Intranasal Surgery Research Articles

Evaluation of sodium hyaluronate-based composite hydrogels for prevention of nasal adhesions.

During the healing process after intra-nasal surgery, the growth and repair of damaged tissues can result in the development of postoperative adhesions. Various techniques have been devised to minimize the occurrence of postoperative adhesions which include insertion of stents in the middle meatus, application of removable nasal packing, and utilizing biodegradable materials with antiadhesive properties. This study assesses the efficacy of two sodium hyaluronate (SH)-based freeze-dried hydrogel composites in preventing postoperative nasal adhesions, comparing them with commonly used biodegradable materials in nasal surgery. The freeze-dried hydrogels, sodium hyaluronate and collagen 1(SH-COL1) and sodium hyaluronate, carboxymethyl cellulose, and collagen 1 (SH-CMC-COL1), were evaluated for their ability to reduce bleeding time, promote wound healing, and minimize fibrous tissue formation. Results showed that SH-CMC-COL1 significantly reduced bleeding time compared to both biodegradable polyurethane foam and SH-COL1. Both SH-COL1 and SH-CMC-COL1 exhibited enhanced wound healing effects, as indicated by significantly greater wound size reduction after two weeks compared to the control. Histological analyses revealed significant differences in re-epithelialization and blood vessel count among all tested materials, suggesting variable initial wound tissue response. Although all treatment groups had more epithelial growth, with X-SCC having higher blood vessel count at 7 d post treatment, all treatment groups did not differ in all histomorphometric parameters by day 14. However, the long-term application of SH-COL1 demonstrated a notable advantage in reducing nasal adhesion formation compared to all other tested materials. This indicates the potential of SH-based hydrogels, particularly SH-COL1, in mitigating postoperative complications associated with nasal surgery. These findings underscore the versatility and efficacy of SH-based freeze-dried hydrogel composites for the management of short-term and long-term nasal bleeding with an anti-adhesion effect. Further research is warranted to optimize their clinical use, particularly in understanding the inflammatory factors influencing tissue adhesions and assessing material performance under conditions mimicking clinical settings. Such insights will be crucial for refining therapeutic approaches and optimizing biomaterial design, ultimately improving patient outcomes in nasal surgery.

Comparative Study on Finger Gloves Nasal Packing Vs Merocel Nasal Packing After Intranasal Surgery: Randomized Controlled Trial.

Nasal packing is one of the common procedures done following various intranasal surgeries in order to prevent the various complications that can arise post-operatively. Some of the complications noted include bleeding from the nose, septal hematoma, septal abscess and formation of mucosal adhesions. There are different types of nasal packing materials available. Few of the commonly used nasal packing material are ribbon gauzes impregnated with antibiotics, merocel, gel foam, glove fingers and Vaseline gauze. This study compared the effectiveness of Merocel nasal packing with Glove finger nasal packing after Septoplasty and Polypectomy. Merocel, a widely used expandable non-absorbable material, was compared with conventional ribbon gauze packs inserted into glove fingers. Results showed no significant differences in post-operative bleeding, pain, discomfort, mucociliary clearance, or late complications between the two groups. However, a slightly earlier return of mucociliary clearance in patients packed with Glove finger nasal packs was observed. Therefore, it can be concluded that both Merocel and Glove finger nasal packs are equally effective in managing post-operative complications following these procedures.

Nasal Airway Function After Prophylactic Intranasal Surgery for Excessive Maxillary Superior Repositioning: A Retrospective Cohort Study Using the Nasal Obstruction Symptom Evaluation Scale.

The purpose of this study is to evaluate the degree of nasal airway function after simultaneous intranasal corrective surgery and bimaxillary surgery in patients with excessive superior maxillary repositioning. A retrospective cohort study was conducted on consecutive LeFort I superior repositioning patients who also underwent simultaneous intranasal surgery to prevent airway obstruction between 2015 and 2019. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to all participants before the operation and after 1 year. Fifteen patients (n=12 females; n=3 males) among 440 bimaxillary orthognathic surgery patients were enrolled with inclusion criteria of maxillary impaction between 8 and 12mm. All subjects underwent at least LeFort I osteotomy, septoplasty, bilateral inferior turbinectomy, and bilateral sagittal split osteotomy. Two patients received custom-made total joint prosthesis. The primary outcome variable investigated was nasal function. The mean preop Nasal Obstruction Symptom Evaluation score was 24.33 and the mean postop score was 5. Intranasal procedures performed simultaneously with 8mm or more maxillary impaction improves postoperative functional outcome in terms of nasal airway patency and breathing. Partial inferior turbinectomies and septoplasty should be performed consistently to avoid nasal obstruction if the impaction of upper jaw exceeds 8mm.

