Effectiveness of modified cutting and suture technique for endonasal caudal septoplasty in correcting nasal obstruction and preventing nasal tip projection loss

Purpose Caudal septoplasty is a difficult procedure. The cutting and suture technique is suitable for caudal septoplasty, but a batten graft is always necessary and bears the risk of nasal tip projection loss. We established a modified cutting and suture technique (MCAST), without using a batten graft, and investigated its effectiveness in correcting nasal obstruction and preventing nasal tip projection loss. Methods We retrospectively reviewed the medical records of 22 patients who underwent caudal septoplasty using MCAST. Subjective assessment by Nasal Obstruction Symptom Evaluation (NOSE) score and objective assessment by computed tomography (CT) were performed before and after the surgery. For evaluating nasal tip projection, we asked patients about their awareness of external nasal deformity. Additionally, the nasal tip projection was measured by CT and compared before and after surgery. Results The median preoperative NOSE score reduced significantly after MCAST (P < 0.001). On CT, the ratio of the area of the convex side to that of the concave side in the anterior portion of the nasal cavity increased significantly after MCAST (P < 0.001). All patients were unaware of external nasal deformity. There were no significant differences in the mean preoperative and postoperative nasal tip height and nasolabial angle. The mean supra tip height was significantly greater postoperatively than preoperatively (P = 0.02). Conclusions The MCAST was useful for correcting nasal obstruction with caudal septal deviation. There was no postoperative loss of nasal tip projection. The MCAST can be suitable for correcting C-shaped caudal deviations without dislocating the caudal septum from the anterior nasal septum.

Pre-treatment clinical study of rhinosinusitis impact on the quality of life among patients having both external nasal deformity and deviated nasal septum

<p><strong>Background: </strong>Sino-nasal disease often gives an experience of impacting quality of life significantly, more so among chronic cases. Hence a self-perceived disease specific impact viz rhinosinusitis disability index (RSDI) which is a validated reliable measure of quality of life is being studied.</p><p><strong>Methods: </strong>A prospective study conducted on patients, attending department of ENT on out and or in-patient basis who are diagnosed to have rhinosinusitis with external nasal deformity and deviated nasal septum (DNS) were selected on simple random basis for this study between July 2018 to November 2019. This study group subjected for answering standard questionnaire of RSDI proforma before treatment. Data statistically analyzed using IBM SPSS version 22.</p><p><strong>Results: </strong>Among the statistically calculated ‘n' (40) patients of this study, 23 were male (57.5%) and 17 were female (42.5%) patients of the age between 15-45 years. In our study, majority of patients (n=23) had simple type DNS (57.5%), followed by obstructive type 37.5% (n=15) and impacted type 5% (n=2) and majority of patients showed type I (50%) external nasal deformity followed by type V (25%). In our study, 11 patients were diagnosed with acute rhinosinusitis, 15 patients with chronic rhinosinusitis without nasal polyps (CRSsNP) and 14 patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The physical, functional and emotional domains showed no statistical significance with respect to external nasal deformity and DNS. However, disease factor had statistically significant impact (p&lt;0.05) on the quality of life among rhinosinusitis patients with mean scores of 13.7, 19.42, and 10.80.</p><p><strong>Conclusions: </strong>In rhinosinusitis patients, the disease affects the quality of life in terms of physical, functional and emotional domains, but not by the external nasal deformity and or DNS associated.</p>

Complications of Submucous Resection versus Septoplasty in Deviated Nasal Septum

Introduction: A deviated or deflected septum is a condition in which the nasal septum consisting of bone and cartilage and that divide the nasal cavity into two halves is significantly off-center, or twisted, making breathing difficult. Two conventional methods that are septoplasty and sub-mucous resection were used for the correction of the deviated nasal septum with varying degrees of complications. Objective: The objective of this study was to compare the complications of sub-mucous resection and septoplasty in patients with the deviated nasal septum. Material and Methods: A Quasi-experimental study was conducted at the Department of Otolaryngology at Bolan Medical Complex, Quetta for a period of one year i.e. from 15-03-2015 to 20-09-2015. 100 patients were selected and divided into two groups. A total of 50 patients were selected for septoplasty and 50 for sub-mucous resection. Patients with nasal bone fracture and external nasal deformity were excluded from the study. Results: Postoperative complications like adhesions were found in 4 cases of each group. Septal perforation found in 3 patients of sub-mucous resection and one patient of septoplasty. Septal hematoma formed in 2 patients of sub-mucous resection only, supra-tip nasal deformity in 2 patients in both groups. Persistence of symptoms in 8 patients of septoplasty and one patient of sub-mucous resection while columellar restriction occurred in only one patent who underwent submucous resection. Conclusion: Sub-mucous resection procedure is technically relatively easy to perform with fewer complications than septoplasty so it deserves it prime role as a surgical procedure for nasal septum corrective surgery. Keywords: Deviated nasal septum, nasal septum corrective surgery, sub-mucous resection, septoplasty

