Septal Perforation Research Articles

Rhinologic outcome of endoscopic transnasal-transsphenoidal pituitary surgery: an institutional series, systematic review, and meta-analysis

PurposeWe aimed to summarize the available data on the objective rhinologic outcome after endoscopic transnasal-transsphenoidal (ETT) surgery.MethodsRetrospective study on a consecutive cohort of treatment-naïve patients undergoing ETT pituitary gland surgery. Additionally, a systematic review and meta-analysis with focus on the rhinologic outcome, including postoperative smell function was performed.ResultsThe institutional series incorporated 168 patients. A concomitant endoscopic septoplasty was performed in 29/168 patients (17.3%). A nasoseptal flap was used for reconstruction of large skull-base defects or high-flow CSF leaks in 4/168 (2.4%) patients. Early postoperative rhinologic complications (< 4 weeks) included epistaxis (3%), acute rhinosinusitis (1.2%) and late postoperative complications (≥ 8 weeks) comprised prolonged crusting (15.6%), symptomatic synechiae (11.9%) and septal perforation (0.6%). Postoperative smell function was not impaired (Fisher’s exact test, p = 1.0). The systematic review included 19 studies on 1533 patients with a median postoperative epistaxis rate of 1.4% (IQR 1.0–2.2), a postoperative acute rhinosinusitis rate of 2.3% (IQR 2.1–3.0), a postoperative synechiae rate of 7.5% (IQR 1.8–19.1) and a postoperative septal perforation rate of 2.2% (IQR 0.5–5.4). Seven studies including a total of 206 patients reported adequate outcome measures for smell function before and after ETT surgery. Only 2/7 studies reported an impairment of smell function postoperatively, especially in patients with nasoseptal flap harvesting.ConclusionEarly and late postoperative rhinologic complication rates after ETT surgery for pituitary lesions seem to be low. A thorough evaluation of smell function, in particular in patients at risk for nasoseptal flap harvesting, may be an important factor in optimal postoperative care.

Using the sino-nasal outcome test (SNOT-22) to study outcome of treatment of nasal obstruction

ObjectiveTo validate the sino-nasal outcome test (SNOT-22) as an outcome measure for nasal obstruction, and to determine if it correlates with the nasal obstruction and septoplasty effectiveness (NOSE) scale. Study designProspective cohort study. MethodsAll patients presenting to our otolaryngology clinic for nasal obstruction secondary to nasal septal deviation and/or inferior turbinate hypertrophy between August 2020 and June 2022 were asked to fill both the SNOT-22 and the NOSE questionnaires. Demographics and comorbidities were reviewed. Patients with chronic rhinosinusitis (CRS) were excluded. SNOT-22 total and subdomain scores were then compared to NOSE scores. Results126 patients completed both surveys. Average age was 42.6 years (range 13.8–78.3 years), and 40.5 % were female. 35 patients had septoplasty and inferior turbinoplasty (IT), 34 had functional septorhinoplasty and IT, 6 patients had IT, 7 had nasal septal perforation repair and 44 patients had medical treatment. Overall, SNOT-22 and NOSE scores correlated well preoperatively and postoperatively (r = 0.54, p < 0.0001; r = 0.68, p < 0.0001 respectively). The rhinologic and sleep SNOT-22 subdomains scores had the strongest correlation to NOSE score (r = 0.56, p < 0.0001; r = 0.64, p < 0.0001 respectively). Both NOSE and SNOT-22 scores showed improvement postoperatively [NOSE: 67.4 vs 25.1 (p < 0.0001) at 3 months, 69.5 vs 34 (p < 0.0001) at 6 months; SNOT-22: 37.1 vs 25.2 (p = 0.002) at 3 months, 38.1 vs 22.6 (p = 0.002) at 6 months]. No significant improvement in NOSE or SNOT scores was seen in the medical treatment group. ConclusionSNOT-22 instrument can be used to study the outcome of treatment for nasal obstruction secondary to nasal septal deviation and/or inferior turbinate hypertrophy.Level of evidence: 4.

Temperature-controlled radiofrequency device treatment of septal swell bodies for nasal airway obstruction: An open-label, single arm multicenter study.

