Key Considerations in Practices and Principles of Endoscopic Septoplasty: Lessons, Mistakes and Future

Background: Conventional surgeries of the nasal septum improve the nasal airway but recent development and advancement of the knowledge about the endoscopic septoplasty has significantly changed the treatment modality and had brought focus over several aspects of possible advantages. This study aims to see the advantages, complications and limitations of endoscopic septoplasty. Methods: It was an observational prospective study conducted over 90 patients of symptomatic deviated nasal septum. It evaluated symptoms, anterior rhinoscopy and nasal endoscopy findings, objective and subjective improvement of symptoms using the nasal obstruction symptom evaluaiton (NOSE) score, post-operative pain using the visual analogue scale (VAS) and complication following the surgery. Results: Deviated nasal septum (DNS) either left or right side was the most common examination finding 97.78%. Post-operatively there was a good symptom relief and significant subjective improvement in NOSE scores with average decline in the score by 96.26%. Objective assessment of all patients showed improved airway. The complication rate was minimum 7.78%. Conclusion: Endoscopic septoplasty (ES) was found to have distinct advantages with good subjective and objective improvement of symptoms and lesser rate of complications. It should be an option offered to all patients requiring septoplasty. We also found that it helps in improving the learning curve and surgical skill of the trainees. Bangladesh J Otorhinolaryngol 2021; 27(2): 170-176

Trans-septal quilting suture versus intranasal silicone splint for preventing complications post endoscopic septoplasty

<p class="abstract"><strong>Background:</strong> Septoplasty is a common procedure in the field of otolaryngology for treatment of septal deviations. Intranasal splints and trans-septal quilting suture are commonly utilized to prevent post-operative complications. The silicone splint is a quick and simple technique to aid in cartilage support; however, it can cause discomfort. Trans-septal quilting suture is more available, well-tolerated and can help in mucosal tear closure, though is time-consuming. This study aimed to compare the efficacy of intranasal silicone splints versus quilting suture in the prevention of post endoscopic septoplasty complications.</p><p class="abstract"><strong>Methods:</strong> This was a retrospective COHORT study comprised of patients who underwent endoscopic septoplasty between January 2017 and December 2019 at Qatif central hospital. The patients were assigned into two groups: group S, who received intranasal splints and group Q, who received trans-septal quilting suturing. Patients’ medical records were reviewed for evaluation of post-operative visits and post-operative nasal endoscopic video recordings from the image archive software were evaluated to document complications. Statistical analysis was conducted using SPSS 23.0 software.</p><p class="abstract"><strong>Results:</strong> The study included 65 patients, of whom 41 were in group S and 24 were in group Q. None of the patients had major bleeding, local infection or mucosal synechia. There was a higher complication rate in terms of mucosal crustation, septal hematoma and perforation among group S; however, the difference was not statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that trans-septal quilting suture and intranasal silicone splints are both equally effective in preventing complications following septoplasty.</p>

Comparative study of outcomes of conventional and endoscopic septoplasty

<p><strong>Background: </strong>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.<strong></strong></p><p><strong>Methods: </strong>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 7^th day, 1 month and 3 months. The study was conducted at Surat Municipal Institute of Medical Education and Research (SMIMER), Surat.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>

Endoscopic septoplasty without nasal packing: our technique and outcomes

<p><strong>Background:</strong> Septoplasty is one of the common procedures performed in otorhinolaryngology practice for treatment of nasal obstruction caused by deviated nasal septum. Septoplasty is traditionally performed using a headlight and nasal speculum. However Endoscopic technique using rigid endoscopes has gained widespread popularity in recent years. Traditionally after correction of septal deviation the mucosal flaps are opposed and held together by some kind of nasal packing to prevent bleeding and septal hematoma. But the nasal pack causes significant morbidity in the post-operative period and also bleeding and pain while pack removal. In the present study we describe our technique of endoscopic septoplasty without nasal packing, in terms of patient comfort and complications.</p><p><strong>Methods: </strong>It was a descriptive study, conducted at Subbaiah institute of medical sciences, Shimoga from January 2017 to December 2020 on 50 subjects and the results were analyzed.</p><p><strong>Results: </strong>All 50 patients included in the study had reduced NOSE scores on the 2^nd post-operative day itself. None of the patients had septal hematoma, reduced oxygen saturation or post-op sinusitis. 3 out of 50 patients had minimal bleeding in the post-operative period. 12 out of 50 patients had crusting post operatively on 2^nd day but none had at 2 weeks. One patient had synechiae and one patient had residual septal deviation.</p><p><strong>Conclusions: </strong>Endoscopic septoplasty is preferred over conventional septoplasty. Trans septal quilting sutures has less complication rate, good quality of life and can be practiced easily and hence a valid alternative to intranasal packing following septal surgery.</p>

