Septoplasty In Patients Research Articles

Septoplasty During Primary Cleft Lip Reconstruction: A Historical Perspective and Scoping Review.

Traditional surgical approaches excluded septoplasty at primary cleft lip reconstruction due to concerns about restricted nasal and midfacial growth. Modern opinion in the treatment of cleft lip has increasingly employed primary septoplasty; this scoping review and historical perspective aims to chronicle the evolution of septoplasty in patients born with cleft lip and palate and discuss current evidence. The historical perspective explicitly contrasts American and European perceptions of septoplasty in cleft lip deformity and the competing anatomical theories of the role of the septum on midfacial and nasal growth. For the scoping review, articles were extracted from Embase, PubMed, and Medline, as well as manual searches of reference lists. Results were compiled, grouped, and appraised by date, outcomes, and historical significance. Inclusion criteria consisted of children who underwent primary septoplasty for any indication and were followed up on outcomes of facial growth and nasal function. Literature reviews, opinion articles, case reports, guidelines, or studies not available in English or online were excluded. Evolving anatomical theories relating to midfacial growth in the mid-late 20th century underpinned a progressive ideological shift on the safety and efficacy of septoplasty in children. This is supported by our scoping review, which included 23 articles mutually selected for inclusion by 2 blinded assessors. Several competing methods have been employed to measure endpoints on facial growth and nasal function, but generally indicate primary septoplasty is successful in improving nasal function and preserving midfacial growth. Perceptions towards septoplasty on facial growth in the pediatric population have transformed significantly and suggest a growing acceptance of primary septoplasty techniques in patients born with a cleft lip.

Improvement in Pulmonary Function Tests After Septoplasty: A Longitudinal Study.

Introduction The relationship between the nasal and pulmonary systems is rooted in the shared anatomy and physiology of the upper and lower respiratory tracts. Our study objective was to assess the improvement in pulmonary function tests (PFTs) after septoplasty in patients with a deviated nasal septum (DNS). Methods A longitudinal study was conducted at a tertiary care center from October 1, 2022, to March 31, 2024. Patients aged 18-55 years with chronic nasal obstruction due to an isolated DNS were included in the study. Patients under 18 or over 55 years of age, those undergoing combined nasal surgeries, and those with comorbidities such as hypertension, diabetes, chronic smoking, chronic obstructive pulmonary disease, bronchial asthma, turbinate hypertrophy, chronic sinusitis, or nasal polyposis were excluded. Pre-operative assessments included detailed ear, nose, and throat examinations, routine blood investigations, X-rays of the chest and paranasal sinuses (Waters' view), PFTs (spirometry), the Sino-Nasal Outcome Test-22 (SNOT22) questionnaire, and the six-minute walk test (6MWT). Post-operative assessments included repeated spirometry, a 6MWT at three weeks post-surgery, and the SNOT22 questionnaire for subjective symptom assessment. Results Participants included 30 males and 30 females, with a mean age of 35.6 ± 8.2 years. Significant improvements (p < 0.05) were observed in PFT parameters (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow), exercise capacity (6MWT distance), and symptom severity (SNOT22 scores) post-septoplasty. High levels of patient satisfaction and notable improvements in quality of life were reported. The average hospital stay was 2.5 days. Conclusion Septoplasty in patients with DNS significantly improves pulmonary function, exercise capacity, and symptom severity, with high patient satisfaction and minimal complications.