Nasal airway obstruction (NAO) is a highly prevalent disorder. Septal swell body (SSB) hypertrophy is an often overlooked contributor to NAO. SSB treatment may relieve symptoms of NAO. The objective of this study was to assess the clinical use of a temperature-controlled radiofrequency (TCRF) device to treat SSBs to improve symptoms in adults with NAO. In this prospective, multicenter, open-label, single arm study, patients with severe or extreme NAO related to SSB hypertrophy received bilateral TCRF treatment in the SSB area. The primary endpoint was improvement in Nasal Obstruction Symptom Evaluation (NOSE) Scale scores from baseline to 3 months postprocedure. A subset of study patients underwent computed tomography (CT) imaging to evaluate posttreatment changes in SSB size. Mean NOSE Scale scores significantly improved from 73.5 (SD 14.2) at baseline to 27.9 (SD 17.2) at 3 months postprocedure, a reduction of -45.3 (SD 21.4, 95% confidence interval [CI]: -50.4 to -40.1; p<0.0001); the responder rate was 95.7% (95% CI: 0.88 to 0.99; p<0.0001). CT evaluation at 3months showed statistically significant reductions in the SSB with the greatest reduction in the middle thickness (mean change -3.4 [SD 1.8] mL, 95% CI: -4.0 to -2.8; p<0.0001). Minimal adverse events with any relationship to the device or procedure were reported; none were serious in nature and no septal perforations occurred. This study demonstrates that TCRF treatment of SSB hypertrophy is well tolerated and effective at reducing both SSB size and symptoms of NAO at 3 months posttreatment.

Peribolosporomycetes class. nov.: description of a new heat resistant and osmotolerant basidiomycete lineage, represented by Peribolospora gen. nov., P. kevripleyi sp. nov., and P. baueri sp. nov.

Heat resistance is the ability to survive short, extreme temperature stresses, exceeding the own growth temperature by far. Despite their occurrence in natural substrates and their relevance for the food and healthcare industry, the diversity of fungi with heat resistance abilities is poorly studied. Sampling of boreal forest soils in Canada in combination with a heat-shock treatment (75 °C, 30 min) yielded, among others, four heat resistant, mesophilic fungal isolates. Based on rDNA barcode sequences, the novel isolates were assigned to Basidiomycota. In this study, we use macromorphological and micromorphological observations, cultivation assays and comparative genomics for physiological characterization, interspecific differentiation, and phylogenetic placement of these isolates. A phylogeny of 38 single-copy orthologous genes, an orthology analysis, and septal pore type analysis revealed the isolates as representatives of two new basidiomycetous species of the novel class Peribolosporomycetes, a sister lineage to all other members of Ustilaginomycotina. Further genomic and phenotypic data support two different species (Peribolospora kevripleyi, Peribolospora baueri), which are heat resistant and osmotolerant.

Large-scale identification of genes involved in septal pore plugging in multicellular fungi

Multicellular filamentous fungi have septal pores that allow cytoplasmic exchange, and thus connectivity, between neighboring cells in the filament. Hyphal wounding and other stress conditions induce septal pore closure to minimize cytoplasmic loss. However, the composition of the septal pore and the mechanisms underlying its function are not well understood. Here, we set out to identify new septal components by determining the subcellular localization of 776 uncharacterized proteins in a multicellular ascomycete, Aspergillus oryzae. The set of 776 uncharacterized proteins was selected on the basis that their genes were present in the genomes of multicellular, septal pore-bearing ascomycetes (three Aspergillus species, in subdivision Pezizomycotina) and absent/divergent in the genomes of septal pore-lacking ascomycetes (yeasts). Upon determining their subcellular localization, 62 proteins were found to localize to the septum or septal pore. Deletion of the encoding genes revealed that 23 proteins are involved in regulating septal pore plugging upon hyphal wounding. Thus, this study determines the subcellular localization of many uncharacterized proteins in A. oryzae and, in particular, identifies a set of proteins involved in septal pore function.

