Different surgical treatments for nasal septal perforation and their outcomes

2007 ◽  
Vol 121 (5) ◽  
pp. 419-426 ◽  
Author(s):  
A Y Goh ◽  
S S M Hussain
Keyword(s):  
Surgical Treatment ◽  
Surgical Intervention ◽  
Journal Club ◽  
Treatment Options ◽  
Surgical Approaches ◽  
Septal Perforation ◽  
Inclusion Criteria ◽  
Hand Search ◽  
Nasal Septal Perforation ◽  
The Subject

Objective: To critically evaluate the literature on surgical treatment options for nasal septal perforations and to analyse the outcomes of these treatment options.Design: A systematic review of studies of nasal septal perforation closure using surgical intervention, published from January 1975 to March 2006.Data sources: Forty-nine papers were identified from electronic databases (all Evidence Based Medicine reviews (Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effectiveness and Cochrane Controlled Trials Register), EMBASE, Ovid (Medline) and British Medical Journal publications) and from a hand search of the reference lists of retrieved papers. Textbooks pertinent to the subject were referred to for background reading. Twenty-three studies met the inclusion criteria.Main outcome measure: Effectiveness of the surgical intervention to completely close the perforation.Results: Five studies examined the sole use of intranasal mucosal flaps to close the perforation, i.e. inferior turbinate flaps, quadrangular cartilage flap and mucoperiosteal flap. Eighteen studies reported the use of a combination of intranasal mucosal flap and interposition graft. Graft materials included temporalis fascia, mastoid periosteum, nasal septal material, acellular human dermal graft, conchal cartilage and porcine small intestine mucosa. Studies utilising interposition grafts generally produced higher closure rates. The surgical approaches documented include closed endonasal, unilateral hemitransfixion, external rhinoplasty and midfacial degloving techniques. A range of surgical treatment methods was reported in the literature, but some papers were excluded from this review as they did not meet the inclusion criteria. It was difficult to infer the true effectiveness of each study as the subject numbers were small, patient selection criteria were often unspecified and the follow-up period was brief. However, factors leading to an increased chance of success were identified.Conclusion: The review found an extensive range of surgical treatment techniques, but reported results were rarely statistically significant. It is difficult to be categorical about the effectiveness of a surgical treatment method; nonetheless, each technique has its own advantages and drawbacks.

scholarly journals The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Jin-Jiao Li ◽  
Jacqueline P. W. Chung ◽  
Sha Wang ◽  
Tin-Chiu Li ◽  
Hua Duan
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Treatment Options ◽  
Management Strategies ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Child Bearing ◽  
Fertility Sparing

The management of adenomyosis remains a great challenge to practicing gynaecologists. Until recently, hysterectomy has been the only definitive treatment in women who have completed child bearing. A number of nonsurgical and minimally invasive, fertility-sparing surgical treatment options have recently been developed. This review focuses on three aspects of management, namely, (1) newly introduced nonsurgical treatments; (2) management strategies of reproductive failures associated with adenomyosis; and (3) surgical approaches to the management of cystic adenomyoma.

scholarly journals Spondylodiscitis Caused by Aspergillus Species

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1899
Author(s):  
Christos Koutserimpas ◽  
Ifigeneia Chamakioti ◽  
Symeon Naoum ◽  
Konstantinos Raptis ◽  
Kalliopi Alpantaki ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Standard Of Care ◽  
Clinical Challenge ◽  
Life Threatening ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
Mean Time

Background: Spondylodiscitis caused by Aspergillus spp. is a rare but life-threatening clinical entity. However, a consensus on diagnostic criteria and most effective medical management is still missing. The present study is a review of all published cases of spondylodiscitis caused by Aspergillus spp., in an effort to elucidate epidemiology, patients’ characteristics, andand the medical and surgical treatment options and their effectiveness. Methods: A thorough review of all existing spondylodiscitis cases caused by Aspergillus was performed. Data regarding demographics, responsible fungus, time between symptoms’ onset and firm diagnosis, antifungal treatment (AFT), surgical intervention, andand the infection’s outcome were investigated. Results: A total of 118 Aspergillus spondylodiscitis cases, yielding 119 Aspergillus spp. isolates, were identified in the literature. The patients’ mean age was 40.6 years. Magnetic resonance imaging (MRI) (after its introduction) indicated the diagnosis in most cases (66.7%), while definite diagnosis was established through cultures in the majority of cases (73.7%). Aspergillus fumigatus was isolated in most cases (73; 61.3%), followed by Aspergillus flavus (15; 12.6%) andand Aspergillus nidulans and terreus (7; 5.9%, each). The mean time between symptoms’ onset and diagnosis was 5.7 months. Amphotericin B was the preferred antifungal regiment (84 cases; 71.2%), followed by voriconazole (31; 26.3%), and the mean AFT duration was 6.1 months. The final outcome was successful in 93 cases (78.8%). Furthermore, 77 patients (65.3%) underwent surgery. Conclusions: Spondylodiscitis caused by Aspergillus spp. represents a clinical challenge, requiring a multidisciplinary approach. The present review has shown that prolonged AFT has been the standard of care of the studied cases, while surgical treatment seems to play an important role in selected patents.

