Day-case surgery is an integral part of otolaryngology, and many procedures can be performed as day-cases provided strict criteria are applied in the selection of patients. We reviewed patients who required unexpected admission from the day-case unit at the Royal National Throat, Nose and Ear Hospital, London between April 1997 and March 1998. The total number of patients undergoing surgery was 1642. Of the total, 29 (1.8%) had to be admitted unexpectedly for overnight stay: 24 of these patients had undergone nasal surgery, representing 5.4% of all the nasal procedures performed--and the cause of all these admissions was haemorrhage. Further analysis revealed 22 of these 24 nasal operations had included a septoplasty. The total number of septoplasties performed was 163; thus, septoplasty had an unexpected admission rate of 13.4%. This information has been used to formulate stricter guidelines for day-case septoplasty admissions in our unit.
Infection can occur after any spinal procedure that violates the disc and although it is not common, the potential consequences are serious. Treatment of discitis is not always successful and the key to management is prevention. Intradiscal prophylaxis with antibiotic is routinely used in spinal surgery, but there is a limited understanding of how well antibiotics can enter the avascular disc after intravenous injection. An in vivo ovine study to optimise prophylactic and parenteral treatment of discitis is described to assess the effectiveness of cephazolin in preventing and treating infection. The concentration of cephazolin was measured in disc tissue from normal and degenerate sheep discs to determine if cephazolin can enter the disc and if disc degeneration affects antibiotic uptake. Fourteen sheep were deliberately inoculated with bacteria to induce discitis. Eight sheep (“prophylaxis” group) were given either a 0, 1, 2 or 3 g dose of prophylactic cephazolin before inoculation while the remaining sheep (“treatment” group) were treated with cephazolin commencing 7 days after inoculation for 21 days at a dose of 50 mg/kg/day. Histopathology and radiography were used to assess the effect of the different treatments. Cephazolin was given 30 min prior to sacrifice and the intradiscal concentration was measured by biochemistry. In the “prophylaxis” group all doses of antibiotic provided some protection against infection, although it was not dose dependent. In the “treatment” group discitis was confirmed radiologically and histologically in all animals from 2 weeks onwards. Biochemical assay confirmed that antibiotic is distributed throughout the disc but was present in higher concentration in the anulus fibrosus than the nucleus pulposus. This study demonstrated that whilst the incidence of iatrogenic discitis can be reduced by antibiotic prophylaxis, it could not be abolished in all incidences with a broad-spectrum antibiotic such as cephazolin. Furthermore, antibiotics were ineffective at preventing endplate destruction once an intradiscal inoculum was established.
Cephazolin; Discitis; Prophylaxis; Treatment; Intervertebral disc
Nasal bone fractures are often accompanied by septal fractures or deformity. Posttraumatic nasal deformity is usually caused by septal fractures. Submucosal resection and septoplasty are commonly used surgical techniques for the correction of septal deviation. However, septal perforation or saddle nose deformity is a known complication of submucosal resection. Hence, we chose to perform septoplasty, which is a less invasive procedure, as the primary treatment for nasal bone fractures accompanied by septal fractures. During septoplasty, we used a bioabsorbable mesh as an internal splint. We used the endonasal approach and inserted the mesh bilaterally between the mucoperichondrial flap and the septal cartilage. The treatment outcomes were evaluated by computed tomography (CT) and the nasal obstruction symptom evaluation (NOSE) scale. The CT scans demonstrated a significant improvement in the septal deviation postoperatively. The symptomatic improvement rated by the NOSE scale was greater at 1 month and 6 months after surgery compared to the preoperative status. There were no cases of extrusion or infection of the implant. In cases of moderate or severe septal deviation without dislocation from the vomerine groove on the CT scan, our technique should be considered one of the treatments of choice.
Nasal septum; Nasal bone; Bioabsorbable implants
A study was conducted to assess the merits and demerits of endoscopic septoplasty. Fifty patients having symptomatic DNS were randomly divided into two groups of 25 patients each. One group underwent endoscopic septoplasty and other group underwent conventional septoplasty. The groups were compared regarding the complaints with pack in postoperative period, relief of symptoms after surgery and complications. The symptoms complained by the patients with pack in postoperative period and complications after surgery were significantly less in endoscopic septoplasty group.