Effect of Nasal Septoplasty on Fibrinogen/HDL Ratio in Patients With Nasal Septal Deviation

Objective: The present study aimed to investigate the plasma fibrinogen/high-density lipoprotein (HDL) ratio in patients with marked nasal septal deviation (NSD) and to evaluate the effect of septoplasty on this ratio. Methods: The present prospective study included 56 patients who had a septoplasty due to a marked NSD (NSD group) in an academic tertiary hospital and 40 age-matched and sex-matched healthy volunteers (control group) between April 2019 and December 2021. The diagnosis of marked NSD was performed via a detailed otorhinolaryngological examination, nasal endoscopy, and computed tomography finding. All patients in the NSD group were evaluated for plasma fibrinogen, HDL, mean platelet volume (MPV), platelet distribution width (PDW), and fibrinogen/HDL values before and 3 months after surgery, and preoperative values were compared with the control group. Preoperative and postoperative fibrinogen, HDL, MPV, PDW, and fibrinogen/HDL values were also compared in the NSD group. Results: There was no significant difference between the NSD and control groups regarding age, sex, fibrinogen, HDL, MPV, PDW, and fibrinogen/HDL values. Fibrinogen, MPV, and fibrinogen/HDL values were significantly decreased, whereas HDL levels significantly increased after septoplasty in the NSD group. There was no significant difference in terms of preoperative and postoperative PDW values. Conclusion: To the best of our knowledge, this is the first study investigating the fibrinogen/HDL ratio and the effect of septoplasty on this ratio in NSD in the literature. In the present study, the fibrinogen/HDL ratio was significantly decreased after septoplasty in patients with NSD, which may be attributed to the therapeutic effect of nasal septoplasty on the restoration of hypercoagulopathy provoked by chronic hypoxia.

Gabapentin and postoperative pain and opioid consumption: A double-blind randomized controlled trial of perioperative pain management for sinus surgery

BackgroundThe link between post-operative narcotic prescription and opioid misuse has spurred a nationwide effort to reduce perioperative opioid use. Previous work has suggested that perioperative gabapentin may reduce post-operative pain and opioid consumption across different procedures, although the optimal regimen remains to be defined. MethodsChronic rhinosinusitis (CRS) patients undergoing functional endoscopic sinus surgery (FESS) with or without septoplasty were randomized to receive a 7-day pre- and post-operative course of placebo or gabapentin, starting at 300 mg daily and titrated to 300 mg three times daily, in a double-blind fashion. Primary endpoint was pain level using a validated visual analog scale (VAS). Secondary endpoints included post-operative opioid consumption and side effects, as well as modified Lund-Kennedy endoscopy, Lund-Mackay, and SNOT-22 scores. ResultsAnalysis of 35 patients (20 gabapentin, 15 control) showed no significant difference in mean postoperative VAS (p = 0.18) or postoperative opioid consumption between the placebo and gabapentin groups (2.3 and 4.8 oxycodone tablets respectively, p = 0.18). 15 of 35 patients did not require any post-operative oxycodone tablets, and only two patients required more than six tablets. ConclusionPreliminary results show no significant change in pain after FESS with or without septoplasty in patients taking 7-day pre- and post-operative gabapentin versus placebo. Results also showed no significant difference in opioid consumption between the treatment and placebo groups. Post-operative pain scores and opioid requirements are both quite low following FESS. Many patients do not need opioids at all, suggesting that routine initial post-operative opioid prescriptions can be limited accordingly.

THE RESULTS OF SEPTOPLASTY IN PATIENTS WITH VARIOUS FORMS OF DEVIATED OF THE NASAL SEPTUM USING THE TECHNIQUE OF EXTRACORPOREAL REMODELING AND REPLANTATION OF THE SEPTUM

