Trans-septal Suturing Technique Research Articles

Application of Submucosal Trans-Septal Suturing Technique in a Septal Extension Graft With Porous High-Density Polyethylene and Concurrent Nasal Lateral Osteotomy.

Recently, a submucosal trans-septal suturing (STSS) technique was introduced to obviate the dead space of septum after septal extension graft (SEG) with porous high-density polyethylene (pHDPE). To investigate STSS technique after SEG with pHDPE and concurrent nasal lateral osteotomy (LO). A retrospective study was conducted in 53 patients who underwent a STSS technique after SEG with pHDPE and concurrent LO. The postoperative discomfort (nasal pain and obstruction), the width of the nasal bony base, Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcomes Evaluation (ROE), and complications were recorded and assessed. The mean surgical duration of STSS was 862.53±227.73 seconds. The maximal mean score of postoperative nasal pain and nasal obstruction was 2.132±0.921 and 1.868±0.8995, respectively. The values on the width of the nasal bony base and ROE were significantly improved after surgery. There was no significant difference in NOSE values preoperatively versus 6 months postoperatively. An infection was found in 1 patient, a recurrent minor bleeding of septum in another patient, and a symptomatic nasal obstruction in other 2 patients. There was no major bleeding, hematoma, foreign body sensation, septal perforation, and other infection. STSS can eliminate the postoperative dead space of nasal septum with low discomfort and complications, and help to avoid a lateral displacement of osteotomized nasal bony segment (ONBS) in patients undergoing SEG with pHDPE and concurrent LO.

Submucosal Trans-Septal Suturing Technique After a Septal Extension Graft with Porous High-Density Polyethylene: A Technical Report.

Porous high-density polyethylene (pHDPE) is an alternative material for a septal extension graft (SEG) in oriental rhinoplasty when autologous cartilage is limited. Although nasal packing (NP) and trans-septal suturing (TSS) techniques are routine procedures to obviate the dead space after septoplasty, they are associated with certain discomforts and complications. To investigate the application of a submucosal trans-septal suturing (STSS) technique after SEG with pHDPE. A prospective study was conducted on 60 female participants who underwent SEG with pHDPE. The participants were randomly divided into the NP group and STSS group. The extra surgical duration of NP and STSS, pain, nasal obstruction, and sleeping disturbance as well as postoperative complications were recorded and compared between groups. No significant difference was found between group NP and group STSS in terms of mean age. The mean extra surgical duration of group STSS was significantly longer than group NP. There were significant higher pains of group NP at 24 hours and 48 hours postoperatively, compared with group STSS. The NP group also experienced significantly more nasal obstruction and sleep disturbance within 48h postoperatively compared to the STSS group. There was one infection in each group, minor bleeding in two NP patients, and one STSS patient. There was no major bleeding, hematoma, graft exposure, or septal perforation in both groups. Although STSS needs a longer extra surgical duration than NP, it significantly improves the patient's postoperative comfort with a faster return to normal respiration compared to NP. 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 .

Transseptal Suturing Septoplasty in Elderly.

Objectives: Assessing the effectiveness of transseptal suturing septoplasty in elderly individuals. Methods: The method used in this study involved the prospective separation of septoplasty candidates over 65 into 2 groups. The first group underwent nasal packing, while the transseptal suture technique was used on the second group. Postoperative pain was measured using the visual analog scale, and the effectiveness of the surgery was assessed using the Standardized Cosmesis and Health Nasal Outcomes-Obstruction scale. In addition, the patients' oxygen saturation levels were monitored using a pulse oximeter, and the results of the 2groups were compared. Results: The study included 26 patients with an average age of 66 years, ranging from 65 to 74 years. Of these patients, 13 received nasal packing, and the transseptal suture technique was used on the other 13. The results showed no statistically significant difference between the Standardized Cosmesis and Health Nasal Outcomes-Obstruction scores (P > .05). However, the oxygen saturation levels in group 1 were significantly lower, and the pain scores were significantly higher (P < .05) than those recorded for the other group. Conclusions: We concluded that transseptal suturing septoplasty is an effective, safe, and more comfortable surgical option for the elderly.