Endoscopic septoplasty; Conventional septoplasty
Subjective assessment of quality of life (QOL) as an important aspect of outcomes research has received increasing importance during the past decades. QOL is measured with standardized questionnaires which had been tested with regard to reliability, validity, and sensitivity.
Surgical procedures of the nasal septum (septoplasty) and the external nose (rhinoplasty) are frequently performed. Since many years subjectively assessed results of these operations have been reported in the literature. However, validated QOL instruments were applied only for one decade. Beforehand, measurements were performed using retrospective assessment of satisfaction or visual analogue scales. Prospective application of validated disease-specific and general measuring instruments has to be demanded for future studies.
Most of the septoplasty patients as well as most of the rhinoplasty patients evaluate the operation being successful. However, a relevant number of patients is not satisfied with the result of surgery. In this context, QOL instruments have the potential to identify further factors influencing the outcome. Especially in rhinoplasty patients, special attention has to be drawn on potential psychosocial effects of the operation.
validation; quality of life; nasal obstruction; nasal function
The trans-septal suturing method has been developed in septoplasty as an alternative to packing. This study was carried out to compare the postoperative results of trans-septal suturing with the anterior Merocel packing technique. The study involved 697 patients who underwent septoplasty. Following surgery, patients were randomly divided into two groups, one with trans-septal suturing and the other with Merocel packing. Patients were asked to record pain levels using a visual analogue scale. Postoperative symptoms and complications were compared. A total of 697 nasal operations were evaluated in the postoperative period considering pain, bleeding, haematoma, septal perforation synechiae and septal perforation. The results for haemorrhage, haematoma, synechiae and perforation were not statistically different (p > 0.05) between groups. In contrast, the level of postoperative pain in patients undergoing trans-septal suturing was significantly less than in the group who received Merocel packing (p < 0.05). Patients with Merocel packing had significantly more pain and nasal discomfort when assessed 1 week after intervention. Therefore, the trans-septal suturing technique may be the preferred option to provide higher patient satisfaction.
Septoplasty; Trans-septal suturing; Nasal packing
Various questionnaires are used in patients who undergo rhinologic surgeries but a unique comprehensive questionnaire is needed to evaluate quality of life (QOL) in rhinologic surgeries. The purpose of this study was to prepare a comprehensive questionnaire and compare QOL among four common rhinologic surgeries including functional endoscopic sinus surgery, septoplasty, septorhinoplasty, and septoplasty with turbinoplasty preoperatively and 6 months postoperatively. This was a prospective interventional before-and-after study. Preoperative and 6 months postoperative evaluations were performed with a Modified Health-Related Quality of Life (HRQL) questionnaire designed to cover all needed QOL aspects and the 22-item Sino-nasal Outcome Test questionnaire to cover all needed QOL aspects. The Modified HRQL included 33 items in six subgroups (nasal symptoms, sleep problems, headache, nonnasal symptoms, and practical and emotional problems) and general feeling. From 202 patients who completed the questionnaire before the procedures, 146 (72% of all patients) who were interviewed 6 months postoperatively were included in this study. Comparing preoperative data between followed up patients and missed patients showed no statistical difference among surgeries (p = 0.90). Comparison of patient's pre- and postoperative QOL showed a significant improvement in global QOL and in all questionnaire items (p < 0.0001 in all comparisons). Comparison of QOL changes before and after surgery among different surgeries revealed no statistical difference (p = 0.282). Our data showed a significant improvement in each surgery but the amount of improvement in different surgeries was almost constant.
