Are we mindful of nasal dorsal integrity during septal surgery? An imaging study of nasal keystone area

Objectives: Review of radiological images of the keystone area to assess risk of disruption to the nasal dorsum when separating the osseo-cartilaginous junction in septoplasty. Methods: A Cross sectional radiological study of adults who underwent CT scan of paranasal sinuses. Outcome measures included were: The Length of the keystone area (shorter length implies a higher risk of disruption) and a high-risk shape (high risk shape implies shorter keystone area) that can predispose to disruption of nasal dorsal integrity during septoplasty surgery. Certain nasal dimensions were evaluated to determine if they add risk to the dorsum. Results: CT scans of 343 patients were reviewed. The mean keystone area length was initially 10.42 mm that came down to 7.43 mm after adjustment in patients with high-risk shape. 31.5% of subjects were at risk of disruption to the dorsum due to short keystone area length <5 mm. Relatively shorter nasal bones (nasal bone length: overall dorsal length <0.49%) were associated with a shorter keystone area length (P = 0.004). Age, gender, septal deviation are not risk factors as they did not significantly influence keystone area length. Conclusions: One third of our patients (31.5%) had short KSA length < 5mm which carries higher risk of disruption to the dorsum integrity upon complete detachment of osseo-cartilaginous junction. We recommend preoperative CT imaging for thorough evaluation and precise measurement of KSA. Patients with relatively shorter nasal bones detected on examination (and confirmed radiologically), need to be recognized as they are more likely to have shorter KSA

Prevention of Septal Perforation Using a Combination of Crushed Cartilage and Thin Silastic Sheet During Septoplasty

Background and Objectives: The aim of the present study was to investigate the effects of a combination of crushed cartilage and thin silastic sheet for patients with a risk of septal perforation during septoplasty.Materials and Methods: A total of 195 people who underwent septoplasty surgery at Dong-A University Hospital from January 2019 to December 2020 were enrolled retrospectively. Among 195 people, our surgical method was provided for those with damage to both septal mucosa. The cartilage was collected, crushed with the cartilage crusher, and inserted between perforated mucosa. After the cartilage insertion, a 0.254-mm-thin silastic sheet was designed to cover both sides of the perforated septal mucosa. Next, a penetrating suture was placed. After thin silastic was applied on both mucosa, a 1-mm-thick silastic sheet was inserted on both sides of the nasal cavity and penetrating sutures were placed on the anterior and inferior septum. The operation concluded after packing both sides of the nasal cavity using non-absorbable packing material. The packing was removed on the second day after the operation, and the nasal cavity condition was checked every week. Thick silastic sheets were removed 5 days after surgery, and thin silastic sheets were maintained until both septal mucosa healed.Results: Of nine total cases, only one 78-year-old male experienced septal perforation at the cartilage portion two months after surgery. In this case, no other action was taken to cover the perforation site because he reported no symptoms or discomfort during the 9 months after surgery. In the other eight cases, both septal mucosa healed completely, and there were no complications.Conclusion: This method with crushed cartilage and silastic sheets to fill the defect after septal surgery is thought to help prevent postoperative perforation at no additional cost, and further research is needed.

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

Auricular Perichondrium Graft for Septal Perforation Repair

Objectives: Procedures which utilize bilateral mucosal flaps with an interposition graft are frequently used when attempting closure of a septal perforation. Concurrent surgical management of the nasal valve or an aesthetic deformity may be indicated. The objective of this study is to report our experience using auricular perichondrium for the interposition graft when auricular cartilage is harvested for structural or aesthetic graft material. Methods: A retrospective medical record review was performed for septal perforation repairs performed at Mayo Clinic in Arizona from January 2010 through January 2020. Patients identified for this study underwent a procedure utilizing bilateral nasal mucosal flaps with an auricular perichondrium interposition graft. Results: Forty-four patients (31 females) with a mean age of 53.3 years met study criteria. The most common presenting symptoms were nasal obstruction, crusting, and epistaxis. Prior septal surgery was the most common perforation etiology (45.5%). Mean perforation length was 11.8 (range, 3-26) mm and height, 9.1 (range, 2-16) mm. Auricular cartilage was harvested for nasal valve surgery in 43 patients. Complete perforation closure was noted in 95.3% (41/43) of patients with a minimum post-operative follow-up of 3 (mean, 20.4) months. Four patients underwent revision surgery for persistent postoperative nasal obstruction. Conclusion: The ear can provide both cartilage and perichondrium for use in septal perforation surgery. Our study demonstrates the successful use of auricular perichondrium as the interposition graft for a perforation closure procedure utilizing bilateral nasal mucosal flaps.