scholarly journals Cost-effectiveness of different surgical treatment approaches for early breast cancer: a retrospective matched cohort study from China

2020 ◽  
Author(s):  
Qing Yang ◽  
Xiaorong Zhong ◽  
Wei Zhang ◽  
Ting Luo ◽  
Ping He ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Surgical Treatment ◽  
Early Breast Cancer ◽  
Medical Center ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Breast Conserving Surgery ◽  
Surgical Approaches ◽  
Treatment Approaches

Abstract Background Both breast-conserving surgery and breast reconstruction surgery are less popular in China, although they can improve patients' quality of life. The main reason comes from the economy. There is currently no economic evaluation of different surgical treatment options for early breast cancer. Our study aimed to evaluate the long-term cost-utilities of different surgical treatment approaches for early breast cancer. The surgical approaches are including mastectomy(MAST), breast-conserving therapy(BCT), and mastectomy with reconstruction (MAST+RECON). Methods We applied the propensity score matching method to perform a 1: 1 match on patients undergoing these three types of surgery in a tertiary academic medical center from 2011 to 2017 to obtain a balanced sample of covariates between groups. A Markov model was established. Clinical data and cost data were obtained from the medical records. Health utility values were derived from clinical investigations. Strategies were compared using an incremental cost-effectiveness ratio (ICER). Results The total cost of MAST, MAST+RECON and BCT was $35,282.24, $69,428.82 and $73,661.08, respectively. The discounted quality-adjusted life year(QALYs) were 17.94, 18.71 and 20.49, respectively. Compared with MAST, MAST+RECON and BCT have an ICER of $106708.06/QALY and $15050.53/QALY, respectively. The ICER of BCT vs. MAST was less than the threshold of $27,931.04. The reliability and stability of the results were confirmed by Monte Carlo simulation and sensitivity analysis. Conclusions We believe that in the context of the limited resources in China, after comparing the three surgical approaches, BCT is the more cost-effective and preferred solution.

scholarly journals Iatrogenic Supraclavicular Nerve Injuries in Surgical Treatment of Clavicle Fractures

2015 ◽  
Vol 22 (2) ◽  
pp. 50-54
Author(s):  
A. S Zolotov ◽  
M. S Feshchenko ◽  
O. I Pak
Keyword(s):  
Surgical Treatment ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Early Postoperative Period ◽  
Surgical Approaches ◽  
Nerve Injuries ◽  
Clavicle Fractures ◽  
Traumatic Damage

Incidence and pattern of disturbed sensitivity in the zone of surgical intervention was studied in 24 patients with clavicle fractures. Traumatic damage of supraclavicular nerve (not related to surgery) was observed only in 1 case. Disturbance of sensitivity in the zone of surgical intervention was noted in 21 (87.5%) patients. Mean area of anesthesia made up 44.5±29.3 cm2 (from 8.0 to 125.5 cm2). That complication developed at both horizontal and vertical surgical approaches. Intraoperatively supraclavicular nerves were visualized and preserved in 6 patients however disturbed sensitivity in early postoperative period was observed in 4 cases. Preventive isolation of supraclavicular nerves does not always ensure the preservation of sensitivity in early postoperative period.

scholarly journals Cost-effectiveness of different surgical treatment approaches for early breast cancer: a retrospective matched cohort study from China

2020 ◽  
Author(s):  
Qing Yang ◽  
Xiaorong Zhong ◽  
Wei Zhang ◽  
Ting Luo ◽  
Ping He ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Surgical Treatment ◽  
Early Breast Cancer ◽  
Medical Center ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Health Utility ◽  
Breast Conserving Surgery ◽  
Surgical Approaches