Recurrent rhinosporidiosis: A case report from Malaysia and review of literature

Over the decades, rhinosporidiosis has remained an enigma. It is a recalcitrant disease caused by Rhinosporidium seeberi, primarily affecting the nasal cavity, conjunctiva, and less frequently involved sites, including skin, urethra, and others. We report a case of a local from Sabah who has presented with recurring symptoms of nasal obstruction and epistaxis for two decades. He had previously undergone multiple endoscopic excisional surgeries before receiving treatment at our centre. Otorhinolaryngeal examination revealed polypoidal masses occupying bilateral nasal cavities with a perforation of the nasal septum. He underwent surgical resection of the lesions, and the histopathological examination confirmed recurrent rhinosporidiosis. Due to its sporistatic effects, dapsone was chosen as the pharmacological treatment in this case. However, after a year of follow-up, he developed similar symptoms and the endoscopic findings, indicated a recurrence of the disease. The histopathological samples obtained during the repeated surgery for recurrent polypoidal masses, confirmed the diagnosis of rhinosporiodiosis. As the disease poses diagnostic and therapeutic challenges, clinicians should be prudent in establishing the diagnosis in non-endemic areas, such as Malaysia, and evaluating the possibility of recurrence.

Approach to Left Bundle Branch Pacing.

Cardiac pacing refers to the implantation tool serving as a treatment modality for various indications, the most common of which is symptomatic bradyarrhythmia. Left bundle branch pacing has been noted in the literature to be safer than biventricular pacing or His-bundle pacing in patients with left bundle branch block (LBBB) and heart failure, thereby becoming the focus of further research on cardiac pacing. A review of the literature was conducted using a combination of keywords, including "Left Bundle Branch Block," "Procedural techniques," "Left Bundle Capture," and "Complications." The following factors have been investigated as key criteria for direct capture: paced QRS morphology, peak left ventricular activation time, left bundle potential, nonselective and selective left bundle capture, and programmed deep septal stimulation protocol. In addition, complications of LBBP, inclusive of septal perforation, thromboembolism, right bundle branch injury, septal artery injury, lead dislodgement, lead fracture, and lead extraction, have also been elaborated on. Despite clinical implications based on clinical research comparing the use of LBBP with other forms such as right ventricular apex pacing, His-bundle pacing, biventricular pacing, and left ventricular septal pacing, a paucity in the literature on long-term effects and efficacy has been noted. LBBP can thus be considered to have a promising future in patients requiring cardiac pacing, assuming that additional research on clinical outcomes and the limitation of significant complications such as thromboembolism can be established.

Minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure: a series of 60 cases

Objective: To examine the short-term curative effect with minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure. Methods: The clinical data of 60 patients who underwent video-assisted thoracoscopic transaortic modified Morrow procedure from August 2021 to August 2022 at Department of Cardiovascular Surgery, Zhejiang Provincial People's Hospital were retrospectively analyzed. There were 31 males and 29 females, with the age (M (IQR)) of 54.0(22.3) years (range: 15 to 71 years). The echocardiography confirmed the diagnosis of moderate mitral regurgitation in 30 patients, and severe mitral regurgitation in 13 patients. Systolic anterior motion (SAM) was present preoperatively in 54 patients. All 60 patients underwent transaortic modified Morrow procedure through a right infra-axillary thoracotomy using femorofemoral cardiopulmonary bypass. Surgical procedures mainly included transverse aortic incision, exposure of left ventricular outflow tract (LVOT), septal myectomy, and correction of the abnormal mitral valve and subvalvular structures. Results: All 60 patients underwent the programmatic procedures successfully without conversion to full sternotomy. The cardiopulmonary bypass time was (142.0±32.1) minutes (range: 89 to 240 minutes), while the cross-clamp time was (95.0±23.5) minutes (range: 50 to 162 minutes). The patients had a postoperative peak LVOT gradient of 7.0 (5.0) mmHg (range: 0 to 38 mmHg) (1 mmHg=0.133 kPa). A total of 57 patients were extubated on the operating table. The drainage volume in the first 24 h was (175.9±57.0) ml (range: 60 to 327 ml). The length of intensive care unit stay was 21.0 (5.8)h (range: 8 to 120 h) and postoperative hospital stay was 8 (5) days (range: 5 to 19 days). The postoperative septal thickness was 11 (2) mm (range: 8 to 14 mm). All patients had no iatrogenic ventricular septal perforation or postoperative residual SAM. The patients were followed up for 4 (9) months (range: 1 to 15 months), and none of them needed cardiac surgery again due to valve dysfunction or increased peak LVOT gradient during follow-up. Conclusion: Using a video-assisted thoracoscopic transaortic modified Morrow procedure through a right infra-axillary minithoracotomy can provide good visualization of the LVOT and hypertrophic ventricular septum, ensure optimal exposure of the mitral valve in the presence of complex mitral subvalvular structures, so that allows satisfactory short-term surgical results.

