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- A comparison of septal stapler to suture closure in septoplasty: a prospective, randomized trial evaluating the effect on operative time. [Journal Article]
- Int Forum Allergy Rhinol 2013 Nov; 3(11):911-4.
Septoplasty requires coaptation of the mucosal flaps at the conclusion of the procedure; classically this is done with nasal packing. Quilting sutures provide a welcome alternative to packing, but can be time-consuming to place. A septal stapler has recently been developed that provides a rapid alternative to quilting sutures but the timesaving has not been quantified.This study was a prospective, randomized trial comparing a septal stapler to quilting suture for coaptation of mucosal flaps in septoplasty. After meeting inclusion criteria, patients underwent septoplasty and inferior turbinoplasty. The total operative time, surgical segment times, including time for closure was recorded. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores were recorded. A sample size of 16 was determined to detect a difference of 5 minutes in closure time.A total of 16 patients were enrolled in the study. The mean time for closure with septal stapler was 35 ± 22 seconds vs 7 minutes ± 1 minute 10 seconds for suture closure (p < 0.0001). The mean total operative time using the septal stapler was 28 minutes ± 6 minutes whereas 43 minutes ± 13 minutes was required for suture (p = 0.014). No difference in postoperative complications or mucosal healing was seen; preoperative and postoperative improvement in NOSE scores was comparable.Coaptation of the mucosal flaps in septoplasty with a septal stapler affords a timesaving in the operating room with no difference in operative outcome.
- Angiofibroma of inferior turbinate as an unusual complication of CO2 laser turbinoplasty. [Journal Article]
- J Craniofac Surg 2013 Sep; 24(5):e513-4.
Angiofibroma is a benign vascular tumor that usually occurs in the nasopharynx, and extranasopharyngeal angiofibromas are rarely reported. We report the first case of an angiofibroma arising from the inferior turbinate after CO2 laser turbinoplasty. Endoscopic excisional biopsy was performed, but the tumor recurred after 2 months of surgery. The mass was excised by endoscopic approach including surrounding normal mucosal tissue. Histologic examination suggested the diagnosis of angiofibroma. The patient was asymptomatic, and there was no evidence of recurrence after 1 year of the second surgery.
- Septoplasty with or without postoperative nasal packing? Prospective study. [Comparative Study, Journal Article, Randomized Controlled Trial]
- Braz J Otorhinolaryngol 2013 Aug; 79(4):471-4.
Anterior nasal packing is carried out in a number of nasal surgeries, especially in septoplasty. However, it is not an innocuous procedure and for this its benefit has been challenged.To assess the need for anterior nasal packing and the quality of life of patients submitted to septoplasty.Patients submitted to septoplasty with or without inferior turbinoplasty were randomized to receive or not anterior nasal packing postoperatively. We recorded and compared postoperative data (pain and bleeding). Quality of life was assessed before and after surgery. This is a randomized prospective study.We had 73 patients (37 packed and 36 who did not receive a nasal packing) with a minimum follow-up of 3 months. Patients with nasal packing complained more of nasal pain and headache in the immediate postoperative period. Of these patients, 75.7% reported moderate/intense pain upon nasal packing removal. Bleeding was more frequent in those patients who did not receive a nasal packing, and only 1 patient required packing. All the patients enjoyed an improvement in quality of life.Septoplasty improves the quality of life of patients with septal deviation and nasal obstruction. Routine use of anterior nasal packing should be challenged for not presenting proven benefit.
- Unilateral visual loss after a nasal airway surgery. [Journal Article]
- Clin Med Insights Case Rep 2013.:119-23.
Septoplasty and turbinoplasty are common ear, nose, throat (ENT) operations which generally have low complication rates. A 45-year-old man had a septoplasty operation and a right turbinoplasty operation under a combined general and local anesthetic. He woke from the procedure with a reduced visual acuity in the right eye and substantial inferior visual field loss. A review of the current literature focuses on the vasospasm effects of local anesthetic, in combination with epinephrine on the intricately linked nasal and orbital vascular supply.