Functional endoscopic sinus surgery; Modified Health-Related Quality of Life questionnaire; quality of life; rhinologic surgeries; septoplasty; septorhinoplasty; turbinoplasty
Patients with deviated nasal septum are advised surgery, which has seen several modifications since its inception. This recent technique of using nasal endoscopes gives better illumination and access to posterior septal deviations. The aim of the study was to identify the nasal septal pathology in relation to lateral nasal wall in a precise way and to correct this with minimal exposure, limited manipulation and least resection. Twenty five patients underwent endoscope aided and 25 conventional septoplasty. Results were graded on subjective and objective improvement. Endoscopic aided septoplasty (Otolaryngol Head Neck Surg, 1999; 120, 678; Laryngoscope 1994, 104, 1507; J Laryngol Otol 1998, 112, 934; Ear Nose Throat J 1997, 76, 622) was found to be safe, effective and conservative approach with better patient compliance, shorter recovery time and greater stability of remaining septum.
Endoscope; septal deviation; septoplasty
Cross-hatching incisions have been considered mandatory for correcting cartilaginous septal deviation. We evaluated the clinical outcome of septoplasty without cross-hatching incisions to determine the necessity for making septal cartilage incisions.
The reconstructed septal components during septoplasty were categorized into four anatomical areas: vomer, maxillary crest, perpendicular plate of ethmoid (PPE) and septal cartilage (the area for cross-hatching incisions). During septoplasty, we attempted to complete the surgery only by removing or fracturing the bony part of the septum without cross-hatching incisions on the cartilage. Only in the cases that the deviation was not immediately corrected, the cross-hatching incisions were made onto the cartilage at the end of the procedure. We analyzed the frequency of manipulating the septal components. The changes of symptoms were evaluated using a modified nasal obstruction symptom evaluation (NOSE) scale and a visual analog scale (VAS) preoperatively, 1 and 3 months after the surgery.
Seventy five percents of the deviated septums were immediately corrected only by removing or fracturing of the bony septal components. In decreasing order of frequency, the sepal components for correcting septal deviation were the vomer (59%), maxillary crest (49%), septal cartilage (cross-hatching only: 25%) and PPE (15%). The modified NOSE scale and the VAS demonstrated significant improvement of the nasal symptoms postoperatively (P<0.05).
Most of septal deviations could be corrected by manipulating only the bony septum. The results of this procedure were not different from conventional septoplasty with cross-hatching incisions. Our data suggest cross-hatching incisions during septoplasty might have been overemphasized and that the main cause for cartilaginous deviation may be the extrinsic forces that are generated by the neighboring bony structures.
Nasal septum; Cartilage; Surgery
This study was conducted to compare the outcome of septoplasty with or without Nasal packing. The study subjects were randomly allocated into two groups. There was significant reduction in frequency of post operative pain, headache, discomfort and duration of hospital stay in patients who have undergone septoplasty without nasal packing. However there was no difference in post operative bleeding and septal perforation between two groups. Therefore after Septoplasty without nasal packing is preferred alternative to with nasal packing.
Septoplasty; Nasal packing
A 20-year-old woman who was fit and well presented with a history of left nasal blockage for 2 years. She was noted on anterior rhinoscopy to have nasal septal deviation towards the left. She was listed for septoplasty with the aim of relieving nasal obstruction. At operation she was found to have a mildly deviated septum to the left. There was also a rhinolith in the left nostril posterior to the deviated septum (figure 1). Following removal of the rhinolith, her nasal airway appeared adequate; hence, septoplasty was not performed. Postoperatively, the patient was pleased with the outcome. When the patient was shown the foreign body she recalled inserting a pen cover into her nose about 10 years previously (figure 2). When she presented to the Accident and Emergency department at that time she was told that there was no foreign body in her nose.
Figure 1Endoscopic view of rhinolith.
Septal surgery has been identified as suitable for day-surgery, but is not widely performed as such. Guidelines for day-surgery state that the unexpected admission rate should be 2–3%. Previous audits have not achieved this figure and septoplasty is not universally considered suitable for day-surgery. We have reviewed practice over 4 years in our institution to identify surgical and patient factors associated with unexpected admission following septoplasty.
PATIENTS AND METHODS
A retrospective case note based audit of day-case septoplasty procedures reviewed at the end of each year between October 1998 and October 2002.
