Septal Deviation Research Articles

Gender Differences in Quality of Life of Adolescent Patients With Chronic Rhinosinusitis.

To identify the differences in the impact of chronic rhinosinusitis (CRS) between female and male adolescent patients at presentation. Cross sectional study. Adolescent patients, age 12 to 18 years old, presenting to our Otolaryngology clinic between August 2020 and April 2023 for CRS were asked to fill both the SNOT-22 and the SN5 forms. Female and male cohorts were compared regarding their demographics, comorbidities, subjective and objective disease measurements, and choice of treatment. Sixty-six patients were included, 30 female and 36 male patients. There were no differences in age, allergic rhinitis, asthma, obstructive sleep apnea, presence of nasal septal deviation, and objective disease severity (P > .05 for all). At presentation, mean overall SNOT-22, ear/facial, sleep, and psychological domains were all higher in female patients (43vs 30.9, P = .02; 9.1vs 6, P = .03; 11.8vs 8.3, P = .07; 14.1vs 8.8, P = .02 respectively). SN5 scores and overall QoL visual analog scale were similar in females and males. Female patients with CRS show higher subjective disease burden. Incorporating data on gender-specific differences may be important to personalize treatment decision making.

Partial Extracorporeal Septoplasty in Crooked Noses.

In crooked noses, the standard septoplasty is a challenge because of the complex deviation of the septum, where straightening of the cartilage in situ is impossible. Hence, it is required to remove the partial/total septum and later is replaced backafter being straightened; the procedure is called partial/total extracorporeal septoplasty. In the present study, we shared our experience of partialextracorporeal septoplasty in patients with crooked noses. It is a retrospective analysis of 30 crooked noses who underwentextracorporeal septoplasty due to gross septal deviation from March 2020 to August 2022. The functional and aesthetic outcomes were evaluated at the end of 12 months. Of 30 cases, partial and totalextracorporeal septoplasty was performed in 28 casesand twocases respectively. Neoseptum was reconstructed with septal cartilage in 27 (90%) cases, costal cartilage in one case and conchal cartilage was usedin two instances. All the patients had good functional and aesthetic outcomes till 12 months of follow-up, and there were no major intraoperative or postoperative complications. Extracorporeal septoplasty can be an excellent surgical procedure in the highly deviated nasal septum, in Indian noses with a crooked nasaldeformity. It provides adequate exposure to the whole septum, ensuring good functional and aesthetic outcomes with minimal complication rate. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Three-Dimensional Evaluation of Alveolar Cleft Volume and Nasomaxillary Form in Patients with Unilateral Cleft Lip and Palate.

To evaluate the alveolar cleft volume (ACV) and to study its correlation with the nasomaxillary form in patients with unilateral cleft lip and palate (UCLP). Retrospective study. University Academic Hospital. 30 patients with UCLP and 30 non-cleft patients. Cone beam computed tomography (CBCT) scans. The Maxillary sinus volume (MSV) and Nasal cavity volume (NCV) were significantly reduced on the affected side in patients with UCLP (P < .001) and also in the cleft group when compared to the noncleft group (P < .01). The septal deviation measured at anterior, mid and posterior nasal spine were increased in the UCLP group significantly when compared to the non-cleft group (P < .01) and maximum deviation was seen at the mid-level. The mean ACV was found to be 0.587 + 0.396 cm3.The nasomaxillary complex was affected in UCLP patients irrespective of cleft size and a statistically significant correlation of ACV was found with septal height only (r value = -0.508). Parameters like septal height, anterior and middle maxillary width were significantly reduced (P < .01) in the cleft group when compared to the non-cleft group. The patients with UCLP showed significant differences among various parameters within the nasomaxillary complex when compared to the control group. Within the cleft group, the MSV and NCV were significantly decreased on the cleft side and also a significant negative correlation of ACV was found with septal height only.

Anatomic Features of the Nasal and Pharyngeal Region Do Not Influence PAP Therapy Response.

