Septal Deviation Research Articles

Risk Factors for Adenoid Hypertrophy in Patients Twelve Year and Older

Background: The adenoids are part of Waldeyer’s ring of lymphoid tissue and when hypertrophied they cause many symptoms, e.g., snoring. They hypertrophy physiologically in children between the ages of 6 and 10 years, and then atrophy by the age of 16 years.
 Objectives: The aim of this study was to reveal the risk factors and clinical patterns associated with adenoid hypertrophy in patients aged over 12 years.
 Methods: We studied 130 patients aged over 12 who had undergone an adenoidectomy between January 2016 to January 2021. Patients were evaluated in the Department of Otorhinolaryngology and Head and Neck Surgery at Jordan University Hospital, Amman, Jordan. Some patients were accessed using medical records and their data were collected by telephone.
 Results: Of the 130 patients, 81 were male and 49 were female, with a mean age of 19.68 years. Snoring was the most common presenting symptom (81.5%), followed by nasal obstruction (75.4%) and mouth breathing (71.5%). The most common associated risk factor was septal deviation (44.6%), and then passive smoking (40.8 %), allergic rhinitis (38.5%), and pollution (38.5%).
 Conclusion: There are multiple suspected risk factors for adenoid hypertrophy in patients aged over 12 years. In our study, septal deviation was the most common associated factor, followed by passive smoking, allergic rhinitis and pollution. Snoring was the most common presenting symptom, followed by nasal obstruction.

Septoplasty and/or inferior turbinoplasty produce significant improvements of the sense of smell.

Patients with septal deviation and/or turbinal hypertrophy may experience olfactory disfunction (OD). The aim of this study was to analyse the effect of septoplasty and/or turbinoplasty on both lateralized and bilateral olfactory function. Prospective study of 47 patients with nasal obstruction secondary to septal deviation and/or turbinal hypertrophy and 20 healthy controls. The Barcelona Olfactory test (BOT-8), a new supraliminal orthonasal subjective olfactometry, was applied 3 times in a row (in each nostril separately and in both simultaneously). The 8 items were applied randomly to minimize the possible risk of learning. The test has not established the minimal clinically important difference (MCID). Anterior rhinomanometry and acoustic rhinometry were performed. All participants self-assessed smell loss and nasal obstruction using a visual analogue scale (VAS) and completed questionnaires for nasal obstruction (Nasal Obstruction Symptom Evaluation, NOSE) and for quality of life (QoL), using disease-specific (SinoNasal Outcome Test-22, SNOT-22) and generic (Short Form-12 Health Survey, SF-12) questionnaires. Nasal measurements and questionnaires were performed preoperatively and 12 months after surgery. Before surgery, patients reported worse VAS on smell loss and on nasal obstruction compared to controls. Patients scored lower BOT-8 than controls. Lateralized preoperative olfactory function showed that all BOT-8 characteristics were lower at the narrow side than the wider one. Smell function and QoL improved significantly one year after surgery. Nasal septal deviation and turbinal hypertrophy lead to an olfactory impairment on the obstructed nostril. Nasal surgery provides a positive outcome on olfactory function, as well as on subjective and objective outcomes.

Level of Knowledge, Perception, and Practice of Septoplasty in Children among Saudi Otolaryngologists: A Cross-sectional, Questionnaire-based Study

Abstract Objectives: This study aimed to determine the opinions and practices of Saudi otolaryngologists’ regarding the indications, contraindications, and timing of septoplasty in pediatric patients. Methods: A cross-sectional study between November 2022 and April 2023; administered an online self-reported questionnaire to evaluate the level of knowledge, perceptions, and practice of pediatric septoplasty among Saudi otolaryngologists. Results: We included 103 otolaryngologists from different regions of Saudi Arabia, approximately half of whom were from the central region. Forty-six physicians (44.7%) reported performing pediatric septoplasty. The others reported not performing it because it may affect the nasal and facial growth plates (n = 38, 21.7%), or they did not feel that clinical data show the benefits compared to the risks of the procedure (n = 18, 10.3%); 11 physicians (6.3%) reported that they were not interested in pediatric septoplasty. Seven physicians (4%) reported that they believe children grow out of their septal deviation. Conclusion: The results show that approximately half of the physicians performed pediatric septoplasty, with sleep-disordered breathing and nasal obstruction being the most common indications. Others cited concerns about the potential negative effects on nasal and facial growth plates or a lack of clinical data showing the benefits compared to the risks.