A total of 432 septal surgery procedures were performed, comprising 378 septoplasties and 54 submucous resections. Thirty-eight patients were admitted, overwhelmingly because of haemorrhage in the immediate postoperative period, giving an overall admission rate of 8.8% within the first 24 h. Factors associated strongly with re-admission were the use of intranasal splints, the performance of revision surgery, submucous resection (as opposed to septoplasty) and, less so, the performance of additional procedures and the peri-operative administration of diclofenac. There was no correlation between unexpected admission and grade of surgeon, surgical technique or any of the patient factors analysed.
The unexpected admission rate of septal surgery performed at our unit is above that recommended for day-case procedures, but is within the range previously published. Patient satisfaction with day-case septoplasty has been shown to be high. We believe that septoplasty should be performed in this setting but there is a significant chance that patients may need admission, and a pathway should be in place for this to occur with minimal disruption to the patient.
Septal surgery; Audit; Day-case
Septoplasty is one of the most common surgery of ENT but even today the difficult septum still presents a great surgical problem. A severe septum deformity is usually due to an accident quite often in childhood. It is also seen in patients with malformation such as cleft lip and cleft palate deformity. It affects not only the nasal function, but also the aesthetic part of the nose. Severe septal deformities can not be corrected properly by the standard septoplasty techniques. Therefore in such cases an extracorporeal septoplasty is recommended. In this technique the whole septum is taken out, the bony and cartilaginous septum in one piece if possible, a new septal plate is reconstructed by different surgical techniques, followed by replantation and reconstruction of the cartilagenous dorsum. The first author kept on improving the safe septal fixation, rebuilding of cartilagenous dorsum and overall the extracorporeal septoplasty technique over the period of time and this technique with all its refinement can be recommended to all the surgeons dealing with this challenging noses.
Extracorporeal septoplasty; spreader graft
Staphylococcal infections are the major causes of morbidity in haemodialysis patients. The source of the staphylococci is the anterior nares. Elimination of nasal carriage of staphylococci could result in a remarkable decrease in the infection rate. The aim of this study was to investigate if there was a difference in the bacterial flora between the nasal vestibule and cavity as well as their antibiotic susceptibility in haemodialysis. Swab samples obtained from 35 haemodialysis patients were subjected to conventional microbiological methods. The antimicrobial susceptibility test was performed for Staphylococcus spp. using cephazolin, cephaclor, trimetoprim + sulfamethoxazole, amoxicillin, oxacillin, clindamycin, erythromycin, tetracycline, ampicillin + sulbactam and amoxicillin + clavulanic acid. Staphylococcus spp. was found more often in the vestibule than in the cavity (88.5 vs. 77.1%). The effectiveness of clindamycin, erythromycin and tetracycline was particularly striking for the methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococci isolates. In conclusion, existence of difference in bacterial flora between the nasal cavity and vestibule and their responsiveness to antibacterial agents may require reconsideration of elimination of secondary infections in haemodialysis patients.
Nose; Bacterial flora; Antibiogram; Haemodialysis
Septate uterus, one of the most common forms of congenital uterine malformations, negatively affects female reproductive health.
In a retrospective cohort study, we evaluated the reproductive outcome after hysteroscopic septoplasty in 64 women with septate uterus and primary or secondary infertility. We performed a systematic review of studies evaluating the reproductive outcome after hysteroscopic septoplasty.
Sixty-four women underwent hysteroscopic septoplasty. In 2/64 (3%) women, intraoperative uterine perforation occurred. Complete follow-up was available for 49/64 (76%) patients. Mean follow-up time was 68.6 +/- 5.2 months. The overall pregnancy rate after hysteroscopic septoplasty was 69% (34/49). The overall life birth rate (LBR) was 49% (24/49). The mean time interval between surgery and the first life birth was 35.8 +/- 22.5 months. Including our own data, we identified 18 studies investigating the effect of septoplasty on reproductive outcome in 1501 women. A pooled analysis demonstrated that hysteroscopic septoplasty resulted in an overall pregnancy rate of 60% (892/1501) and a LBR of 45% (686/1501). The overall rate of intra- and postoperative complications was 1.7% (23/1324) and the overall rate of re-hysteroscopy was 6% (79/1324).
