Prospective cohort study on short-term evaluation of septoplasty as early management of naso-septal fractures - A correlation of clinical outcomes with computational fluid dynamic parameters.

PURPOSE: Post-traumatic deviated nasal septum (PTDNS) leads to impaired breathing and poor esthetics. The aim of this study was to assess treatment outcomes of early septoplasty for correction of PTDNS and correlate it with computational fluid dynamic (CFD) parameters. METHODS: This prospective cohort study included patients who underwent early septoplasty for PTDNS. Outcome variables were clinical (pain, nasal symmetry, and nasal obstruction) and computational (velocity, pressure, wall shear stress and Reynold's number). The cohort consisted of two groups: patients with history of closed reduction for nasal fractures (CR) and patients without (NCR). The primary outcome measure was response to treatment. Correlation between clinical and computational parameters, and influence of closed reduction on septoplasty outcomes were the secondary and tertiary outcomes, respectively. Descriptive and inferential statistics were performed to analyze data. Level of significance was fixed at 5% (α = 0.05). RESULTS: The sample included 12 patients, of which 5 underwent CFD analysis. Pain score reduced from a pre-operative mean of 7.3 to 0.5 post-operatively (p<0.001). All patients demonstrated reduction of nasal obstruction (p<0.001) and deviation (p<0.001) post-operatively. CFD analysis revealed post-operative reduction of velocity (p = 0.005) and Reynold's number (p = 0.007), with positive correlation between nasal obstruction and CFD parameters. Though patients in the CR group demonstrated reduced nasal deviation and obstruction before septoplasty, as compared to the NCR group, their outcomes were comparable following septoplasty. CONCLUSION: Early septoplasty improves functional and esthetic outcomes in patients with PTDNS. CFD simulation is a predictable method to objectively evaluate nasal function.

Laser-Assisted Microvascular Anastomosis of Free Flaps in Reconstruction of Orofacial Defects: A Comparative Study Among Conventional Methods and Diode Laser Anastomosis.

BACKGROUND: The key role played by anastomosis determines the outcome of any free flap surgery. Besides many methods, the application of LASERS for performing microvascular anastomosis gaining popularity in recent times. The ease of application, utilizing lesser time for performing anastomosis than the conventional methods and minimal injury to the vessel layers, are contributing factors to the success of free flap surgery. Laser-assisted vascular anastomosis (LAVA) fulfills the criteria of lesser vessel wall damage and faster anastomosis and thus resulting in reduced flap ischemic time and overall outcome of the surgery. METHODS: A prospective randomized case-control trial comparing conventional suturing methods (group I) with Laser-assisted vascular anastomosis (group II) on free flaps were performed for the reconstruction of orofacial defects. The parameters assessed for evaluation were anastomotic time, ischemic time and vessel patency following anastomosis. Student's t test and Fisher's exact tests were implied for statistical analysis. RESULTS: The mean time taken for anastomosis was 19.75 min in the conventional group and 3.86 min in LAVA anastomosis. This difference was found to be extremely statistically significant (p < 0.00001). The mean ischemic time of the free flap harvested was 384.87 min in group I and 138.7 min in group II. This difference was also found to be extremely statistically significant (p < 0.00001). CONCLUSION: The average anastomosis time for LAVA group was considerably reduced and total ischemic time was considerably less with successful uptake of the flap. In LAVA group, the post-operative complication was less when compared to the conventional anastomosis technique.