Combined effects of the nasal cycle and septal deviation on the relative humidity in the nasal cavity during inspiration

Combined effects of the nasal cycle and septal deviation on the relative humidity in the nasal cavity during inspiration

Characteristics of maxillary sinus ostia and their correlation with anatomic variations of the osteomeatal complex: Indications for sinus floor elevation.

Knowledge of the anatomy and variations of the maxillary sinus is essential for reducing oral surgery complications, such as sinus floor elevation, and increasing surgery success. The CBCT images of 385 patients were examined. The prevalence, localization, and height of PMO (Primer Maxillary Ostium) and AMO (Accessory Maxillary Ostium) were evaluated with respect to sex, dentition, dental treatment, Schneiderian membrane (SM) thickness, concha bullosa, Haller Cells, and septal deviation. The PMO was present in 87.3% of all patients. Further analysis showed that the mean PMO diameter was 1.42 ± 0.62 mm. Although 11.6% of the PMO was in the inferior region, 60.4% was in the middle and 28% in the superior region. The effect of age and SM on the height and diameter of the PMO was found to be statistically significant. An AMO was present in 20% of the CBCT images. The mean AMO diameter was 2.55 ± 1.25 mm. Although 45.4% of the AMO was in the inferior region, 48% was in the middle and 6.6% was in the superior region. Moreover, SM thickness seemed to influence the height. A significant positive relationship was found between the PMO and AMO height. Also, a significant relationship was observed between the presence of the AMO and septum deviation. The presence of the AMO, PMO diameter, and height should be added to the preoperative evaluation criteria for the success of sinus floor evaluation. Specifically, sinonasal and demographic conditions should be carefully examined preoperatively for the long-term success of the surgery.

Open Reduction of an Isolated Anterior Nasal Spine Fracture: A Case Report and Review of the Literature.

A 14-year-old girl had a midfacial trauma event caused by hitting against an opening door and experienced discomfort and swelling of the columella and upper lip. Physical examination revealed mild tenderness on light palpation without any discomfort with upper lip movement. A computed tomography scan of the maxillofacial bones with three-dimensional reconstruction showed a fracture of the anterior nasal spine with obvious leftward displacement, mild-deviation of the caudal aspect of the nasal septum, and no sign of nasal bone fracture. Open reduction and internal fixation was performed with regard to aesthetic and functional concerns, including nasal septum deviation. The postoperative course was uneventful, and healing proceeded normally without complications. Herein, we emphasize the importance of differential diagnosis of isolated anterior nasal spine fractures in patients with midfacial trauma and clinicians' strategic decision-making in treatment modalities.

The correlation between nasal and paranasal sinus anatomical variations with severity of Chronic Rhino Sinusitis Based on CT Scan Examination at Dr. Zainoel Abidin Hospital Banda Aceh

