Perioperative management of patients with operated nasal cavity  and paranasal sinuses

Nowadays due to the growth of the antibiotic resistance of the bacteria, the issue of the perioperative prophylaxis in surgery of the nasal cavity and paranasal sinuses has become especially relevant. Although the use of antibiotics more than 24 hours after surgery for prophylactic purposes does not increase the effectiveness of perioperative prevention of infectious complications, systemic antibiotics are often continued in the otorhinolaryngology departments for 5-7 days after surgery. Objective: Evaluation of the possibility of using of alternative antimicrobial agents in the framework of perioperative prevention of infectious complications during operations of the nasal cavity and paranasal sinuses. 178 patients undergoing surgical treatment for deviated nasal septum, chronic hypertrophic rhinitis, chronic rhinosinusitis without polyps, were divided into 2 groups. In the first group, 2 weeks before the operation and within 7 days of the postoperative period, applications were applied to the nasal cavity with a gel with Otofag bacteriophages, 2 doses 3 times a day for 60 minutes. In the second group, systemic antibiotic therapy (ceftriaxone 1.0 intramuscularly once) was prescribed 40-60 minutes before the operation. Results: There wasn’t a significant difference in the regression of reactive phenomena of the nasal mucosa and intoxication syndrome, except for the intensity of crust formation in the nasal cavity, the severity of which was 1.9 ± 0.1 points in the first and 4.19 ± 0.54 points in the second group on the 7’th day after surgery. Conclusion: The use of the gel with Otofag bacteriophages can be recommended in the perioperative period during planned operations on the nasal septum, inferior turbinates, and paranasal sinuses, which will allow avoiding the use of standard antibacterial drugs in these patients.

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Is Septoplasty Necessary When Using the Endoscopic Endonasal Transsphenoidal Approach for a Deviated Nasal Septum?

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1641602 ◽

2018 ◽

Vol 79 (06) ◽

pp. 569-573

Author(s):

Do Hyun Kim ◽

Yong-Kil Hong ◽

Sin-Soo Jeun ◽

Jae-Sung Park ◽

Soo Whan Kim ◽

...

Keyword(s):

Nasal Cavity ◽

Nasal Septum ◽

Middle Turbinate ◽

Case Series ◽

Septal Cartilage ◽

Transsphenoidal Approach ◽

Deviated Nasal Septum ◽

Endoscopic Endonasal ◽

Significant Difference ◽

Group B

Objective This article describes the role played by endoscopic endonasal transsphenoidal approach (EETSA) to the sphenoidal process of the septal cartilage of a deviated nasal septum. Design Case series with chart review. Setting Tertiary referral center. Participants Between 2009 and 2016, 177 patients with skull base tumors who underwent EETSA were included. Main Outcome Measures In 8 cases, the conventional two nostrils–four hands technique was employed (group A). In 16 cases, we placed a right-side conventional nasoseptal flap and a left-side modified nasoseptal rescue flap (group B), and in 153 cases, bilateral modified nasoseptal rescue flaps (group C). The number of septoplasty-required cases and the change of nasal cavity area differences reflecting septal deviation were measured. Results Septoplasty during EETSA was performed in two cases: one from group B and one from group C. There was no significant difference in the ratio of septoplasty-required cases among the three groups (p = 0.127). Between pre- and postoperative nasal cavity, the cross-sectional area difference at the anterior end of the middle turbinate level significantly decreased (p = 0.045). Also, the angle of deviation at the level of ostiomeatal unit significantly decreased after EETSA (p < 0.001). Conclusion Separation of a deviated complex surrounding the sphenoidal process of the septal cartilage is the key to relieving a deviated nasal septum. EETSA combined with the two nostrils–four hands technique allows posterior septectomy (including removal of this deviated complex) to be performed. Thus, EETSA may commence without preceding septoplasty even in cases with severe nasal septum deviations.

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Comparative study of outcomes of conventional and endoscopic septoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212901 ◽

2021 ◽

Vol 7 (8) ◽

pp. 1325

Author(s):

Kush B. Pandya ◽

Manit M. Mandal ◽

Ajay K. Panchal ◽

Rakesh Kumar ◽

Parth B. Kapadia ◽

...