Abstract Background: Both breast-conserving surgery and breast reconstruction surgery are less popular in China, although they can improve patients' quality of life. The main reason comes from the economy. There is currently no economic evaluation of different surgical treatment options for early breast cancer. Our study aims to assess the economic impact and long-term cost-effectiveness of different surgical treatments for early breast cancer. The surgical approaches are including mastectomy (MAST), breast-conserving therapy (BCT), and mastectomy with reconstruction (MAST+RECON).Methods: We applied the propensity score matching method to perform a 1: 1 match on patients undergoing these three types of surgery in a tertiary academic medical center from 2011 to 2017 to obtain a balanced sample of covariates between groups. A Markov model was established. Clinical data and cost data were obtained from the medical records. Health utility values were derived from clinical investigations. Strategies were compared using an incremental cost-effectiveness ratio (ICER).Results: The total cost of MAST, MAST+RECON and BCT was $35,282.24, $69,428.82 and $73,661.08, respectively. The quality-adjusted life year (QALYs) were 17.94, 18.71 and 20.49, respectively. Compared with MAST, MAST+RECON and BCT have an ICER of $106708.06/QALY and $15050.53/QALY, respectively. The ICER of BCT vs. MAST was less than the threshold of $27,931.04. The reliability and stability of the results were confirmed by Monte Carlo simulation and sensitivity analysis.Conclusions: We believe that in the context of the limited resources in China, after comparing the three surgical approaches, BCT is the more cost-effective and preferred solution.

scholarly journals Surgical closure of nasal septal perforation. Early and long term observations

2011 ◽  
Vol 49 (4) ◽  
pp. 486-491 ◽  
Author(s):  
L.K. Dosen ◽  
R. Haye
Keyword(s):  
Surgical Treatment ◽  
Septal Deviation ◽  
Long Term Results ◽  
Septal Perforation ◽  
Surgical Closure ◽  
Nasal Septal Perforation ◽  
Perennial Rhinitis ◽  
Long Term Observation ◽  
Duct Stenosis

Background: Results of surgical treatment of nasal septal perforation are usually evaluated using closure of the perforation as criterion of success. Patients, however, may still have symptoms. Aim: To assess the long-term results of surgical treatment of nasal septal perforation with bilateral, posterior based mucoperichondrial septal flaps using a four-point symptom score to ultimately improve treatment and selection criteria. Methodology: Patients were seen 6 months postoperatively. Questionnaires were sent to 116 surviving patients in 2008-2009. The response was 104. Patients reporting moderate or severe symptoms were seen as outpatients. Results: Between 1987 and 2004, 126 patients were surgically treated using posterior based bilateral mucoperichondrial septal flaps. Sixteen patients had a reperforation during the first 3 months, and another 3 several years later. There was no correlation between early outcome and diagnosis, preoperative size of the perforation, gender or severity of preoperative crusting. There was an increased rate of reperforation with increasing age. Complications seen at the 6 months` follow-up of patients with closed perforations were lachrymal duct stenosis, partial vestibular stenosis, hypoesthesia, crusting and septal deviation, most of which were treatable. Long-term observation mean 10 years) of the same patients showed the following moderate or severe symptoms: crusting, obstruction and bleeding, mainly in men. Obstruction was often due to various forms of perennial rhinitis, sometimes to crusting and more rarely to septal deviation. Crusting was the only independent symptom. There was no correlation between crusting and diagnosis, preoperative size of the perforation, age or severity of preoperative crusting. Conclusions: Results of the surgical technique using posterior based bilateral mucoperichondrial septal flaps for treatment of nasal septal perforations were good, but depend on surgical expertise and age of the patient. Long-term results from other studies will be a guide to choose the proper surgical procedure to minimize the number of late symptoms. Prosthetic treatment cans be an alternative. Patients with return of symptoms should seek further advice.

scholarly journals Operative Outcomes for Cervical Myelopathy and Radiculopathy

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
J. G. Galbraith ◽  
J. S. Butler ◽  
A. M. Dolan ◽  
J. M. O'Byrne
Keyword(s):  
Surgical Treatment ◽  
Cervical Myelopathy ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Intractable Pain ◽  
Spinal Stability ◽  
Nerve Roots ◽  
Operative Outcomes ◽  
Anterior Posterior