Background: Chronic rhinosinusitis (CRS) is a persistent inflammation of the nasal mucosa and paranasal sinuses. Anatomical variations of the nasal and paranasal sinuses can obstruct and impair the drainage and ventilation functions of the sinus ostium, causing CRS. Objective: To determine the correlation between nasal and paranasal sinus anatomical variations with the degree of severity of CRS based on a CT scan at Dr. Zainoel Abidin Hospital. Methods: An analytic observational study with a cross-sectional design from the results of CT scans of CRS patients in the period on October 2019-october 2022. The anatomical variations assessed were the degree of deviation of the nasal septum, type of bullous turbinate, paradoxical turbinate, hypertrophy of ethmoid bullae, Haller cells, deflection of uncinate process, type of superior insertion of the uncinate process, pneumatization of the uncinate process and frontal sinus cells to the degree of CRS using the Lund Mackay score. Data were analyzed using the Chi-Square test or Fisher's exact test. Result: Analysis of 64 CT scans consisting of 128 sides of the nose found a significant relationship between anatomic variations and the degree of CRS, namely the degree of deviation of nasal septum, type of concha bullosa, ethmoid bulla hypertrophy and deflection of the uncinate process to the severity of maxillary sinusitis (p=0.023; p=0.024; p=0.039; p=0.029) and paradoxical medial concha for the severity of maxillary sinusitis, anterior and frontal ethmoiditis (p=0.018; p=0.013; p=0.000) Conclusion: Anatomical variations of the nasal and paranasal sinuses are related to the severity of CRS.

Risk Factors for Recurrence of Nasal Polyps after Endoscopic Sinus Surgery in Patients with Allergic Chronic Rhino Sinusitis.

Rhino sinusitis, is a common inflammatory disease that affects the nasal cavity and paranasal sinuses in millions of individuals. Chronic sinusitis patients complain of a combination of nasal obstruction, rhinorrhea, post nasal drip and facial pain. To identify the risk factors of the recurrence of nasal polyps in chronic rhino sinusitis patients after endoscopic sinus surgery. After a review of 60 patients with chronic rhino sinusitis with failed medical treatment requiring FESS presenting in Kasr Alainy Hospital in Cairo University and October 6 University Hospital from May 2022 to March 2023. All patients were subjected to history taking, clinical examination including endoscopy, subjective evaluation of symptoms and CT-scan. Of our patients, six patients (15%) were diagnosed with recurrence of nasal polyps with chronic rhino sinusitis and needed revision surgery. There are multiple risk factors related to the recurrence of nasal polyps including smoking followed by having a history of an asthma, the presence of an allergy, septal deviation, prior sinus surgery, and turbinate hypertrophy. Other factors, as proper medical treatment such as topical steroids and treatment of allergy had a significant role in decreasing the recurrence rate. Risk factors related to the recurrence of nasal polyps should be avoided before surgery. The avoidance of risk factors protects the patients from the recurrence of nasal polyps, the hazards of anaesthesia on surgical treatment, and the financial cost of surgery. Follow up is important in the prevention of recurrence of nasal polyps and improves the symptoms.

The Effect of Trans-Sutural Distraction Osteogenesis on Nasal Bone, Nasal Septum, and Nasal Airway in the Treatment for Midfacial Hypoplasia in Growing Patients.

The purposes of this study were to analyze the effect of trans-sutural distraction osteogenesis (TSDO) on nasal bone, nasal septum, and nasal airway in the treatment of midfacial hypoplasia. A total of 29 growing patients with midfacial hypoplasia who underwent TSDO by a single surgeon were enrolled. The 3-dimensional measurement of nasal bone and nasal septum changes was performed using computed tomography (CT) images obtained preoperatively (T0) and postoperatively (T1). One patient was selected to establish 3-dimensional finite element models to simulate the characteristics of nasal airflow field before and after traction. After traction, the nasal bone moved forward significantly (P<0.01). The septal deviation angle was lower than that before traction (14.43±4.70 versus 16.86 ±4.59 degrees) (P<0.01). The length of the anterior and posterior margin of the vomer increased by 21.4% (P<0.01) and 27.6% (P<0.01), respectively, after TSDO. The length of the posterior margin of the perpendicular plate of ethmoid increased (P<0.05). The length of the posterior inferior and the posterior superior margin of the nasal septum cartilage increased (P<0.01) after traction. The cross-sectional area of nasal airway on the deviated side of nasal septum increased by 23.0% after traction (P<0.05). The analysis of nasal airflow field showed that the pressure and velocity of nasal airflow and the nasal resistance decreased. In conclusion, TSDO can promote the growth of the midface, especially nasal septum, and increase the nasal space. Furthermore, TSDO is conductive to improve nasal septum deviation and decrease nasal airway resistance.