- Unilateral hemiplegia: a unique complication of septoplasty. [Journal Article]
- J Laryngol Otol 2013 Aug; 127(8):809-10.
Septoplasty is one of the most common otolaryngological operations. It is often dismissed as a simple procedure, despite the wide range of potential complications. We describe the first reported case of unilateral hemiplegia as a complication of septoplasty.A 51-year-old man presented with right hemiplegia following a septoplasty and turbinoplasty procedure carried out elsewhere. Cranial imaging showed a breakthrough fracture of the left sphenoid sinus anterior wall and clivus, with a haemorrhagic area in the left paramedian pons, which was responsible for the patient's right hemiplegia. Despite neurological and physiotherapeutic rehabilitation, the patient gained only partial recovery from his right hemiplegia.Good intra-operative visualisation and appropriate surgical technique are essential to prevent complications and achieve a functional nasal airway. The importance of the presented case to the pre-operative informed consent process is underlined.
- Efficacy of intra- and extraturbinal microdebrider turbinoplasty in perennial allergic rhinitis. [Comparative Study, Journal Article, Randomized Controlled Trial]
- Laryngoscope 2013 Dec; 123(12):2945-9.
Microdebrider-assisted inferior turbinoplasty (MAIT) has become a popular method for relieving symptoms of allergic rhinitis and can be performed intraturbinally or extraturbinally. The objective of this study was to evaluate and compare the long-term efficacy of these two methods.Prospective randomized study.Sixty patients diagnosed with perennial allergic rhinitis were selected. Thirty patients were treated with intraturbinal MAIT (group 1) and 30 patients were treated with extraturbinal MAIT (group 2). Postoperative changes in nasal obstruction, rhinorrhea, sneezing, nasal itching, and postnasal drip were evaluated 3, 6, and 12 months postoperatively. The cross-sectional area of the second notch and nasal cavity volume were compared at 12 months. The operation time, duration of crust formation, and postoperative bleeding were also compared.All symptoms improved significantly in both groups at 3, 6, and 12 months. However, when improvement of rhinorrhea, sneezing, and nasal itching was compared, improvement was statistically significant in group 2 at 12 months. Acoustic rhinometry demonstrated a significant increase in the cross-sectional area of the second notch and nasal cavity volume in both groups, which did not differ significantly between the two groups at 12 months. The operation time and duration of crust formation were longer in groups 1 and 2, respectively. The incidence of postoperative bleeding was higher in group 2.Although both methods showed significant improvement, extraturbinal MAIT seemed more effective for long-term relief of allergic symptoms. However, the advantages and disadvantages of each method should be considered before choosing the surgical technique.
- Endoscopic assisted modified turbinoplasty with mucosal flap. [Comment, Letter]
- J Laryngol Otol 2013 Jul; 127(7):728.
- The effect of nasal surgery on nasal continuous positive airway pressure compliance. [Journal Article]
- Laryngoscope 2014 Jan; 124(1):317-9.
Nasal continuous positive airway pressure (CPAP) is the standard therapy for sleep apnea; however, compliance rates are historically poor. Among the most commonly cited reasons for nonadherence is nasal obstruction. Our study sought to examine if nasal surgery actually increases CPAP compliance.Prospective case series.Nasal CPAP-intolerant obstructive sleep apnea (OSA) patients, with documented nasal obstruction, underwent septoplasty plus inferior turbinoplasty. Preoperative and postoperative data were collected on CPAP usage per night and subjective nasal obstruction with the Nasal Obstruction Symptom Evaluation (NOSE) Scale questionnaire.Eighteen patients met inclusion criteria and underwent septoplasty. CPAP usage increased significantly from 0.5 hours per night preoperatively to 5 hours per night postoperatively (P < .05). Subjective nasal obstruction on the NOSE Scale decreased from 16.1 preoperatively to 5.4 following surgical intervention (P < .05). CPAP pressure decreased from 11.9 preoperatively to 9.2 after surgery, with a trend toward significance (P = .062).This study demonstrates improved CPAP compliance rates following septoplasty in OSA patients with nasal obstruction. Correction of nasal obstruction should be offered in nasal CPAP-intolerant individuals to improve CPAP compliance.