A Comparative Study between Endoscopic Septoplasty and Conventional Septoplasty

Background: Conventional nasal septal surgery depending on head light improves the nasal airway but leaves some complications, but with recent advancement in endoscopic approach limits the complication and improves the outcome. This is due to better visualization, improved illumination, avoiding unnecessary manipulation, limited exposure and scope for second surgery if required. Aim and objective: To assess the functional outcome of endoscopic septoplasty over conventional septoplasty. Material and method: This study was carried out in the department of Otolaryngology – Head & Neck Surgery of Bangladesh Medical College Hospital and Popular Medical College Specialized Hospital over a period of 5 years (2014- 2019). Ethical clearance was obtained from Hospital authority. All consecutive patients with symptomatic deviated nasal septum who were refractory to medical treatment were included in the study. Patients were equally divided into two groups of conventional and endoscopic septoplasty. Patients & their attendants, or legal guardians (in patients of less than 18 years) were thoroughly briefed about the each operative procedure. Patients with acute rhinitis or allergic rhinitis or vasomotor rhinitis or upper respiratory tract infection, external deformity, patients unfit for surgeries and patients not giving consent were excluded from the study. After surgery all patients were followed up monthly, 3 monthly and 6 monthly for 01 year. At each follow up visit, subjective and objective assessments were done. Objective assessment was done by Gertner-Podoshin plate and diagnostic nasal endoscopy. Results: In this study, nasal obstruction was relieved in 91% of conventional and 95% in endoscopic septoplasty group. Headache was improved in 75.68% and 86.5% patients and snoring was improved in 79.5% & 88.6% of patients of respectively. Intraoperative complications such as hemorrhage (21.67% vs 3.33%) and mucosal tear (28.33% vs 5%) are significantly higher in conventional septoplasty group than the endoscopy group. Conclusion: The use of endoscope in septal surgery improves visualization, illumination, and thus reduces complication with improved functional outcome. It can be performed in other diseases of nose and para nasal sinus diseases in the perspective of functional endoscopic sinus surgery. J Bangladesh Coll Phys Surg 2021; 39(3): 178-184

Resection of Huge Nasal Septal Chondroma Via Endoscopic Septoplasty Approach Through Modified Killian Incision

Chondromas are benign cartilaginous tumors that frequently occur in the long bones, pelvis, sternum, ribs, and scapula. They seldom develop in the head and neck region, and there have been rare reports of them arising in the nasal septum. Although the mainstay of management is surgery, surgical treatment strategies vary depending on the size, location, and extent of the disease. Herein, we describe a case of huge chondroma originated from the anterior nasal septum, which was completely removed by endoscopic septoplasty approach thorough modified Killian incision.

A comparative study of endoscopic verses conventional septoplasty

<p><strong>Background: </strong>Septoplasty is the surgical procedure for the correction of a deviated nasal septum. It can be achieved either with an endoscopic or a conventional approach. Endoscope allows better visualization and magnification, helps in enhancing surgical procedure accuracy and there is also no need for overexposure, excessive septal anatomy manipulation, osseocartilaginous disarticulation of the nasal septum and further resection. Endoscopic septoplasty is not only used to address symptomatic nasal obstruction, but also to improve visualization in sinus surgery. This study was conducted to compare intra operative bleeding of the two techniques in treatment of deviated nasal septum.</p><p><strong>Methods: </strong>The present study was conducted in the department of otorhinolaryngology, Prince Mohammed hospital and Aseer central hospital. The study was conducted in 30 patients having symptomatic DNS, in the age group of 18-50 years after obtaining their consent. The patients were randomly divided into two groups of 15 patients each. Group A (n=15) underwent endoscopic septoplasty and group B (n=15) underwent conventional septoplasty under general anesthesia. The two groups were compared regarding intra operative bleeding of surgery.</p><p><strong>Results: </strong>In conventional septoplasty there is more bleeding during surgery but in Endoscopic septoplasty the bleeding is less during surgery.</p><p><strong>Conclusions: </strong>The endoscopic septoplasty offers an alternative to conventional technique with superior visualization, excellent illumination and excellent tool for teaching. It preferred for posterior deviation, whereas conventional septoplasty is still preferred for anterior deviation.</p>

Evaluation of effectiveness of single-stage septoplasty during endoscopic rhinosinus surgery in children

The purpose of this study was to analyze results of simultaneous septoplasty and functional endoscopic sinus surgery in children. The study included 341 children who underwent endoscopic functional sinus surgery. The average age of patients was 11.2 ± 0.4 years. The follow – up period was 33.06 ± 6.9 months. Endoscopic septoplasty was performed simultaneously with FESS (functional endoscopic sinus surgery) in 72 children (21.1%). A comparative analysis of the results of FESS and endoscopic septoplasty showed a statistically significant association for 15 indicators on the SNOT 20 scale (p < 0.05). Significant differences were found both in general symptoms: sleep disturbance, cough, irritability, dizziness, decreased concentration, fatigue, emotional depression, sadness, grief, and local: nasal obstruction, post-nasal drip, hyposmia, mucosal edema, secretory otitis media, rhinorrhea, dry throat. Correlation analysis of the results of FESS and endoscopic septoplasty in relation to the child’s age did not reveal statistically significant differences: chi2 = 3.42 p = 0.33. The results of the study showed the efficacy of single-stage septoplasty when performing endoscopic rhinosinus surgery in childhood in improving local and general symptoms and a low degree of complications in the postoperative period.