The objective of this study was to investigate to which extent anatomic features of the nasal and pharyngeal region contribute to the severity of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy response. Therefore, 93 patients (mean age 57.5 ± 13.0 years, mean body mass index 32.2 ± 5.80 kg/m2, 75 males, 18 females) diagnosed with OSA who subsequently started PAP therapy were randomly selected from the databank of a sleep laboratory of a tertiary university medical center. Patients were subdivided based on nasal anatomy (septal deviation, turbinate hyperplasia, their combination, or none of the above), pharyngeal anatomy (webbing, tonsillar hyperplasia, their combination, or none of the above), and (as a separate group) tongue base anatomy (no tongue base hyperplasia or tongue base hyperplasia). Then, polysomnographic data (e.g., arousal index, ARI; respiratory disturbance index, RDI; apnea index, AI; hypopnea index, HI; and oxygen desaturation index, ODI) of diagnostic polysomnography (PSG) and PAP therapy control PSG were collected, grouped, and evaluated. Septal deviation, turbinate hyperplasia, or their combination did not significantly affect the assessed PSG parameters or the response to PAP therapy compared with patients without nasal obstruction (p > 0.05 for all parameters). Accordingly, most PSG parameters and the response to PAP therapy were not significantly affected by webbing, tonsil hyperplasia, or their combination compared with patients without pharyngeal obstruction (p > 0.05 for RDI, AI, HI, and ODI, respectively). However, in the pharyngeal anatomy group, ARI was significantly higher in patients with tonsil hyperplasia (p = 0.018). Further, patients with tongue base hyperplasia showed a significantly higher HI in the diagnostic PSG (p = 0.025) compared with patients with normal tongue base anatomy, but tongue base anatomy did not significantly affect the response to PAP therapy (p > 0.05 for all parameters). The influence of anatomic features of the nasal and pharyngeal region on PAP therapy response appears to be small, and generalizability of these results requires further studies.

The Rate and Predictors of Allergic Fungal Rhinosinusitis Recurrence Post-sinus Surgery: A Retrospective Cohort Study.

Objectives Chronic rhinosinusitis (CRS) is the persistent inflammation of the mucosal lining of the paranasal sinuses (PNS). By definition, the inflammatory process persists beyond 12 weeks. One of its subtypes is allergic fungal rhinosinusitis (AFRS), which has a high risk of recurrence, leading to revision surgery. This study aimed to establish the predictive factors for the recurrence of AFRS in post-sinus surgery patients. Methods This single-center retrospective study was conducted in Al-Noor Specialist Hospital, Makkah, Saudi Arabia. The charts of patients with AFRS who underwent surgery in our rhinology clinic between 2000 and 2020 were reviewed. Results Among the 116 patients included in this study, approximately half (53%) were female, with a median age of 24.5 years. Thirty-nine (33.6%) patients had recurrence post-sinus surgery, with 33.3% occurring within six months of follow-up. The results showed that patients with coexisting bronchial asthma were three times more likely to experience recurrence (adjusted odds ratio {AOR}, 3.43; confidence interval {CI}, 1.35-8.71), patients with uncorrected deviated nasal septum (DNS) were three times more likely to experience symptoms again following surgery (AOR, 3.70; CI, 1.14-12.02), and patients who presented with concomitant sinusheadaches are 66% less likely to experience recurrence (AOR, 0.34; CI, 0.13-0.86). Conclusion The results showed that 33.62% of patients experienced recurrence following surgery. Bronchial asthma and DNS were strongly associated with recurrence; however, their presence does not always imply the need for additional surgery.

Persistent Idiopathic Facial Pain After a Coronavirus Disease 2019 Diagnostic Nasopharyngeal Swab

Nasopharyngeal swabs are commonly performed in the medical field and have recently been used regularly for coronavirus disease 2019 diagnostic testing. Recently, a patient visited our clinic due to left facial pain, which developed immediately after receiving a nasopharyngeal swabbing and has been persistent for four months. A sinonasal endoscopic examination and paranasal (PNS) CT scan were performed to evaluate the abnormalities in the sinonasal cavity. We identified a severe septal deviation, which had come into contact with the medial mucosa of the left inferior turbinate, forming a mucosal contact point suggesting a previous trauma due to the nasopharyngeal swabbing. We suspected that blind nasopharyngeal swabbing induced mucosal damage on the previously deviated septum, causing a mucosal contact point. Additionally, we suggest that healthcare workers be educated on facial pain as one of the nasopharyngeal swab-related complications.