Objective: To present the results of extracorporeal septoplasty in patients with various forms of deviated of the nasal septum, using the technique of replantation of the septum and to discuss the advantages and limitations. Materials and methods: The work is based on clinical observations of 164 patients with curvature of the nasal septum from 2018 to 2023. All patients underwent a standard otorhinolaryngological examination, spiral computed tomography CT of the nose and paranasal sinuses in coronary and axial projections. Endoscopic examination of the nasal cavity carried out by an endoscope of the Karl Storz company. Nasal breathing is objectively evaluated with the help of the "PC 300 nose manometer" by ATMOS, which allows to register the pressure in one half of the nose while the patient breathes through the other. A modified "extracorporeal" septoplasty is used, which consists in the complete isolation and temporary removal of the deformed quadrilateral cartilage, followed by its correction and reimplantation. The operation was performed under general anesthesia with performed oral intubation. Results: No complications were observed during the operation, the patients were satisfied with the aesthetic and functional results of septoplasty. Complications were noted in the remote postoperative period. long-term swelling of the mucous membrane of the nose (partially obstructed nasal breathing), which was stopped by taking antihistamines, in 5 patients. In all clinical observations, stable support of the cartilaginous part of the nasal septum and the absence of its secondary deviation were obtained, which also directly affects the harmonic aesthetic results of the shape of the external nose and free nasal breathing. The indicators of the rhinomanometer showed a significant improvement in nasal breathing and are approaching the values accepted as the norm. Conclusions: Extracorporeal septoplasty in patients with various forms of curvature of the nasal septum is an effective surgical technique that gives optimal functional results.

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 .

Comparison of Nasal Functional Outcomes, Sleep Quality, and Anxiety Parameters Following Septoplasty in Patients with Different Septum Deviation Types

Comparison of Nasal Functional Outcomes, Sleep Quality, and Anxiety Parameters Following Septoplasty in Patients with Different Septum Deviation Types

Patient Outcomes following Septoplasty in Patients with Attention-deficit/Hyperactivity Disorder

Summary: Recent research has indicated that daytime manifestations of sleep-disordered breathing, frequently caused by deviated septum, can mimic many characteristic symptoms of attention-deficit/hyperactivity disorder (ADHD) and could indicate intermittent hypoxia or hypercarbia as factors in the development of ADHD. To investigate the differences in outcomes following septoplasty between patients with ADHD and deviated septum, we used a retrospective cohort design to compare outcomes in patients diagnosed with deviated septa between June 1, 2002 and June 1, 2022. We then separated these patients into four total groups based on the presence or absence of ADHD diagnosis and the presence or absence of septoplasty. After matching cohorts to create insignificant differences in age, sex, and race, we analyzed various outcomes associated with ADHD, such as conduct disorders, anxiety disorders, fractures, and substance abuse disorders. Septoplasty reduces the risk for nearly all outcomes in patients with deviated septum, with statistically significant results present in 11 of 15 outcomes in both ADHD and non-ADHD groups. The effect of septoplasty was up to 10 times greater for the ADHD cohort. Patients with ADHD who receive septoplasty display a plethora of beneficial effects, with significantly reduced risk of common sequelae such as depression, obsessive-compulsive disorder, anxiety, and addictive disorders. The difference in outcomes indicates future prospective studies into outcomes of septoplasty in patients with ADHD.

Efficacy of Septoplasty in Patients with Nasal Obstruction: A Systematic Review and Meta-analysis.

Septoplasty is the most frequently performed ENT surgery to correct nasal septal deviation (NSD). The present study aimed to quantify the effectiveness of septoplasty with or without turbinate surgery according to NOSE questionnaire scores, with the hypothesis that it is able to clinically improve patient-reported nasal obstructive symptoms in the post-operative follow-up. An electronic search was performed on PubMed/MEDLINE, Embase, and Cochrane Library. The primary outcome was the change in NOSE score at 6 months after surgery. It was assessed with the mean difference (MD) between baseline and postoperative results. A total of 2577 patients (males: 65.1%, 95% CI: 59.9-70.2) with a mean age of 33.3 years (n = 1456, 95% CI: 30.4-36.2) were included in this meta-analysis. The pooled baseline NOSE mean score was 68.1 (n = 2577, 95% CI: 64.3-71.9). The pooled MD in NOSE score at 6-months follow-up compared to baseline was -48.8 (n = 1730, 95% CI: -54.6 to -42.9). Functional septoplasty with or without turbinate surgery shows a critical improvement of obstructive symptoms and quality of life according to the validated NOSE score. NA Laryngoscope, 133:3237-3246, 2023.