Two-year outcomes of temperature-controlled radiofrequency device treatment of the nasal valve for patients with nasal airway obstruction.

The objective of this study was to evaluate long-term symptom improvements in patients with nasal airway obstruction (NAO) secondary to nasal valve collapse (NVC) following minimally invasive temperature-controlled radiofrequency (TCRF) treatment. A prospective, single-arm, multicenter study in patients >18 years with NAO due to NVC. Inclusion criteria were response to nasal valve dilation (e.g., modified Cottle maneuver) and baseline Nasal Obstruction Symptom Evaluation (NOSE) Scale score ≥60. Patients were treated in the nasal valve region with a TCRF device and followed through 2 years. A responder was ≥20% reduction NOSE Scale score or ≥1 reduction in severity class. A total of 122 patients were treated and 91 reached 2 years. The mean baseline NOSE Scale score was 80.3 (95% CI, 78.1-82.6). The adjusted mean change in score at 2 years was -45.8 (95% CI, -53.5 to -38.1), p < 0.001; a 57.0% improvement. The 2-year responder rate was 90.1% (95% CI, 82.3%-94.7%). Significant and sustained symptom improvement was achieved in subpopulations based on sex, age, body mass index, baseline NAO severity, nasal surgery history, NVC mechanism, septal deviation, and other anatomic contributors of NAO. No serious adverse events with a relationship to the study device and/or procedure were reported. Minimally invasive TCRF device treatment of the internal nasal valve for NAO is well tolerated and leads to significant and sustained improvement in NAO symptom severity through 2 years, including in patients with both static and dynamic NVC, septal deviation, turbinate enlargement, or prior nasal surgery. 2b.

Body Mass Index and Related Risk Factor of Sinusitis Among Adults in Saudi Arabia: A Cross-Sectional Study.

Chronic rhinosinusitis (CRS) is a widespread condition worldwide that is leading to a significant burden on society in terms of healthcare consumption and productivity loss.Multiple risk factors have been implicated in the pathogenesis of CRS, such as nasal allergies, bronchial asthma, smoking, nasal polyps, and immune system-related diseases. The present study aimed to assess the prevalence of CRS, the most common risk factors, and the association between diabetes, body mass index(BMI), and CRS in Saudi Arabia. A cross-sectional study was conducted through random sampling that included 3602 participants from different regions of Saudi Arabia from November 2022 to January 2023. Electronic questionnaires were used for data collection. A total of 3602 individuals responded to our questionnaires; 948 (26.3%) were diagnosed by physicians as having chronic rhinosinusitis, and 75.1% were females. The majority (41.5%) were between the ages of 18 and 28 years. We found that smoking was significantly associated with sinusitis (OR 2.01, 95% CI 1.23-5.69) (p value 0.003) and that obesity was also significantly associated with sinusitis, 17.0% of persons with sinusitis were obese class I (BMI 30-35 kg/m2); 7.8% were obese class II (BMI>35 kg/m2); and 29.4% were overweight, whereas 45.8% were of normal weight. All percentages differ significantly from persons with normal weight (p value = 0.000). The most common risk factors for sinusitis were nasal allergies (44.4%), stuffy nose (22.8%), and deviation of the nasal septum (19.2%). All percentages differ significantly from persons without comorbidity (p value = 0.000). The present study showed a slight increase in the prevalence of CRS in Saudi Arabia, which is attributable to increased exposure to allergens. The most common risk factors were nasal allergies, nasal blockage, deviation of the nasal septum, and asthma. There was a significant correlation between CRS and BMI in the form of increased prevalence in overweight and obese compared to normal-weight individuals.