Keyword(s):

Medical Education ◽

Hospital Stay ◽

Nasal Septum ◽

Objective Evaluation ◽

Point Of View ◽

The Other ◽

Deviated Nasal Septum ◽

Endoscopic Septoplasty ◽

Significant Difference ◽

Septal Spur

Background: Literature and other available research states lots of comparison between endoscopic and conventional septoplasty. The study helps conclude the merits and demerits of both techniques and compares the superiority of one method over the other on various aspects from surgeon’s and patient’s point of view. The objective of the study was to compare outcomes of conventional and endoscopic septoplasty.Methods: Study included 48 patients having symptomatic deviated nasal septum willing for surgery randomly divided into two groups of 24 each who underwent endoscopic septoplasty and conventional septoplasty. All the patients selected for study, were assessed for subjective and objective evaluation pre-operatively and post-operatively on 7th day, 1 month and 3 months. The study was conducted at Surat Municipal Institute of Medical Education and Research (SMIMER), Surat.Results: There are technical advantages of using endoscope during septoplasty as it is definitely superior from surgeon’s point of view but there is no significant difference in terms of functional outcome, complications and post-operative hospital stay.Conclusions: There are technical advantages of using endoscope being superior in terms of illumination, preciseness and surgery, visualization of deeper parts of nasal cavity and resection of posterior deviation and spur especially in isolated septal spur and in achieving hemostasis. The study helps us conclude that endoscopic septoplasty has merits over conventional septoplasty on various aspects.

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Comparative Study between Endoscopic Aided Septoplasty with Two Handed Technique using Endoholder and Conventional Septoplasty

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v16i3.29193 ◽

2020 ◽

Vol 16 (3) ◽

Author(s):

Apar Pokharel ◽

Naganawalachullu Jaya Prakash Mayya ◽

Nabin Gautam

Keyword(s):

Comparative Study ◽

Nasal Septum ◽

Deviated Nasal Septum ◽

Endoscopic Septoplasty ◽

Septal Surgery ◽

Significant Difference ◽

Common Causes ◽

Prospective Comparative Study ◽

Evolutionary Step ◽

One Year

Introduction: Deviated nasal septum is one of the most common causes for the nasal obstruction. The objective of this study is to compare the surgical outcomes in patients undergoing conventional septoplasty and endoscopic septoplasty in the management of deviated nasal septum. Methods: Prospective comparative study was conducted on 60 patients who presented to the Department of ENT, College of Medical sciences, during a period of one year. The severity of the symptoms was subjectively assessed using NOSE score and objectively assessed using modified Gertner plate. Results: There was significant improvement in functional outcome like NOSE Score and area over the Gertner plate among patients who underwent endoscopic septoplasty. Significant difference in incidence of post-operative nasal synechae and haemorrhage was seen in conventional group compared to endoscopic group. Conclusions: Endoscopic surgery is an evolutionary step towards solving the problems related to deviated nasal septum. It is safe, effective and conservative, alternative to conventional septal surgery.

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Prevalence and clinical features of nasal septum deviation: a study in an urban centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20173670 ◽

2017 ◽

Vol 3 (4) ◽

pp. 842 ◽

Cited By ~ 2

Author(s):

Vinnakota Sriprakash

Keyword(s):

Nasal Cavity ◽

Nasal Obstruction ◽

Nasal Septum ◽

Critical Role ◽

Geographical Area ◽

Nasal Discharge ◽

Deviated Nasal Septum ◽

Septum Deviation ◽

Aesthetic Appearance ◽

Nasal Septum Deviation

Background: Considerably large nasal septum plays a critical role in the obstruction of the nasal cavity, leading to snoring, and other symptoms, aesthetic appearance of the nose, and increased nasal resistance. This study was performed with an aim to investigate the prevalence of nasal septum deviation in our geographical area.Methods: 446 patients who attended the ENT department in the study period were evaluated for the nasal septum deviation. General demographic details were obtained from all of them. Detailed physical exam was performed on all the patients. Disposable nasal speculum and otoscope was used to observe the interior of the nasal cavity. Results: Out of 446 patients visiting the ENT department of our hospital, 138 (30.9%) of them had DNS. The C shaped NSD was the most common type to be encountered in our study, with 57 patients showing this disorder. Nasal obstruction was the predominant symptom observed in 119 (86.2%) of the patients, followed by rhinitis and nasal discharge (34.8%).Conclusions: Deviated nasal septum is a very prevalent condition in our area, with severe symptoms such as nasal obstruction and rhinitis. Most of the patients had C shaped deviated septum.

