Septal Hematoma Research Articles

Conventional Versus Endoscopic Assisted Septoplasty for Management of Severe Nasal Septal Deviation

AbstractBackground: Endoscopic septoplasty is an attractive alternative to the traditional septoplasty. It ensures the mini-mum dissection of the tissue with less postoperative compli-cations.Aim of Work: The aim of this work was to compare the efficacy of the conventional and the endoscopic assisted septoplasty in the management of cases with severe septal deviation.Patients and Methods: 60 patients with severe symptomatic deviated nasal septum, presented to the Otorhinolaryngology outpatient clinic at Tanta University Hospitals divided into two equal groups: Group A included 30 patients underwent endoscopic septoplasty and group B included 30 patients underwent traditional septoplasty. All participants evaluated regarding the nasal obstruction improvement, and the degree of the improvement, the accompanying symptoms and any complications.Results: There was a significant difference between both groups in duration of surgery, the intraoperative blood loss. In this study, the difference of the endoscopic group as compared to the conventional group was statistically insignif-icant regarding either early post-operative complications or in nasal synechiae development, pain, septal hematoma, septal perforation, or CSF leakage or in the intraoperative flap. The pre-operative nose score comparative evaluation revealed that all patients of both groups reported a severe problem in all parameters (nasal congestion and stuffiness, nasal blockage or obstruction, trouble breath in through the nose, trouble sleeping, and inability to get enough air through the nose during exercise or exertion. No statistically significant differ-ences were detected between both groups.Conclusion: We concluded that, endoscopic septoplasty is superior to traditional septoplasty with better result and less complication.

Intracorporeal Septorhinoplasty: Technique and Outcome.

Septal deformities usually associated with functional and aesthetic nasal consequences. Multiple techniques were described to correct these deformities. Using less invasive and at the same time competent technique with loge standing results is important. This study aimed to assess intracorporeal correction for septal deviation with assessment of its competence in managing deferent degrees of deviation and to show concomitant patient-dependant internal valve manipulation used. Intracorporeal correction of septal deviation was used in 35 patients which was performed at plastic surgery departments of Menoufia University Hospital and Mawada Privet Hospital, Egypt. The study was carried out between July 2014 and July 2017. Thirty-five patients with variable types of septal deformities, 16 of them were females and 19 were males, were included in the study. Age of patients was between 18 and 55 years (mean 24.9, standard deviation 7.9). Etiology was found as follows: 15 (about 43%) posttraumatic septal deviation, 8 (about 23%) patients had postcleft septal deviation, and the remaining 12 had idiopathic septal deviation. Spreader graft was in 22 (about 63%) patients. Septal hematoma followed by septal perforation occurred in 1 patient (2.8%), while dorsal irregularities were found in 3 (8.4%) patients. Recurrent septal deviation occurred in 2 (5.6%) patients. Concerning functional outcome, no residual nasal obstruction was found in all patients with negative Cottle sign postoperative. Intracorporeal correction of septal deformities in open rhinoplasty technique is still found to be effective and less invasive option even with sever septal deviation.

Spontaneous nasal septal haematoma and abscess: a case report and literature review

Spontaneous nasal septal haematoma and abscess: a case report and literature review

Extracorporeal septoplasty with internal nasal valve stabilisation.

SUMMARYAmong various septoplasty techniques, the extracorporeal one is used for severe deformities of the caudal septum and consists essentially in removal of the nasal septum followed by correction of deformities. Reconstruction of the neo-septum is carried out by repositioning the septal fragments in a straight position. The disadvantages of this surgical technique are the septal haematoma, oedema of the mucosa in the valve area and some types of abnormalities of the middle third of the nose such as saddling of the dorsum. All of these conditions can be associated with various degrees of functional disorders. To prevent these possible complications, we developed a suture technique to fix the caudal portion of the neo-septum and avoid alterations or narrowing of the internal nasal valve. The purpose of this study is to describe extracorporeal septoplasty results with this suture technique in stabilising the internal nasal valve. From January 2011 to December 2013, a retrospective review of adult patients treated with extracorporeal septoplasty was performed at the ENT department of Imola Hospital. Pre- and post-operative evaluations were carried out by rhinomanometry and acoustic rhinometry. Statistical analysis was performed with commercially available software (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). 133 cases fulfilled inclusion criteria and were enrolled. A significant improvement was evident after surgery based on the results of rhinomanometry and acoustic rhinology. Extracorporeal septoplasty with stabilisation of the internal nasal valve is an effective and reproducible surgical technique that yields optimal functional results.