DYNAMIC CHANGES OF TISSUE ENZYMES AND THE ITS INFLUENCE ON WOUND HEALING OF NASAL MUCOSA IN THE POSTOPERATIVE PERIOD

Intranasal surgery is widely spread all over the world and has the leading position among all otorhinolaryngological surgical interventions. However, any surgery makes sensitive trauma to the ciliaryepithelium that covers the nasal cavity and paranasal sinuses despite the modern technics of operations. That’s why reveling peculiarities, patterns and ways of correction of nasal mucosa regeneration in the postoperative period is very important for clinicians. So the main aim of our paper is to investigate the role of some tissue enzymes in the process of nasal mucosa regeneration after surgical interventions on the structures of the nasal cavity in adults. As a result of our investigation, the role of some tissue enzymes was shown. We have based the usage of drugs that influence wound healing. Thus, the proper medicines have positive effects on the regeneration processes of the ciliated epithelium. A more thorough investigation of the role of these enzymes will allow developing methods of its correction for improving the efficiency of endonasal surgery rapid and qualitative recovery of mucociliary clearance.

Регенерация мерцательного эпителия полости носа в норме и после хирургических вмешательств

The problem of postoperative management of patients after surgical interventions on intranasal structures is still actual. Statistically the frequency of nasal pathology that required surgical correction is on rise. These facts stimulate to make an analysis of wound healing processes of nasal mucosa and triggers that influence on these processes. In this paper morphological and functional changes of nasal mucosa during different pathological conditions are observed. The wound healing is regulated on different levels and one of the most significant role some tissue and cells mediators are played. The effects of transforming growth factor beta (TGF-b) and matrix metalloproteinases (MMP) on nasal mucosa regeneration are shown based on literature search. Possibility of correction of these substances for better and faster restoring of nasal mucosa after intranasal surgery is discussed.

Surgical Approaches for Allergic Rhinitis: A Systematic Review Protocol.

Background:Exposure to inhaled allergens in patients with allergic rhinitis results in IgE mediated hypersensitivity of nasal mucosa. The mainstay of management is allergen identification and avoidance, pharmacotherapy with antihistamines, corticosteroids and nasal douching and immunotherapy. Patients refractory to medical management can be offered surgical interventions aimed at providing symptom relief. The objective of this review is to evaluate the effectiveness of surgical intervention on functional and symptomatic outcomes in patients with allergic rhinitis that have failed medical management.Methods:Prospective and retrospective studies that assess the effectiveness of intranasal surgery to include inferior turbinate surgery, posterior nerve resection, vidian neurectomy, septoplasty and endoscopic sinus surgery (ESS) in patients that have failed medical treatment for proven allergic rhinitis. Medline, Web of Science and Embase will be searched for studies published in English from 1990. Two authors will independently screen the search results and assess the full text of potentially relevant studies. Studies that meet the inclusion criteria will be critically appraised and the data will be extracted and synthesised by two authors.Ethics and Dissemination:Ethical approval was not required for this study as secondary data will be collected. The results will be disseminated through peer-reviewed medical journal.Systematic Review Registration:This protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020223773).Highlights:Allergic rhinitis (AR) is a chronic immune-mediated inflammatory nasal condition with hallmark symptoms of sneezing, nasal obstruction, mucus discharge and anosmia in adverse cases.A plethora of interventions are at the hands of otolaryngologists in order to relieve symptoms of AR, however literature is yet to determine which method is best for patient outcome and quality of life.The primary objective of this study is to convey a systematic qualitative analysis of all the surgical interventions used in AR management.

Incision of Hasner's valve under endoscopic intranasal surgery for the treatment of nasolacrimal duct obstruction in children.