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CT Evaluation of Anatomical Variations in Osteomeatal Complex in Patients with Deviated Nasal Septum

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v21i2.27646 ◽

2016 ◽

Vol 21 (2) ◽

pp. 90-93

Author(s):

Mirza Aneesa ◽

Sajad Majid Qazi ◽

Aijazul Haq

Keyword(s):

Paranasal Sinuses ◽

Nasal Septum ◽

Complex Disease ◽

Anatomical Variation ◽

Middle Turbinate ◽

Inferior Turbinate ◽

Anatomical Variations ◽

Lateral Nasal Wall ◽

Deviated Nasal Septum ◽

Osteomeatal Complex

Background:The presence of septal deviation has been positively associated with sinus disease, especially osteomeatal complex disease and anterior and posterior ethmoid disease.Computerized tomographic imaging (CT) of the paranasal sinuses has become a widely accepted tool for assessing the paranasal sinuses (PNS) and providing a detailed anatomy of the lateral nasal wall.Objective:The objective of the study was to identify the anatomical variations of lateral nasal wall and paranasal sinuses in patients with Deviated nasal septum.Methods:Computerized tomographic (CT) examination was carried out using the bone algorithm in the coronal plane in 40 patients who met the inclusion criteriain the Postgraduate Department of Otorhinolaryngology and Head and Neck Surgery, SMHS Hospital an associated Hospital of Government Medical College, Srinagar from March 2011 to May 2012.Results:In our study, CT Nose and PNS revealed Deviated nasal septum in 40 (100%) patients, Hypertrophied Inferior turbinate in 11 (27.50%) patients, Concha bullosa in 5 (12.50%) patients, Paradoxical Middle turbinate in 8 (20%) patients, Everted Hypertrophied Uncinate in 2 (5%) patients, Aggernasi cells in 4 (10%) patients, Haller cells in 3 (7.50%) patients and Onodi cells in 2 (5%) patients.Conclusion:The most common anatomical variation associated with deviated nasal septum was Hypertrophied Inferior turbinate and the least encountered variation was Everted Hypertrophied Uncinate and Onodi cells. The CT scan provides supplementary clinical data to the history and endoscopic examination and assists in directing surgical treatment to the affected areas.Bangladesh J Otorhinolaryngol; October 2015; 21(2): 90-93

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Assessment of the effect of deviated nasal septum on the structure of nasal cavity

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-015-3770-y ◽

2015 ◽

Vol 273 (6) ◽

pp. 1477-1480 ◽

Cited By ~ 5

Author(s):

Junguo Wang ◽

Xin Dou ◽

Dingding Liu ◽

Panpan Song ◽

Xiaoyun Qian ◽

...

Keyword(s):

Nasal Cavity ◽

Nasal Septum ◽

Deviated Nasal Septum

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Phaeohyphomycosis of the paranasal sinuses caused by Fonsecaea pedrosoi - A case report

The Journal of Infection in Developing Countries ◽

10.3855/jidc.5361 ◽

2015 ◽

Vol 9 (11) ◽

Author(s):

Chadiesh Nagarajan ◽

Premamalini Thayanidhi ◽

Rajyoganandh S Vijayaraman ◽

Anupma J Kindo ◽

John Samuel

Keyword(s):

Case Report ◽

Mortality Rate ◽

Paranasal Sinuses ◽

Nasal Septum ◽

Treatment Options ◽

Surgical Correction ◽

Antifungal Treatment ◽

Fonsecaea Pedrosoi ◽

Deviated Nasal Septum ◽

Paranasal Sinusitis

Phaeohyphomycosis of paranasal sinuses is not very frequent. We here report a case of paranasal sinusitis caused by Fonsecaea pedrosoi in a 53 year old diabetic male, with deviated nasal septum. With surgical correction and antifungal treatment with itraconazole, the patient’s condition improved and he was discharged. Fonsecaea exists in the environment as a saprophyte and its infection is usually not lethal. However in immunocompromised individuals, when there is systemic invasion the mortality rate is high. With limited treatment options available for this fungus, early and prompt identification plays a major role not only in treatment, but also prevents further invasion.

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SEPTOPLASTY AND BLOOD PRESSURE REDUCTION IN HYPERTENSIVE PATIENTS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i3.640 ◽

2019 ◽

Vol 3 (3) ◽

Author(s):

Dr. Krishna Murari Bansal ◽

Dr. Prithvi Raj Singh

Keyword(s):