Rhinoplasty: Experience in Combined Military Hospital, Dhaka

Background: Rhinoplasty, perhaps is the most complex and challenging cosmetic surgical procedure performed today. Hence, a thorough preoperative evaluation and the surgical skill in performing the operation is most important for final desired outcome. Establishing an accurate diagnosis through a comprehensive nasal analysis is obligatory. Objective: To assess post-operative functional and aesthetic outcome and patient’s satisfaction of all rhinoplasty operations. Methods: Retrospective study carried out in combined military hospital, Dhaka. 50 patients with external nasal deformity who were operated for functional, aesthetic or for both reason were included. Patients’ satisfaction levels from the procedures were routinely documented in the post op visits as completely satisfied, partialy satisfied and not satisfied at all. Results: A total of 50 cases underwent rhinoplasty and septorhinoplasty operations. The most common reason of disfigurement was traumatic injury during games (40%). Different surgical procedures were done without any major complications. Except few most of the patients were fully satisfied. Conclusion: For better satisfaction of patients, adequate preoperative counseling and realistic expectations are warranted. Skillful surgical techniques reduce the chances of complications. Bangladesh J Otorhinolaryngol; April 2019; 25(1): 3-9

Posttransplant Lymphoproliferative Disorders Presenting as an External Nasal Deformity: A Case Report

Introduction: Posttransplant lymphoproliferative disorder (PTLD) is a serious disease that usually occurs after solid organ transplant and stem cell transplant. Posttransplant lymphoproliferative disorder often involves the head and neck, but it is rare to present as a nasal deformity. Here, we describe a case of external nasal enlargement resulting from PTLD. Case report: A 40-year-old man presented with an enlarged external nose half a year ago. The nasal ala thickened, and the external nose was gradually enlarged, accompanied by bilateral nasal obstructions. A biopsy was taken under endoscopy procedure, and the result suggested a diagnosis of PTLD. Discussion: Posttransplant lymphoproliferative disorder usually appears in lymphoid tissues that form Waldeyer’s rings or cervical lymph nodes in the head and neck. The early involvement of other head and neck subpoints is considered rare. This case is the first report of PTLD presenting as an external nasal deformity. The symptoms and clinical manifestations of PTLD in otorhinolaryngology are usually diverse and nonspecific but are early symptoms in the clinical course of PTLD.

Primary nasal septal acinic cell carcinoma

BACKGROUND. Acinic cell carcinoma (ACC) is a rare malignant salivary gland tumour. It is of a low-grade type. The commonest site involved is the parotid gland. ACC is not common in minor salivary glands; this tumour type mainly arises in the oral cavity. CASE REPORT. We present an 84-year-old Malay man with spontaneous, self-limiting, left-sided epistaxis for 2 days. He also had progressive left-sided nasal blockage. There was no hyposmia, blurry vision or headache. He had underlying hypertension. The clinical examination showed he was normotensive. There was no external nasal deformity. The anterior rhinoscopy demonstrated a fungating irregular mass filling up the left nasal vestibule. There was no neck node. The computed tomography showed a tumour localized in the nasal cavity. The biopsy showed features of acinic cell carcinoma. We proceeded with left lateral rhinotomy and wide excision. Intraoperatively, we discovered that the tumour aroused from the nasal septum and part of the septum had to be sacrificed for margin clearance. Currently, he is on routine surveillance and tumour-free. CONCLUSION. We highlighted the importance of recognizing nasal acinic cell carcinoma and the fact that early biopsy is important as surgery provides a good prognosis even in the extreme age group.

Our experience with spreader graft in septorhinoplasty by open approach

<p class="abstract"><strong>Background:</strong> Spreader graft being one of the best method for volumetric expansion of internal nasal angle to address the nasal valve pathologies, popularised by Sheen.</p><p class="abstract"><strong>Methods:</strong> To evaluate its functional effect on relieving nasal obstruction secondary to nasal valve pathologies, our study was conducted in 40 patients (35 male and 5 female; mean age 28 years) having both external nasal deformity and nasal obstruction. NOSE scale was used to assess functional improvement. </p><p class="abstract"><strong>Results:</strong> Out of total 40 patients (22 patients with saddle nose deformity, 10 crooked nose and 8 nasal dorsum deformity), 35 patients (87.5%) were fully satisfied with functional outcome as assessed by NOSE score.</p><p><strong>Conclusions:</strong> Spreader graft is good way to handle nasal obstruction secondary to narrow internal nasal angle. </p>

Predictors of Nasal Obstruction: Quantification and Assessment Using Multiple Grading Scales

Objective. To evaluate the association between nasal obstruction and (1) demographic factors, (2) medical history, (3) physical tests, and (4) nasal exam findings. Study Design. Case series. Methods. Chart review at a tertiary medical center. Results. Two hundred-forty consecutive patients (52.1±17.5 years old, with a Nasal Obstruction Symptom Evaluation (NOSE) score of 32.0±24.1) were included. Demographic factors and inferior turbinate sizes were not associated with NOSE score or Nasal Obstruction Visual Analog Scale (NO-VAS). A significant association was found between higher NOSE score on univariate analysis and positive history of nasal trauma (p=0.0136), allergic rhinitis (p<0.0001), use of nasal steroids (p=0.0108), higher grade of external nasal deformity (p=0.0149), higher internal nasal septal deviation grade (p=0.0024), and narrow internal nasal valve angle (p<0.0001). Multivariate analysis identified the following as independent predictors of high NOSE score: NO-VAS: ≥50 (Odds Ratio (OR) = 17.6 (95% CI 5.83–61.6), p<0.0001), external nasal deformity: grades 2–4 (OR = 4.63 (95% CI 1.14–19.9), p=0.0339), and allergic rhinitis: yes (OR = 5.5 (95% CI 1.77–18.7), p=0.0041). Conclusion. Allergic rhinitis, NO-VAS score ≥ 50, and external nasal deformity (grades 2–4) were statistically significant independent predictors of high NOSE scores on multivariate analysis. Inferior turbinate size was not associated with NOSE scores or NO-VAS.

Criteria for Defining ‘Severe Septal Deviation’

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.