In women with septate uterus and a history of infertility, hysteroscopic septoplasty is a safe and effective procedure resulting in a pregnancy rate of 60% and a LBR of 45%.
To study the outcome of endonasal endoscopic dacryocystorhinostomy (DCR) with or without mucosal flap preservation, without mitomycin local application, silicon tube stenting or laser assistance. To determine the duration of the surgical procedure of DCR, influence of simultaneously performed endonasal endoscopic procedures for concomitant sinonasal diseases.
Combined retrospective and prospective study in our tertiary referral center. 24 patients with chronic dacryocystitis underwent 25 standard endonasal endoscopic DCR procedures, 10 with and 15 without mucosal flap preservation. 6 of these had concomitant sinonasal diseases for which they underwent septoplasty or functional endoscopic sinus surgery (FESS) or both, simultaneously or as staged procedures. Relief from epiphora and patency of the nasolacrimal fistula was assessed by nasal endoscopy and syringing of the lacrimal apparatus at 1 week, 3 weeks and 3 months postoperatively.
Out of 18 patients who underwent only DCR, 17 patients (94.44%) had complete relief from epiphora. Out of 6 patients who underwent 7 DCRs with concomitant sinonasal surgery, 5 patients (85.71%) had complete relief from epiphora. Overall 23 out of 25 DCRs (92%) had complete relief. In 15 of the 25 procedures, mucosal flap was excised completely. In remaining 10 procedures, flap was trimmed, repositioned to cover exposed bone around the newly created nasolacrimal fistula. In either situation, only one patient each had partial block of the nasolacrimal fistula. Average duration of the surgical procedure of DCR was 18 min.
Endonasal endoscopic DCR is a viable alternative to external DCR, co-existing sinonasal diseases can be managed simultaneously, as may be required in 25% of cases. It can be performed under 20 min without mucosal flap preservation, mitomycin local application, silicon tube stenting or laser assistance and can still provide a good success rate (92%) with less complications.
Epiphora; Endoscopic dacryocystorhinostomy; DCR; Mucosal flap
To evaluate whether virtual surgery (VS) performed on 3D nasal airway models can predict post-surgical, biophysical parameters obtained by computational fluid dynamics (CFD).
Pre- and post- surgery CT scans of a patient undergoing septoplasty and right inferior turbinate reduction (ITR) were used to generate 3D models of the nasal airway. Prior to obtaining the post-surgery scan, the pre-surgery model was digitally altered to generate three VS models: 1) right ITR only, 2) septoplasty only, and 3) septoplasty with right ITR. The results of the VS CFD analyses were compared with post-surgical CFD outcome measures including nasal resistance, unilateral airflow allocation, and regional airflow distribution.
Post-surgery CFD analysis and all VS models predicted similar reductions in overall nasal resistance, as well as more balanced airflow distribution between sides, primarily in the middle region, when compared with the pre-surgery state. In contrast, virtual ITR alone produced little change in either nasal resistance or regional airflow allocation.
We present an innovative approach for assessing functional outcomes of nasal surgery using CFD techniques. This preliminary study suggests that virtual nasal surgery has the potential to be a predictive tool that will enable surgeons to perform personalized nasal surgery using computer simulation techniques. Further investigation involving correlation of patient-reported measures with CFD outcome measures in multiple individuals is underway.
The advent of endoscopes has revolutionized rhinology and the traditional headlight based surgeries have largely been replaced by endoscopes. Septoplasty for deviated nasal septum or Sluder’s neuralgia have been conventionally performed with the aid of headlight. This can be technically challenging as visualization of the nasal cavity, particularly the posterior portion is rather limited as the procedure is performed via the nostrils. In addition, with headlights for illumination, teaching this procedure can be difficult as only the surgeon who is wearing the headlights has direct vision of the surgical field.
Endoscopic septoplasty is an accepted alternative to traditional headlight approach to septoplasty. This approach provides a direct-targeted route to the anatomic deformity, improved visualization, and magnification of the surgical field. Our experience in endoscopic septoplasty is highlighted in this paper, excluding septoplasties performed as part of exposure to the sinuses. We use the open book method that to best of our knowledge has not been described in literature before.