Piriform Rim Asymmetry in Unilateral Cleft Lip and Palate Patients Before Orthognathic Surgery

Complete unilateral cleft lip and palate (UCLP) creates a continuity defect on the nasal floor, which contributes to nasal asymmetry. Traditionally, piriform rim symmetry has been evaluated by comparing cleft and noncleft sides. No study has compared the magnitude of perinasal asymmetry in UCLP patients with a control group of patients without clefts. To address the following question: In UCLP patients, whose alveolar clefts are reconstructed with alveolar bone grafts (ABGs), is the magnitude of remaining piriform rim asymmetry similar to that of patients without UCLP? This is a retrospective cohort study that used the CBCT of UCLP and non-UCLP patients to evaluate the piriform rim symmetry. The sample was derived from patients who presented for orthognathic surgery between January 2015 and December 2022. To be included, patients had to have a maxillary deficiency. The cleft group had ABG performed with symphyseal bone harvest and BMP application. Patients were excluded from the control group if they had clinical asymmetry and nasal septum deviation. Patients from the UCLP group were excluded if they failed the first attempt of ABG or had a syndrome. Preorthognathic CBCT was used to measure the distance from the inferior and lateral aspects of the piriform rim to reference lines. UCLP status grouped as present or absent (control). The magnitude of piriform rim asymmetry defined as the millimetric distance from the inferior and lateral aspects of the piriform rim to reference lines. The covariates were age, sex, tissue thickness at the level of the alar base, and turbinate size. Welch's two-sample t-test was utilized to compare means. A level of significance of 5% (P<.05) was used for all analyses. To analyze the reliability of the measurements intraexaminer and interexaminer errors were tested using the Weir method. A total of 60 patients were included, 30 in each group. The mean age of UCLP patients was 16.76 (range 13 to 25), and the control group was 17 (range 13 to 25), P=.71. The UCLP group had 12 girls, and the control had 18 girls (P=.12). In the UCLP group, the mean discrepancy between affected and unaffected sides at the inferior aspect of the piriform rim was 3.9mm (range 0.9 to 7mm, P<.01), and in the control group the discrepancy between right and left sides was 0.1mm (0-2.1mm, P=.87). The mean discrepancy between affected and unaffected sides at the lateral aspect of the piriform rim was 3.6mm (range 0.7 to 7.6mm, P<.01) in the UCLP group, and in the control group the discrepancy between right and left sides was 0.1mm (range 0.1 to 5.8mm, P=.78) in the control group. The mean alar base soft tissue thickness discrepancy was 3.1mm (range 0.9 to 7.9mm, P<.01) in the UCLP group and 0mm (range -1.8 to 1.9mm, P=.97) in the control group. The mean difference in the turbinate area in the UCLP group was 314mm2 (range 797 to 2,898) and in the control group 35mm2 (range 702 to 2,302) (P=.19). ABG with symphyseal bone and BMP was not able to provide the same level of piriform symmetry observed in patients without a cleft. Alar base tissue was thicker on the cleft side, and the turbinate size demonstrated greater variability in the UCLP patients.

Correlational Analysis of Nasal Resistance and Acoustic Rhinometry Measurements With the Localization of Fungus Balls in the Paranasal Sinuses.

Objective: To investigate the reason for fungal balls (FBs) being localized in paranasal sinuses, we analyzed the clinical presentations of patients with FB rhinosinusitis (FBS). Methods: Clinical data, anatomical variation (ie, nasal septal deviation, concha bullosa, and Haller cell), as well as measurements of nasal resistance (NR), nasal cavity volume (NCV), and nasal cross-sectional area (NCA) using active anterior rhinomanometry and acoustic rhinometry were collected from FBS patients hospitalized in our hospital between January 2021 and December 2022. A retrospective analysis was conducted using IBM SPSS 19.0 to perform the Shapiro-Wilk test, t-test and logistic regression analysis. Results: A total of 95 FBS patients, including 33 male and 62 female patients, were included in this study. FBs in maxillary sinus were the most common (83, 87.4%), followed by sphenoid sinus (9, 9.5%). Logistic multivariate regression analysis revealed that a higher left-to-right NR ratio was associated with an increased likelihood of FBs being present in the left sinus [Odds ratios (OR) = 0.185; 95% CI, 0.061-0.558; P < .01]. When the ratio of the left-to-right second-minimum NCA was higher and the FB was more in the right sinus (OR = 3.194; 95% CI, 1.593-6.405; P = .001). Additionally, when the difference between left and right NCV was greater and FB occurred more commonly in the right sinus (OR = 1.435; 95% CI, 1.196-1.721; P < .001). Nonetheless, the presence of nasal septum deviation and concha bullosa did not significantly contribute to FB formation. Conclusions and significance: The differences in NR, NCA, and NCV between the affected and unaffected sides of nasal cavity are risk factors for the FB formation. To reduce FBS recurrence, it is important to focus on improving nasal ventilation during the surgical treatment.