Surgical treatment for obstructive hypertrophic cardiomyopathy: a five-year single-center experience of 421 cases

Objectives: To examine the short-term and mid-term effects of surgical treatment of obstructive hypertrophic cardiomyopathy (HCM) in one center. Methods: The perioperative data and short-term follow-up outcomes of 421 patients with obstructive HCM who received surgical treatment at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University from January 2017 to December 2021 were analyzed retrospectively. There were 207 males and 214 females, aged (56.5±11.7) years (range: 19 to 78 years). Preoperative New York Heart Association (NYHA) classification included 45 cases of class Ⅱ, 328 cases in class Ⅲ, and 48 cases in class Ⅳ. Fifty-eight patients were diagnosed with latent obstructive HCM and 257 patients had moderate or more mitral regurgitation with 56 patients suffering from intrinsic mitral valve diseases. All procedures were completed by a multidisciplinary team, including professional echocardiologists involving in preoperative planning for proper mitral valve management strategies and intraoperative monitoring. A total of 338 patients underwent septal myectomy alone, and 59 patients underwent mitral valve surgery along with myectomy. A single transaortic approach was used in 355 patients, and a right atrial-atrial septal/atrial sulcus approach was used in 51 other patients. Long-handled minimally invasive surgical instruments were used for the procedures. Student t test, Wilcoxon rank sum test, χ2 test or Fisher exact test were used to compare the data before and after surgery. Results: The aortic cross-clamping time of septal myectomy alone was (34.3±8.5) minutes (range: 21 to 94 minutes). Eighteen patients had intraoperative adverse events and underwent immediate reoperation, including residual obstruction (10 patients), left ventricular free wall rupture (4 patients), ventricular septal perforation (3 patients), and aortic valve perforation (1 patient). Four patients died during hospitalization, and 11 patients developed complete atrioventricular block requiring permanent pacemaker implantation. After discharge, 384 (92.1%) patients received a follow-up visit with a median duration of 9 months. All follow-up patients survived with significantly improved NYHA classifications: 216 patients in class Ⅰ and 168 patients in class Ⅱ (χ2=662.73, P<0.01 as compared to baseline). At 6 months after surgery, follow-up echocardiography showed that the thickness of the ventricular septum ((13.6±2.5) mm vs. (18.2±3.0) mm, t=23.51, P<0.01) and the peak left ventricular outflow tract gradient ((12.0±6.3) mmHg vs. (93.4±19.8) mmHg, 1 mmHg=0.133 kPa, t=78.29, P<0.01) were both significantly lower than baseline values. Conclusion: The construction of the surgical team (including echocardiography experts), proper mitral valve management strategies, identification and management of sub-mitral-valve abnormalities, and application of long-handled minimally invasive surgical instruments are important for the successful implementation of septal myectomy with satisfactory short-and medium-term outcomes.

Unusual Presentation of Anca Vasculitis with Otitis Media and CVA

A 42-year-old African female (Kenyan in origin), known to have hypertension that was diagnosed during gestation and persisted; presented with a history of dysphagia for four years. Before her admission, she had presented to the surgical clinic with ear fullness and ear pain with throbbing headaches, and she was diagnosed with bilateral oto-mastoditis. Her symptoms subsequently, progressed to a multisystemic disease involving the lungs, brain, kidneys, and peripheral nerves. ANCA vasculitis is a rare disease, the main target organs in granulomatous polyangiitis include the ear, nose throat, and upper respiratory tract, and glomerulonephritis of the kidney and the lungs. Localized disease manifestation can include the nose (rhinorrhea, nasal crusts, septal perforation) and ear (otitis media, hearing loss, sensorineural deficits). The diagnosis of vasculitis from localized disease manifestation can be difficult to diagnose.

Septal perforations – state of the art

Abstract Septal perforation is a nasal condition discovered incidentally during an ENT clinical examination. Sometimes, patients may experiment epistaxis, septal crusts at the edge of perforation, nasal obstruction, whistling, rhinorrhea or even pain. Doctors should be familiarized with the etiology of septal perforations in order to apply the best treatment possible. This etiology includes some of the following: iatrogenic, self-injury, drugs, inflammatory diseases, etc. A very good anamnesis and clinical examination should be performed. Also, paraclinical investigations are required depending on the particular situation. Treatment should be individualized and may include conservational techniques or applying of grafts/flaps for closing the septal perforation. In this article, some of the most frequent causes of septal perforation are reviewed, with some examples from our clinic and short reminder of steps to be taken in this case.