Complications in septoplasty based on a large group of 5639 patients

PurposeSeptoplasty is a common surgical procedure used for correction of the nasal obstruction caused by a deviated septum. The aim of the study was to identify complications in septoplasty and analyze incidence depending on the surgical technique, based on the material from 2009 till 2017.MethodsThe material consisted of 5639 medical records from patients aged 16–69, operated in the tertiary referral center. Patients were divided into two groups (2784 exclusively with septoplasty and 2855 with combined septoplasty and turbinoplasty). Z test for the equality of two proportions was made to investigate the assumption that the proportions from two populations are equal, based on two samples, one from each population.ResultsComplications were listed according to international standards. Among the whole study group, different types of complications were noted in 193 patients (3.42%). The most frequent complication was excessive bleeding. Significant differences were observed between the two investigated groups. In patients with combined septoplasty and turbinoplasty septal hematoma, hyposmia, prolonged healing due to infection, adhesions and temporary reduced visual acuity were significantly more often encountered.ConclusionsMeticulous attention to detail in identifying the appropriate anatomy and maintaining good visualization is the key to a safe and effective septoplasty, enabling for very low complication rate.

An unusual presentation of nasal septal abscess in 13-year-old boy

Nasal septal abscess is an uncommon clinical entity. There is a collection of the pus in the space between the nasal septum and its overlying mucoperichondrium and/or mucoperiosteum. It usually results from the trauma which leads to nasal septal hematoma and followed by septal abscess formation. If nasal septal abscess is not treated early, this may lead to fatal complications. In the growing child, early treatment along with reconstruction of the damaged septal cartilage is essential for normal development of midfacial area. Here, we are presenting a case of bilateral nasal septal abscess completely obstructing the nostrils in a mentally retarded child without any known history of trauma.

A case of interventricular septal hematoma diagnosed using intraoperative transesophageal echocardiography during congenital heart surgery

A case of interventricular septal hematoma diagnosed using intraoperative transesophageal echocardiography during congenital heart surgery

SEPTOPLASTY WITH OR WITHOUT ANTERIOR NASAL PACKING

Isam M Al-Shareda* & Ghanem Sikhi Ghanem# *MBChB, FICMS, Assist. Prof. of Otolaryngology, Dept. of Surgery, College of Medicine, Basrah University. #MB,ChB, CABS, Basrah General Hospital, Basrah, IRAQ. Abstract Nasal packing is carried out in many nasal surgeries specially in septoplasty for hemostasis and internal stabilization of the cartilaginous & bony skeleton of the nose. However, these packing methods are not a harmless procedures and for this reason their benefit has been tested. The study was performed to compare the use of plastic intranasal splints with or without anterior nasal packing to determine the need of nasal packing after septoplasty. This is a prospective comparative study which was carried out in Basrah General Hospital, Otolaryngology Department, Basrah, Iraq in the period from July 2014 to April 2015. Forty seven patients of different age and gender groups were included in the study. Analysis was done regarding their history and examination including nasendoscopy which was done before septoplasty. The patients were randomly selected at the end of the procedure into two groups; one had plastic intranasal splints without anterior packing and the other had plastic intranasal splints with two different types of packing materials (ribbon gauze impregnated with Vaseline and glove fingers). Patients were compared for postoperative pain, headache, discomfort, bleeding, sleep difficulty, epiphora, septal hematoma on the day of the operation, 24 hours and 48 hours postoperatively. The collected data was analyzed by using SPSS v.17. The age of patients in this study ranged from 18 to 44 years with mean age of (29.6±6.2) years and most of them were between 28 to 37 years (48.9%). Among those 47 patients, 28 (59.6%) were males and 19 (40.4%) were females with male:female ratio was 1.47:1. Pain, headache, discomfort and bleeding was higher in patients in group two with anterior nasal packing materials especially during removal of the packing. there was significant reduction in the frequency of sleep disturbance, epiphora among the patients in group one without nasal packing, however there was no significant difference in septal hematoma between two groups. In conclusion, the plastic intranasal splints can be used alone without the need of anterior nasal packing materials after septoplasty as it can be considered as a type of packing methods that offers the advantages of elimination of pain and discomfort and reduce the complications of packing. The anterior nasal packing should be reserved only for selected cases.

Surgical Outcomes of Bony Batten Grafting to Correct Caudal Septal Deviation in Septoplasty.