Septal Reconstruction: Simple to Complex.

Nasal septal deviation is a frequent problem treated by otolaryngologists and facial plastic surgeons. Complete correction of the septal deformity is often essential both for straightening a crooked nose and for restoration of the nasal airway. While standard septoplasty techniques provide excellent outcomes in most patients, severe septal deformities may require treatment with more advanced maneuvers including adjacent grafting, caudal septal replacement, and even extracorporeal septoplasty. This article reviews a range of septoplasty techniques, with an emphasis on complex septal reconstruction and approaches that can be utilized to maintain keystone stability and establish a robust midline L-strut even in cases with challenging anatomy.

Endoscopic septoplasty versus conventional septoplasty for nasal septum deviation: a systematic review and meta-analysis of randomized clinical trials.

The authors searched five electronic databases for relevant clinical trials. The records were screened for eligibility. Data were extracted from the included studies. Outcomes were pooled as risk ratios (RR) or mean differences with 95% CIs using RevMan ver.5.4. Our study included 13 randomized clinical trials with 735 patients. Our analysis revealed that endoscopic septoplasty was significantly (P<0.05) superior to conventional septoplasty for postoperative nasal obstruction relief, intraoperative and postoperative hemorrhage, and mucosal adhesion and synechiae across both long-term and short-term follow-ups. The following pooled RR values were found in short-term follow-up periods: [RR=1.20, 95% CI:=(1.09,1.32)]; [RR=0.27, 95% CI=(0.14,0.54)]; and [RR=0.16, 95% CI=(0.08,0.32)], respectively. Regarding persistent septal deviation and septal tear, endoscopic septoplasty had the upper hand only in short-term follow-up periods [RR=0.30, 95% CI=(0.17,0.53)] and [RR=0.26, 95% CI=(0.15,0.46)], respectively. Our analysis revealed that endoscopic septoplasty was significantly superior to conventional septoplasty in postoperative nasal obstruction relief rate and reducing the risk of intraoperative and postoperative hemorrhage, mucosal adhesion and synechiae, persistent septal deviation, septal tear, and surgery duration.

Septoplasty- Does It Change the Quality of Life in Patients Having Nasal Obstruction?

Introduction: Deviated nasal septum (DNS) is one of the most common causes of nasal obstruction. However, there are several other etiologies which cause difficulty in nasal breathing. The definitive treatment of symptomatic DNS is septoplasty. The efficacy of septoplasty remains controversial as there are no solid tools for clinical evaluation of patients for establishment of reliable statistical data. Our aim was to evaluate patients who have undergone septoplasty for symptomatic DNS, by following them up with the NOSE questionnaire for predicting the surgical efficacy of septoplasty. Materials and Methods: This was a prospective observational study, conducted over 1 year. 50 cases of either sex of 18-65 years, having symptomatic DNS not relieved by medical management, and corrected by isolated septoplasty were included. The primary outcome was measured by the NOSE questionnaire, applied before surgery, and 6th week and 12th week after the procedure from which the 12th week nasal score was taken into consideration. Results: The paired T test done among the variables showed a clear significance, proving the efficacy of the NOSE score in predicting the symptom reducing efficiency of septoplasty Conclusion: The NOSE score can be used as a regular quality scoring system in analysing the outcomes of septoplasty.