Modified transseptal approach in endoscopic transsphenoidal pituitary surgery.

Transsphenoidal pituitary surgery is commonly performed via a direct transostial approach with a posterior septectomy. However, a technique via an endoscopic transseptal route has been described that avoids a posterior septectomy, but it comes with its own disadvantages. This paper describes a modification, and discusses its pros and cons. The initial incision in the mucosa is placed level with the anterior middle turbinate. The mucoperichondrial flap is raised ipsilaterally until the sphenoid sinus ostium. An incision is made at the osseocartilaginous junction, and the contralateral mucoperichondrial flap is raised. The bony septum and posterior aspect of this flap is excised. The size and position of this window can be adapted. At the end of the operation, the lateralised intact mucoperichondrial flap is moved back to the midline. Excision or deflection of the cartilaginous septum is not required. It maintains an intact septal mucosa on one side and avoids a septal perforation.

SIGNIFICANCE OF NASAL SEPTUM ANGULATION AND ITS ASSOCIATION WITH RHINOSINUSITIS USING SYMPTOMS SCORES AND VISUAL ANALOGUE SCALE

Objective- The aim of the study is to determine the association of angulation of nasal septum with the severity of rhinosinusitis as measured by symptom score and visual analog score. Materials and methods- 50 patients who were diagnosed with rhinosinusitis and fullled the selection criteria were assessed for symptom score and VAS and measurement of angulation of nasal septum was performed through a coronal view of CT paranasal sinuses in bone window setting. Patients older than 18 years, diagnosed with rhinosinusit Inclusion criteria- is and carrying indications for CT scan of paranasal sinuses were included in the study. Patients with history of nasal Exclusion criteria trauma, septal surgery, septal haematoma ,septal perforation, concha bullosa, sinonasal tumors were excluded from the study. Results- The result obtained from one-way ANOVA test revealed a signicant association between category of severity of septal angulation and the symptom score of rhinosinusitis. Severity of nasal septum angulation may be signicantly asso Conclusion- ciated with severity of rhinosinusitis based on symptom score and VAS.these ndings could be used in management of patient with rhinosinusitis during functional endoscopic sinus surgery

The Efficacy of Topical Lactoferrin on Wound Healing in an Experimental Animal Model of Nasal Septum Perforation.

The aim of the present experimental animal study was to investigate the efficacy of bovine lactoferrin (LF) on wound healing in an animal model of nasal septum perforation (NSP).Twenty-two, 8 to 10 weeks of age, male Sprague-Dawley rats were separated into two groups. Nasal septum perforation was created in each rat. The saline (control) and 0.05 mg LF (study) groups were delivered locally for 14 days. On the 14th day of the study, after the sacrifice, the cartilage nasal septa of the animals were excised. The degeneration and regeneration observed in the nasal septum epithelium and cartilage, the number of acute inflammatory cells, the number of eosinophils, the amount of new vessel formation, the amount of granulation, and the collagen density were examined microscopically. The microscopic parameters and macroscopic healing of NSPs were analyzed. The epithelium regeneration, the fibroblast number, the granulation tissue formation, the collagen density, and the macroscopic healing were significantly higher in the LF group (p < 0.05). Besides, the acute inflammatory cell count was lower in the LF group (p = 0.034). In conclusion, the topically delivered LF can improve wound healing in an experimental rat model of NSP.

Effect of Bilateral Nasal Packing on Systemic Blood Pressure in Patients Treated with Septoplasty

