Caudal Septal Division and Interposition Batten Graft: A Novel Technique to Correct Caudal Septal Deviation in Septoplasty

2019 ◽  
Vol 128 (12) ◽  
pp. 1158-1164 ◽  
Author(s):  
Shin Ae Kim ◽  
Yong Ju Jang
Keyword(s):  
Postoperative Complications ◽  
Nasal Obstruction ◽  
Surgical Outcomes ◽  
Septal Cartilage ◽  
Septal Deviation ◽  
Surgical Approaches ◽  
Symptom Improvement ◽  
Level Of Evidence ◽  
Novel Technique ◽  
Evaluation Scores

Background: Correction of caudal septal deviation is a challenging task that may require multiple surgical approaches. Objective: To introduce a novel technique – caudal septal division and interposition batten graft – and evaluate its surgical outcomes in patients undergoing correction of caudal septal deviation. Method: The surgical procedure includes a division of the deviated caudal L-strut preserved after resection of the deviated quadrangular septal cartilage at the central portion. A batten graft made of septal cartilage or bone is interposed between the cut ends of the caudal L-strut, the upper part of which mobilized toward the more concave side of the nasal cavity, and then sutured. The medical records of 29 patients with caudal septal deviation who underwent septoplasty using caudal L-strut division and interposition batten graft technique between January 2016 and March 2018 were retrospectively reviewed. Patient satisfaction and symptom improvement were evaluated by using the Nasal Obstruction Symptoms Evaluation scores. Endoscopic assessment of deviation correction was performed and postoperative complications were analyzed. Results: Of the 29 patients, 19 (65.5%) answered the telephonic interview. Mean Nasal Obstruction Symptoms Evaluation scores were 62.1 preoperatively and 9.2 postoperatively, exhibiting significant improvement ( P < .001). Satisfaction was rated as much improved in 9 (32.0%) patients, improved in 16 (57.0%), unchanged in 2 (7%), and worse in 1 (4%). Records of endoscopic examinations showed that 26 (82.9%) patients had a straight septum, 4 (11.4%) had improved but persisting caudal deviation, and 2 (5.7%) had no available data. Four patients had postoperative complications: 2 had septal abscesses, 1 had wound dehiscence, and 1 had synechia. All of these complications were managed without persistent problems. Conclusions: Caudal septal division and interposition batten graft can serve as an alternative surgical approach with acceptable surgical outcomes for managing severely deviated caudal septum. Level of evidence: 4

scholarly journals Criteria for Defining ‘Severe Septal Deviation’

2014 ◽  
Vol 5 (1) ◽  
pp. 6-8
Author(s):  
Rahil Muzaffar ◽  
Owais Mattoo ◽  
Raja Salman Khurshid ◽  
Shafqat Islam
Keyword(s):  
Nasal Obstruction ◽  
Septal Deviation ◽  
Nasal Discharge ◽  
List Type ◽  
Nasal Valve ◽  
Deviated Nasal Septum ◽  
Evaluation Scores ◽  
Symptom Evaluation ◽  
External Nasal Deformity ◽  
Valve Area

ABSTRACT Objective Criteria for defining ‘severe septal deviation’ and to describe the clinical profile of the same. Study Retrospective study. Materials and methods Hundred patients who were diagnosed with severe DNS and treated with extracorporeal septoplasty (ECSP) from September 2010 to December 2012, were retrospectively evaluated for this study. A review of their clinical charts formed the basis of this study. Results In this study, majority of patients (96%) had nasal obstruction as their prime symptom followed by postnasal discharge in 60% cases, headache in 40% cases and anterior nasal discharge in 30% cases. External nasal deformity was reported by 22 patients. Snoring was seen in 24% of patients with same percentage complaining of altered sense of smell and throat discomfort. Epistaxis, sneezing and facial pain were seen in 14% patients. Epiphora was complained by only 8% of patients. In this study, nasal endoscopy/anterior rhinoscopy was used to type the septal deformity. The commonest septal deviation was C-shaped cephalocaudal (48%), followed by S-shaped cephalocaudal (18%), C-shaped AP (16%), S-shaped AP (12%) and sharp septal deviation/angulation in 6% cases. All but three patients (6%) had deviated nasal septum involving multiple Cottle's areas. These three patients had sharp septal angulation involving Cottle's area 2 only. In this study, most common region involving DNS was area 1 + 2 + 3 (48%) followed by area 2 + 4 + 5 (28%) and 1 + 2 + 3 + 4 (18%). Area 2 was invariably involved in 100% of cases. NOSE (nasal obstruction symptom evaluation) scores. Preoperatively, mean NOSE score was 67.60 ± 5.26 (65.34-72.86). NSS (nasal symptoms score): – Preoperatively, mean NSS was –5.08 ± 0.38 (–5.46-–4.70). Conclusion A septal deviation is regarded as ‘severe’ if patient satisfies all of the below-mentioned criteria: – Preoperatively, mean NOSE score should be 65.34 or more. Preoperatively, mean NSS should be –4.70 or more negative. The septal deviation must cause significant obstruction to Cottle's area 2 or nasal valve area. Patients of severe septal deviation report significantly higher rates of snoring (24% in our study) and PND (60% in our study) when compared with mild/moderate cases. All severe septal deviations display significant obstruction of Cottle's area 2/nasal valve area and it is thus concluded that a severe septal deviation must cause significant obstruction of area 2/nasal valve. How to cite this article Mattoo O, Muzaffar R, Khurshid RS, Islam S. Criteria for Defining ‘Severe Septal Deviation’. Int J Head Neck Surg 2014;5(1):6-8.