To evaluate the effectiveness and safety of a Hasner's valve incision performed under endoscopic intranasal surgery for the management of congenital nasolacrimal duct obstruction. This retrospective study comprised 484 patients with congenital nasolacrimal duct obstruction who underwent incision of Hasner's valve under endoscopic intranasal surgery between April 2000 and October 2016. The primary endpoint was the procedure's functional success rate. The secondary endpoints were Hasner's valve and inferior turbinate anatomical findings, demographic data, complication rate and surgical duration. In patients with no medical history of nasolacrimal duct probing, 91 per cent had a successful result, 5 per cent had a partially successful result, 3.9 per cent showed no change and 0.1 per cent had a worse result following the procedure. Concerning the secondary endpoints, outcomes were more frequently successful in children younger than three years. Only one patient had a post-operative infection. All patients underwent general anaesthesia; no complications related to general anaesthesia were observed. Mean surgical duration was 13.1 ± 5.7 minutes. Incising Hasner's valve after medially displacing the inferior turbinate under nasal endoscopy seems to be an adequate primary surgical treatment for congenital nasolacrimal duct obstruction.

The Upper Airway Nasal Complex: Structural Contribution to Persistent Nasal Obstruction.

To determine the contribution of the nasal floor and hard palate morphology to nasal obstruction for nonresponders to prior intranasal surgery. Retrospective case-control study. Tertiary academic center. Institutional review board-approved, retrospective institutional database analysis was obtained of a cohort of 575 patients who presented with nasal obstruction over a 21-year period. Of the patients, 89 met inclusion criteria: 52 were placed into the experimental group, defined as having persistent nasal obstruction following endoscopic sinus surgery (ESS), septoplasty, nasal valve repair, and/or turbinoplasty using validated subjective questionnaires, and 37 were placed into the control group, defined as having resolution of subjective nasal obstruction. Computed tomography imaging was presented to 3 blinded experts, who measured numerous nasal airway and hard palate morphology parameters, including anterior nasal floor width, anterior maxillary angle, maxilla width, anterior nasal floor width, and palatal vault height. Standard demographic information, comorbidities, perioperative 22-item Sinonasal Outcome Test (SNOT-22), and follow-up time were also assessed. Wilcox rank sum analysis or t test was performed where appropriate. Follow-up ranged from 2 to 36 months following surgical intervention. Several skeletal characteristics within the upper airway were significantly associated with persistent nasal obstruction, including acute maxillary angle (P = .035), narrow maxillary width (P = .006), and high arched palate (P = .004). Persistent nasal obstruction may be seen in patients with narrow, high arched hard palate despite prior nasal surgical intervention and may benefit from additional skeletal remodeling procedures such as maxillary expansion.

Primary Mandibular Deficiency Dentofacial Deformities: Occlusion and Facial Aesthetic Surgical Outcomes

The purpose of the present study was to document the malocclusion and facial dysmorphology in primary mandibular deficiency (PMD) subjects with chronic obstructive nasal breathing before treatment and the outcomes after bimaxillary orthognathic, genioplasty, and intranasal surgery. A retrospective cohort study of PMD subjects undergoing bimaxillary, chin, and intranasal surgery was implemented. The predictor variables were grouped into demographic, anatomic, operative, and longitudinal categories. The primary outcome variables were the initial postoperative occlusion achieved at 5weeks postoperatively (T2) and that maintained long-term more than 2years after surgery (T4). Six occlusion parameters were assessed: overjet, overbite, coincidence of dental midlines, Angle classification, molar vertical, and transverse positions. A second outcome variable was the facial esthetic results. Photographs were analyzed to document 7 facial contour characteristics. Forty subjects met the inclusion criteria. Their age at surgery averaged 32years (range 13 to 63). The study included 25 females (63%). The findings confirmed that the occlusion after initial surgical healing (T2) met the objectives for all parameters in 39 of the 40 patients (98%). Most patients (35 of 40; 88%) achieved and maintained a favorable occlusion for each parameter in the long-term (mean 5years, 3months). Subjects requiring counterclockwise rotation of the maxillomandibular complex were more likely to a have recurrent anterior open bite in the long-term. Facial contour deformities on presentation included weak chin (80%), deep labiomental fold (90%), everted lower lip (100%), short neck-to-chin length (88%), obtuse neck-to-chin angle (85%), weak mandible angles (93%), and "bunching" of the neck soft tissues (85%). Before surgery, 88% of the subjects exhibited a minimum of 5 of the 7 facial deformities. Correction of all 7 facial deformities was confirmed in 86% of the subjects in the long-term. Most PMD subjects achieved and maintained a corrected occlusion in the long-term. In the untreated subjects, a "facial type" was identified. Orthognathic surgery proved effective in correcting the associated facial dysmorphology in most patients.

