cases. Our analytical study of the epidemiological and clinical factors that may influence the functional results showed that: Severe or moderate overall discomfort, severe ON (NOSE scale> 50) or moderate (NOSE scale between 26 and 50), DS classified zone I, II, III according to the Cottle classification, a quasi-obstructive deviation were considered as a predictor of the success of septoplasty. Conclusion: Several factors can influence the results of a septoplasty that must be considered before any surgical indication.

Relationship between nasal septum morphology and nasal obstruction symptom severity: computed tomography study / Relação entre a morfologia do septo nasal e a gravidade dos sintomas de obstrução nasal: estudo de tomografia computadorizada

Abstract Introduction The impact of the nasal septum morphology on the severity of obstruction symptoms has not been fully explored. Objective This study aimed to investigate whether the morphology of the deviated nasal septum assessed by computed tomography may explain nasal obstruction severity. Methods The study included 386 patients who were referred to the computed tomography examination of the paranasal sinuses. Patient selection criteria were the absence of facial anomalies, facial trauma, nasal surgery, and sinonasal tumors. Computed tomography images were used to estimate deviated nasal septum prevalence, the prevalence of Mladina's seven types of deviated nasal septum, and to measure the deviated nasal septum angle. Nasal obstruction severity was assessed by the nasal obstruction symptom evaluation, NOSE scale. The relationship between NOSE score, deviated nasal septum morphology, and deviated nasal septum angle was performed by a statistical regression model on the reduced sample of 225 patients. Results The prevalence of deviated nasal septum was 92.7%. Type 7 deviated nasal septum was the most frequent (34.2%) followed by type 5 (26.2%) and type 3 (23.6%). The worst NOSE scores were recorded in the type 2 deviated nasal septum (45.00 ± 28.28). The mean deviated nasal septum angle in patients with nasal obstruction was 8.5° ± 3.24. NOSE scores were not significantly associated with deviated nasal septum types and angles. Conclusion Patients with different types of deviated nasal septum have different NOSE scores. Computed tomography morphology of the deviated nasal septum could not fully explain the severity of nasal obstruction.

Resumo Introdução O impacto da morfologia do septo nasal na gravidade dos sintomas obstrutivos nasais ainda não foi totalmente explorado. Objetivo Investigar se a morfologia do desvio do septo nasal avaliada pela tomografia computadorizada pode explicar a gravidade da obstrução nasal. Método O estudo incluiu 386 pacientes encaminhados para exame tomográfico de seios paranasais. Os critérios de seleção dos pacientes foram: ausência de anomalias faciais, trauma facial, cirurgia nasal e tumores nasossinusais. Imagens de tomografia computadorizada foram usadas para estimar a prevalência de desvios do septo nasal, a prevalência dos sete tipos de desvios do septo nasal de Mladina e para medir o ângulo do desvio septal. A gravidade da obstrução nasal foi avaliada pela escala Nasal Obstruction Symptom Evaluation, NOSE. A relação entre o escore da NOSE, a morfologia e o ângulo do desvio septal foi verificada por um modelo de regressão estatística em uma amostra reduzida de 225 pacientes. Resultados A prevalência de desvios do septo nasal foi de 92,7%. O desvio septal do tipo 7 foi o mais frequente (34,2%), seguido do tipo 5 (26,2%) e do tipo 3 (23,6%). Os piores escores da escala NOSE foram registrados nos desvios septais tipo 2 (45,00 ± 28,28). O ângulo médio do desvio em pacientes com obstrução nasal foi de 8,5° ± 3,24. Os escores da escala NOSE não foram significativamente associados aos tipos e ângulos do desvio septal. Conclusão Pacientes com tipos diferentes de desvios do septo nasal apresentam diferentes escores na escala NOSE. A morfologia do desvio septal à tomografia computadorizada não conseguiu explicar totalmente a gravidade da obstrução nasal.