Use of Bone-Cartilaginous Unit in Revision Rhinoplasty

2018 ◽  
Vol 39 (8) ◽  
pp. 841-847
Author(s):  
Amir A Sazgar ◽  
Yeganeh Teimouri ◽  
Amir K Sazgar
Keyword(s):  
Nasal Obstruction ◽  
Composite Graft ◽  
Septal Cartilage ◽  
Outcome Evaluation ◽  
Common Finding ◽  
Level Of Evidence ◽  
Revision Rhinoplasty ◽  
Tertiary Center ◽  
Patient Questionnaires ◽  
A New Technique

Abstract Background Insufficient septal cartilage is a common finding when performing revision rhinoplasty. Such cases require costal or conchal cartilage to be harvested, which is time consuming and brings the risk of morbidity. A new technique involves the use of a septal bone-cartilage composite graft or a bone-cartilaginous (BC) unit as a rhinoplasty graft. Objectives The aim of this research was to evaluate the subjective and objective effects of using a BC unit graft in revision rhinoplasty. Methods In this clinical trial, we examined 40 patients with insufficient septal cartilage for grafting who were referred to a tertiary center and a private setting from January 2016 to March 2017 for revision septorhinoplasty. The patients had nasal deformity and nasal obstruction. Assessment of surgical outcome was based on anthropometric measurements and by measuring the width of the middle nasal third from photographs, and on 2 patient questionnaires: the Nasal Obstruction and Septoplasty Effectiveness (NOSE) and the Rhinoplasty Outcome Evaluation (ROE) questionnaires. Results Nasolabial angles and the middle nasal third improved significantly after surgery (P < 0.005). Based on the NOSE questionnaire, 85% of patients had no or mild nasal obstruction, and the ROE questionnaire indicated that 62.5% were completely or very satisfied with the appearance of their nose. Conclusions The BC unit is an effective graft in revision rhinoplasty, and can be used in place of the rib graft. In skilled hands, harvesting of this graft results in no morbidity and is not time consuming. Level of Evidence: 4

scholarly journals Pattern of symptom improvement following endoscopic sinus surgery for chronic rhinosinusitis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Salma S. Al Sharhan ◽  
Mohammed H. Al Bar ◽  
Shahad Y. Assiri ◽  
Assayl R. AlOtiabi ◽  
Deemah M. Bin-Nooh ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Endoscopic Sinus Surgery ◽  
T Test ◽  
Sinus Surgery ◽  
Symptom Improvement ◽  
P Value ◽  
Psychological Dysfunction ◽  
Significant Difference ◽  
The Mean ◽  
Snot 22

Abstract Background Chronic rhinosinusitis (CRS) is a common inflammation of the nose and the paranasal sinuses. Intractable CRS cases are generally treated with endoscopic sinus surgery (ESS). Although the effect of ESS on CRS symptoms has been studied, the pattern of symptom improvement after ESS for CRS is yet to be investigated. The aim of this study was to determine the magnitude and sequence of symptom improvement after ESS for CRS, and to assess the possible preoperative factors that predict surgical outcomes in CRS patients. Methods This was a longitudinal prospective study of 68 patients who had CRS (with or without nasal polyps). The patients underwent ESS at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was used for assessment at four time points during the study: pre-ESS, 1-week post-ESS, 4 weeks post-ESS, and 6 months post-ESS. Results The difference between the mean scores recorded for the five SNOT-22 domains pre-ESS and 6 months post-ESS were as follows: rhinologic symptoms (t-test = 7.22, p-value =  < 0.001); extra-nasal rhinologic symptoms (t-test = 4.87, p-value =  < 0.001); ear/facial symptoms (t-test = 6.34, p-value =  < 0.001); psychological dysfunction (t-test = 1.99, p-value = 0.049); and sleep dysfunction (t-test = 5.58, p-value =  < 0.001). There was a significant difference between the mean scores recorded for the five domains pre-ESS and 6 months post-ESS. Rhinologic symptoms had the largest effect size (d = 1.12), whereas psychological dysfunction had the least effect size (d = 0.24). The only statistically significant difference in the SNOT-22 mean scores recorded 4 weeks post-ESS was observed between allergic and non-allergic patients (t = − 2.16, df = 66, p = 0.035). Conclusion Understanding the pattern of symptom improvement following ESS for CRS will facilitate patient counselling and aid the optimization of the current treatment protocols to maximize surgical outcomes and quality of life. Level of evidence Prospective observational.