Primary Maxillary Deficiency Dentofacial Deformities: Occlusion and Facial Esthetic Surgical Outcomes

The purpose of this study was to document the malocclusion and facial dysmorphology in patients with primary maxillary deficiency (PMD) and chronic obstructive nasal breathing before treatment and the outcomes after bimaxillary orthognathic, genioplasty, and intranasal surgery. A retrospective cohort study of patients with PMD undergoing bimaxillary orthognathic, chin, and intranasal surgery was implemented. The predictor variables were grouped into demographic, anatomic, operative, and longitudinal follow-up categories. The primary outcome variables were the initial postoperative occlusion achieved (T2; 5weeks postoperatively) and that maintained long-term (T3 or T4; >2years after surgery). Six occlusion parameters were assessed: overjet, overbite, coincidence of dental midlines, Angle classification, and molar vertical and transverse positions. A second outcome variable was facial esthetic results. Photographs were analyzed to document 7 facial contour characteristics. Sixty-six patients met the inclusion criteria. Age at operation averaged 22years (15 to 55yr). The study included 18 women (27%). Most patients (57 of 66; 86%) achieved and maintained a favorable occlusion for each parameter studied long-term (mean, 5yr). The need for a 3-segment Le Fort I was strongly associated with long-term posterior malocclusion. Facial dysmorphology before surgery included the appearance of a prominent chin (56%), flat labiomental fold (61%), prominent lower lip (88%), prominent nose (77%), sunken midface (100%), flat cheekbones (82%), and recessed upper lip (73%). Before surgery, 82% of patients exhibited at least 5 of the 7 key facial contour deformities. Correction of all 7 facial contour deformities was confirmed in 92% of patients in the long-term. In 8% of patients, an overly prominent-appearing chin persisted. Using orthognathic techniques, most patients with PMD achieved and maintained a corrected occlusion long-term. In unoperated patients, a "facial esthetic type" was identified. Bimaxillary orthognathic and chin surgery proved effective in correcting associated facial dysmorphology in most patients.

Long-Face Dentofacial Deformities: Occlusion and Facial Esthetic Surgical Outcomes

The purpose of this study was to document malocclusion and facial dysmorphology in a series of patients with long face (LF) and chronic obstructive nasal breathing before treatment and the outcomes after bimaxillary orthognathic, osseous genioplasty, and intranasal surgery. A retrospective cohort study of patients with LF undergoing bimaxillary, chin, and intranasal (septoplasty and inferior turbinate reduction) surgery was implemented. Predictor variables were grouped into demographic, anatomic, operative, and longitudinal follow-up categories. Primary outcome variables were the initial postoperative occlusion achieved (T2; 5weeks after surgery) and the occulsion maintained long-term (>2years after surgery). Six key occlusion parameters were assessed: overjet, overbite, coincidence of dental midlines, canine Angle classification, and molar vertical and transverse positions. The second outcome variable was the facial esthetic results. Photographs in 6 views were analyzed to document 7 facial contour characteristics. Seventy-eight patients met the inclusion criteria. Average age at surgery was 24years (range, 13 to 54yr). The study included 53 female patients (68%). Findings confirmed that occlusion after initial surgical healing (T2) met the objectives for all parameters in 97% of patients (76 of 78). Most (68 of 78; 87%) maintained a favorable anterior and posterior occlusion for each parameter studied long-term (mean, 5years 5months). Facial contour deformities at presentation included prominent nose (63%), flat cheekbones (96%), flat midface (96%), weak chin (91%), obtuse neck-to-chin angle (56%), wide lip separation (95%), and excess maxillary dental show (99%). Correction of all pretreatment facial contour deformities was confirmed in 92% of patients after surgery. Long face patients with higher preoperative body mass index levels were more likely to have residual facial dysmorphology after surgery (P=.0009). Using orthognathic surgery techniques, patients with LF dentofacial deformity achieved the planned occlusion and most maintained the corrected occlusion long-term. In unoperated patients with LF, a "facial esthetic type" was identified. Orthognathic surgery proved effective in correcting associated facial dysmorphology in most patients.

