Sandwich graft technique outcomes in medium and large size nasal septal perforations / Resultados da técnica de enxerto sanduíche em perfurações do septo nasal de médio e grande porte

Abstract Introduction: Surgical treatment of medium and large sized nasal septal perforation is challenging. Techniques with and without interposition grafts are used. Objective: The aim of this study is to explain how we apply the sandwich graft technique that we use in medium and large nasal septal perforations as well as to present the results. Methods: We retrospectively reviewed the patients who were operated with the sandwich graft technique between January 2014 to December 2018 and followed up for at least 6 months. The demographic data, symptom scores, examination, and surgical findings of the patients were taken from the hospital records. Surgical outcomes were presented according to both perforation etiologies (idiopathic or iatrogenic) and sizes (Group A: < 2cm, Group B: ≥ 2 cm). Results: We reviewed 52 cases and 56 surgeries. The average diameter of the perforations was 19.2 mm. The success rate after initial surgeries was 84.6% (44/52). After 4 revision surgeries, the perforation was closed in 88.5% of the cases (46/52). Success rates for Group A and Group B were 90.0% and 86.4%, respectively (p = 0.689). The success rates in idiopathic and iatrogenic cases were 93.3% and 86.5%, respectively (p = 0.659). Conclusion: This study showed that the success rate of sandwich graft technique was higher in medium-sized perforations than large-sized ones and in idiopathic perforations compared to iatrogenic ones, but the latter rate was not statistically significant. This demonstrated that perforation size was not as important in the sandwich graft technique as in flap techniques.

Resumo Introdução: O tratamento cirúrgico da perfuração do septo nasal de médio e grande porte ainda é um desafio. Várias técnicas são usadas, com e sem enxertos de interposição. Objetivo: Descrever o uso da técnica de enxerto sanduíche que usamos nas perfurações de septo nasal de médio e grande porte e apresentar os resultados. Método: Revisamos retrospectivamente os prontuários de pacientes que foram operados com a técnica de enxerto sanduíche entre janeiro de 2014 e dezembro de 2018, com acompanhamento por pelo menos seis meses. Os dados demográficos, escores de sintomas, exames e achados cirúrgicos dos pacientes foram extraídos dos registros hospitalares. Os resultados cirúrgicos foram apresentados de acordo com as etiologias (idiopática ou iatrogênica) e os tamanhos da perfuração (Grupo A: < 2cm, Grupo B: >2cm). Resultados: Revisamos 52 casos e 56 cirurgias. O diâmetro médio das perfurações foi de 19,2 mm. A taxa de sucesso após as cirurgias iniciais foi de 84,6% (44/52). Após quatro cirurgias de revisão, a perfuração foi fechada em 88,5% dos casos (46/52). As taxas de sucesso para os Grupos A e B foram, respectivamente, 90,0% e 86,4% (p = 0,689). As taxas de sucesso nos casos idiopáticos e iatrogênicos foram, respectivamente, 93,3% e 86,5% (p = 0,659). Conclusão: Este estudo mostrou que a taxa de sucesso da técnica de enxerto sanduíche foi maior nas perfurações de médio porte do que nas de grande porte e nas perfurações idiopáticas do que nas iatrogênicas, mas sem significância estatística. Esse dado demonstrou que o tamanho da perfuração não foi tão importante na técnica de enxerto sanduíche quanto nas técnicas com uso de retalho.

Sandwich graft technique outcomes in medium and large size nasal septal perforations.