Cervical spondylotic myelopathy and radiculopathy are common disorders which can lead to significant clinical morbidity. Conservative management, such as physical therapy, cervical immobilisation, or anti-inflammatory medications, is the preferred and often only required intervention. Surgical intervention is reserved for those patients who have intractable pain or progressive neurological symptoms. The goals of surgical treatment are decompression of the spinal cord and nerve roots and deformity prevention by maintaining or supplementing spinal stability and alleviating pain. Numerous surgical techniques exist to alleviate symptoms, which are achieved through anterior, posterior, or circumferential approaches. Under most circumstances, one approach will produce optimal results. It is important that the surgical plan is tailored to address each individual's unique clinical circumstance. The objective of this paper is to analyse the major surgical treatment options for cervical myelopathy and radiculopathy focusing on outcomes and complications.

scholarly journals Laser surgical treatment options for diseases of the upper respiratory tract in horses – An overview

2012 ◽  
Vol 1 (2) ◽  
Author(s):  
Bernhard Ohnesorge ◽  
Anna Rötting
Keyword(s):  
Surgical Treatment ◽  
Respiratory Tract ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Minimal Invasive ◽  
Surgical Approaches ◽  
Upper Respiratory Tract ◽  
Common Diseases ◽  
Life Threatening ◽  
Upper Respiratory

AbstractDiseases of the upper respiratory tract in horses can be life-threatening, or more frequently, limit the ability of the equine athlete to perform. Traditional surgical approaches are often invasive and are limited due to anatomic considerations. This article summarizes minimal invasive surgical techniques and in particular, laser surgical techniques useful for treatment of common diseases of the upper respiratory tract in horses.

scholarly journals Surgical Management in Primary Congenital Glaucoma: Four Debates

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Ta C. Chang ◽  
Kara M. Cavuoto
Keyword(s):  
Surgical Treatment ◽  
Surgical Management ◽  
Medical Management ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Congenital Glaucoma ◽  
Definitive Treatment ◽  
Primary Congenital Glaucoma ◽  
Compare And Contrast ◽  
Early Surgical Intervention

Primary congenital glaucoma is a worldwide diagnostic and therapeutic challenge. Although medical management is often a temporizing measure, early surgical intervention is the definitive treatment. As the abundance of surgical treatment options continues to expand, the authors will compare and contrast the available options and attempt to provide a consensus on surgical management.

scholarly journals A paediatric patient with nasal septal perforation – symptoms, diagnosis and treatment options

New Medicine ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Maciej Pilch ◽  
Anna Tuszyńska ◽  
Karolina Raczkowska-Łabuda ◽  
Lidia Zawadzka-Głos
Keyword(s):  
Nasal Septum ◽  
Treatment Options ◽  
Diagnostic Methods ◽  
Septal Perforation ◽  
Nasal Cavities ◽  
Nasal Septal Perforation ◽  
Paediatric Patients ◽  
External Nose ◽  
Supporting Element ◽  
Medical University

Introduction. Nasal septum is an anatomical structure which not only separates both nasal cavities, but is also a supporting element for the external nose, and has an impact on its physiology. Structural abnormalities of the nasal septum, such as deviations and defects, affect the airflow in the nasal cavities. Nasal septal perforation is one of the factors that impair nasal patency due to secondary pathological changes. There are various treatment options, depending on the symptoms reported and the stage of septal lesions. Treatment strategy is selected individually for each patient. Aim. The aim of this paper was to discuss the symptoms, diagnostic methods and treatment options in children with nasal septal perforation. Patients of the Department of Paediatric Otolaryngology, Medical University of Warsaw, were included in the analysis. Material and methods. We present cases of 18 patients aged between 3 and 17 years, admitted to the Outpatient ENT Clinic at the Department of Paediatric Otolaryngology, Medical University of Warsaw. Results. A total of 18 patients aged between 3 and 17 years (mean age 12.83 years, SD = 4.34) reported to our clinic. In most cases, nasal septal perforation developed as a complication of septoplasty (4) or nasal trauma. Nasal bleeding and crusting were the most commonly reported symptoms. Perforation was accompanied by external nasal deformity in about 1/3 of patients. Conclusions. Only few reports on paediatric patients with nasal septal perforation may be found in literature. All data obtained was analysed based on reports describing adult and paediatric patients. The severity of symptoms varied depending on the aetiology.

Sign in / Sign up

Export Citation Format

Share Document