“Silent” Sleep Apnea in Dentofacial Deformities and Prevalence of Daytime Sleepiness After Orthognathic and Intranasal Surgery

The purposes of this study were to determine the occurrence of undiagnosed "silent" obstructive sleep apnea (OSA) in dentofacial deformity (DFD) patients at initial surgical presentation and to report on the level of daytime sleepiness in DFD patients with OSA and chronic obstructive nasal breathing (CONB) after undergoing bimaxillary, chin, and intranasal surgery. A retrospective cohort study of patients with a bimaxillary DFD and CONB was implemented. Patients were divided into those with no OSA (group I) and those with OSA (group II). Group II was further subdivided into patients referred with polysomnogram (PSG)-confirmed OSA (group IIa) and those with a diagnosis of OSA only after surgical consultation, airway evaluation, and a positive PSG (group IIb). Group II patients were analyzed at a minimum of 1year after surgery (range, 1 to 10years) for daytime sleepiness with the Epworth Sleepiness Scale.Patients with postoperative excessive daytime sleepiness were assessed for risk factors and continued need for OSA treatment. Patients in group II were studied to determine which DFD patterns were most associated with OSA. We compared the prevalence of OSA between our study population and the general population. Two hundred sixty-two patients met the inclusion criteria. Of these, 23% (60 of 262) had PSG-confirmed OSA (group II). This rate was much higher than that found in the general population. Of the patients, 7% (19 of 262) were known to have OSA at initial surgical consultation (group IIa). An additional 16% (41 of 262) were later confirmed by PSG to have OSA (group IIb). Patients with primary mandibular deficiency and short face DFDs were most likely to have OSA (P<.001 and P=.001, respectively).In group II, 91% (55 of 60) rated their daytime sleepiness as "not sleepy" at a minimum of 1year after surgery. A significant association was found between group II patients with postoperative excessive daytime sleepiness ("sleepy" or "very sleepy") and a preoperative body mass index category of overweight (P=.026). Our study found silent OSA to be frequent in the DFD population. The prevalence of OSA in DFD patients exceeded that estimated in the general population, with retrusive jaw patterns most affected. In DFD patients also presenting with OSA and CONB, we confirmed low levels of daytime sleepiness long-term after simultaneous bimaxillary orthognathic, chin, and intranasal surgery.

Insights in the treatment of congenital nasolacrimal duct obstruction.

Introduction: Congenital nasolacrimal duct obstruction is one of the most common causes of epiphora in newborns and the main cause of this condition is the persistence of Hasner membrane. Several treatment options are available, like conservative treatment, probing, irrigation, or more complex techniques. Objective: The objective of this paper is to discuss the efficiency of different treatment options addressing congenital nasolacrimal duct obstruction based on trials reported in literature. Methods: Clinical trials were identified on PubMed. The results were discussed regarding patient age, type of treatment and efficiency of the treatment. Results: 41 trials were reviewed. The rate of resolution according to different treatment options was the following: conservative treatment 14.2-96%, probing 78-100%, irrigation 33-100%, silicon tube intubation 62-100%, inferior turbinate fracture 54.7-97%, balloon dacryocystoplasty 77%, endoscopic intranasal surgery 92.72%, and dacryocystorhinostomy 88.2-93.33%. Conclusions: The first choice in uncomplicated cases should be a conservative treatment, which can be followed until the age of 1 year, while in complicated cases other solutions should be considered. Abbreviations: CNDO = Congenital nasolacrimal duct obstruction, DCR = Dacryocystorhinostomy, MCI = Monocanalicular intubation, BCI = Bicanalicular intubation.

Method of osteotomy fixation and need for removal following bimaxillary orthognathic, osseous genioplasty, and intranasal surgery: a retrospective cohort study