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.

The outcome of a single-stage endoscopic tympanoplasty with septoplasty using autologous septal cartilage graft in patients with mucosal chronic otitis media and deviated nasal septum

Background: Single-stage endoscopic tympanoplasty with septoplasty using autologous septal cartilage graft in patients with mucosal chronic otitis media and deviated nasal septum had resulted in successful repair of the tympanic membrane perforation and correction of the deviated nasal septum with improved eustachian tube dysfunction at the same time. Aims and Objectives: To study the structural and functional outcome of single-stage endoscopic Type 1 tympanoplasty using autologous septal cartilage graft after septoplasty in patients having mucosal chronic otitis media and deviated nasal septum. Material and Methods: We prospectively analysed 102 patients with chronic mucosal otitis media and central perforation of the tympanic membrane and deviated nasal septum with Eustachian tube dysfunction. The patients underwent endoscopic Type I tympanoplasty using an autologous septal cartilage graft with a thickness of approximately 0.5 mm that was harvested during endoscopic septoplasty. Morphological and functional results were recorded at 1, 6 and 12 month follow ups. Result: All patients were between years of age 31 to 40 years (31%). The average age of the study subject was 33.38 ± 12.63 years, with the male to female ratio of 1.31. Postoperatively the patients were looked for the acceptance of the cartilage graft and hearing gain. Of the total 102 patients, in 90 patients, eardrums perforations were closed satisfactorily, and 12 patients suffered from residual perforation (12%). On the functional front the mean pre-operative hearing loss of 40.98 ± 8.71 dB, improved significantly to 32 ± 9.06 dB postoperatively (P-value < 0.001). with a mean gain of 8.98 dB. Also, the mean pre-operative Air-Bone gap (27 ± 9.13 dB) was reduced postoperatively (13.82 ± 8.45 dB) (P-value < 0.001). Thus, improvement was noted to be 13.18 dB. Conclusion: Endoscopic cartilage tympanoplasty with autologous septal cartilage graft of the nose is a safe and effective way for Type I tympanoplasty with good structural and functional results and added benefits of reduced operating time, optimal graft uptake rate, minimal morbidity and pain and more importantly, ear surgery without a postauricular scar.

Study on Clinical Profile and Impact of Septoplasty in Patients Attending National Medical College Birgunj for Deviated Nasal Septum

Introduction: A deviated nasal septum is a common anatomic disorder that presents in up to 62% of the population but, not all are symptomatic. However, it may play a critical role in nasal obstruction symptoms, aesthetic appearance of the nose, increased nasal resistance and sometimes snoring. This study was done with an aim to determine the profile of subjects having deviated nasal septum and assess the impact of septoplasty on them. Materials and Methods: A cross-sectional study was done at National Medical College, Department of Otorhinolaryngology, Head and Neck Surgery, Birgunj from January 2022 to June 2022. Total 30 cases with symptomatic deviated nasal septum were included. Ethical clearance (F-NMC/579/078-79) was obtained from institutional review committee of NMC Birgunj. Details of nasal patency test followed by anterior rhinoscopy and nasal endoscopy were noted. Patients were followed up on 1st, 7th and 30th day post operatively after septoplasty. Pre and post operative comparison was done by using NOSE questionnaire. Wilcoxon signed rank test was done. Results: The ratio of male to female being 1.1:1. The age of the patients varied between 18 to 55 years, and the mean age was 29.07±10.409 years. most common type of deviation seen was type IV (30%). Nasal obstruction was seen in all the study cases which was followed by headache (76.7%) There was decline in the Nose scoring gradually from preoperative period to postoperative period. In anterior rhinoscopy spur (73.3%) was the most common finding. A significant (p&lt;0.001) improvement in nose score after septoplasty was seen. Conclusion: Significant improvement in NOSE score was seen in our study which was in accordance with similar studies conducted.