Allergic rhinitis improvement after septorhinoplasty in a sample of allergic rhinitis patients with septal deviation: a quasi-experimental study

ABSTRACT BACKGROUND: Allergic rhinitis (AR) is a chronic inflammatory disease that affects almost 30% of the adult population. OBJECTIVE: To describe and compare the evolution of symptoms in patients diagnosed with AR and septal deviation prior to and following septoplasty (STP). DESIGN AND SETTING: Quasi-experimental study developed in A Coruña University Hospital. METHODS: Patients aged 18-65 years who had been diagnosed with AR and septal deviation were recruited. Obstruction airflow was evaluated before and after surgery, by means of anterior rhinomanometry (RNM). Severity symptoms and quality of life were assessed using a visual analogue scale (VAS) and the ESPRINT questionnaire, respectively. RESULTS: A total of 50 subjects underwent STP and 42 were included in this study. Their mean age at the time of surgery was 34.16 ± 9.74 years (range 18-64). Significant reductions in mean VAS and ESPRINT were observed after surgery (P < 0.01). These outcomes were considered to represent an overall improvement in quality of life. The RNM results also improved significantly, from mean values of 478.07 ± 165.4 cm3/s before STP to 826.4 ± 175.5 cm3/s afterwards (P < 0.01). CONCLUSIONS: The negative correlations of VAS and ESPRINT with RNM, from before and to after STP, demonstrate the efficacy of scales and questionnaires as objective methods for determining obstruction in the absence of rhinomanometry. Patients with allergic rhinitis and septal deviation showed improvements in obstruction severity and medication use after STP.

The Role of Imaging in the Preoperative Assessment of Patients with Nasal Obstruction and Septal Deviation-A Retrospective Cohort Study

Abstract Introduction Isolated nasal obstruction (INO) is a common complaint of multiple etiology. The preoperative evaluation of patients presenting with nasal obstruction and deviated nasal septum (DNS) does not typically include imaging. The benefits of performing computed tomography (CT) in the preoperative setting are inconclusive. Objective Assessing the contribution of preoperative CT to the surgical treatment of non-sinusitis patients presenting with INO and DNS. Methods A retrospective cohort study on patients referred to surgery for nasal obstruction due to DNS or turbinate hypertrophy between 2006 and 2015. Data was retrieved from patients' medical charts. The CT scans and clinical data were reassessed by a second surgeon blinded to the patients' clinical course. Results Seventy of the 843 patients (8.06%) who underwent endoscopic sinonasal procedures during the study period had presented with INO and met the inclusion criteria. Thirty-eight (55.88%) of them underwent CT scans during their preoperative assessment. Modification of the initial preoperative planning based on the radiological findings was required in 32 cases (84.2%). When reassessed by a second blinded surgeon, 58% of cases required surgical modification rather than classical submucosal resection of nasal septum and turbinate reduction (P = 0.048). Conclusion Computed tomography was found beneficial in the preoperative planning for patients with INO. The original surgical plan based upon physical examination findings was modified based on radiological findings in 84.2% of the patients.

Evaluation of choroidal thickness measurements in patients with marked nasal septal deviation / Avaliação das medidas da espessura da coroide em pacientes com acentuado desviode septo nasal

Abstract Introduction: Chronic upper airway obstruction due to marked nasal septal deviation may cause chronic hypoxia. It may change the balance of the sympathetic-parasympathetic system and may affect blood flow in the choroid. Objective: To assess choroidal thickness measurements of patients with marked nasal septal deviation. Methods: The patients who had nasal obstruction symptoms diagnosed with marked nasal septal deviation by anterior rhinoscopy and nasal endoscopy and scheduled for septoplasty were included in the study. The control group consisted of age, sex and body mass index-matched healthy individuals. The choroidal measurements at the central fovea and 1000 µm away from the fovea in the nasal and temporal regions were performed using enhanced depth imaging optical coherence tomography. Results: In the study group, 52 eyes of 26 patients with a mean age of 26.34 ± 8.14 years were examined. In the control group, 52 eyes of 28 healthy individuals with a mean age of 26.69 ± 7.84 years were examined. There was no statistically significant difference in terms of choroidal thickness measurements between the groups (p > 0.05). Conclusion: Our results suggest that marked nasal septal deviation may not lead to significant hypoxia and sympathetic activation, resulting in deterioration of the choroidal blood flow and consequent choroidal thickening.