The purpose of this study was to determine the incidence and causes of fixation hardware removal after bimaxillary orthognathic, osseous genioplasty, and intranasal surgery. A retrospective study was performed, involving subjects with a bimaxillary developmental dentofacial deformity (DFD) and symptomatic chronic obstructive nasal breathing. At a minimum, subjects underwent Le Fort I osteotomy, bilateral sagittal ramus osteotomies (SROs), septoplasty, inferior turbinate reduction, and osseous genioplasty. The primary outcome variable studied was fixation hardware removal. Demographic, anatomical, and surgical predictor variables were assessed. Two hundred sixty-two subjects met the inclusion criteria. Their mean age at operation was 25 years (range 13–63 years); 134 were female (51.1%). Simultaneous removal of a third molar was performed in 39.9% of SROs. Three of 262 Le Fort I procedures (1.1%) and two of 524 SROs (0.4%) required hardware removal. There were four cases of ramus wound dehiscence, four of ramus surgical site infection (SSI), one of chin SSI, two of maxillary sinusitis, and one of lingual nerve injury; none of these subjects underwent hardware removal. A limited need for fixation hardware removal after orthognathic procedures was confirmed. There was no statistical correlation between hardware removal and patient sex, age, pattern of DFD, simultaneous removal of a third molar, or occurrence of wound dehiscence, SSI, or lingual nerve injury.

Surgical Site Infections Following Bimaxillary Orthognathic, Osseous Genioplasty, and Intranasal Surgery: A Retrospective Cohort Study

Frequency estimates of surgical site infection (SSI) after orthognathic surgery vary considerably. The purpose of this study was to determine the incidence and site of SSIs and associated risk factors after bimaxillary orthognathic, osseous genioplasty, and intranasal surgery. The authors executed a retrospective cohort study of patients with a bimaxillary developmental dentofacial deformity (DFD) and symptomatic chronic obstructive nasal breathing. All patients underwent at a minimum Le Fort I osteotomy, bilateral sagittal ramus osteotomies (SROs), septoplasty, inferior turbinate reduction, and osseous genioplasty. The primary outcome variable studied was the incidence and site of SSI. Predictor variables were type and extent of prophylactic antibiotic used, demographic (age and gender), and anatomic (pattern of DFD, surgical site, and presence of third molar). Two hundred sixty-two patients met the inclusion criteria. Their average age at surgery was 25years (range, 13 to 63yr) and there were 134 female patients (51%). The major presenting patterns of DFD included long face (30%) and maxillary deficiency (25%). Forty percent of patients undergoing an SRO and 47% of those undergoing a Le Fort I osteotomy underwent simultaneous removal of a third molar. Ninety percent of patients received cefazolin or cephalexin antibiotics. Overall, 5 of 1,048 (0.5%) osteotomy sites sustained an infection, including 1 chin and 4 ramus SSIs. There were no delays in bone healing. Fixation hardware removal was not required in any patient who developed an infection. Two of the 25 patients (8%) given clindamycin prophylaxis developed an SSI, whereas 3 of 237 patients (1%) receiving cefazolin did. Three of the 4 patients who developed an SRO SSI underwent simultaneous removal of an erupted or partially erupted mandibular third molar (P < .05). In this study, the incidence of SSI was limited to 1% of patients who were given cefazolin or cephalexin extended for 5days. The removal of an erupted or partially erupted mandibular third molar in conjunction with an SRO was associated with risk of SSI, but the incidence remains low.

Comparison of post-operative recovery with or without pre-extubation throat wash in patients undergoing intranasal surgery under general anaesthesia

BackgroundIntranasal surgery under general anaesthesia has potential to complicate immediate postoperative recovery period with multitude of respiratory problems. These include from mild respiratory distress to oxygen desaturation to moderate to significant laryngospasm. These problems can be mitigated by employing some innovative manoeuvres by anaesthesiologists to achieve smooth and safe recovery.Study settingThe study was conducted at PAF Hospital MM Alam after permission from the hospital ethics committee from March 2013 to December 2013.Level of evidenceThe study conforms to level 1b of evidence rating scale.Study designThis randomised control trial included 120 American Society of Anaesthesiologists physical status I patients aged less than 40 years of both genders, undergoing intranasal surgery under general anaesthesia, who were randomly divided into two groups naming Throat Wash (TW) group or Simple Suction (SS) group. Patients of both groups were induced general anaesthesia as per set protocol while TW group was subjected to throat wash after removal of throat pack while SS group was only suctioned under direct laryngoscopy. Incidence of any adverse respiratory event in immediate post-extubation period was recorded for further comparison.Results1.6% patients in TW group developed laryngospasm as compared to 15% patients of SS group (P < 0.0001). 4.8% patients of TW group and 44.9% patients of SS group developed moderate to significant respiratory problems respectively (P < 0.0001). 5% patients in SS group had to re-intubated as compared to none in the TW group (P < 0.00001). Debris recovered during throat wash in TW group included clogs of blood, pieces of bones, cartilage and polyps, rhinolith, and wax from the packing gauze as compared to only some clots of blood in the SS group.ConclusionThroat wash, after removal of throat pack in nasal surgery, ensures clearer airway and decreases the risk of adverse respiratory events in immediate post-extubation period. The adverse sequel due to un-recognised debris in the upper airway is minimised resulting in smooth recovery and rapid discharge from the post-anaesthesia care unit.