Aim: The primary aim of this research was to assess the impact of bilateral nasal packing on systolic blood pressure in individuals undergoing septoplasty. Study Design: Retrospective study. Place and Duration: This study was conducted at Hospital Dow International Medical College, Dow University of Health Sciences Karachi and Shahida Islam Medical College, Lodhran during in the period from March, 2022 to August, 2022. Methods:152 patients who had a clinically determined nasal septoplasty were included in this study. Patients in this ranged in age from 18 to 50. The patients were randomly split in two groups. Seventy-six patients were assigned to Group I, where no nasal packing was utilized, and Group II, where conventional anterior nasal packing was applied. One may say that there was a 50/50 split between the two groups. Before to and throughout septoplasty, all patients underwent round-the-clock ambulatory blood pressure monitoring. Statistical analysis was performed on all data using SPSS 24. Results: 90 (59.2%) of the 152 patients were male, and 62 (40.8%) of the patients were female. The patients which were under the age of 30 are 59(38.8 percent) of the total patients, 55 (36.2 percent) were between the ages of 31 and 40, and 38 (25 percent) were above the age of 40.50% of the patients are comprised of rural locale. Study participants in Group II were found to have higher mean blood pressure (p-Value 0.05) following septoplasty therapy than those in Group I (P-Value &gt;0.05). Group II patients had bleeding, vestibulitis, and septal perforations as a result of their nasal packing procedure. Conclusion: The study determined that bilateral nasal packing was linked with the preferment in either systolic or diastolic blood pressure in individuals who had septoplasty treatment. There is no statistical significance change showed up with the patients who did not get nasal packing from the rest of the group. Keywords: Septoplasty, Bilateral Nasal Packing, systemic blood pressure

Characteristics of Nasal Foreign Bodies and Equipment on Complications During Removal Procedures.

The treatment of nasal foreign bodies involves safe and reliable removal. Few reports have investigated the relationship between equipment and the incidence of complications. This retrospective study included 300 patients with nasal foreign bodies (average: 3.28 years, interquartile range: 2-4 years). Patients' background, characteristics of nasal foreign body, equipment to remove the nasal foreign body, and complications were obtained from medical records. Statistical analysis was performed using Pearson's chi-square test for associated factors and the incidence of epistaxis among the complications. Nasal foreign bodies were found and removed in 256 patients. Forceps, hooks, suction, modified paper clips, and cotton swabs were mainly used to remove the nasal foreign bodies. Epistaxis due to the removal procedure was observed in 26 patients. The occurrence of epistaxis differed depending on the equipment (p=0.077) and was less frequent in suction and paper clips than in forceps (p < 0.05 and p=0.077). Epistaxis was not observed when a cotton swab was used. Aspiration and septal perforation were not observed. A statistical relationship was not detected between the hardness of foreign bodies and the occurrence of epistaxis (p=0.251). The incidence of epistaxis was higher in cases nasal foreign bodies remained for 1 day and over than in cases foreign bodies were removed within 1 day (p < 0.05). This study revealed that suction, modified paper clips, and cotton swabs could be beneficial options for minimizing complications in the removal of nasal foreign bodies. 4 Laryngoscope, 133:2553-2557, 2023.

Factors Affecting the Complication Rate of Septoplasty: Analysis of 1,506 Consecutive Cases of Single Surgeon.

Based on the analysis of a single surgeon's consecutive cases, we present the incidence of septoplasty complications and factors that contribute to the increased risk of complications. We retrospectively reviewed the medical records from 1,506 patients diagnosed with deviated nasal septum who underwent septoplasty by a single surgeon from January 2003 until May 2020. The incidence of different complications was investigated. Predisposing factors for specific complications were examined with univariate analysis. The average age of patients was 35 (11-76) years. Out of 1,506 patients, 1,252 were male, and 254 were female. The most frequent complication was insufficient correction (78 cases, 5.2%), and revision septoplasty was performed in 21 cases. We also reported 59 (3.9%), 55 (3.7%), 33 (2.2%), 20 (1.3%), and 18 (1.2%) cases of olfactory dysfunction, hematoma, synechia, abscess, and septal mucosal defect, respectively. Additionally, there were nine (0.6%), six (0.4%), five (0.3%), four (0.3%), and four (0.3%) cases of septal perforation, postoperative bleeding, saddle nose, chondritis, empty nose syndrome, respectively. The proportion of insufficient correction was higher in revision cases than in primary cases. Hematoma formation, abscess formation, and septal mucosal defect occurred more frequently in the bilateral flap elevation group. Olfactory dysfunction was significantly more frequent when the bony batten was inserted, while hematoma, abscess formation, and septal mucosal defect were more frequent when the cartilage batten was used. Septoplasty was associated with the risk of several complications, while complication rates were influenced by choice of surgical techniques and approaches.

Efficacy and safety of endoscopic septoplasty for treating nasal septal deviations compared with conventional septoplasty: A systematic review and meta-analysis.