Evaluation of presence of nasal deviation in patients presenting with obstructive sleep apnea using cone beam computed tomography

ABSTRACT Objective Evaluation of the presence of nasal septal deviation in patients presenting with obstructive sleep apnea (OSA) using Cone-Beam Computed Tomography (CBCT). Method Patients diagnosed with OSA using polysomnography were further evaluated radiographically for the presence of nasal septal deviation, maxillary sinus septa, and oropharyngeal airway volume using CBCT. Results Nasal deviation was present in all the patients and was classified according to Negus et al classification, further categorized with Apnea-hypopnea index (AHI) score, maxillary sinus septa in those patients were classified according to Al Faraj et al, and the oropharyngeal airway volume was found to be an average of 10,086.37 ± 3966.116 mm2 airway volume. Conclusion All the patients in the study had nasal septal deviation, hence it can be considered as a radiographic marker in suspecting OSA.

Relationship Between Ostiomeatal Complex Variations and Maxillary Sinus Pathologies in Children and Adolescents Using CBCT

&#x0D; Objective: The aim of this study is to evaluate relationship between ostiomeatal complex variations (OMC) and maxillary sinus pathologies in children and adolescents using cone-beam computed tomography (CBCT). &#x0D; &#x0D; &#x0D; Methods: CBCT images of 72 patients (44 males and 28 females) aged 7-18 years were evaluated retrospectively. Presence of nasal septal deviation (NSD), nasal septal pneumatization (NSP), concha bullosa (CB), accessory maxillary ostium (AMO), agger nasi cell (ANC), Haller cell (HC), Onodi cell (OC), ethmoid sinusitis and maxillary sinus pathologies were investigated. Maxillary sinus pathologies were classified. Correlations of OMC variations with each other, maxillary sinus pathologies and ethmoid sinusitis were investigated. Chi-square test was used to analyze relationships among variables and distribution of parameters. &#x0D; &#x0D; &#x0D; Results: NSD was determined in 70.8%, NSP in 40.3%, ethmoid sinusitis in 75%, maxillary sinus pathology in 34.8% of images. OMC variations rates were detected as CB 31.3%, AMO 16%, ANC 16%, HC 24.3% and OC 18.8%. The most common maxillary sinus pathology was localized mucosal thickening, with a rate of 15.3% on right and 22.2% on left. Statistically significant differences were determined between almost all OMC variations with each other, and between anatomical variations in OMC with maxillary sinus pathologies except for NSP and AMO (p &lt; 0.05). The presence of ethmoid sinusitis was more common in males (p =0.026). &#x0D; &#x0D; &#x0D; Conclusion: Anatomical variations in OMC had no significant effect on maxillary sinus pathology except for NSP and AMO. Besides, most of anatomical variations in OMC were statistically significantly correlated with each other. CBCT visualization of these variations is important for sinonasal surgery and is an effective method in children and adolescents with low radiation dose and high image quality compared to computed tomography.&#x0D;

Sinonasal Anatomy Variations on CT Scans of a Sample of Filipino Adults With Chronic Rhinosinusitis