Correction of caudal septal deviation with a batten graft has been popularized recently. However, few reports have documented the surgical outcomes of this technique, especially the use of bony batten grafts in septoplasty. To evaluate the surgical outcomes of bony batten grafting for the management of caudal septal deviation in endonasal septoplasty. This retrospective cohort study evaluates the medical records of 141 patients with caudal septal deviation who underwent septoplasty using bony batten grafts from September 1, 2011, through February 29, 2016, at a tertiary referral hospital. Patients were divided into primary and secondary surgery groups. Patients were also divided into the septoplasty plus turbinate surgery and the septoplasty only group. Endoscopic assessment of deviation correction was performed, and postoperative complications were analyzed. Patient satisfaction and symptom improvement were evaluated via telephone interviews by using the Nasal Obstruction Symptoms Evaluation (NOSE) scores. Of the 141 patients (24 women [17%] and 117 men [83%]; mean [SD] age, 32.8 [12.9] years), 86 (61%) rated their symptoms in the postoperative survey as much improved; 50 (35.5%), improved; 4 (2.8%), no change; and 1 (0.7%), worse. All patients had significantly improved mean (SD) postoperative NOSE scores (28.7 [22.0]; 95% CI, 25.0-32.4) compared with preoperative scores (70.5 [26.7]; 95% CI, 66.0-75.0; P < .001). No significant intergroup differences were observed in surgical outcome between the 116 patients undergoing primary surgery (mean [SD] NOSE score, 28.2 [21.9]) and 25 undergoing secondary surgery (mean [SD] NOSE score, 30.8 [24.3]; P = .34). No significant difference in surgical outcome was found between the 102 patients in the turbinate surgery group (mean [SD] NOSE score, 28.1 [20.8]) and 39 in the septoplasty only group (mean [SD] NOSE score, 30.4 [23.7]; P = .65). On endoscopic examination for surgical outcome, 128 patients (90.8%) had a straight septum and 13 (9.2%) had improved but residual caudal deviation. Postoperative complications included septal hematoma in 4 patients, hyposmia in 2, and chondritis in 1; all patients were treated successfully. Four patients required revision surgery because of incomplete functional correction or a desire for rhinoplasty. Septoplasty using bony batten grafts is useful for correcting caudal septal deviation with favorable surgical outcomes and an acceptable complication rate. 3.

Does a single dose of pregabalin help with postoperative pain after septoplasty?

Does a single dose of pregabalin help with postoperative pain after septoplasty?

Masses of the Nose, Nasal Cavity, and Nasopharynx in Children.

A wide range of masses develop in the nose, nasal cavity, and nasopharynx in children. These lesions may arise from the nasal ala or other structures of the nose, including the mucosa covering any surface of the nasal cavity, the cartilaginous or osseous portion of the nasal septum, the nasal turbinates, and the nasal bones. Lesions may also arise from the nasopharynx or adjacent structures and involve the nose by way of direct extension. The causes of nasal masses in children include congenital and developmental disorders such as congenital nasolacrimal duct mucocele, dermoid cyst, cephalocele, and nasal neuroglial heterotopia; inflammatory and infectious processes such as mucocele, polyp, and pyogenic granuloma; benign neoplasms such as infantile hemangioma and juvenile nasopharyngeal angiofibroma; malignant lesions such as rhabdomyosarcoma and nasopharyngeal carcinoma; and masses related to prior trauma such as septal hematoma. Although direct visualization, without imaging, is frequently sufficient to diagnose pediatric nasal conditions, in many cases imaging has a key role in the treatment of the affected child. Some of these lesions have characteristic computed tomography and/or magnetic resonance imaging findings, some of them are diagnosed on the basis of the location and imaging findings combined, and others demonstrate nonspecific imaging findings. However, imaging is important for better defining the total extent of the lesion and guiding the clinician in determining whether medical and/or surgical intervention is required. In this article, the authors review the imaging findings of the most common causes-and many of the not-so-common causes-of nasal masses encountered in the pediatric population. ©RSNA, 2017.

