Comparative evaluation of endoscopic with conventional septoplasty

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.     

Aesthetic sequelae of septoplasty

This prospective study, using standardized pre- and post-operative photographs examined by three independent observers, included 100 septoplasty patients with a minimal follow up of 9 months. A risk of minimal aesthetic changes (21%) could be documented, but significant post-operative changes (1%) were rare. Surprisingly, statistical evaluation of operative data in relation to aesthetic changes could not identify specific surgical manoeuvres which may increase the risk of aesthetic changes. All patients must be fully informed about possible changes in nasal shape as a result of septoplasty. Pre-operative photographs should be considered a prerequisite before any type of septal surgery.     

Extracorporeal septoplasty-how we do it at marienhospital stuttgart germany

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.     

鼻中隔棘突激光切除术

目的：研究鼻中隔棘突激光切除术的疗效。方法：52例鼻中隔棘突患者通过激光手术纠正鼻中隔棘突,术后进行疗效评估。结果：50例鼻塞患者中,术后46例（92.0%）治愈,4例（8.0%）好转。32例头痛患者中28例（87.5%）头痛视觉模拟评分改善了50%以上,其中9例头痛完全缓解,4例头痛评分效果改善不到25%。随访发现鼻中隔创面可在1个月内完全自行修复,所有患者均未发现有鼻中隔穿孔、脓肿,脑脊液漏等并发症发生。结论：鼻中隔棘突激光切除术视野清晰,操作简单,出血少,并发症少,费用低,患者术后痛苦小。     

Modified nasal specula and flexible holder for endoscopic nasal surgery

The use of an endoscope in nasal surgery has now extended to surgery on the nasal septum as well as to sinus surgery. We devised the use of the modified nasal specula with Yasargil's flexible holder to resolve the technical problems in using an endoscope for septal surgery. One nasal speculum has two plates for connecting to the Yasargil's flexible holder. This speculum allows the surgeon to use both hands freely and also functions as a guide for stabilizing an endoscope. Another nasal speculum has two long adjustable wings. This speculum can widen the working space between the cartilage or bone of the nasal septum and detached mucosa. Our modified nasal specula are readily applicable to resolve the problems such as unstable endoscope and narrow working space in septal surgery under endoscopic view.     

Comparative study of endoscopic aided septoplasty and traditional septoplasty in posterior nasal septal deviations

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.     

Surgical technique in endoscopic posterior septoplasty for an adult patient with choanal stenosis

The technique in endoscopic posterior septoplasty for the case of a female aged 49 with bilateral choanal stenosis is presented. This female had undergone endoscopic nasal surgery for stenosis twice before the posterior septoplasty. However, restenosis of the choanae had arisen within 2 weeks after each surgery. This patient underwent the endoscopic posterior septoplasty under general anesthesia. After removal of the cartilage and bony structures of the nasal septum, the posterior one-third of bilateral septal membranes was excised. This technique is to enlarge the choanal opening obliquely. Excellent visualization for the septoplasty using the endoscope was obtained. Sufficient patency of the choanae was achieved using this technique. There still is no restenosis of the choanae observed and the rhinomanometry shows extreme decrease of nasal airway resistance 1 year after this surgery. It is considered that endoscopic posterior septoplasty for choanal stenosis is an effective procedure with low morbidity and long-term patency.     

Endoscopic septoturbinoplasty: Our update series

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].     

Effects of fibrin glue on nasal septal tissues

OBJECTIVES: To investigate the changes in adult rabbit nasal septal tissues after application of fibrin glue during septoplasty. STUDY DESIGN: Preclinical animal study. METHODS: Nineteen adult albino Vienna rabbits were included in the study. Rabbits were randomly divided into study (n = 14) and control groups (n = 5). The study group was subsequently divided into two subgroups with seven rabbits in each group to investigate short- and long-term effects of fibrin glue. After raising the mucoperichondrial flap on one side of the septum, fibrin glue was used to fix the mucoperichondrial flap over the septal cartilage. Rabbits were killed 3 weeks and 6 weeks after septoplasty. Samples from the excised nasal septa underwent routine tissue procedure for histopathologic investigation. RESULTS: Both short-term and long-term results were compared with the control group and with each other. There was a significant difference regarding mucosal inflammation and cartilaginous damage between groups. A significant difference was found between groups in terms of loss of cilia, loss of goblet cells, the presence and degree of fibrosis. Loss of cartilage was significantly different between groups. In comparing the thickness of the mucosa, thickness of the perichondrium, and thickness of cartilage, there were significant differences between groups. CONCLUSION: Our results demonstrate that fibrin glue causes distinctive inflammation, creates mucosal damage, increases mucosal thickness, decreases perichondrial thickness and cartilaginous thickness, and causes segmental cartilage loss in rabbits. Further comparative clinical investigations are required to assess the clinical efficacy of fibrin glue in nasal septal surgery in humans.