Significance of Inner Nasal Valve In Septoplasty

Background: Nasal obstruction due to deviated septum is commonly treated with conventional septoplasty. This surgery however is inadequate in cases of compromised nasal valves and leads to persistent symptoms. Hence, we stressed the evaluation of nasal valves before septal surgery & studied the outcome of the patients with valve area correction. Aim: To prove the significance of inner nasal valve in nasal surgery. Objective : To analyse the outcome of Open septoplasty. Methodology:A retrospective review of our patients undergoing Open septoplasty was analysed from April 2016 to January 2021. The preoperative and post operative evaluations were calculated & statistically analysed. Results : A total of 400 patients underwent Open septoplasty. Out of which 392(98%) showed symptomatic improvement in breathing difficulty & 380(95%) were happy with the asthetic improvement. Conclusion: Open septoplasty and Spreader grafts is best solution to improve Internal Nasal valve angle. Rim graft to improve external valve collapse. Spreader graft also gives asthetic & functional improvement

The Effects of Using Bioglue in Nasal Septal Surgery

Objectives: Nasal septal surgery is one of the most common surgical procedure performed by otolaryngologists. Nasal packs are used for bleeding control, prevention of septal hematoma, replacement of mucoperichondrial flaps, and stabilization of the septum after nasal septal surgery. The aim of this study was to investigate the effects of albumin-glutaraldehyde–based tissue adhesive (Bioglue), which can be used as an alternative to nasal pack on the nasal septum after experimental nasal septum surgery. Methods: A total of 16 female Wistar albino rats were randomly separated into the study group (n = 10) and the control group (n = 6). After raising the mucoperichondrial flap on one side of the septum, Bioglue was used to fix the mucoperichondrial flap over the septal cartilage ın the study group and nasal packs (Merocel) were used for fixation in the control group. The rats were sacrificed at 2 and 4 weeks after septoplasty. All the tissue samples were evaluated under light microscope by the same pathologist in respect of foreign-body reaction, degree of inflammation, granulation tissue, fibrosis, cartilage damage, and cilia and goblet cell damage. In the control group, the Merocel packs were removed after 2 days and the groups were compared in terms of hematoma. Results: No hematoma was observed in any group. Septal perforation was determined in all the study group participants and loss of cilia and goblet cells and foreign-body reaction were found in 8 samples of the study group participants and in none of the control group. Conclusions: The results of this study show that Bioglue caused segmental cartilage injury; therefore, it may not suitable for use following septal surgery.

Use of Biodegradable Implant in Rhinoplasty and Nasal Septum Surgery

The nasal septum has a significant influence on the form and function of the nose, as it is a key element of the nasal framework. Its shape, size, position, and integrity help determine not only the patency of the nasal fossae but also the appearance of the nasal pyramid. Achieving satisfactory functional and aesthetic results presents a real challenge for the surgeon in a wide range of nasal septal deformities. During the last decade, the absorbable biodegradable plate DePuySynthes Rapidsorb fixation system has been used to repair pediatric facial fractures. It provides stability during the initial period of healing until the bony fracture segments have reunited. There are many differently sized and shaped plates with varying thickness available. We believe this is a useful technique to improve the rate of septoplasty success, and with further experience, the indications and role in septal surgery can be better defined.

Septoplasty in Pediatric Population: A Ten Years' Experience

Introduction: Septoplasty is a commonly performed surgical procedure worldwide in otorhinolaryngology. Septoplasty aims to correct the deviated nasal septum at the midline thereby opening the nasal airway in patients with long standing nasal obstruction secondary to septal deviation. Nasal breathing is important for proper facial growth and improvement of quality of life in children. Most surgeons are still reluctant to perform septoplasty in children. But septoplasty should be performed in children if there are severe breathing problems related to septal deviation. Objectives: The objectives of this study were to identify the incidence of children presenting with symptomatic nasal septal deviation and to analyze the early outcomes of septal surgery in children with regard to improvement in nasal symptoms, residual disease and need for revision surgery. Methodology: Children less than seventeen years of age who underwent septoplasty for symptomatic DNS from 1st January 2009 to 31st December 2018 were enrolled in the study. Patients having the follow up record of at least 6 months after surgery were included in the final analysis. Results: There were 37 male and 13 female children enrolled in the study. Male to female ratio was 2.84:1.Majority of children in the study were of 13 years (24%). Left sided DNS was seen in 28 children and right sided DNS in 22 children. Bleeding requiring re-packing, septal hematoma, recurrent DNS, synechia and septal perforation were the common complications, which were comparable to adult population. Conclusion: Early correction of the obstructed nose due to deviated nasal septum is essential to provide normal nasal breathing, relieve complications of mouth breathing and to promote normal craniofacial growth. Septoplasty can be performed in pediatric population with relatively good results without occurrence of nasal deformity and equal complications as that in adults.