Horizontal Dorsal Septal Incision for High Deviation Correction During Septoplasty

When performing septoplasty in patients with a high deviation of the nasal septum, effective correction is difficult and postoperative complications such as a saddle nose may result if the bone or cartilage is removed inordinately. Although several surgical techniques have been introduced, some are difficult to apply easily. Furthermore, the deviation may persist despite the application of surgical techniques due to the rebound memory of the remaining cartilage. This study aimed to describe a simple and safe surgical technique for crooked nasal septa with a high deviation. This method using horizontal dorsal septal incision allows easy separation of the highly deviated portion from the upper lateral cartilage. Furthermore, it is less traumatic than other methods, and predictably preserves the keystone area.

Feasibility of distraction osteogenesis maxillary expansion in patients with persistent nasal obstruction after septoplasty.

Distraction osteogenesis maxillary expansion (DOME) is an emerging surgical concept for obstructive sleep apnea patients with a high-arched and narrow hard palate presenting with nasal obstruction. Herein we demonstrate the feasibility of DOME in the treatment of patients with persistent nasal obstruction after primary septoplasty. A total of 32 consecutive patients with persistent nasal obstruction after septoplasty who underwent DOME were enrolled in this study. The efficacy of DOME in treating persistent nasal obstruction in septoplasty failure patients was evaluated using the validated Nasal Obstruction Symptom Evaluation (NOSE) scale. Pre- and postoperative computed tomography (CT) scans were performed to measure the change of nasal floor width after surgery. NOSE score improved significantly from 13.62±4.74 to 5.15±3.50 (p<0.001) after DOME. The postoperative CT scan showed a significant increase of the nasal floor width from 22.4±4.21 to 28.06±4.52 (p<0.01). No patient had major complications such as wound infection, oronasal fistula, sinusitis, loss of incisor teeth, or malunion. We found that DOME appears to improve persistent nasal obstruction after septoplasty in patients with a narrow and high-arched hard palate.

Short report: nasal obstruction recovery after septoplasty in patients with nasal septal deviation affected by anxiety and depression

ABSTRACT This research was aimed to explore whether the recovery of subjective symptoms and objective examination in nasal septum deviation (NSD) patients after septoplasty were related to the degree of preoperative anxiety or depression, in the hope of providing new ideas for clinical treatment. A total of 150 NSD patients were included in this prospective research. Visual analogue scale (VAS) scores, Nasal Obstruction Symptom Evaluation (NOSE) scores, self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, total inspiratory and expiratory nasal resistance were recorded before and 6 months after operation. The results showed preoperative anxiety or depression was not statistically different between groups in terms of age, gender and course, but positively correlated with nasal obstruction (VAS and NOSE). The recovery of nasal obstruction in patients with anxiety or depression was worse than that in normal NSD patients 6 months after surgery, and was decreased with the increase of anxiety or depression degree. And no significant difference showed in the reduction of total inspiratory and expiratory nasal resistance between groups. In conclusion, anxiety and depression affected the improvement of nasal obstruction feeling in NSD patients after septoplasty, and the improvement was negatively correlated with the degree of anxiety and depression. It is necessary to evaluate the anxiety and depression of NSD patients before septoplasty.

Comparison of Subjective and Objective Success of Septoplasty in Patients with Nasal Septum Deviation: A Before and After Study