Resumo Introdução: A obstrução crônica das vias aéreas superiores devido a acentuado desvio do septo nasal pode causar hipóxia crônica. Pode alterar o equilíbrio do sistema simpático-parassimpático e afetar o fluxo sanguíneo na coroide. Objetivo: Avaliar as medidas da espessura da coroide em pacientes com acentuado desvio de septo nasal. Método: Foram incluídos no estudo pacientes que apresentavam sintomas de obstrução nasal, com diagnóstico de acentuado desvio de septo realizado por rinoscopia anterior e endoscopia nasal, e com septoplastia programada. O grupo controle consistiu de indivíduos saudáveis pareados por idade, sexo e índice de massa corporal. As medidas da coroide na fóvea central e a 1.000 µm da fóvea nas regiões nasal e temporal foram feitas com tomografia de coerência óptica com imagem de profundidade melhorada. Resultados: No grupo de pacientes, 52 olhos de 26 pacientes com média de 26,34 ± 8,14 anos foram examinados. No grupo controle, 52 olhos de 28 indivíduos saudáveis com média de 26,69 ± 7,84 anos foram examinados. Não houve diferença estatisticamente significante em termos de medidas da espessura da coroide entre os grupos (p > 0,05). Conclusão: Nossos resultados sugerem que desvios do septo nasal acentuados podem não levar à hipóxia significativa e ativação simpática, resultar na deterioração do fluxo sanguíneo coroidal e consequente espessamento da coroide.

Radiologic study of the nasal septal swell body and its relationship to septal deviation

Objective@#To compare the radiographic features of the nasal septal swell body (NSB) with the laterality of nasal septal deviation and investigate whether there is a correlation between the severity of the septal deviation and difference in NSB size.@*Methods@#Design: Retrospective Observational Study. Setting: Tertiary Private University Hospital. Participants: 30 paranasal sinus computerized tomography scans from January to October 2017.@*Results@#A septal deviation was present in 60% of the subjects. In 78% of cases with septal deviation, the NSB was noted to be significantly larger on the side opposite the nasal septal deviation (p < .05). @*Conclusion@#The correlation between the severity of the septal deviation and difference in NSB size had a value of (r = 0.37) therefore, no positive correlation was established. Subjects with almost symmetric NSB measurements tend to have no septal deviation. On the other hand, the NSB is more prominent contralateral to a septal deviation.

Anatomical Variations in Nose and Paranasal Sinuses in Patients Presenting with Chronic Rhinosinusitis

Introduction: The anatomy of organs of ENT is a herculeantask to understand and evaluate in the whole human anatomy.Knowledge about the possible variabilities is never complete,since there is always a scope to understand better and knowmore. Many studies have been undertaken in the past tounderstand better the already existing knowledge about thevarious anatomical details in the nose and paranasal sinusescausing chronic rhinosinusitis. The present study was carriedto know the details of variations in anatomy of nose andparanasal sinuses causing chronic sinusitis.Material and Methods: A Cross sectional study conductedover a period of two years, in patients presenting to ENTOPD with symptoms and signs and chronic rhinosinusitis, ina setting of tertiary hospital, with the requisite investigativeprotocols. Patients meeting the inclusion criteria were includedin the study and subjected to the prescribed interventions.Results: Observations gathered from this study are- of the65patients included, 86.1% had septal deformities, 58.4% hadConcha bullosa, 52.3% had Agger Nasi, 15.3% had HallerCell, 13% had Paradoxical Middle Turbinate, 4.6% hadEverted Uncinate Process, 3% had Enlarged Bulla.Conclusion: Sinonasal anatomy is different in each individual,with various combined variations also.