ABSTRACT&#x0D; Objective: To determine the prevalence of sinonasal anatomic variations seen on paranasal sinus (PNS) CT scans of a sample of Filipino adults with chronic rhinosinusitis.Methods: Design: Cross-sectional study Setting: Tertiary Government Training Hospital Participants: The PNS CT scans of 51 Filipino patients with chronic rhinosinusitis with and without nasal polyposis diagnosed at our outpatien Department of Otorhinolaryngology-Head and Neck Surgery between October 2015 to December 2020 were reviewed for the presence of sinonasal anatomic variants. The prevalence of the identified variants was calculated.&#x0D; Results: The CT scans of 51 patients, 41 (80.4%) men and 10 (19.6%) women, were included. The median age was 48 years (Q25: 35, Q75: 56, IQR:21). The median Lund Mackay Score (LMS) was 15 (Q25: 12, Q75: 20, IQR:8). Majority (94%) had an LMS of ≥5. The most common anatomic variant in the study population was agger nasi (n=46/51, 90.2% present bilaterally) followed by uncinate process attachment to the lamina papyracea (n=90/102, 88.24%). The third to sixth most common findings were Keros type II classification (n=76/102, 74.51%), nasal septal deviation (n=35/51, 68.62%), optic nerve canal type 1 (n=67/102, 65.69%) and anterior ethmoid artery grade 1 (n=46/102, 45.1%), respectively. Less common variants were Onodi cell (n=13/51, 25.49% unilateral and n=10/51, 19.61% bilateral), Haller cell (n=8/51, 15.69% unilateral and n=1/51, 1.96% bilateral), supraorbital cell (n=4/51, 7.84% unilateral and n=4/51, 7.84% bilateral), middle turbinate concha bullosa (n=3/51, 5.88% unilateral and n=6/51, 11.76% bilateral), superior turbinate concha bullosa (n=2/51, 3.92% unilateral and n=1/51, 1.96% bilateral), pneumatized crista galli (n=2/51, 3.92%) and optic nerve dehiscence (n=1/51, 1.96% bilateral). &#x0D; Conclusion: In the adult Filipino population with CRS sampled in this study, the six most common sinonasal anatomic variants were agger nasi, superior attachment of the uncinate process to the lamina papyracea, Keros type II classification, septal deviation, optic nerve canal type 1 and anterior ethmoid artery grade 1. Pre-operatively, the PNS CT scan of every patient must be meticulously evaluated for the sinonasal anatomic variants to avoid surgical complications.

Evaluation of the Image Quality of Ultra-Low-Dose Paranasal Sinus Computed Tomography Scans

Objective: We aimed to investigate the image quality of paranasal sinus computed tomography (CT) scans obtained with the “Advanced intelligent Clear-IQ Engine” (AICE) software and ultra-low dose parameters in patients with prediagnosed rhinitis, sinusitis or nasal septum deviation. Methods: The first 50 patients (31 men and 19 women, aged 18-70 years) who agreed to participate in our prospectively planned study were included in the study. Imaging of the patients was performed with a 160-slice multidetector CT device Canon Aquilion Prime SP (Canon Medical Systems, Otawara, Japan). Tube voltage of 80 kV and tube current of 40 mA were chosen. The effective radiation dose (ED) was calculated based on the “dose-length product” (DLP) information of each patient. Evaluation of images was made on reformat images made with “AiCE Bone” filter in the axial and coronal planes. All images were double-blindly evaluated by 2 radiologists out of 5 points (5 = very good; 1 = not diagnostic). The visibility of 17 bilateral important anatomical landmarks examined on paranasal sinus CT was scored (0 = not visible; 2 = completely visible). In the evaluation of images, the agreement between radiologists was evaluated with Kappa statistics. Results: The median ED value of the CT protocol was 0.015±0.001 mSv [range 0.012-0.017 mSv]. The overall image quality of the images in our study was interpreted as 4 (good) or 3 (moderate) for all patients. Inter-research agreement was 92%. Most of the anatomical landmarks evaluated were completely visible. Six (bilateral of three) anatomical landmarks could be partially visible in some patients. Conclusion: Combining the ultra-low dose CT protocol and the AiCE reconstruction algorithm makes it possible to achieve very low ED values ​​in paranasal sinus CT scans and still obtain sufficient image quality in indications such as septum deviation and sinusitis.