Bacterial diversity and community characteristics of the sinus and dental regions in adults with odontogenic sinusitis

BackgroundThe microbiome plays a crucial role in odontogenic sinusitis (OS); however, the bacterial characteristics of the sinuses and connected dental regions in OS are poorly understood. In this study, nasal secretion samples were collected from 41 OS patients and 20 simple nasal septum deviation patients, and oral mucosa samples from dental regions were collected from 28 OS patients and 22 impacted tooth extraction patients. DNA was extracted, and 16S rRNA sequencing was performed to explore the characteristics and structure of the microbiome in the sinuses and dental regions of OS patients.ResultsThe alpha diversity of the oral and nasal microbiomes in OS patients was higher than that in controls. Principal coordinate analysis (PCoA) showed that oral samples clustered separately from nasal samples, and the beta diversity of oral and nasal samples in OS patients was higher than that in controls. The dominant phylum was Bacteroidetes in OS patients and Firmicutes in controls in both the oral and nasal cavity. The dominant genera in the oral microbiome and nasal microbiome of OS patients were similar, including Fusobacterium, Porphyromonas and Prevotella. Co-occurrence network analysis showed decreased microbial connectivity in the oral mucosa and nasal secretion samples of OS patients.ConclusionsOdontogenic infection promotes structural and functional disorders of the nasal microbiome in OS. The interaction of dominant pathogens in the nasal and oral regions may promote the development of OS. Our study provides the microbiological aetiology of the nasal and connected dental regions in OS and is expected to provide novel insights into the diagnosis and therapeutic strategies for OS.

Evaluation of the Patient with Nasal Obstruction.

Patients often present with a complaint of nasal blockage, either primarily, or in conjunction with aesthetic concerns. The evaluation of the patient with nasal obstruction involves a comprehensive history and a detailed physical examination. The nose is an organ in which form and function are inseparable, and as such, examination of the patient with nasal obstruction must focus not only the internal structures that may cause obstruction of the nasal airway, but also the external structure of the nose as it impacts nasal breathing. Detailed facial analysis and a systematic nasal examination will reveal details regarding nasal obstruction due to internal sources such as septal deviation, turbinate hypertrophy, or nasal lining abnormalities, and structural abnormalities such as nasal valve collapse or external nasal deformity. This approach, in categorizing each component of the nasal exam and its findings, allows the surgeon to formulate an appropriate treatment plan that emerges from the details of the examination.

PREVALENCE OF SEPTATION AND SYMMETRY OF SPHENOID SINUS AND NASAL SEPTAL DEVIATION IN MULTISLICE COMPUTED TOMOGRAPHY

The sphenoid sinuses (SS) are pneumatic spaces located in the diaphysis of the sphenoid bone. The morphology of the SS is characterized by great diversity. One such being the presence of septa; which may vary in number and be complete or incomplete. In the present study, we investigated: total number of septa present and whether there is a relationship between septation, symmetry and nasal septal deviation (SD) using multidetector computed tomography (MDCT) in adults from thestate of Para and Ceara. A retrospective cross-sectional study was carried out with images of patients who did not present any pathology in the SSs between the ages of 18-49 years. A total of 121 images were evaluated (59 females and 62 males) in the axial plane using the ITK-SNAP software version 3.6.0. Results were recorded by age and gender and revealed that in both males (100%) and females (98.3%%); SS was detected as having at least one complete septum. SD was present in 45.5% of patients and asymmetry was detected in 77.7%. In conclusion the present study verified that the diversity of anatomical variations present is considerable; therefore, its tomographic evaluation may aid in surgical planning or forensic identification, however more specific studies within different populations are necessary.

Overview of the different surgical modalities for correction of caudal septal dislocation; a review article

Objectives: Despite the various approaches currently available to treat CSD, this issue still needs to be resolved. Different methods and techniques to manage caudal septal dislocation with good results and according to each patient. This article reviewed the other surgical modalities for correcting caudal septum dislocation with the effectiveness of currently practiced modalities.&#x0D; Searching strategy: We reviewed relevant literature and used PubMed and Google Scholar. Published articles in English were included in the search. The unique and compound keywords used were caudal septum dislocation. The primary search resulted in many reports from all databases and search engines, followed by the exclusion of irrelevant articles. &#x0D; Findings: Different surgical modalities for correcting caudal septum dislocation have been described to correct caudal septum dislocations. Several techniques and maneuvers for surgical correction of caudal septal displacement are mentioned in the literature; nevertheless, there are different opinions and preferences regarding which approach to use.&#x0D; Conclusion and recommendations: An ideal caudal septoplasty should be minimally invasive and improve nasal obstruction. Surgical correction of a deviated septum can be performed using the traditional open endonasal approach, the endoscopic approach, or the open septorhinoplasty approach. In Saudi Arabia, many patients are seeking caudal septal deviation correction. However, there is a need for more trained surgeons, and it is recommended that all levels of training be considered.