Nasal septal angle deviation: effect on lateral wall in nasal obstruction

Background: Deviation of the nasal septum (DNS) refers to the convexity of the septum to one side disturbing the nasal physiology with obstructed nasal breathing leading to lateral nasal wall abnormalities and paranasal sinuses (PNS) mucosal disease. Knowledge of nasal morphological parameters plays an important role in planning successful nasal surgery. Our aim was to evaluate the angle of septal deviation (ASD) on CT scan and study its influence on the lateral nasal wall abnormalities and PNS mucosal disease.Methods: A prospective cross-sectional observational study was conducted on 130 patients with clinical evidence of DNS and chronic sinusitis. The direction and severity of DNS was recorded on CT scan along with evaluation of lateral nasal wall and sinus mucosal abnormalities.Results: Increasing ASD had statistically significant correlation with the lateral nasal wall abnormalities, most commonly, contralateral middle and inferior turbinate hypertrophy (p-value <0.0001). No significant association was found with the incidence of ipsilateral or contralateral osteomeatal complex (OMC) obstruction and sinus mucosal disease.Conclusions: The direction and severity of septal deviation has significant impact on contralateral middle and inferior turbinate hypertrophy. The analysis of these ancillary pathologies can be of great help to the surgeon in better management of patients with nasal obstruction.

Usefulness of Unilateral Nasal Packing for Recurred Septal Deviation within a Month after Septoplasty: Preliminary Study

BACKGROUND AND OBJECTIVES: To investigate the effect of unilateral nasal packing on the correction of recurred septal deviation after septoplasty. MATERIALS AND METHOD: We analyzed 12 patients who had undergone septoplasty and developed septal deviation recurrence. Polyvinylacetate and Vaseline gauze were inserted into the nasal passage on the convex side of the septum for 4 days in order to shift the septum to the midline. We analyzed nasal symptoms, acoustic rhinometric results, and endoscopic findings before and after unilateral packing in order to evaluate the treatment outcomes. RESULTS: Ten (83%) out of 12 patients showed improvements in nasal obstruction, acoustic rhinometric results, and endoscopic findings. The mean visual analogue scale (VAS) score for nasal obstruction was 5.25±1.60 before and 2.08±1.50 after packing (p=0.004). The minimal cross-sectional area (MCA) improved from 0.17±0.14 to 0.27±0.13 (p=0.002), and the mean endoscopic score improved from 2.0±0.43 to 1.08±0.29 (p=0.002). CONCLUSION: Unilateral nasal packing was a safe, easy, and effective method for correcting recurred septal deviation after septoplasty.

Relation between Nasal Septal Deviation and Pneumatization of Mastoid Air Cells – A Computerised Tomographic Study

Introduction: The environment of middle ear cavity gets regulated mostly by pneumatized mastoid air cell system (MACS). Many theories exist that details the process of pneumatization of this MACS. The nasal septal deviation (NSD) has been shown to be instrumental in influencing pneumatization of paranasal sinuses to varied degrees. The effect of NSD on the pneumatization of MACS remains questionable due to limited literature available. And so this study was done to find the relation between the side of NSD and extent of Pneumatization of MACS on that side by computerized tomographs of Paranasal sinus region. Subjects and Methods: 120 CT images of paranasal region from archives of radiology department were studied for NSD. The NSD was classified according to the nasal septal angle. The extent of pneumatization of mastoid region was studied and classified. The relation between severe NSD and extent of mastoid pneumatization was noted. Results: NSD was found to be right sided in 90% cases studied and 20, 45, 55 were seen belonging to group I, II and III NSD respectively. The mean NSA was found to be 13.5o. Mastoid region was observed to be hypo pneumatized in the side of NSD in 42 cases of group III NSD. Conclusion: The findings of the study puts forth the need for assessment of NSD and planning possible correction of NSD prior to middle ear and mastoid surgeries for successful results.

Effect of Septoplasty on Mean Platelet Volume in Patients of Deviated Nasal Septum.

Background: Mean platelet volume corresponds to average size of platelets and studies proved that large platelets are enzymatically and metabolically more active and have prothrombotic potential. Chronic upper airway like marked nasal septal deviation leads to higher Mean platelet volume and vice versa septoplasty operation lowers the volume of the platelets over a period of time and hence reduces other associated comorbidities. Objectives: This study was done with an aim to analyze the effect of Septoplasty on Mean Platelet Volume Levels in patients with Marked Nasal Septal Deviation. Methods: A prospective study was done in a total of 50 patients who were selected from ENT OPD and ENT Ward of Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh after proper history and examination. Results: Data obtained from preoperative and postoperative blood investigation were analysed using paired t-test and it was statistically proved that after Septoplasty, Mean Platelet Volume was significantly lowered in patients who had Marked Nasal Septal Deviation. Conclusion: Septoplasty plays an important role in reducing the MPV value in cases with Marked nasal septal deviation and thus other comorbid conditions can be prevented by doing septoplasty in these patients.