We assessed the effects and safety of endoscopic septoplasty in patients with nasal septal deviations (NSD), compared with those of conventional septoplasty. Systematic review and meta-analysis. Patients who have undergone various endoscopic septoplasty procedure, such as hemitransfixion incision, incision at the deviated site and Killian incision, and conventional septoplasty. Six databases were searched up to April 2022. We analysed studies comparing improvements in NSD-related symptoms and post-operative complications between endoscopic septoplasty and control (conventional septoplasty) groups. A total of 38 articles with 2733 individuals were included. There were no significant differences in operative time (-0.4354, 95% confidence interval [CI: -1.1670; 0.2962]) or intra-operative bleeding (-1.3011 [-2.8003; 0.1981]) between the two groups. In the endoscopic septoplasty group, the change in nasal obstruction symptom evaluation score (9.5143 [5.4613; 13.5674] was statistically higher and the incidence of mucosal tearing (0.2766 [0.1889; 0.4049]) was lower. The incidences of full relief from symptoms such as headache (2.1996 [1.6896; 2.8634]), hyposmia (4.4468 [2.6806; 7.3767]), nasal obstruction (5.9871 [4.3292; 8.2800]), post-nasal drip (4.7241 [3.4086; 6.5472]) and snoring (2.9980 [1.2622; 7.1211]) were significantly higher in the endoscopic septoplasty group. In terms of post-operative endoscopic findings, epistaxis (0.3043 [0.1969; 0.4703]), hematoma (0.2022 [0.0785; 0.5213]), nasal obstruction 0.3373 [0.1334; 0.8527]), residual posterior septal deviation (0.1562 [0.0921; 0.2650]), septal perforation (0.2286 [0.1069; 0.4889]), residual spur (0.1294 [0.0602; 0.2780]) and synechia (0.2537 [0.1849; 0.3483]) were significantly less common in the endoscopic septoplasty group. Endoscopic septoplasty better relieved NSD-related symptoms and reduced surgery-related complications compared to conventional septoplasty.

Nasal Swell Body Characteristics in Patients With Septal Perforation.

To determine whether septal perforations have an effect on nasal swell body (NSB) size. Retrospective cohort study. Two tertiary academic medical centers. Computed tomography maxillofacial scans of 126 patients with septal perforation and 140 control patients from November 2010 to December 2020 were evaluated. Perforation etiology was determined. Measurements included perforation length and height and swell body width, height, and length. Swell body volume was calculated. The width and volume of the NSB are significantly smaller in perforation patients when compared to controls. The swell body is significantly smaller and thinner in perforations exceeding 14 mm in height compared to small perforations. Perforation etiology groupings into prior septal surgery, septal trauma, septal inflammatory, and mucosal vasoconstriction categories all demonstrated decreased swell body volume and width compared to controls. Inflammatory etiology had the greatest decrease in swell body size. The hemi-swell body on the contralateral side of a septal deviation is significantly thicker than the ipsilateral side. The NSBis smaller in patients with septal perforation regardless of perforation size or etiology.

Образование в хиазмально-селлярной области у пациента с фиброзной дисплазией в практике оториноларинголога (клиническое наблюдение)

Cerebral tumors at their onset are asymptomatic or manifest in minor nonspecific signs. Nosebleed is considered one of the most common types of ENT emergency, a manifestation of brain tumors and postoperative complications. The article presents a case of a 35-year-old male patient who visited an otorhinolaryngologist with complaints of nosebleeds. Anamnesis showed that the patient had previously undergone transsphenoidal tumor resection due to the tumor in the chiasmo-sellar region detected by computed tomography (CT). Tumor nature at that moment could not be established due to intraoperative hemorrhage. CT angiography was performed to clarify the nature of hemorrhage, which revealed multiple brain arteriovenous malformations. CT also revealed a pattern of the patient: the diffuse bone lesion of the skull and facial skeleton, characteristic of fibrous dysplasia, which was first diagnosed at the age of 12. The article discusses further tactics of patient management with recurrent nosebleeds and breathing difficulties, taking into account a multidisciplinary approach. KEYWORDS: arteriovenous malformations, nasal septal perforation, tumor of the chiasmo-cellular region, ethmoidal air cells, fibrous dysplasia, biopsy. FOR CITATION: Khapaeva M.M., Zhuboev R.T., Khakuasheva I.A. Tumor in the chiasmo-sellar region of a patient with fibrotic dysplasia: practice of an otorhinolaryngologist (case report). Russian Medical Inquiry. 2023;7(8). (in Russ.). DOI: 10.32364/2587-6821-2023- 7-8-10.