Comparison on the Effectiveness and Safety of Transseptal Suturing Versus Intranasal Splints After Septoplasty: A Systematic Review and Meta-analysis.

The application of transseptal suturing as an alternative to intranasal splints in preventing postoperative complications, such as synechia, and maintaining nasal septal stability following Septoplasty, remains controversial. This meta-analysis aims to systematically compare the effectiveness and safety of transseptal suturing with intranasal splints after Septoplasty. A comprehensive systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. The review included randomized clinical trials (RCTs) identified through a database search in July 2023, comparing postoperative complications following Septoplasty with the transseptal suturing technique versus intranasal splints. Eight published RCTs involving 570 participants were included in the meta-analysis. The analysis revealed no significant difference between the transseptal suturing and intranasal splint techniques following Septoplasty in postoperative complications, including postoperative hemorrhage, synechia, septal hematoma, septal perforation, local infection, crusting, and residual septal deviation. Transseptal suturing can be applied following Septoplasty as an alternative to intranasal splints without increasing the rate of postoperative complications. 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 Trans-septal Suturing Technique With Polyvinyl Alcohol Sponge-Based Nasal Packing for Hemostasis in Septoplasty.

IntroductionDespite the theoretical advantages of bleeding control, there is increased morbidity in postoperative pain, sleep disturbance, allergy, toxic shock syndrome, and mucosal injury with the nasal packing in septoplasty procedure for deviated nasal septum. Trans-septal suturing after septoplasty has been advocated as an effective alternative to conventional nasal packing. The current study aims to compare the frequency of subjective symptoms, such as postoperative nasal pain, nasal bleeding, postnasal drip, sleep disturbance, dysphagia, headache, and epiphora between the trans-septal suturing technique and nasal packing in septoplasty surgery.MethodsWe prospectively recruited all adult septoplasty patients for a one-year duration. Trans-septal nasal suturing was done for hemostasis after septoplasty in the case group. Anterior nasal packing after septoplasty was performed in the control group. The postoperative subjective symptoms were evaluated, such as postoperative nasal pain, nasal bleeding, postnasal drip, sleep disturbance, dysphagia, headache, and epiphora. Procedure-related complications were compared between the two groups.ResultsA total of 50 patients were recruited for the study (25 in each group). The postoperative symptoms evaluation suggested that the number of patients with postoperative pain was significantly higher in the control group on both occasions. Besides pain, a significantly higher number of patients in the control group had symptoms of nasal bleeding, postnasal drip, sleep disturbance, dysphagia, headache, and epiphora.ConclusionTrans-septal suture technique is an effective alternative to nasal packing with a low risk of nasal pain, bleeding, postnasal drip, epiphora, headache, dysphagia, and sleep disturbance. In addition, there is a low risk of complications like nasal bleeding, septal hematoma, septal perforation, and synechiae formation. The only disadvantage of trans-septal suturing compared to PVA-coated nasal packing is the increase in the operative time.

Effects of nasal packing and transseptal suturing on swallowing after septoplasty.