Objective: Aim of the study is to evaluate the subjective outcomes and objective outcomes postoperatively and investigate correlations between these measurements. Material and Methods: This prospective before and after surgical study was conducted with patients admitted with symptomatic nasal septum deviation (NSD) and who underwent Cottle’s septoplasty. Morphometric diameters of the nasal cavity were measured using a multi-detector computed tomography. Preoperative and postoperative one-month Nasal Obstruction Symptom Evaluation Scale (NOSE) score, acoustic rhinometry (AR), and anterior active rhinomanometry (AAR) measurements were used to evaluate the success of surgery. The correlations between these measurements were also evaluated. Results: The study population consisted of 30 patients, including 19 males and 11 females, with a median age of 27.5 years. There was a statistically significant difference between pre and postoperative NOSE scores, with a mean difference of 53.17 points (p&lt;0.001). There were statistically significant differences between pre and postoperative AR parameters of both the deviated side (DS) and non-deviated side (NDS) of the nose both before and after decongestion. There were statistically significant improvements in all postoperative airflow and airway resistance parameters of the DS of the nose before decongestion when compared to preoperative measurements. There were moderate to large positive correlations between morphometric diameters and differences in NOSE score. Further, there were several statistically significant correlations between differences in AR and AAR measurements and differences in NOSE score. Conclusion: Our findings showed that the objective measurements are strongly correlated with the NOSE score.

Increased Risk of Nasal Septal Abscess After Septoplasty in Patients with Type 2 Diabetes Mellitus.

To investigate the risk of nasal septal abscess (NSA) in patients with type 2 diabetes mellitus (T2DM) after septoplasty. Retrospective cohort study through Taiwan National Health Insurance database. The Taiwan National Health Insurance Research Database was used to conduct this retrospective cohort study. A total of 382 patients with T2DM (DM group) diagnosed between 2000 and 2010 and 382 matched patients without a DM diagnosis (non-DM group) were enrolled. Patients were followed up until death or December 31, 2013. NSA incidence was the main outcome. After septoplasty, the cumulative incidence of NSA in the DM group was significantly higher than that in the non-DM group (P< .001). Cox proportional hazards regression indicated a significant association between T2DM and higher NSA incidence (adjusted hazard ratio, 2.62; 95% CI, 1.44-3.61; P< .001). However, subgroup analysis and sensitivity testing demonstrated that the effect of T2DM on NSA risk was stable. In addition, the subgroup with a Diabetes Complications Severity Index (DCSI) of ≥1 had higher NSA risk than that with DCSI=0 (adjusted hazard ratio, 3.58; 95% CI, 2.10-6.09; P< .001). The treatment type for NSA did not differ between the groups. T2DM is an independent risk factor for NSA in patients undergoing nasal septoplasty, and the NSA risk is greater among patients with high DM severity. IV Laryngoscope, 131:E2420-E2425, 2021.

The systolic pulmonary artery pressure and the E/e’ ratio decrease after septoplasty in patients with grade 2 and 3 pure nasal septal deviation

IntroductionNasal septal deviation may contribute to a wide range of symptoms including nasal obstruction, headache, increased secretion, crusting, mucosal damage, and loss of taste and smell. Excessive increase in the respiratory resistance, as seen in nasal septal deviation, results in reduced lung ventilation, thereby potentially leading to hypoxia, hypercapnia, pulmonary vasoconstriction. The deformities in the nasal cavity can be associated with major respiratory and circulatory system diseases. ObjectiveTo investigate cardiovascular effects of septoplasty by comparing pre- and postoperative transthoracic echocardiography findings in nasal septal deviation patients undergoing septoplasty. MethodsThe prospective study included 35 patients with moderate and severe nasal septal deviation (mean age, 23.91±7.01) who underwent septoplasty. The Turkish version of the nasal obstruction symptom evaluation, NOSE questionnaire, was administered to each participant both pre- and postoperatively in order to assess their views on the severity of nasal septal deviation, the effect of nasal obstruction, and the effectiveness of surgical outcomes. A comprehensive transthoracic echocardiography examination was performed both preoperatively and at three months postoperatively for each patient and the findings were compared among patients. ResultsMean preoperative NOSE score was 17.34±1.62 and the mean postoperative score was 2.62±1.68 (p=0.00). Mean preoperative systolic pulmonary artery pressure value was 22.34±4.31mmHg and postoperative value was 18.90±3.77mmHg (p=0.00). Mean E/e’ ratio was 5.33±1.00 preoperatively and was 5.01±0.90 postoperatively (p=0.01). The NOSE scores, systolic pulmonary artery pressure values, and the E/e’ ratios decreased significantly after septoplasty (p<0.05 for all), whereas no significant difference was found in other transthoracic echocardiography parameters (p>0.05). ConclusionThe decrease in NOSE scores following septoplasty indicated that the satisfaction levels of the patients were increased. Upper airway obstruction secondary to nasal septal deviation may be a cardiovascular risk factor and may affect transthoracic echocardiography measurements. Moreover, the significant decrease in the systolic pulmonary artery pressure value and E/e’s ratio following septoplasty indicated that negative echocardiographic findings may be prevented by this surgery.

