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- 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. [Journal Article]
- 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.1b. Laryngoscope, 123:2945-2949, 2013.
- 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.
- Inferior turbinoplasty during cosmetic rhinoplasty: techniques and trends. [Journal Article]
- Ann Plast Surg 2014 Jan; 72(1):5-8.
The sheer number of accepted inferior turbinoplasty techniques emphasizes the fact that there is no general agreement on which approach yields optimal results, nor are there data available that describes prevalent techniques in turbinate surgery among plastic surgeons.The aim of this study was to identify practice patterns among plastic surgeons who perform inferior turbinoplasty during rhinoplasty.Members of the American Society of Plastic Surgeons were invited to participate in an anonymous, Internet-based survey containing questions related to personal preferences and outcomes in inferior turbinate surgery.A total of 534 members of the American Society of Plastic Surgeons participated in the survey. Most (71.7%) trained in an independent plastic surgery program with prerequisite training in general surgery. More than half (50.6%) had more than 20 years of operative experience; only 15.2% reported performing greater than 40 rhinoplasties per year. The 5 most preferred inferior turbinate reduction techniques were outfracture of the turbinates (49.1%), partial turbinectomy (33.3%), submucous reduction via electrocautery (25.3%), submucous resection (23.6%), and electrocautery (22.5%). Fewer than 10% of the respondents reported the use of newer techniques such as radiofrequency thermal ablation (5.6%), use of the microdebrider (2.2%), laser cautery (1.1%), or cryosurgery (0.6%). Mucosal crusting and desiccation were the most frequently reported complications.The results of this survey provide insights into the current preferences in inferior turbinate reduction surgery. Plastic surgeons are performing more conventional methods of turbinate reduction rather than taking advantage of the many of the more novel technology-driven methods.
- [Microdebrider-assisted inferior turbinoplasty. Minimally invasive technique for the treatment of nasal airway obstruction caused by enlarged turbinates]. [English Abstract, Journal Article]
- HNO 2013 Mar; 61(3):240-9.
Various methods are available for the surgical treatment of nasal airway obstruction caused by enlarged turbinates. These methods include partial turbinectomy, submucosal electrocautery, radiofrequency surgery, and laser turbinoplasty, all of which can have adverse effects such as defects of the mucous lining of the turbinates, prolonged postoperative healing, and bleeding. The purpose of this study was to analyse the effectiveness and potential adverse effects of microdebrider-assisted inferior turbinoplasty (MAIT), which is a less commonly used treatment option.In a prospective randomized study, 35 patients underwent microdebrider-assisted inferior turbinoplasty. Two control groups (35 patients each) underwent conventional partial turbinectomy or submucosal electrocautery. Endoscopic and functional studies (active anterior rhinomanometry, saccharin test) were performed before surgery and 2, 4, and 24 weeks after surgery. Pain and other postoperative problems were assessed using analogue scales.After 2 weeks, MAIT patients, unlike the other patients, showed almost no more mucosal lesions. After 4 weeks, mean saccharin clearance time was 11.1 min in the MAIT group, 15.9 min in the partial turbinectomy group, and 13.7 min in the electrocautery group. When the patients were asked to rate their symptoms on a scale of 0-10, the mean score in the fourth postoperative week was 6.1 in the MAIT group, 7.7 in the partial turbinectomy group, and 7.8 in the electrocautery group. Rhinomanometry showed a mean flow rate increase from 178 ml/s to 574 ml/s after MAIT (401 ml/s after partial turbinectomy, 361 ml/s after electrocautery).Microdebrider-assisted inferior turbinoplasty is a minimally invasive method for reducing inferior turbinate size and maintaining mucosal integrity. It has the advantages of a short healing time, only a mild decrease in mucociliary clearance, only minor postoperative problems, and a good functional outcome.