This clinical trial aimed to investigate the effects of different nasal packing methods and transseptal suture technique on swallowing after septoplasty. This randomized prospective study consists of 180 consecutive patients with septal deviation. All the patients underwent septoplasty. All the patients were randomly assigned to three groups. In group A, transseptal sutures were used for septal stabilization. In group B, both nasal passages were packed with Merocel tampons for septal stabilization. In group C, both nasal passages were packed with Doyle silicone splints for septal stabilization. For the evaluation of swallowing, the Eating Assessment Tool (EAT-10) questionnaire and a visual analog scale (VAS) were administered to all the patients preoperatively and on the second and seventh postoperative days. One hundred and twenty two of the patients (67.7%) were female and 58 of them (32.2%) were male. The mean age was 32.41 ± 12.37years (range: 18-57years). Both EAT-10 and VAS scores on the second postoperative day were significantly higher than the preoperative scores in all the groups (p < 0.05). The transseptal suture group had significantly lower EAT-10 and VAS scores on the second postoperative day than the Merocel packing and silicone packing groups (p < 0.05). Both EAT-10 and VAS scores on the postop 7th day significantly decreased in all groups compared to the postop second day (p < 0.05). Septoplasty affects swallowing, regardless of whether a tampon is applied. Transeptal suturing has a lesser effect on swallowing than other techniques. Although silicone packing is a less invasive method, it negatively affects swallowing, similar to Merocel packing. The transseptal suture technique is more comfortable than the other techniques in terms of swallowing function in the postoperative period.

Trans-septal Suturing Versus Merocel Nasal Packing: A Post Septoplasty Comparison.

It has been observed that nasal packing following septoplasty contributes to co-morbidities like post-operative pain, bleeding and increased duration of hospital stay. Trans-septal suturing has been suggested as a safe and effective alternative with a view to obviate the need for nasal packing and the hence avoid the discomfort associated with it. To compare the outcome of trans-septal suturing technique with merocel nasal packing after septoplasty. This was a prospective comparative study done on 60 patients who underwent septoplasty. The patients were divided randomly into 2 groups, while Group A comprised of patients undergoing Post-operative nasal packing with poly vinyl alcohol sponge (also commercially called Merocel), Group B included patients who underwent nasal septal suturing after surgery. The postoperative pain, hemorrhage and duration of hospital stay were the main parameters that were assessed and a comparison was drawn between the post-operative outcome of two techniques. Post-operative global pain score was 62.18 ± 4.75 in the group A (patients with nasal packing) and 24.73 ± 4.29 (patients with trans-septal suturing) in group B ('p'value was < 0.0001). Post-operative bleeding was noticed in 19 patients (out of 30) in group A, and in 2 patients of group B ('p'value was < 0.0001). 27 out of 30 patients of Group A were discharged on day 2 whereas 24 out of 30 patients of Group B required only 1day of hospital stay after the surgery ('p' value was < 0.0001). Trans-septal suturing technique reduces the duration of hospital stay, causes lesser post-operative bleeding and pain and is a relatively less painful technique than merocel nasal packing.

Comparison the Effect of trans-septal suture technique versus the intranasal Merocel packing regarding local nasal pain and sleep disturbances after septoplasty

Background and objectives: Nasal septal deviation is corrected by septoplasty which is a common surgical procedure performed by otolaryngologists. Septal surgery may be associated with numerous complications mainly pain. Otolaryngologists frequently pack both nasal cavities with different types of nasal packing to minimize these complications. Nasal packing is associated with some burden on the patient in post-operative days like local pain. To avoid these issues, many surgeons use transseptal [through and through] suturing techniques to overcome the need for packing after surgery. The aim of this study was to compare the effect of the transseptal suture technique versus the intranasal packing regarding local nasal pain and sleep disturbances after septoplasty. Methods: Prospective comparative study conducted on 120 patients. These patients underwent septoplasty, without additional nasal procedure, for nasal septal deviation. Patients were randomly divided into two equal groups before the operation. Group (A) with trans-septal su- ture technique was compared with group (B) in which intra-nasal packing with Merocel was done which were removed on the second postoperative day. Pain level using visual analog scale postoperatively was recorded over a follow-up period of 1st and 2nd postoperative day. Results: Out of 120 patients who had classical septoplasty, 74 patients were males (61.7%) and 46 patients were females (38.3%). Patients who had intra-nasal packing got significantly more postoperative pain (P&lt;0.05), Visual analog scale score was significantly higher in group B than those who had trans-septal suture [group A]. Conclusions: Trans-septal suturing technique without nasal packing for septoplasty postoperatively can be safely performed and with minimal local pain and sleep disturbances compared with the intra-nasal packing technique.