Endoscopic septoplasty; deviated nasal septum
Endoscopic septoplasty is a minimally invasive technique that helps us to correct defornity of septum under excellent visualization. Lanza et al & Stammberger initially described the application of endoscopic technique for the correction of septal deformity in 1991. A retrospective study was carried out of all the cases that underwent endoscopic septoplasty at Dr. Shroff’s Charity Eye hospital from March 1998 to March 2000. 78 consecutive septoplasty patients were identified in two years. Out of these 48 septoplasties (52%) were performed with endoscopic technique. A large percentage of cases 48(41%) were those where septoplasty was performed in conjunction with endoscopic dacro cysto rhinostomy. In 8 cases (16%) it was performed alone as a primary procedure, 4 deviations were broadly based deflections (12%), 10 of septal deformities were spurs (20%), in 4 cases more than one type septal deformities were encountered. Thus we feel that endoscopic septoplasty is a fast developing concept & gaining popularity with increasing trend towards sinus endoscopic surgeries. Furthermore in complex deformities, better correction is possible with the help of endoscope. Since we can clearly see the posterior deviations.
Endoscopic Septoplasty; Dacro cysto rhinostomy; Endoscopic Sinus Surgery (ESS)
Nasal obstruction is a common symptom. Rhinomanometry is a tool to objectively assess the nasal airway. A prospective study was undertaken to assess the nasal airflow and nasal resistance in 25 patients of deviated nasal septum undergoing septoplasty using rhinomanometry preoperatively and postoperatively. Rhinomanometric improvement in nasal airflow and decreased nasal resistance were found in 88% patients after surgery.
Nasal obstruction; Rhinomanometry; Nas al resistance; Nasal airflow; Septoplasty
There are often multiple anatomic factors that contribute to nasal obstruction, creating difficulty in deciding which components to address for a successful outcome. The purpose of this pilot study is to demonstrate the effect of individual components of functional nasal airway surgery in a patient with multifactorial obstruction and discuss the potential benefit of computational fluid dynamics (CFD)-aided virtual surgery.
A 53 year old female underwent septoplasty, turbinate reduction, and nasal valve repair. Pre- and post-operative digital nasal models were created from CT images and nasal resistance was calculated using CFD techniques. The digital models were then manipulated to isolate the effects of the components of the surgery, creating a nasal valve repair alone model and a septoplasty/turbinate reduction alone model.
Bilateral nasal resistance on the post-operative model was approximately 25% less than pre-operative values. Similarly, CFD analysis showed reductions in nasal resistance of the virtual models: 19% reduction with intranasal surgery alone and 6% reduction with nasal valve repair alone.
Most of the reduction in nasal resistance was accomplished with performance of septoplasty and inferior turbinate reduction. The contribution from nasal valve repair was less in comparison but not insignificant. This pilot study implies that CFD-aided virtual surgery may be useful as part of pre-operative planning in patients with multifactorial anatomic nasal airway obstruction.
Postoperative vision loss following routine nasal surgery is an extremely rare and devastating complication. We report a case of unilateral blindness due to central retinal artery occlusion associated with third cranial nerve following septoplasty.
We report a patient who developed an unusual central retinal artery occlusion with unilateral blindness following nasal surgery under general anesthesia. A 45-year-old man underwent a nasal septal surgery for severe epistaxis. Soon after recovery, the patient noticed loss of vision in his right eye and was unable to lift his upper eyelid. Upon ophthalmic examinations, we determined that he had right-sided third cranial nerve palsy with central retinal artery obstruction and ptosis of right upper eyelid, restriction of ocular movements, and no perception of light in the right eye. Postoperative computerized tomography scan revealed multiple fractures of the left medial orbital wall, including one near the optic canal. Ptosis and ocular defects were recovered partially, but visual loss persisted until the last follow-up.
This paper highlights one case of complete unilateral blindness from direct central retinal artery occlusion associated with third cranial nerve palsy following an apparently uneventful septorhinoplasty. Ophthalmologists and otolaryngologists should therefore be aware of the possible occurrence of such complications.