Should the High Septal Deviation be Corrected to Improve Nasal Obstruction During Septal Surgery?

BACKGROUND AND OBJECTIVES: High dorsal deflection of the nasal septum around cartilage or the perpendicular plate is technically difficult to correct. The objective of this study was to assess whether correction of high septal deviation during septoplasty is necessary to improve nasal airflow. PATIENTS AND SURGICAL METHOD: Twenty-one patients with high septal deviation around the septal cartilage or the perpendicular plate were included in this study. In order to improve nasal obstruction, septoturbinoplasty was performed, but high septal deviation was not corrected. Subjective and objective improvements were evaluated using the visual analogue scale and acoustic rhinometry 1 month before and 3 months after surgery. RESULTS: After correction of nasal septum deviation except high septal deviation and reduction of turbinate mucosal volume, postoperative nasal volume and minimum cross-sectional area were significantly increased. Subjective symptom scales for nasal obstruction, rhinorrhea, sneezing, and posterior nasal drip were considerably improved after limited septoturbinoplasty in patients who still had high dorsal deflection of the nasal septum. CONCLUSION: Our findings suggest that limited septoturbinoplasty without excessive resection of high dorsal deflection of the nasal septum can improve nasal airflow and reduce subjective symptoms, including nasal obstruction.

Correction of Caudal Septal Deviation: Septal Batten Graft with a Bioabsorbable Plate / 대한이비인후과학회지

Caudal septal deviation is difficult to correct due to elasticity of cartilage. Septal batten graft is a useful surgical technique used for correction of caudal septal deviation and the septal cartilage is used mainly for graft material. However, in some cases (i.e., revision surgery), its quality may be insufficient or inadequate to be useful. Septal batten graft with a bioabsorbable plate can be an alternative in these cases. The use of a bioabsorbable plate connected with septal cartilage would facilitate surgical correction of severe caudal septal deviation and offer mechanical stability until the manipulated cartilage heals. With a brief review of the literature, we describe our experience of treating a 29-year-old woman with severe caudal septal deviation and clinical summary of 7 patients who underwent septal batten graft using a bioabsorbable plate for caudal septal deviation.

Radiological Examinations of Inferior Turbinate in Patients with or without Deviated Nasal Septum by Using Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to analyse the radiological anatomic dimensions of the inferior turbinate in patients without deviated nasal septum and compare it to those in the patients with deviated nasal septum using computed tomography. SUBJECTS AND METHOD: The OMU CTs of 98 patients, 196 nostrils with or without deviated nasal septum were evaluated (control group: 42 patients, deviated septum group: 56 patients). The analysis of the CT scans contained the mucosal and bony length, mucosal width of the turbinate and the anterior and posterior mucosal overlay. And also evaluated the cross-sectional area and the type of inferior turbinate bone. RESULTS: All subjects were divided into three groups: the concave, convex, and control groups. The correlations of fifteen measuring points such as anterior, middle and posterior medial mucosal thickness, total width, bone width, medial mucosa width of inferior turbinate, and area of inferior turbinate bone were significantly different among the groups (concave side>con-trol group>convex side). Of the demographic factors, age was negatively correlated with mucosa and bone length. Types of inferior turbinate bone were as follows: lamella type (38%), combined type (37%), compact type (25%). CONCLUSION: There were statistical differences in some measured anatomical points among the concave, convex, and control groups. Greater septum deviation was correlated with greater degree of hypertrophysm of the inferior turbinate. The age of patients showed negative correlation with inferior turbinate length. Most frequent type of inferior turbinate was lamella type. The results of this study may provide important information when considering turbinate surgery.