Comparison of the Transseptal Suturing with Nasal Packs After Septoplasty

Objective: Nasal packs are commonly used after septoplasty. However, there are numerous complications associated with nasal packing in the literature. This study aimed to compare the efficacy of transseptal suture technique (TSS) versus three different types of nasal packs regarding to postoperative complications and patient satisfaction after septoplasty. Material and Method: The study group included 80 patients who underwent septoplasty. The patients were randomly divided into four groups: Merocel group (group 1), internal nasal splint (INS) group (group 2), synthetic polyurethane foam (SPF) group (group 3) and TSS group (group 4). The VAS scores of groups were compared for pain (during pack, on removal of the pack), sense of pressure, dysphagia and postnasal drip. The complications including bleeding, synechiae, septal hematoma and septal perforation were also compared for each group. Results: The mean VAS scores of postoperative pain during packed and on removal of packs, sense of pressure and dysphagia found significantly higher in Merocel group than in silicone and Nasopore groups. There was no significant difference between other three groups regarding to VAS scores. Bleeding ratio was highest in Merocel group, and lowest in TSS group. Synechiae ratio was highest in Merocel group followed by TSS and SPF groups and lowest in INS group. There was no difference between groups regarding to septal hematoma and septal perforation. Conclusion: Our results showed that TSS technique might be safely used in septoplasty patients regarding to high patient’s satisfaction and low complication ratios. Merocel does not seem to be an appropiate material for septoplasty due to its high complication and low patient’s quality of life ratios.

Risk factors for nasal septal perforation after septoplasty operation

Aim: Nasal septal perforation is the most common complication in the long term after septoplasty. Nasal septal perforation is the partial opening of the wall between both nasal cavities. In this study, we will evaluate the causes of septal perforation after septoplasty.Methods: 400 patients aged between 18 and 50 years who underwent septoplasty operation in Otorhinolaryngology clinic between 2016 and 2019 were evaluated. The study was performed as a retrospective cohort. These patients were divided into groups with and without perforation. Patients with perforation were evaluated in terms of age, gender, alcohol and cigarette use, and stabilization technique used in surgery.Results: There were 280 male and 120 female patients in the study. 378 patients had no postoperative septal perforation. 22 had perforation after surgery. 19 of the patients in the perforated group were male and 3 were female. Male sex ratio was significantly dominant in perforated patients (19/3) (P=0.022). 21 of the patients were smoking and 1 patient was not drinking. (P=0.012). 11 of these patients were drinking alcohol and 10 of them did not drink alcohol. To stabilize the septum in patients with perforation while transseptal suturation + nasal splint was used in 14 patients, only nasal splint was used in 8 patients. The perforation rate after surgery was 22/400 (1.3%) (21/1) (P=0.012). There was no significant difference in the perforation rate among the patients with alcohol intake (P=0.082). There was significant difference between the methods used to stabilize the septum. The rate of perforation was significantly increased in patients who underwent transseptal suturation (P=0.023). Conclusion: Patients with perforation after septoplasty were found to increase the risk of perforation by male sex, smoking and surgical technique as transseptal suturing technique.

A Prospective Study of Trans-Septal Suture Technique in Stabalising the Middle Turbinate and Preventing Adhesions after Endoscopic Sinus Surgery

A Prospective Study of Trans-Septal Suture Technique in Stabalising the Middle Turbinate and Preventing Adhesions after Endoscopic Sinus Surgery

Trans-Septal Suture Technique to Stabilise the Middle Turbinate After Endoscopic Sinus Surgery

Trans-Septal Suture Technique to Stabilise the Middle Turbinate After Endoscopic Sinus Surgery

Evaluation of the Functional Results and Complications of Trans-Septal Suture Technique in Septoplasty

Evaluation of the Functional Results and Complications of Trans-Septal Suture Technique in Septoplasty

Effectiveness of Nasal Packing in Trans-septal Suturing Technique in Septoplasty: A Randomized Comparative Study.