Severe Intramyocardial Hematoma as a Complication of Retrograde Approach in Chronic Total Occlusion

Interventricular septal hematoma is a rare but potentially dangerous complication of retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI) [(1,2)][1]. A 58-year-old man was referred for right coronary artery CTO-PCI performed by a retrograde approach via the collateral

Respect the Septal Perforator: Septal Artery Perforation During CTO PCI Resulting in Massive Interventricular Septal Hematoma and Biventricular Cardiac Obstructive Shock

A 70-year-old man with debilitating refractory angina underwent percutaneous coronary intervention (PCI) of a right coronary artery chronic total occlusion (CTO). Previous echocardiogram showed normal biventricular function with interventricular septum (IVS) diameter = 1.0 cm. Through a

A comparative study between nasal clips and anterior nasal packing in septoplasty/submucosal resection patients at VIMS Bellary, Karnataka

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nasal packing is used primarily to control bleeding, for internal stabilization and to prevent postoperative complications in endonasal surgeries. Nasal septal clip is one of the alternatives, whose effectiveness in surgical practice is less studied upon.&lt;strong&gt; &lt;/strong&gt;To compare the effectiveness between nasal septal clip and anterior nasal packing following septoplasty/submucous resection.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective Randomised Controlled Study was conducted in Department of Otolaryngology at Vijayanagara Institution of Medical Sciences, Bellary, between November 2014 to May 2016. Study involved 100 patients fulfilling inclusion and exclusion criteria. Adopting sealed envelope technique, patients were allotted into two equal groups for anterior nasal pack and nasal septal clip following septoplasty or submucosal resection. Interventions were done following standard procedures and data was collected by using pre-tested proforma. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean age of anterior nasal pack group and nasal septal clip group was 27.86 and 25.24 years respectively. Intra-operatively, packing with nasal septal clip was easier with significantly less trauma to mucous membrane (X&lt;sup&gt;2&lt;/sup&gt;= 6.353, P= 0.011), consuming significantly less time (t= 9.329, P&amp;lt;0.0001) and support provided to septum could be assessed visually when compared to anterior nasal packing. During immediate post-operative period and while pack removal, nasal septal clip had significantly less complications (P &amp;lt; 0.001). Follow-up complications like septal haematoma, synaechiae &amp;amp; septal perforations were lesser in nasal septal clip group&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; During intra-operative period, immediate post-operative period, during nasal pack removal and during follow-up period nasal septal clip provided technical superiority, smooth post-operative experience and lesser complications compared to anterior nasal packing proving nasal septal clip to be a better choice for nasal packing. Limitations of NSC are its availability and cost. &lt;/p&gt;

A Comparative Study between Universal Eclectic Septoplasty Technique and Cottle.

Introduction Since the last century surgical correction of nasal septum deviation has been improved. The Universal Eclectic Technique was recently reported and there are still few studies dedicated to address this surgical approach. Objective The objective of this study is to compare the results of septal deviation correction achieved using the Universal Eclectic Technique (UET) with those obtained through Cottle's Technique. Methods This is a prospective study with two consecutive case series totaling 90 patients (40 women and 50 men), aged between 18 and 55 years. We divided patients into two groups according to the surgical approach. Fifty-three patients underwent septoplasty through Universal Eclectic Technique (UET) and thirty-seven patients were submitted to classical Cottle's septoplasty technique. All patients have answered the Nasal Obstruction Symptom Evaluation Scale (NOSE) questionnaire to assess pre and postoperative nasal obstruction. Results Statistical analysis showed a significantly shorter operating time for the UET group. Nasal edema assessment performed seven days after the surgery showed a prevalence of mild edema in UET group and moderate edema in Cottle's technique group. In regard to complication rates, UET presented a single case of septal hematoma while in Cottle's technique group we observed: 02 cases of severe edemas, 01 case of incapacitating headache, and 01 complaint of nasal pain. Conclusion The Universal Eclectic Technique (UET) has proven to be a safe and effective surgical technique with faster symptomatic improvement, low complication rates, and reduced surgical time when compared with classical Cottle's technique.

Nasal septum suture combined with inferior turbinate coblation after septoplasty: Does it improve quality of life and reduce complications?

ObjectiveNasal packing is routinely applied after septoplasty. Patients, however, report feeling very uncomfortable while the packing is in place. The aim of this study was to compare the effects of nasal septum suture combined with inferior turbinate coblation to the effects of nasal packing after septoplasty.MethodsIn this study, 135 patients undergoing septoplasty were divided into 3 groups: group 1 patients had microdebrider with packing, group 2 received coblation with packing and group 3 had coblation with suture. Early postoperative quality of life and complications were compared between the 3 groups.ResultsThe patients in group 1 experienced the most postoperative nasal pain, headache, dysphagia, sleep disturbance and bleeding on the night of surgery; while the patients in group 3 experienced the fewest symptoms. No difference in epiphora was observed between the 3 groups. More pain and bleeding were experienced when comparing the pack removal (Group 1 and 2) with the clearance of the nasal cavity (Group 3). We noted one case of postoperative bleeding in group 1, one septal hematoma in group 1 and a second septal hematoma in group 2. No such postoperative complications were found in group 3.ConclusionNasal septum suture combined with inferior turbinate coblation was not only associated with less pain, increased patient satisfaction and an improved quality of life; but also reduced postoperative complications. Our results confirm that it is a more comfortable, reliable alternative to the more common nasal packing.