Blood Pressure ◽

Nasal Cavity ◽

Nasal Septum ◽

Preoperative Evaluation ◽

Blood Pressure Reduction ◽

Vascular Complications ◽

Lateral Wall ◽

Septal Deviation ◽

Deviated Nasal Septum ◽

Total Distance

INTRODUCTION: Nasal septum is the bone and cartilage of the nose that separates the nasal cavity into two passages the space between the septum and the lateral walls of the nasal cavity regulates airflow and respiration. Nasal septum deviation is one of the most frequent reasons for nasal obstruction presented with a reduction in nasal airflow and chronic mucosal irritation. Abnormal upper airway resistance can play a role in the development of hypertension. Effective management of hypertension decreases the risk of, myocardial infarction, stroke, chronic kidney disease and heart failure. MATERIAL AND METHODS: Adults of both sexes with age range from 20–40 years, suffering from symptomatic nasal septal deviation and newly detected hypertension (mean BP ≥140/90 mm Hg), undergoing submucosal resection (SMR) of the deviated septum, were included in the study. Preoperative evaluation was done and detailed history was taken. asal septal deformities were classified according to the Dreher scale (0 = none i.e. no deviation, 1 = mild deviation i.e. deviation less than half of the total distance to the lateral wall, 2 = moderate deviation i.e. deviation greater than half of the total distance to the lateral wall but not touching it, 3 = severe deviation i.e. deviation touching the lateral wall). Compensatory inferior turbinate hypertrophy, when present, was noted. Hypertension was considered as controlled in patients who had a mean SBP <140 mm Hg and mean DBP <90 mm Hg on follow up, Patients in whom SBP was ≥140 mm Hg and/or DBP ≥90 mm Hg, were considered as uncontrolled hypertensive and they were started on medical treatment for hypertension. Postoperatively, patients were followed up after 1 month, 3 months and at the end of 1 year. RESULTS: Of the 50 patients included in the study 40 (80%) were male and 10(20%) were female. Mean age was 34 ± 4.56. Mild septal deviation was seen in 10(20%), moderate septal deviation was observed in 31 (62%) and severe septal deviation was seen in 9 (18%). Compensatory hypertrophy was observed in 11(22%) of cases. Mean preoperative SBP was 143.76 ± 2.78 mm Hg and mean DBP was 93 ± 1.55 mm Hg. Hypertension was controlled in 70 % of patients who showed a strongly significant (P < 0.001) decrease in BP about 10–12 mm Hg decrease in SBP and 4–5 mm Hg decrease in DBP. CONCLUSION: Patients with hypertension and deviated nasal septum, surgical correction is always indicated as it helps in reducing the blood pressure and thereby prevent cardio-pulmonary and cardio vascular complications secondary to hypertension.

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A case of a schwannoma in the nasal columella

SAGE Open Medical Case Reports ◽

10.1177/2050313x18823091 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1882309

Author(s):

Tae Hoon Kim ◽

Joo Hyun Shin ◽

Eun-Kyoung Kwak

Keyword(s):

Nasal Cavity ◽

Paranasal Sinuses ◽

Nasal Septum ◽

Benign Tumor ◽

Relevant Literature ◽

Nerve Sheath ◽

Sublabial Approach ◽

Slow Growing

Schwannoma is a slow-growing, benign tumor of the nerve sheath. It rarely presents in the nasal cavity or the paranasal sinuses. Although schwannomas in the nasal septum have been reported previously, cases of this tumor in the nasal columella are rare in the literature. Here, we report on a 67-year-old woman with a schwannoma in the nasal columella that was successfully removed using a sublabial approach, along with a review of relevant literature.

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The Efficacy of Turbinate Surgery for the Relief of Nasal Obstruction

American Journal of Rhinology ◽

10.2500/105065893781976555 ◽

1993 ◽

Vol 7 (1) ◽

pp. 25-30 ◽

Cited By ~ 2

Author(s):

Charles P. Kimmelman ◽

Robert D. Jablonski

Keyword(s):

Nasal Obstruction ◽

Nasal Septum ◽

Subjective Perception ◽

Nasal Airway ◽

X Rays ◽

Deviated Nasal Septum ◽

Group Iii ◽

Group I ◽

Significant Difference

To study the role of turbinate surgery 60 consecutive patients complaining of nasal airway obstruction were evaluated. All patients had a deviated nasal septum and turbinate hypertrophy and had received medical therapy of at least 8 weeks duration. Plain x-rays or computerized tomography scans of the paranasal sinuses excluded sinusitis. Each patient was randomized into one of three groups. Group I underwent septoplasty for correction of the deviated nasal septum. Group II underwent bilateral anterior turbinectomy, and Group III underwent both septoplasty and bilateral anterior turbinectomy. All patients were evaluated preoperatively and on at least one postoperative visit for their subjective perception of improvement or worsening of nasal obstruction. Likewise, all patients underwent anterior rhinomanometry preoperatively and postoperatively. The data revealed no significant difference in reduction of the nasal airway resistance as measured by rhinomanometry for Groups I and II. The patients’ own perceptions of improvement, however, were augmented when turbinectomy was performed (Groups II and III). We conclude that anterior turbinectomy is a useful operation in alleviating the sense of nasal obstruction in patients with hypertrophied inferior turbinates.

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