Nasal packing is routinely used after septoplasty, but there are patient factors for which its use needs to be reconsidered. Effectiveness of nasal packing in trans-septal suturing technique in septoplasty. Prospective, comparative study, patients submitted to septoplasty were randomized to receive or not nasal packing postoperatively. Comparison in postoperative status for pain, headache, discomfort in swallowing, epiphora, bleeding, infection and pain on pack removal are assessed. In all the patients trans-septal suturing technique was used. Study group has 60 patients. Two groups were made group A in whom nasal packing done post operatively with merocel, group B in whom nasal packing was not done, in both groups quilting sutures were applied on to the septum. There was pain in nose and headache in all the patients in group A. Other symptoms in group A were epiphora, discomfort in swallowing due to ear discomfort. In addition to these there is pain on removal of packs. Routine use of nasal packing can be avoided instead sutures can be placed over the septum, which benefits in improving pain and symptoms due to pack in the postoperative period.

Transseptal suturing technique in septoplasty: impact on bacteremia and nosocomial colonization.

Although effects of Merocel® nasal packs and silicone splints on nasal flora alterations and bacteremia formation after septoplasty were assessed before, the effect of transseptal suturing technique has not been studied yet. The objective of this study is to compare nasal flora alterations and bacteremia occurrence rates between Merocel packs, silicone splints, and transseptal suturing technique in septoplasty. Ninety patients were divided into three groups randomly: Merocel packing (Group M), silicone splint (Group S), and transseptal suturing without packing (Group T). Group M and S received prophylactic antibiotics and antibiotic pomade application to packs, whereas neither antibiotic prophylaxis nor topical pomade was applied to Group T. Preoperative, after pack removal and 1month after pack removal nasal swab cultures and preoperative, immediately after surgery and 24h after surgery blood cultures were taken from all patients. Group M increased Methicillin-sensitive Staphylococcus aureus (MSSA) colonization (p = 0.003) and decreased normal flora colonization (p = 0.038), whereas Group S and T did not affect MSSA or normal flora colonization (p > 0.05). Antibiotic prophylaxis did not affect MSSA colonization (p = 0.14), whereas decreased normal flora colonization (p = 0.029). Transseptal suturing did not prevent bacteremia formation. Postoperative increasing of MSSA colonization in nasal cavity for septoplasty patients can be prevented by using transseptal suturing technique or silicone splints instead of Merocel packing, rather than applying prophylactic antibiotic treatment. Using transseptal suturing does not prevent bacteremia formation during septal surgery. These findings should be kept in mind to prevent postoperative life-threatening infective complications of septoplasty especially in immunosuppressive patients and patients with cardiovascular diseases.

Comparison of nasal airway splint, synthetic polyurethane foam (nasopore) and transseptal suture technique in septoplasty

Comparison of nasal airway splint, synthetic polyurethane foam (nasopore) and transseptal suture technique in septoplasty

Septoplasty without Nasal Packing: Functional Outcomes and Complications A Prospective Clinical Study

Objective: To evaluate the functional outcomes and complications of pack free septoplasty in adults. Subject: This study included 49 patient who underwent septoplasty randomize prospectively. Nasal obstruction was scored with the NOSE scale before the operation. Septoplasty was performed by the same surgeon. Nasal obstruction was re-scored in the 1 st and the 3 rd postoperative months. The postseptoplasty complications were recorded. The preoperative and postoperative NOSE scores were compared. Results: 35 patients (71.4%) were male and 14 patients (28.6%) were female. The subjective rate of success in the NOSE score was determined as 81.63%. There was statistically significant difference between preoperative and postoperative 1 st -3 rd months NOSE scores (p<0.05). Minor hemorrhage was observed in 17 cases (34.7%), nasal synechiae in 3 cases (6.1%) and flap apposition in 2 cases (4.1%). Conclusion: Pack free septoplasty which performed with the transseptal suture technique is effective on the treatment of septum deviation. It can be performed confidently in septum surgery.

