RESUMO
Nasal obstruction is the most common complaint in nasal and sinus disease. Deviated nasal septum is a very frequently encountered and common cause. Surgical correction of a deviated septum- nasal septoplasty- is the definite treatment for septal deviation. Over the last 2 decades, the applications for endoscopy in the field of rhinology have evolved beyond functional endoscopic sinus surgery (FESS). Septoplasty which is among the three most commonly performed procedures in otolaryngology is particularly well suited to endoscopic application. Endoscopic septoplasty as a minimally invasive technique can limit the dissection and minimize trauma to the nasal septal flap under excellent visualization whose primary advantage is to decrease morbidity and post operative swelling in isolated septal deviation by limiting the excision to the area of deviation. This was a retrospective study, conducted in a tertiary care medical college hospital over a period of 5 years. The study group comprised 415 patients in and around Nashik District; who visited our tertiary health centre and were subjected to endoscopic septoplasty. Complete data records from 415 patients were available for statistical analysis. Maximum numbers of patients were in age group 20-39. The youngest patient was 7 years old and oldest was 75 years. Mean age was 32 years. The 7 years old was operated for DCR for congenital NLD block and septoplasty was adjunct procedure. Even the 75 years was operated for DCR. In the present study out of 415 cases, 256 (67.5 %) cases were male and 115 (32.5 %) cases were female. There is a male preponderance in the overall distribution of cases. In the present study of 415 patients, the most common operative procedure done was septoplasty in 260 (62.6 %), FESS with septoplasty in 38 (9.2 %) cases, septorhinopolasty in 41 (9.9 %) cases and DCR with septoplasty in 78 (18.3 %) cases. Endoscopic septoplasty facilitates good access to accomplish endoscopic DCR, FESS, and accurate and adequate septal graft harvest in severely deviated noses for septorhinoplasty. Complications like dental pain, paraestaesia, septal perforation, saddle nose deformity and persistent deviation are a rarity.
RESUMO
To evaluate the success rate, in terms of anatomical and functional results, in our technique of cartilage support for fascia graft in type I tympanoplasty. Retrospective study of tragal cartilage support for fascia graft in tympanoplasty for large central perforation in 748 patients was carried at an academic institution during January 2004 to March 2012. Patients' age ranged from 11 to 65 years. 325 (43.4 %) male and 423 (56.6 %) female patients were operated and mean post-operative follow up was of 24 months (range 6-48 months). The inclusion criteria were large central or subtotal perforation, anterior quadrant perforation, anterior tympanosclerotic patch with perforation and revision myringoplasty. Small central perforation, posterior perforations, traumatic perforations and Ossiculplasty were excluded from this study. In this technique, a piece of tragal cartilage carved in semi lunar shape is inserted medial to anterior remnant of tympanic membrane. Temporalis fascia graft is sandwiched between cartilage and anterior remnant of tympanic membrane. Post-operative closure of perforation was noted. Pure-tone average pre and post-operative air-bone gap in dB at 250, 500, 1000, 2000, and 4,000 Hz were compared. The overall success rate of our technique was 98.3 % in terms of graft uptake and within 13.35 ± 5.22 dB of air bone gap closure in terms of hearing improvement. This study reveals that cartilage support for fascia graft in type I tympanoplasty is a highly reliable technique and gives significant improvement in graft take-up and hearing status.