Headache Characteristics in Rhinologic Patients and the Role of Surgical Treatment

OBJECTIVES: Even though headache is a common symptom in patients with chronic rhinosinusitis (CRS) or nasal septal deviation (NSD), there are very few recent reports investigating headache characteristics in rhinologic patients. Therefore, we investigated the headache characteristics and differences in CRS and NSD patients who were diagnosed by computerized tomography and endoscopic exams. METHODS: We enrolled 257 patients who had undergone nasal and sinus surgery between January 2012 and December 2013. The subjects were divided into a CRS group (n=147) and NSD group (n=110). They were asked to fill out a Sinonasal Outcome Test (SNOT-20) and questionnaire about pre-operation headaches (1 day prior) and post-operation headaches (1 month after) they experienced, to evaluate their sinonasal symptoms and headache characteristics. RESULTS: There was no significant pre-operative difference in rhinologic symptoms and headache characteristics between the CRS and NSD groups. Females experienced more headaches. Both groups reported significant improvements to their headaches after surgery; however, we found no significant differences in the degree of improvement between the two groups. CONCLUSIONS: There was no significant difference in the headache characteristics and the degree of post-operative improvement between the CRS and NSD groups. Surgical treatments appear to reduce headaches in patients with rhinologic diseases.

Correction of Caudal Septal Dislocation or Subluxation with Excision and Suturing the Cartilage to the Premaxilla Bone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is difficult to correct anterior nasal septal dislocation and subluxation. This study reviewed our surgical technique for correcting septal dislocation and subluxation. SUBJECTS AND METHOD: This retrospective study reviewed the medical records of 20 patients who underwent septal reconstructive suturing of the cartilage to the premaxilla. Acoustic rhinometry, endoscopic pictures, visual analogue scale (VAS) scores, and patient satisfaction were evaluated. RESULTS: The results of acoustic rhinometry showed that there was significant (p<0.05) improvement in the minimum cross-sectional area on both sides of the nasal cavity. The nasal cavity volume was also increased bilaterally, although not significantly on the convex side (convex side, p=0.108; concave side, p=0.007). Thirteen patients had complete correction of the septal deformity on the endoscopic pictures and seven had incomplete correction. The VAS score for nasal obstruction was decreased significantly (p<0.05). Most patients (85%) felt satisfied with the surgery. Only one patient complained about a mild deformity of the external nose. No other major complications were encountered. CONCLUSION: The correction of caudal septal dislocation or subluxation with the excision of excessive septal cartilage and suturing the cartilage to the premaxilla are both successful methods for treating septal deformities.

Evaluation of the lateral wall of the nasal cavity in relation to septal deviation / Evaluación de la pared lateral de la cavidad nasal en relación con la desviación septal

The objective of this study was to evaluate the relationship between variations of the lateral wall of the nasal cavity and septal deviation (SD). Coronal and axial paranasal sinus CT images of 115 individuals (65 females, 50 males) were reviewed and the presence of pneumatisation and hypertrophy of the conchae was evaluated. Pneumatisation of the concha was classified as lamellar concha bullosa (LCB), bulbous concha bullosa (BCB), or extensive concha bullosa (ECB). If bulbous and extensive conchae and hypertrophic conchae were bilateral the side on which it was greatest was accepted as the dominant concha. The relationship between these variations and nasal septum deviation was also taken into account. Eighty-six (74.8 percent) of the 115 subjects had SD. Of these, 20 were not affected by the size of the middle nasal concha (MNC) or inferior nasal concha (INC). Thirty-four cases had dominant MNC, 20 had dominant INC, and 11 had both dominant MNC and dominant INC, and all of which had SD towards the opposite side. In one case there was SD towards the side in which the MNC was dominant. Our data indicate that coexistence of pneumatisation or hypertrophy of the conchae and SD was more common in adults compared to the results of similar studies conducted with a wide range of age groups, including children. Thus the presence of SD together with a large concha increases with age. A prospective study, which will include infants, will elucidate the relationship between conchae and SD.