Screening of Children with Upper Respiratory Tract Infection for Otitis Media with Effusion

Objective: To determine the recurrence rate of Otitis Media with Effusion (OME) among children without hearing loss, in relation to different upper respiratory tract infections.&#x0D; Methodology: This cross-sectional study was conducted at the Shifa Foundation Community Health Centre (SFCHC) in Islamabad from February 2020 to February 2021, this study involved otoscopic examinations by a blinded team member. Tympanometry was performed on patients displaying OME signs. Both the examiner and performer were unaware of the child's study status to minimize bias.&#x0D; Results: The study included children with a mean age of 7.35 ± 2.30 years, predominantly males (59.4%). Common symptoms were nasal obstruction (98%), mouth breathing (97%), and sore throat (98%). Physical examination revealed no Deviated Nasal Septum (DNS), nasal polyps, or tender sinuses. Mucopurulent nasal discharge (94.1%), adenoid hypertrophy (98%), and congested tonsils (96%) were prevalent. Dull/opaque tympanic membranes were present in 22.8% of children, while 74.3% displayed a light reflex, and 26.7% had a prominent short process of malleus.&#x0D; Conclusion: Otitis media with effusion is frequent in children with recurrent upper respiratory tract infections, non-specific ear symptoms, and poor school performance. Although typically benign with a high rate of spontaneous resolution, it often leads to parental anxiety, unnecessary investigations, and sometimes unwarranted medication.&#x0D; Key Words: Otitis Media with Effusion, Recurrent Upper Respiratory Tract Infection, Hearing Loss.

Comparing the success rate of external dacryocystorhinostomy with anterior flap versus flap excision in managing chronic dacryocystitis.

Nasolacrimal duct obstruction (NLDO) is characterized by epiphora and recurrent episodes of acute dacryocystitis. Despite the temporary effect of antibiotics in the acute phase, it is primarily managed by dacryocystorhinostomy (DCR). There is a new modification of external DCR that is performed without either anterior or posterior flaps. This study aimed to compare the outcomes of flapless and single-flap external DCR in adult patients with chronic symptomatic dacryocystitis secondary to NLDO. In this retrospective, non-randomized, interventional, comparative study of patients with chronic dacryocystitis secondary to primary acquired NLDO, we compared the surgical outcomes and complication rates of flapless external DCR to those of external DCR with only anterior flap suturing. We excluded patients who declined participation and those with soft stops, nasal problems, lid margin abnormalities, lid malposition or laxity, previous lacrimal surgery, lacrimal fistula, trauma involving the lacrimal drainage system, lack of adequate follow-up, or severe septal deviation or turbinate hypertrophy. Anatomical and functional success rates were determined at the last follow-up visit and were compared. Postoperative complications were recorded and compared between groups. We included 53 patients with a male-to-female ratio of 16 (30.2%) to 37 (69.8%); 25 eyes underwent flapless DCR (group 1) and 28 eyes underwent anterior flap suturing DCR (group 2). The two groups had comparable demographic characteristics (all P > 0.05). Furthermore, anatomical (92.0% in group 1 and 92.9% in group 2) and functional (84.0% in group 1 and 92.9% in group 2) success rates at final follow-up were comparable between groups (both P > 0.05). At the one-month postoperative examination, premature tube extrusion was more often reported in group 1 (12.0%) compared to group 2 (7.1%). At the two-month follow-up examination, tube extrusion was noted in 4.0% in group 1 and 0.0% in group 2, yet the difference failed to attain statistical significance (P > 0.05). We found that neither surgical method was superior in terms of anatomical or functional success rate at a maximum of one year after external DCR. Flapless DCR is a simple, effective, and reproducible alternative to the single anterior flap suturing technique for managing NLDO in adults with chronic dacryocystitis. However, further randomized clinical trials with larger sample sizes and longer follow-up periods are recommended before generalization can be justified.

Comparison of quality of life in chronic rhinosinusitis patients based on SNOT-22 before and after administration of saline nasal irrigation at Sanglah General Hospital Denpasar