Septal Reposition during Intermediate Cleft Rhinoplasty: A Second Chance for Correcting Caudal Septal Deviation.

The authors investigated postoperative nasal morphologic changes in patients undergoing secondary correction of cleft-lip nose with septal repositioning and alar cartilage suspension during preschool age. The authors performed a retrospective review of 77 patients who underwent secondary correction of cleft-lip nose. The patients were 5 to 6 years of age and underwent intermediate rhinoplasty by alar cartilage suspension, with or without septal repositioning. They were divided into 2 groups based on time, encompassing septal repositioning (September of 2015 through November of 2017) and control (November of 2009 through August of 2015) groups. The authors performed a photogrammetric comparison by assessing the postoperative nasal morphologic changes using linear and angular measures. The cleft-to-noncleft-side ratio of each parameter was measured for the nostril width and height, nostril area, and caudal septal deviation angle. Among the 77 patients, 43 were selected as the septal repositioning group and 34 as the control group. Evaluation timing was 5.32 ± 0.45 years of age for the preoperative period (T0), 6.57 ± 0.5 years of age for short-term follow-up (T1), and 9.28 ± 0.65 years of age for long-term follow-up (T2). The septal repositioning group showed significantly improved nostril width ratio and caudal septal deviation angle in the T1 and T2 periods. Septal repositioning significantly decreased the nostril area ratio in the T1 and T2 periods due to decreased cleft-side and increased noncleft-side nostril area. The secondary correction of cleft-lip nose with septal repositioning during preschool age offers a second chance to correct nasal appearance by balancing the nostril symmetry and correcting the caudal septal deviation. Therapeutic, III.

Comparison of complete nasal packing with and without integrated airways.

To compare the effects of nasal packing using a Nasopore nasal packing with and without an airway tube on postoperative pain, SpO2, nasal obstruction, and difficulty in breathing complaints. This comparative study was conducted at Dow University of Health Sciences (DUHS), DMC Civil Hospital Karachi between September 18, 2021, to May 19, 2022. A total of 70 patients who underwent septoplasty for septal deviation and chronic hypertrophic rhinitis were equally divided into two groups. Group-A patients received nasal packing using a Nasopore nasal packing with an airway tube, and Group-B patients received nasal packing using a Nasopore nasal packing without an airway tube. Post-operation Nasal pain sensations were measured using the Wong-Baker Faces Pain Rating Scale at 2 and 12 hours. SpO2 was measured at 30 minutes pre-operatively with an O2 saturation monitor and 12 hours post-operatively during sleep. The postoperative pain at two hours and 12 hours was compared between the two groups, and a significant difference was observed. In Group-A, the average SpO2 decreased > 4% from baseline in 5.7% patients, and 37% in Group-B. A significant difference was observed in the severity of nasal obstruction and difficulty breathing, P-value < 0.05. It is concluded that septoplasty followed by applying nasal packing with integrated airway reduces postoperative pain and improves oxygen saturation compared to nasal packing without integrated airways.

Comparative Study of Surgical Outcome in Endoscopic-Assisted Versus Conventional Septoplasty Using Nasal Surgical Questionnaire (NSQ): A Randomized Control Trial.