Sleep Disorders in Patients with Severe Nasal Obstruction Due to Septal Deviation

1997 ◽  
Vol 117 (sup529) ◽  
pp. 199-201 ◽  
Author(s):  
P. Silvoniemi ◽  
J. Suonpää ◽  
J. Sipilä ◽  
R. Grénman ◽  
M. Erkinjuntti
Keyword(s):  
Sleep Disorders ◽  
Nasal Obstruction ◽  
Septal Deviation

Total Knee Arthroplasty Is Safe in Jehovah's Witness Patients—A 12-Year Perspective

2019 ◽  
Vol 33 (01) ◽  
pp. 034-041 ◽  
Author(s):  
Theodore S. Wolfson ◽  
David Novikov ◽  
Kevin K. Chen ◽  
Kelvin Y. Kim ◽  
Afshin A. Anoushiravani ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
Subgroup Analysis ◽  
Blood Management ◽  
Folate Supplementation ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Total Knee

AbstractDespite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The mean follow-up was 3.1 years in both the JW and non-JW cohorts. Postoperative complications, including in-hospital complications (7.9 vs. 4.8%; p = 0.47), revision TKA (1.6 vs. 1.6%; p = 1.00), and 90-day readmission (1.6 vs. 4.8%; p = 0.31) were not significantly different between the JW and non-JW groups. Subgroup analysis demonstrated JW patients who received TXA had a significantly lower decline in postoperative hemoglobin (Hgb) (8.6 vs. 14.0%; p < 0.01). At a follow-up of up to 12 years, JW patients who underwent TKA have outcomes equivalent to non-JW patients without the need for transfusion. Our findings support that surgeons are more likely to optimize JW patients preoperatively with iron and folate supplementation. Despite these variations in preoperative optimization efforts, no significant difference with regard to Hgb or hematocrit levels was demonstrated. Level of evidence is III, retrospective observational study.

Surgical Loupe at 4.0× Magnification in Pancreaticoduodenectomy—Does It Affect the Surgical Outcomes? A Propensity Score–Matched Study

2018 ◽  
Vol 26 (2) ◽  
pp. 201-208
Author(s):  
Mohamed El Shobary ◽  
Ayman El Nakeeb ◽  
Ahmad Sultan ◽  
Mahmoud Abd El Wahab Ali ◽  
Mohamed El Dosoky ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Hospital Stay ◽  
Pancreatic Fistula ◽  
Surgical Outcomes ◽  
Operative Time ◽  
Postoperative Pancreatic Fistula ◽  
Tube Removal ◽  
Matched Study ◽  
The Impact

Background. There is paucity of data about the impact of using magnification on rate of pancreatic leak after pancreaticoduodenectomy (PD). The aim of this study was to show the impact of using magnifying surgical loupes 4.0× EF (electro-focus) on technical performance and surgical outcomes of PD. Patients and Method. This is a propensity score–matched study. Thirty patients underwent PD using surgical loupes at 4.0× magnification (Group A), and 60 patients underwent PD using the conventional method (Group B). The primary outcome was postoperative pancreatic fistula. Secondary outcomes included operative time, intraoperative blood loss, postoperative complications, mortality, and hospital stay. Results. The total operative time was significantly longer in the loupe group ( P = .0001). The operative time for pancreatic reconstruction was significantly longer in the loupe group ( P = .0001). There were no significant differences between both groups regarding hospital stay, time to oral intake, total amount of drainage, and time of nasogastric tube removal. Univariate and multivariate analyses demonstrated 3 independent factors of development of postoperative pancreatic fistula: pancreatic duct <3 mm, body mass index >25, and soft pancreas. Conclusion. Surgical loupes 4.0× added no advantage in surgical outcomes of PD with regard to improvement of postoperative complications rate or mortality rate.

scholarly journals Universal 2 total wrist arthroplasty for the salvage of failed Biaxial total wrist arthroplasty

2019 ◽  
Vol 44 (6) ◽  
pp. 614-619 ◽  
Author(s):  
Hero J. A. Zijlker ◽  
Merel J. Berkhout ◽  
Marco J. P. F. Ritt ◽  
Niels van Leeuwen ◽  
Cees B. IJsselstein
Keyword(s):  
Level Of Evidence ◽  
Wrist Arthrodesis ◽  
Evaluation Scores ◽  
Total Wrist Arthroplasty ◽  
Hand Evaluation ◽  
Wrist Arthroplasty

Universal 2 implants may be an alternative to total wrist arthrodesis for the salvage of failed Biaxial total wrist prostheses. We assessed 40 Universal 2 revision implants retrospectively. Fourteen of these wrists were converted to total wrist arthrodeses, and two wrists received a third total wrist arthroplasty after a mean period of 5.5 years. Twenty-four of the Universal 2 implants that remained in situ after a mean follow-up of 9 years (range 4 to 13 years) were re-examined. Sixteen functioned satisfactorily. Patient-Rated Wrist and Hand Evaluation scores and Quick Disabilities of the Arm, Shoulder and Hand scores were 53 and 47, respectively. Twenty-nine patients would choose the Universal 2 again and would also recommend it to other patients. The survival of the revision implants was 60% at a mean follow-up of 9 years. Level of evidence: IV

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