Central retinal artery occlusion; Third nerve palsy; Septoplasty; Nasal polypectomy; Visual loss
Decades have passed since septoplasty was first introduced for the management of the nasal airway. Various modifications of the technique have been made to deal with the pathology of the nasal septum. The authors have used the nasal endoscope successfully for the ultraconservative management of the deviated nasal septum and turbinoplasty [inferolateral partial resection of the turbinate/s]. The present study is an update series of the previously published preliminary series, and comprises of 480 cases of deviated nasal septum who underwent endoscope aided septo-turbinoplasty [EAS] to improve the nasal airway. The subjective assessment of the efficacy of this procedure was done by visual analogue scoring system and the objective assessment was done by endoscopy. This study demonstrates significant improvement in relieving nasal obstruction and the contact areas. The authors advocate a combined approach-an endoscopic approach for inaccessible posterior deviation and a conservative traditional technique for accessible anterior segment [caudal septum].
Deviated nasal septum; endoscopic septoplasty; turbinoplasty
BACKGROUND--A study was undertaken to determine if cephalometric radiographs could identify those who will benefit from nasal surgery in patients with a sleep apnoea hypopnoea syndrome (SAHS) and chronic nasal obstruction. METHODS--Fourteen patients with SAHS were enrolled. Those with normal posterior airway space and mandibular plane to hyoid bone distances on preoperative cephalometric radiographs were matched with those with abnormal cephalometry for the frequency of sleep disordered breathing and body mass index. Polysomnographic studies (all subjects) and nasal resistance measurements (n = 10) were performed one to three months before and two to three months after surgery (septoplasty, turbinectomy, and polypectomy). RESULTS--There was no difference in the baseline results of the polysomnographic studies between the two groups of patients. Nasal resistance decreased from a mean (SE) value of 2.9 (0.3) cm H2O/l/s before surgery to 1.4 (0.1) cm H2O/l/s after surgery in the normal cephalometry group and from 2.7 (0.3) cm H2O/l/s to 1.3 (0.3) cm H2O/l/s in the other group. The apnoea + hypopnoea index returned to normal (< 10 breathing abnormalities/hour) in all but one subject with normal cephalometric measurements, and sleep fragmentation improved with a decrease in the arousal index from 23.9 (3.3)/hour at baseline to 10.6 (2.5)/hour after surgery. Both of these parameters remained unchanged after surgery in the patients with abnormal cephalometry. CONCLUSIONS--Normal cephalometry is helpful in identifying patients with mild SAHS and nasal obstruction who will benefit from nasal surgery. The presence of craniomandibular abnormalities makes it unlikely that nasal surgery will improve sleep related breathing abnormalities.
To determine if chronic rhinosinusitis (CRS)-specific health-related quality-of-life (HRQoL) outcomes are affected by concurrent septoplasty performed during endoscopic sinus surgery (ESS) for medically refractory CRS.
Prospective, multi-center cohort study.
A total of 221 patients with medically refractory CRS without nasal polyposis who elected primary ESS were included in this study. Patients were dichotomized into two cohorts: concurrent septoplasty (n=108) or no septoplasty (n=113) during ESS. Main outcomes of interest included two CRS-specific HRQoL instruments: the Rhinosinusitis Disability Index (RSDI) and the Chronic Sinusitis Survey (CSS). Symptom presentation was assessed using eight sinonasal visual analog scale (VAS) symptom scores.
There were no differences in CRS-specific HRQoL improvements on all RSDI and CSS measures following ESS between cohorts with or without septoplasty (all p>0.05). In patients with medically refractory CRS, the presence of septal deviation did not result in a different CRS-specific symptom presentation compared to patients without septal deviation (all baseline VAS symptom score comparisons p>0.295).
To optimize nasal patency and improve surgical access, septoplasty is commonly performed during ESS. Based on the results of this study, concurrent septoplasty does not appear to affect CRS-specific HRQoL or symptom outcomes and does not function as a confounding factor in HRQoL improvement.
Level of evidence
Septoplasty; quality of life; endoscopic; surgery; chronic rhinosinusitis; sinusitis