The role of antimicrobial defense factors in the pathogenesis of immune disorders in deviated septum. Part 2

The article presents the data from Russian and foreign researchers on the state of humoral and cellular factors of antimicrobial protection of the mucous membrane of the nasal cavity and paranasal sinuses in the pathogenesis of immune disorders in deviated septum. One of the factors affecting the intensity of the inflammatory reaction and the rate of epithelialization of the mucous membrane is a decrease in IL-10 receptor expression, and, as a consequence, a decrease in its endogenous production. In vivo experiments have shown that the reduced expression of genes responsible for the synthesis of interleukin-10 inhibits infiltration of the wound postoperative surface of phagocytes, reducing the expression of CC-chemokines (MCP-1, MIP-1α), their receptors, cytokines, and interleukin-1α. The role of cellular and humoral factors, interreceptor interactions of cells of the respiratory, glandular epithelium, phagocytes, and lymphocytes in pathological conditions of the nasal mucosa and paranasal sinuses was analyzed. The role of immune mechanisms in the development of pathological reactions in deviated septum is shown. The presented review will expand the understanding of the role of antimicrobial factors in the pathogenesis of immune disorders in deviated septum.

The role of antimicrobial defense factors in the pathogenesis of immune disorders in deviated septum

The article presents the data from Russian and foreign literature on the state of humoral and cellular factors of local antimicrobial protection of the mucous membrane of the nasal cavity and paranasal sinuses in the pathogenesis of immune disorders in deviated septum. The role of cellular, humoral factors, and interreceptor interactions of cells of the respiratory, glandular epithelium, phagocytes, lymphocytes in pathological conditions of the nasal mucosa and paranasal sinuses was analyzed. The role of immune mechanisms in the development of pathological reactions in deviated septum is shown. The presented review will expand the understanding of the role of antimicrobial factors in the pathogenesis of immune disorders in deviated septum.

Biofilms and inflammation in patients with chronic rhinosinusitis

Introduction. The aim of the present study is to evaluate the presence of biofilms in patients with chronic rhinosinusitis (CRS), with or without nasal polyps, and their relationship to eosinophils and plasma cells. We compared the results with those obtained in nonCRS patients. Methods. A total of 50 patients were included in the study, 30 CRSwNP patients, 10 CRSsNP cases and 10 control patients who were operated for deviated septum. Biofilm detection was performed by means of H&E staining and SEM. Eosinophil and plasma cell values were recorded and compared between groups. Results. Biofilms were identified in 30 patients (60%), 76.6% (23 out of 30) of the CRSwNP patients, 70% (7 out of 10) of the CRSsNP patients and none of the septoplasty patients. Eosinophil and plasma cell values were more elevated in CRS patients, being strongly correlated to biofilm presence and nasal polyposis. Conclusion. Biofilm presence was demonstrated in many of the CRS patients, with no evidence in the control cases. Our study findings indicate that inflammatory cell counts are higher in patients with CRS compared to controls, but also more elevated in patients with polyposis. In biofilm-positive patients, eosinophil and plasma cell counts were greater than those in patients without biofilms, demonstrating the proinflammatory action of the biofilm in the sino-nasal pathology.

Chronological events in the surgery of the septum

<p class="abstract">Nasal obstruction unilateral or bilateral, secondary to congenital birth passage or adult, nasal trauma requires surgical intervention of the deviated septum. Intervention ranges from a minimal septal repositioning to submucosal resection, simple septoplasty or the extensive extracorporeal septoplasty. The development of septal surgery with the developments in the field of rhinology has been reviewed.</p><p class="abstract"> </p>

Septoplasty in elderly patients

This review article attempts to systematize and summarize the data on the major age-related pathophysiological, biomechanical, and histological processes that contribute to the progression of nasal breathing impairment or the appearance of these symptoms in elderly patients. The specifics of risk assessment of deviated septum surgery using various questionnaires and scoring systems is discussed. The article demonstrates that deviated septum surgery can be performed in these patients and addresses the specificity of donor site selection for a septal graft in elderly patients considering the histological features of various septal cartilage regions. Prior assessment of individual risks is of particular importance since it determines surgical success and favorable postoperative course in these patients. Studies addressing the perspective use of tissue-engineering transplants are unraveled. Management strategies that consider aging biomechanisms potentially affecting treatment efficacy are described. Finally, the article highlights preoperative management, treatment choice, drug dosage regimens, and postoperative management after septoplasty. KEYWORDS: deviated septum, septoplasty, elderly persons, age-related disorders, neuromuscular tone, nasal breathing impairment. FOR CITATION: Karpishchenko S.A., Lavrenova G.V., Vereshchagina O.E., Gas’kova P.I. Septoplasty in elderly patients. Russian Medical Inquiry. 2020;4(4):243–246. DOI: 10.32364/2587-6821-2020-4-4-243-246.

Clinical experience with endoscopic septoplasty

This article reviews current surgical techniques for a deviated septum and, in particular, focuses on the comparison of conventional and endoscopic approaches to septoplasty. Relevant issues of the anatomy and physiology of the nasal septum affecting the course of the comorbidities of the nasal cavity and the surrounding structures are discussed. The conventional and endoscopic approaches to septoplasty, indications, the benefits and drawbacks of each technique are addressed. The authors highlight the spectrum of the potential surgical procedures to the surrounding structures with the correction of the deviated septum as the first step. This surgical strategy in patients with the combined disorders of the internal structures of the nasal cavity is accounted for by the favorable course of the chronic conditions of the nasal cavity in the postoperative period and the possibility for providing adequate care for the nasal cavity. This article describes authors’ experience with the surgical correction of the deviated septum using endoscopic approach at all steps of the surgery. Clear advantages of this techniques in terms of both intraoperative accuracy and postoperative care for the nasal cavity are uncovered. KEYWORDS: endoscopic septoplasty, nasal septum, rhinological patients, conus beam computed tomography of the paranasal sinuses, nasal tumor. FOR CITATION: Karpishchenko S.A., Vereshchagina O.E., Teplova E.O. Clinical experience with endoscopic septoplasty. Russian Medical Inquiry. 2020;4(4):254–258. DOI: 10.32364/2587-6821-2020-4-4-254-258.

A comparative study of conventional septoplasty versus endoscopic septoplasty

Introduction: A deviated septum can be asymptomatic or can cause functional and cosmetic abnormalities. Different studies have been proposed for the correction of deviated septum, but septoplasty has been the treatment of choice. Septoplasty is a more conservative surgery and endoscopic septoplasty has become increasingly popular over the past few decades. Materials and Methods: The study was carried out to compare the post-operative results among patients of conventional and endoscopic septoplasty and to assess the efficacy of endoscopic septoplasty with other surgeries. The present study was conducted among 40 patients of deviated nasal septum admitted in the Department of Otolaryngology of Adesh Institute of Medical Sciences and Research, Bathinda. Patients were selected by simple random sampling and were divided into Groups A and B, with 20 patients in each group. Group A underwent conventional septoplasty and Group B underwent endoscopic septoplasty. Results: The male-to-female ratio in the present study was 3:1. Deviated nasal septum was commonly associated with inferior turbinate hypertrophy (45%) and concha bullosa (27.5%). Postoperatively, a significant relief from the symptoms of nasal obstruction (85%), nasal discharge (25%), headache (30%), and postnasal drip (55%) was observed in endoscopic septoplasty. Complication rate was higher in conventional septoplasty. The endoscopic approach facilitates proper alignment by limited and precise resection of pathological areas. Conclusion: Endoscopic septoplasty provides precise resection of the pathological areas and better illumination with limited flap dissection and exposure.