Narrowed Posterior Nasal Airway Limits Efficacy of Anterior Septoplasty.

Background: Predicting symptomatic relief after septoplasty has been difficult. Minimal cross-sectional area (mCSA) measured by acoustic rhinometry and airflow resistance (R) measured by rhinomanometry have been used to select surgical candidates with mixed success. An important assumption is that mCSA and resistance are tightly coupled, but studies have reported weak or no correlation. Recently, we proposed the Bernoulli Obstruction Theory as an explanation, where tight coupling between mCSA and R is only predicted below a critical mCSA (Acrit). Methods: The nasal airway and septum of 10 healthy subjects were reconstructed from computed tomography scans. Simulated anterior septal deviations of increasing severity were created. Computational fluid dynamics simulations were performed to quantify mCSA, resistance, and flow in the healthy septum model and four simulated septal deviation models for each subject (total of 50 models). Results: A tighter coupling between mCSA and resistance was found below Acrit, estimated to be 0.20 cm2 (a very severe deviation). Above Acrit, enlarging the mCSA had a smaller effect in patients with narrower cross-sectional area in the postvalve region (CSAPV). Conclusions: Two patterns of flow increase are expected with septoplasty. Below Acrit, enlarging mCSA predictably increases flow. Above Acrit, the effect size of increasing mCSA depends on CSAPV. Unrecognized small CSAPV may explain persistent sensation of nasal obstruction after septoplasty. Our data suggest that inferior turbinate reduction ipsilateral to a septal deviation may amplify airflow benefits after septoplasty in patients with a narrow CSAPV.

Complications of Submucous Resection versus Septoplasty in Deviated Nasal Septum

Introduction: A deviated or deflected septum is a condition in which the nasal septum consisting of bone and cartilage and that divide the nasal cavity into two halves is significantly off-center, or twisted, making breathing difficult. Two conventional methods that are septoplasty and sub-mucous resection were used for the correction of the deviated nasal septum with varying degrees of complications. Objective: The objective of this study was to compare the complications of sub-mucous resection and septoplasty in patients with the deviated nasal septum. Material and Methods: A Quasi-experimental study was conducted at the Department of Otolaryngology at Bolan Medical Complex, Quetta for a period of one year i.e. from 15-03-2015 to 20-09-2015. 100 patients were selected and divided into two groups. A total of 50 patients were selected for septoplasty and 50 for sub-mucous resection. Patients with nasal bone fracture and external nasal deformity were excluded from the study. Results: Postoperative complications like adhesions were found in 4 cases of each group. Septal perforation found in 3 patients of sub-mucous resection and one patient of septoplasty. Septal hematoma formed in 2 patients of sub-mucous resection only, supra-tip nasal deformity in 2 patients in both groups. Persistence of symptoms in 8 patients of septoplasty and one patient of sub-mucous resection while columellar restriction occurred in only one patent who underwent submucous resection. Conclusion: Sub-mucous resection procedure is technically relatively easy to perform with fewer complications than septoplasty so it deserves it prime role as a surgical procedure for nasal septum corrective surgery. Keywords: Deviated nasal septum, nasal septum corrective surgery, sub-mucous resection, septoplasty