Effects of nasal pack use on surgical success in septoplasty.

This study aims to evaluate the effects of nasal packs on surgical success and related complications in septoplasty. Thirty-eight patients (21 males, 17 females; mean age, 36.6 years, range 18 to 61 years) were included in the study. Septoplasty candidates were prospectively divided into two groups. Nasal packing and transseptal suture technique was applied to patients in group 1 (n=16) and group 2 (n=22), respectively. Postoperative pain was assessed with the visual analog scale. The success of surgery was questioned using the Nasal Obstruction Septoplasty Effectiveness (NOSE) scale. Surgical success was defined as a 50% decrease in the NOSE scores. There was no statistically significant difference in surgical success and complication rates between the groups (p>0.05). Pain scores were significantly higher in group 1 (p=0.015). Our study results suggest that nasal pack use does not affect surgical success and complication rates in septoplasty. Pack-free septoplasty with the transseptal suture technique is an effective method in the treatment of septal deviation.

Another Advantage of the Transseptal Suture

The aim of this study was to investigate the effects of transseptal suturing against 3 different types of nasal packings with respect to pain, operating time, and postoperative complications after nasal septal surgery. Two hundred twenty-eight patients (aged between 18 and 58 y) undergoing nasal septal surgery were included in the study. After surgery, 4 types of nasal packing were used: (1) transseptal suturing (group A: 57 patients), (2) internal nasal splint (group B: 57 patients), (3) Merocel standard 8-cm packing without airway (group C: 57 patients), and (4) soft paraffin gauze dressing (group D: 57 patients). Regarding the mean operating time, there was no statistically significant difference among groups B, C, and D (P > 0.05). However, when the operating times observed in the said 3 groups were compared with those observed in group A, the difference was statistically significant (P < 0.05). The mean (SD) postoperative pain score within 1 to 48 hours was 2.9 (1.3; median, 2) in group A, 6.3 (1.4; median, 6) in group B, 7.5 (1.1; median, 7) in group C, and 7.7 (1.8; median, 7) in group D. Starting from the postoperative 48th hour, internal nasal splint, Merocel packing, and soft paraffin gauze dressing were significantly more painful compared with transseptal suturing (P < 0.05). When compared with the other groups, extubation period and postoperative care unit stay were shorter in the transseptal suturing group (P < 0.05). Regarding infection, hematoma, synechia, or perforation, there was no statistically significant difference among the groups (P > 0.05). Transseptal suturing technique is a useful alternative to packing, with only a minor increase in operating time. Particularly, transseptal suturing shortens extubation time and postoperative care unit stay.

Comparison of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique after septoplasty in terms of immediate respiratory distress related to anesthesia and surgical complications

Conclusion: The patients who underwent septoplasty with bilateral totally occlusive nasal packing had an increased risk of experiencing respiratory distress (RD). Objective: To compare the immediate RD rates during recovery from anesthesia and surgical complications of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique. Methods: A total of 150 patients were assigned to one of three groups according to the technique utilized following septoplasty: transseptal suturing, internal nasal splint, or Merocel (nasal dressing without airway). To determine RD related to anesthesia in the operating theatre, the criterion was defined as any unanticipated hypoxemia, hypoventilation or upper airway obstruction (stridor or laryngospasm) requiring an active and specific intervention. Postoperative hemorrhage, infection, synechia formation, and septal perforation were evaluated. Results: Patients in the Merocel group were 3.6 times more likely to have RD than patients in the transseptal suture and internal nasal splint groups. Also, patients who smoked had an increased risk of RD during the recovery phase of anesthesia after the septoplasty. In addition, all three techniques resulted in similar complication rates after septoplasty, with the exception of minor hemorrhage, which had a significantly higher rate in the transseptal suture group.