Is Middle Ear Pressure Effected by Nasal Packings after Septoplasty?

To investigate the effects of different types of nasal packings on middle ear pressure in patients undergoing septoplasty. Sixty patients who were suffering from nasal obstruction and who had to undergo septoplasty because of nasal septal deviation were included in the study. After the septoplasty, Merocel packings and internal nasal splints were intraoperatively applied in thirty patients each. Middle ear pressure was evaluated by tympanometry. Tympanometric peak pressures were used for this aim. Acoustic impedance measurements were performed in both ears, and the average values of the two ears were calculated. Tympanometric measurements were performed for patients during the preoperative period and on the 2(nd) and 5(th) postoperative days. There were 30 (5 females, 25 males; average age 23 years) patients in the internal nasal splint group and 30 (8 females, 22 males; average age 26 years) patients in the anterior Merocel packing group. When the values obtained by acoustic impedancemetry before the operation and on the postoperative 5(th) day were compared, there was no statistically significant difference between the groups. The middle ear pressure significantly decreased in the anterior Merocel packing group compared with that in the internal nasal splint group. The intragroup comparison of the acoustic impedance measurements of the internal nasal splint group revealed no significant difference between the preoperative acoustic impedance values and the values obtained on the postoperative 2(nd) day. Cannulated silicone intranasal splints are better in terms of patient comfort after an intranasal surgery without effecting eustachian tube function.

内視鏡下経上顎洞法で翼口蓋窩の操作を行った若年性血管線維腫例

内視鏡下経上顎洞法で翼口蓋窩の操作を行った若年性血管線維腫例

A Case of Surgical Treatment of Juvenile Angiofibroma in the Pterygopalatine Fossa with Endoscopic Transmaxillary Surgery Combined with Endoscopic Intranasal Surgery

A Case of Surgical Treatment of Juvenile Angiofibroma in the Pterygopalatine Fossa with Endoscopic Transmaxillary Surgery Combined with Endoscopic Intranasal Surgery

Endoscopic endonasal surgery in orbital decompression and orbital reconstruction

Objectiv The aim of this study was to clarify and evaluate the role and the outcome of endoscopic endonasal surgery in both orbital decompression and orbital reconstruction. Background Traditional external techniques are now known to reduce proptosis significantly, but have the disadvantage of cosmetic morbidity in terms of a cutaneous scar and a high incidence of postoperative complications. Recent advances in endoscopic sinus surgery have extended its applications beyond the nose to the orbit. Orbital decompression, drainage of subperiosteal abscess, optic nerve decompression, and orbital wall reconstruction are performed very safely and effectively by endoscopic intranasal surgery. Patients and methods Fifty-four patients indicated for endoscopic orbital decompression or reconstruction were divided according to the cause into five groups (20 infection, eight inflammatory, eight neoplastic, eight congenital, and 10 traumatic). Preoperative evaluations performed were history taking, physical examination, and computed tomography and MRI of orbit and paranasal sinuses. After creating an endoscopic wide middle meatal antrostomy dealing with the pathology causing extraconal orbital compression and in intraconal compression penetrate the lamina papyracea and periosteum until prolapsed fat fill the ethmoid sinus. Reconstruction was performed by removal of the fractured bone, extraocular muscle reposition with support using Foley's catheter in floor fracture and a silastic sheet with Merocel packing in medial wall fracture. Results There was significant proptosis reduction in all groups, especially in the infection group ( P P Conclusion Endoscopic nasal decompression of the orbit is a safe and effective approach for reducing proptosis and improving vision and ocular motility in cases of orbital compression, which include infection, inflammatory, neoplastic, congenital, and traumatic causes. Endoscopic intranasal reduction of the orbital floor with a Foley's catheter balloon and with a silastic sheet and Merocel packing of the medial orbital wall provided good functional results and definite advantages. Complications were limited.