Deviated nasal septum (DNS) causes nasal obstruction, secretions, decreased sense of smell, bleeding, headache and snoring. This study aims to compare endoscopic-assisted septoplasty versus conventional septoplasty in terms of surgical outcome and intra-and post-operative complications. A prospective study was done on 50 patients aged between 18 and 41years of which, 41 (82%) cases were males and 9 (18%) were females who had DNS based on clinical examination and diagnostic nasal endoscopy. Patients were randomized by simple randomization into two groups. Functional outcome was assessed using nasal surgical questionnaire (NSQ) prior to and after surgery for 3months post-operatively and complications associated with the surgery were compared between two groups. In this study, most of the patients had anterior dislocations, present in 37 cases (74%). Improvement in pre- to post-operative visual analogue scale (VAS) for nasal obstruction was significantly better in endoscopic-assisted than conventional septoplasty (p < 0.001*). Pre-and post-operative differences in 4-point likert scale for other nasal symptoms like decreased sense of smell, snoring, secretions, headache and crusting were better in endoscopic-assisted septoplasty (p < 0.001*). Complications in endoscopic-assisted septoplasty were less common compared to conventional septoplasty (p = 0.05). In endoscopic-assisted septoplasty patients, pre-to post-operative NSQ (Nasal Surgical Questionnaire) VAS improvement for nasal obstruction, likert scale change from pre-to post-op were better and complications were lesser compared to conventional septoplasty. This suggests endoscopic-assisted septoplasty has better surgical outcomes and fewer complications and posterior deviations, spurs and inferior deviations can be corrected with ease and fewer complications.

Importance of nasal air conditioning in pre-septoplasty planning: A heat and mass transfer perspective

Nasal air conditioning (heat and mass transfer) is one of the essential functions of the nasal cavity, which can get significantly altered due to deviated nasal septum (DNS). Its importance in pre-septoplasty planning remains poorly investigated, with existing literature focusing primarily on the importance of airflow and pressure drop in determining the efficacy of septoplasty. Nevertheless, this parameter should be considered as ignorance can lead to an erroneous selection of septoplasty patients. In this regard, the current study uses virtual septoplasty and image-based CFD modeling based on the finite volume method (FVM) to investigate the alteration in nasal air conditioning in seventeen DNS patients. Changes in relative humidity (RH) at the nasopharynx region are highlighted. In addition, a new parameter known as the septoplasty score is introduced, which considers the combined effect of pressure drop and RH to quantify the effectiveness of the septoplasty. The insilico results show that DNS leads to asymmetric distribution of water mass fraction and temperature, with higher values on the narrower side of the nasal cavity leading to local drying of the mucosal layer. This asymmetric effect becomes less potent after virtual correction with a maximum decrease in the mass transfer of up to 85 gm per week. Further, the inspired air's RH is significantly altered at the nasopharynx region before and after the virtual septoplasty with a maximum difference of up to 10%. The septoplasty score always increases after correction with a maximum increase of up to 90%; thereby, it can be used by ENT surgeons to quantify septoplasty's benefits.

Does Le Fort I Osteotomy Influence Nasal Septum Deviation?

Le Fort I osteotomy is a technique for surgically correcting the maxillary position. Le Fort I osteotomy may affect the nasolabial structures since a very close relationship exists between the maxilla and the nose. This study aimed to investigate the effect of different maxillary movements on the nasal septum after Le Fort I osteotomies with cone beam computed tomography (CBCT) images. We hypothesized that nasal septal angle changes after maxillary impaction and advancement movements. This retrospective cohort study involved patients who underwent Le Fort I osteotomy to correct the maxillary position at Erciyes University, Oral and Maxillofacial Surgery Hospital. This study included patients who had CBCT images before (T0) and ≥12months after (T1) surgery. Patients with a history of septoplasty or rhinoplasty before orthognathic surgery, congenital deformities, or posttraumatic deformities were excluded. Its predictor variable was the direction and magnitude of the maxilla's vertical and horizontal movements. Change in septal deviation (in degrees) was the main outcome of the study. Age, sex, operation (Le Fort I alone or double jaw surgery), cartilage reduction, and anterior nasal spine reduction during surgery were covariates. Angle values were compared with independent samples t test or the Mann-Whitney U test in two-category variables. The Kruskal Wallis test was used to compare the angle values according to the movement. A P value of < .05 was considered statistically significant. This study evaluated 154 CBCT images of 77 patients (44 [57.1%] females and 33 [42.9%] males), of which 68 (88.3%) had double jaw surgery and nine (11.7%) had single Le Fort I surgery. The average nasal septum angle was significantly smaller preoperatively (166.2° [157.1° to 172.15°]) than postoperatively (168.7° [131.5° to 180.0°]) across subjects (P=.031). The septal angle decreased in 28 patients, and the rate of postoperative angular change was higher in patients with both advancement and impaction during the surgery (P=.014). Septum deviation can occur in 37% of cases after Le Fort I surgery. Therefore, Le Fort osteotomies are associated with changes in nasal appearance.