Introduction: Rhinosinusitis is an inflammation of the mucosa nasal cavity and paranasal sinuses and still a health problem in both developing and developed countries with a high prevalence and impacts in various aspects including quality of life and socioeconomics. Chronic rhinosinusitis occurs in 12.5% of the US population or 31 million patients per year.2 Saline nasal irrigation is a conservative treatment that can be used in patients with rhinosinusitis. Currently, SNOT-22 questionnaire is the best specific questionnaire that can be applied to assess the quality of life of chronic rhinosinusitis patients. Objective: To determine the impact of nasal saline irrigation on the quality of life of patients with chronic rhinosinusitis. Methods: This research is an observational study of the one-group test posttest design (before-after study). The selection of samples from all patients chronic rhinosinusitis who come to the ENT-KL polyclinic at Sanglah General Hospital Denpasar from October 2019 to December 2020 Result: In this study, the total sample that met the inclusion criteria was 52 people. In this research, it was found that the majority of the research subjects were male as many as 28 sufferers or 53,8%. Based on age, the majority of subjects were aged 25–44 years, namely 24 (46.1%). Based on the characteristics of comorbid diagnoses, there were 22 (42.3%) subjects with turbinate hypertrophy and septal deviation. The mean difference in improvement of SNOT-22 score was found to be 22.4 with a p value of &lt;0.001. Conclusion: From this study, it was found that the most characteristics of research subjects were male, aged 25-44 years, with concomitant diagnoses of turbinate hypertrophy and septal deviation. There was a significant improvement in quality of life based on the SNOT-22 score in patients with chronic rhinosinusitis after administration of saline nasal irrigation.

Efficacy of Nostril Supportive Splint Treatment for Nasal Septum Deformities after Le Fort I Osteotomy.

This retrospective study aimed to evaluate the efficacy of support splint treatment for deformities and deviations of the nasal septum after Le Fort I osteotomy (LFI). Patients were divided into two groups: the retainer group wore a nasal support splint immediately after LFI for 7 days, and the no retainer group did not wear a nasal support splint. Evaluation was performed by measuring the ratio of the difference between the left and right sides of the nasal cavity area (ratio of nasal cavity) and the angle of the nasal septum using three computed tomography frontal images (anterior, middle, and posterior) before and one year postoperatively. Sixty patients were included and divided into two groups, the retainer and no retainer group (n=30 each). Regarding the ratio of nasal cavity on middle images at one year postoperatively, the retainer and no retainer groups differed significantly (0.79±0.13 and 0.67±0.24, respectively; P =0.012). The angle of the nasal septum on anterior images at one year postoperatively was 164.8±11.7° in the retainer group and 156.9±13.5° in the no retainer group, showing a significant difference ( P =0.019). This study suggests that support splint treatment after LFI is effective in preventing post-LFI nasal septal deformation or deviation.

Bucco-maxillo and systemic repercussions of the mouth breathing syndrome: a comprehensive review

Introduction: Mouth breathing syndrome is characterized by full or partial breathing through the mouth. Its most frequent causes are allergic rhinitis and enlarged tonsils and/or adenoids. These conditions interfere with the passage of air through the nose and upper airways, causing the child to breathe through the mouth. The treatment of the syndrome is done in a multidisciplinary way and counts on the participation of the dental surgeon, who will monitor and take care of any damage to oral health. Objective: It was to present, through a comprehensive review, the main considerations of mouth breathing syndrome in childhood and youth and the role of orthodontics in the management of this problem. Methods: The research and development of the work were carried out from January to March 2023 in the Scopus, PubMed, Science Direct, and Scielo databases, using scientific articles from 2009 to 2022, following the PRISMA rules. Results and Conclusion: It was found 94 studies performed eligibility analysis. The final sample had 28 eligible studies and only 13 studies were described in the comprehensive review. The major cause of mouth breathing syndrome is nasal obstruction, but nasal and facial deformities, allergic rhinitis, septum deviation, tonsils, and nasal conchae, and adenoid hypertrophy also frequently occur. Mouth breathing syndrome negatively affects the respiratory system, cardiovascular system, sleep, hematopoietic system, gastrointestinal tract, endocrine system, and Dental-Skull-Facial development. Thus, the dental surgeon needs to acquire in-depth knowledge about the subject, so that he can develop educational-preventive programs in the place where he works, to promote health and quality of life.