INTRODUCTION: Surgical treatment of medium and large sized nasal septal perforation is challenging. Techniques with and without interposition grafts are used. OBJECTIVE: The aim of this study is to explain how we apply the sandwich graft technique that we use in medium and large nasal septal perforations as well as to present the results. METHODS: We retrospectively reviewed the patients who were operated with the sandwich graft technique between January 2014 to December 2018 and followed up for at least 6 months. The demographic data, symptom scores, examination, and surgical findings of the patients were taken from the hospital records. Surgical outcomes were presented according to both perforation etiologies (idiopathic or iatrogenic) and sizes (Group A: < 2 cm, Group B: ≥ 2 cm). RESULTS: We reviewed 52 cases and 56 surgeries. The average diameter of the perforations was 19.2 mm. The success rate after initial surgeries was 84.6% (44/52). After 4 revision surgeries, the perforation was closed in 88.5% of the cases (46/52). Success rates for Group A and Group B were 90.0% and 86.4%, respectively (p = 0.689). The success rates in idiopathic and iatrogenic cases were 93.3% and 86.5%, respectively (p = 0.659). CONCLUSION: This study showed that the success rate of sandwich graft technique was higher in medium-sized perforations than large-sized ones and in idiopathic perforations compared to iatrogenic ones, but the latter rate was not statistically significant. This demonstrated that perforation size was not as important in the sandwich graft technique as in flap techniques.

Acute invasive fungal rhinosinusitis: our experience with 19 patients.

Acute invasive fungal rhinosinusitis (AIFR) is a potentially fatal infection that affects immunocompromised patients. Early diagnosis and treatment, including aggressive surgical debridement, antifungal medication, and correction of underlying predisposing factors are essential for recovery. The aim of this study was to review our experience with AIFR. The records of 19 patients histopathologically diagnosed with invasive fungal rhinosinusitis were retrospectively reviewed. Demographic data, presenting symptoms and signs, underlying diseases, and outcomes of the patients are presented and invasive fungal rhinosinusitis is discussed in light of the current literature.

Comparison of two endoscopic examination methods, the Muller maneuver and fiberoptic pharyngoscopy during sleep, in patients with obstructive sleep apnea.

OBJECTIVES: This study was designed to compare two endoscopic examination methods, the Muller maneuver (MM) and fiberoptic pharyngoscopy during sleep, both of which are used to detect obstructed segments in patients with obstructive sleep apnea. PATIENTS AND METHODS: The study included 28 patients (23 males, 5 females; mean age 44.6 years; range 28 to 59 years) who underwent uvulopalatopharyngoplasty (UPPP) for snoring or obstructive sleep apnea. Obstruction was examined both at the level of the soft palate and tongue base while the patients were awake and asleep and was scored. The Muller maneuver was performed in the sitting and supine positions. In addition, fiberoptic pharyngoscopy was performed right after induction of anesthesia. The results of the two methods were compared. RESULTS: Changes in body position were not associated with significant differences in the results of MM. The two methods were found to be highly discordant, in that a greater degree of obstruction was noted especially at the level of the soft palate by fiberoptic pharyngoscopy. CONCLUSION: It was concluded that the degree of obstruction might be underestimated by MM.

Body fat composition: a predictive factor for obstructive sleep apnea.

OBJECTIVE: To investigate body fat composition, measured by bioelectrical impedance assay (BIA), for predicting the presence and severity of obstructive sleep apnea-hypopnea syndrome (OSAHS). Body fat composition was also compared with other well-known OSAHS predictors such as body mass index (BMI), neck circumference, and abdominal visceral fat. STUDY DESIGN: A prospective study was designed. Fifty-one patients (41 male, 10 female), who were referred to Hacettepe University Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery with suspected OSAHS, between April 2003 and June 2004, were included in the study. METHODS: All patients underwent polysomnography (PSG) and were classified according to their apnea-hypopnea index (AHI) into four groups. The cross-sectional area of abdominal visceral fat was measured by computed tomography (CT) scanning in 33 of the patients. Neck circumference and BMI was measured for all patients. BIA was performed to determine body fat composition. The groups were compared, and correlation of the variables with AHI was investigated. RESULTS: Of the variables, BMI and percentage of body fat (determined by BIA) were found to be significantly correlated with AHI (r = 0.782, r = 0.647). CT of cross-sectional area of abdominal visceral fat provided 100% sensitivity and specificity (P < .001) in differentiating simple snorers from OSAHS patients. By combining percentage of body fat and body fat mass, higher levels of sensitivity (95%) and specificity (100%) were achieved for diagnosis of OSAHS. CONCLUSION: It was concluded that the BIA could be an inexpensive and practical alternative to prePSG screening tests and should be included in the evaluation of OSAHS patients.