Anesthetic management in a patient with Friedreich's Ataxia: a different approach

Friedreich\'s Ataxia (FA) is a rare autosomal recessive disease. FA is clinically characterized by progressive ataxia, especially loss of reflex and power in the lower extremities, spasticity and loss of proprioceptive sensory. There is an increased sensitivity to non-depolarizing muscle relaxants in neurodegenerative diseases. Care must be taken of anesthesia management for the use of volatile anesthetics and muscle relaxants, and precautions should be taken for difficult airway management which is due to secondary to kyphoscoliosis and comorbidities. In this case, anesthesia management of emergency operation for septal hematoma by TIVA without using of muscle relaxants and minimalized hemodynamic response depending on the intubation by videolaryngoscope were presented.

Is nonabsorbable nasal packing after septoplasty essential? A meta-analysis.

Septoplasty is one of the most frequently performed rhinologic surgeries. Complications include nasal bleeding, pain, headache, septal hematoma, synechia, infection, residual septal deviation, and septal perforation. In this study, we aimed to compare complication rates among patients according to packing method. We performed a literature search using PubMed, Embase, and the Cochrane Library through August 2016. Our systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effect models were used to calculate risk differences and risk ratio with 95% confidence intervals (CIs). Cases referred to the nonpacking group included patients treated with transseptal sutures or septal splints. Cases referred to as the packing group included patients treated with nonabsorbable packing such as Merocel or gauze. Our search included 20 randomized controlled trials (RCTs) with a total of 1,321 subjects in the nonpacking group and 1,247 subjects in the packing group. There were no significant differences between packing methods regarding bleeding, hematoma, perforation, infection, and residual septal deviation. The risk differences of postoperative pain, headache, and postoperative synechia were -0.50 [95% CI: -0.93 to -0.07, P = .02], -0.42 [95% CI: -0.66 to -0.19, P = .0004], and -0.03 [95% CI: -0.06 to -0.01, P = .01], respectively. Nonabsorbable nasal packing is no more effective than treatments without packing after septoplasty. Septal splints and transseptal sutures reduce postoperative pain, headache, and synechia. 1B Laryngoscope, 127:1026-1031, 2017.

The comparison of the quality of life and intranasal edema between the patients with or without nasal packing after septoplasty.

Septoplasty is one of the most common operations performed in otolaryngology and anterior nasal packing is done routinely to prevent postoperative bleeding, septal hematoma or nasal synechia. Currently, transseptal sutures have gained a broader application area, not only for preventing the complications such as septal hematoma and bleeding but also closing any accidental tears of septal mucosa and providing additional support for the cartilage pieces retained in septoplasty. We evaluated the quality of life of the patients in early postoperative period (in the first postoperative week), intranasal edema with endoscopic examination and the intranasal changes with acoustic rhinometry. We performed a prospective and randomized study with patients undergoing septoplasty without inferior turbinectomy. As packing material, there were two groups: in group A, gauze in a glove finger and in group B, Doyle splint were used, and in the additional group C, only transseptal suture with 4/0 vicryl among the cartilaginous septum was performed. The patients were invited to control examinations on the postoperative 2nd, 4th and 7th days to evaluate the scores from 1 to 5 on the questionnaire for the pain, nasal fullness, sneezing, epiphora, difficulty in swallowing and sleep disturbances. The patients were also administered an endoscopic nasal examination for the purpose of detecting the intranasal edema, and acoustic rhinometry was performed during the control examinations to detect the intranasal changes. Total occluding packing was found to cause much more frequent and higher scores of epiphora, sneezing, difficulty in swallowing, but mainly, the pain compared to in silicone packing with airway and transseptal suture only. Although the silicone packing with airway was found to be much more comfortable, it also led to sneezing and epiphora. The patients without nasal packing had more comfortable period especially in the early postoperative days (the first 4days). However, 1week after surgery, groups with and without nasal packing were found to be equalized on behalf of the objective and subjective parameters. As any complication was not observed due to not using nasal packing, it is thought that nasal packing usage following septoplasty is not a necessity.

Spontaneous septal hematoma developing on underlying idiopathic thrombocytopenia: a rare case

Spontaneous septal hematoma developing on underlying idiopathic thrombocytopenia: a rare case