El objetivo del estudio fue evaluar la relación existente entre las variaciones de la pared lateral de la cavidad nasal y la desviación septal. Se revisaron los senos paranasales en imágenes de TC de 115 individuos (65 mujeres, 50 varones) coronales y axiales y se evaluó en ellas la presencia de neumatización e hipertrofia de los conchas nasales. La neumatización de la concha fue clasificada como concha laminar bulosa (CLB), concha bulbosa bulosa (CBB), o concha extensa bulosa (ECB). Conchas nasales bulbosa y extensa y conchas hipertróficas eran bilaterales siendo el lado en que esta era más grande como la concha dominante. También se tuvo en consideración la relación entre estas variacio nes y la desviación del tabique nasal. Ochenta y seis (74,8 por ciento) de los 115 sujetos tenían desviación septal. De éstos, 20 no se vieron afectados por el tamaño de la concha nasal media (CNM) o concha nasal inferior (CNI). Treinta y cuatro de los casos tenía CNM dominante, 20 tenían CNI dominante, y 11 tenían tanto CNM dominante y CNI dominante, todos los cuales tenían desviación septal hacia el lado opuesto. En un caso hubo desviación septal hacia el lado en el que el CNM era dominante. Nuestros datos indican que la coexistencia de neumatización o hipertrofia de conchas nasales y la desviación septal es más común en adultos en comparación con los resultados de estudios similares realizados con una amplia gama de grupos etarios, incluidos los niños. Así, la presencia de desviación septal, junto con una gran concha aumenta con la edad. Un estudio prospectivo, que incluirá los bebés, aclarará la relación entre concha nasal y desviación septal.

The Effect of Dacryocystorhinostomy and Septoplasty Combination Surgery for Lacrimal Obstruction with Septal Deviation

PURPOSE: To evaluate the clinical effect of endonasal dacryocystorhinostomy (DCR) and septoplasty combination surgery for lacrimal obstruction in patients with nasal septal deviation. METHODS: The study group consisted of 24 eyes of 24 lacrimal obstruction patients with nasal septal deviation who had undergone endonasal DCR combined with septoplasty from 2006 to 2012. The types of lacrimal obstruction included nasolacrimal duct obstruction (18 cases), common canaliculus obstruction (5 cases) and lower lacrimal duct obstruction (1 case). The operations' procedure was as follows: first, an otorhinolaryngologist performed septoplasty and then, an ophthalmologist performed endonasal DCR. For catamnesis observation after the surgery, the operations' results and nasal complications were retrospectively analyzed. RESULTS: A total of 24 eyes of 24 patients were included in the present study. Eight patients were males, 16 patients were females and the mean patient age was 52.1 years. During 15.5 months of catamnesis, loss of epiphora was observed in 20 cases, improvement in epiphora was found in 3 cases, and the functional and anatomical success rate was 95.8% (23/24). Eight cases of postoperative complication were observed, 7 cases of granuloma were found in the bony ostium and surrounding area, and 1 case of synechia was found in the nasal cavity. CONCLUSIONS: The combination surgery of endonasal DCR and septoplasty provides a wider surgical view, allowing for an easier nasal cavity treatment, rendering the operation and after-care less difficult, as well as reducing the risk of surrounding tissue damage. This method is adequate for preventing complications after surgery and offers a better prognosis.

Correction of bent cartilaginous vault / 中华医学美学美容杂志

Objective To seek a method to correct the bent cartilaginous vault.Methods This study included 18 patients (12 women,6 men,aged 18-45 years) suffering from the bent cartilaginous vault with the various degrees of nasal obstruction from January 2005 to December 2009.A open surgical approach was adopted to allow correction of the dorsal and caudal deviations of the nasal septum without weakening its structural support to the dorsum or nasal tip.The approach depended on full mobilization of deviated cartilage,removal of the deviated part of the quadrangular cartilage,followed by straightening of a caudal septal extension graft and its fixation in the corrected position.Rhinoplasty was performed to correct bent cartilaginous vault.Results A satisfactory result was gained in all clinical cases,except a septum still to remain light tilt (not affect the breathing function).Follwing-up for 3-24 months,all cases dorsum of nose was straighten and nasal septum situated mediately.All patients indicated cosmetic satisfaction of nasal dorsum and tip and improvement in nasal obstruction.No nasal deformity and septum tresis was found in all patients.Conclusions ()pen rhinoplasty is a helpful technique in the treatment of the bent cartilaginous vault.Septal surgery is necessary in the patients with cartilage framework,not only to improve breathing but also to achieve a straight,symmetrical and external nose as well.