- Changes of histamine receptors and CC chemokines in nasal epithelial cells and fibroblasts after respiratory syncytial virus infection. [Journal Article]
- Am J Rhinol Allergy 2013 Jan; 27(1):e17-21.
Respiratory syncytial virus (RSV) is reported as the most influential factor that triggers hyperreactivity of the airway and causes asthma in infants and children. However, the mechanisms remain to be elucidated. The study evaluated the changes in the levels of four types of histamine receptor (HR) and CC chemokines, such as eotaxin and regulated on activation, normal T cell expressed and presumably secreted (RANTES), in nasal epithelial cells and fibroblasts after RSV infection.Nasal cavity mucosa attained from 20 patients who had undergone inferior turbinoplasty were cleaned by normal saline mixed with gentamicin. Each sample was divided in half. One-half was used for incubation of epithelial cells, and the other half was used for culturing fibroblasts. The levels of HR 1 (H1R), 2 (H2R), 3 (H3R), 4 (H4R), eotaxin, and RANTES were measured by real-time polymerase chain reaction 0, 12, and 36 hours after infection with RSV.H1R was significantly increased at 12 and 36 hours compared with 0 hours in both cell types. The level of H2R was significantly increased in epithelial cells from 0 to 36 and 12 to 36 hours and in fibroblasts from 0 to 12 and 0 to 36 hours. There were significant increases of H3R level in fibroblasts from 0 to 12 and 0 to 36 hours, and of H4R in epithelial cells and fibroblasts from 0 to 12 and 0 to 36 hours. Eotaxin and RANTES were also significantly increased in both epithelial cells and fibroblasts from 0 to 12 and 0 to 36 hours.RSV infection increases the levels of all four HRs, especially H1R and H2R, as well as the levels of eotaxin and RANTES in nasal epithelial cells and fibroblasts. These findings suggest that RSV infection might cause respiratory tract hyperreactivity by increasing the content of HRs and CC chemokines.
- Effect of turbinoplasty in concha bullosa induced rhinogenic headache, a randomized clinical trial. [Journal Article]
- J Res Med Sci 2012 Mar; 17(3):229-34.
Rhinogenic origin is an important source for headache, which may be treated by medical or endoscopic intervention. An aim of this study was to clarify whether the surgical or medical intervention is superior.In this randomized double blind clinical trial study, 44 patients (19 male and 25 female) with periorbital or frontal pain were enrolled. Patients were divided into 2 groups of surgical or medical intervention randomly. Medical group received 3 courses of 1.5 months 125 μg per puff, fluticason nasal spray (2 puffs Q 24 hours in each side), and oral Pseudoephedrin 30 mg Q 8 hours with 2 weeks intervals. Surgical group underwent turbinoplasty with functional endoscopic sinus surgery approach. Duration (per hour), frequency (per week) and severities of the headaches were measured by Visual Analog Scale (VAS) before treatment, and at 1.5, 3 and 6 months after institution of treatment by an examiner, who was unaware of the patients' treatment plan.Before treatment, chronicity (P = 0.980), severity (P = 0.742), frequency (P = 0.730), and duration (P = 0.603) of the headaches were not significantly different. The severities of the headaches in surgical group were significantly lower at 1.5, 3 and 6 months (P < 0.001), also the frequencies and the durations of the headaches were significantly lower at 6 months after an institution of treatment compared to medical group (P = 0.027, P = 0.008, respectively).Turbinoplasty in chonca bullusa patients is an acceptable and a simple procedure for relieving pain in rhinogenic headaches, compared with medical treatment.