Medial flap middle turbinoplasty for solid middle turbinate hypertrophy: improving airway, speeding healing and preserving olfaction.

PURPOSE: The techniques to be performed for bullous middle turbinates are well-defined and widely accepted in the literature. However, in the case of solid middle turbinate hypertrophy, information on surgical techniques that take into account function and sense of smell is very limited in the literature. The aim of this study was to compare the airway patency and olfaction results of patients diagnosed with solid middle turbinate hypertrophy, who underwent subtotal (transverse) resection or medial flap turbinoplasty of the middle turbinates. METHODS: Thirty-five adult patients who were diagnosed with solid middle turbinate hypertrophy were divided into two groups, namely medial flap middle turbinoplasty (study group = 17) and transverse resection to the middle turbinate (control group = 18). Acoustic rhinometry, anterior rhinomanometry, peak nasal inspiratory flowmeter test, odor identification test, and n-butanol threshold measurements were performed before and 3 months after the surgery. In addition, preoperative and postoperative nasal obstruction and olfactory senses of the patients were evaluated with visual analog scale and nasal obstruction symptom evaluation scale. RESULTS: Visual analog scores for olfaction were significantly higher in the study group compared to the control group. In odor identification test, a significant improvement was observed in the study group, while a decrease was observed in the control group. While there was a decrease in the n-butanol thresholds values in the study group, there was an increase in the control group. CONCLUSIONS: Medial mucosal flap technique is an effective and functional turbinoplasty technique that can be used in solid hypertrophy of the middle turbinate, which offers advantages in terms of enhanced airway healing and olfactory results.

Evaluating the changes in nasal airway volume and nasal airflow after surgically assisted rapid maxillary expansion.

OBJECTIVE: This study aims to compare the changes in the nasal airway volume and nasal airflow using acoustic rhinometry (AR), rhinomanometry (RMN), and dental volumetric tomography (DVT) after surgically assisted rapid maxillary expansion (SARME). STUDY DESIGN: Our study consists of 13 adults, 3 male and 10 female patients, aged between 15 and 26, with completed skeletal development. In our study, DVT imaging was obtained twice, preoperation and 3 months after expansion. AR and RMN measurements were recorded, and Visual Analog Score (VAS) and Nasal Obstruction Symptom Evaluation (NOSE) Scale surveys were scored at preoperation and 3 months after expansion. Nasopharyngeal-oropharyngeal airway volume and areas were calculated using the Romexis 3.8.3.R (Planmeca, Helsinki, Finland) and Nemotec V2019 (Madrid, Spain) software programs. IBM SPSS Statistics 22 (SPSS IBM, Armonk, New York) was used for statistical analysis. RESULTS: Comparing the preoperation and postexpansion measurements by both software programs revealed a statistically significant increase in the nasopharyngeal airway volume. No statistically significant change was observed in the oropharyngeal airway volume. Furthermore, we found a statistically significant increase in VAS but a significant decrease in NOSE. CONCLUSION: According to our findings, nasal airway volume increased after SARME, and although there was no significant change in nasal resistance, patients' quality of life increased significantly.

Dry Eye and Dry Nose Caused by the Effect of Allergic Rhinitis on Tear and Nasal Secretion Osmolarity.

OBJECTIVE: Allergic rhinitis is a type 1 hypersensitivity reaction of immunoglobulin E in the rhino-ocular mucosa. This study was planned to demonstrate in patients with allergic rhinitis to evaluate changes in tear, nasal secretions, and blood osmolarity compared to healthy individuals. METHOD: Forty allergic rhinitis patients, 25 patients with acute upper respiratory tract infections, and 26 healthy participants were included in the study. Positive patients with allergic symptoms and skin prick test results were included in the allergic rhinitis group. Tear, nasal secretion, and blood osmolarity values were examined for the 3 groups. RESULT: In patients with allergic rhinitis, tear and nasal secretion osmolarity values were significantly higher in patients with acute upper respiratory tract infections and those of the healthy participants (P = .001, P = .038). In blood osmolarity measurements, there was no statistical difference between the groups (P = .489). In patients with allergic rhinitis, Schirmer test results were significantly shorter than patients who had acute upper respiratory tract infection and those of the healthy participants (P = .001, P = .001). Patients with allergic rhinitis and acute upper respiratory tract infections had significantly shorter Schirmer test results than in healthy participants (P = .001, P = .001). CONCLUSION: Tear osmolarity was increased in allergic rhinitis patients, and this was thought to lead to dry eye findings. In the presence of allergic rhinitis, nasal secretions were found more hyperosmolar than tears. Nasal secretion osmolarity was higher in allergic rhinitis patients than in patients with acute upper respiratory tract infections and control group.

The Effect of Sphenopalatine Ganglion Block on the Postoperative Pain in Patients Undergoing Septorhinoplasty.

OBJECTIVES: This study aimed to evaluate the effect of preoperative sphenopalatine ganglion block (SPBG) on the postoperative pain (POP) in patients undergoing septorhinoplasty (SRP). METHODS: A retrospective cohort study was performed. A total of 42 patients that had received septorhinoplasty included in the study. The patients that had received SPBG before the surgery included in the Block group (n:20) and the patients that had not received SPBG before the surgery included in the Control group (n:22). POP was questioned with a numeric rating scale (NRS) at the 30th minute (t1), 1st hour (t2), 4th hour (t3), 12th hour (t4), and 24th hour (t5) and noted. The intraoperative details and the dose of the postoperative rescue analgesics were also noted. RESULTS: The average dose of Paracetamol that was used in the postoperative first 24 hours was 500 mg in the Block group and 1363 mg in the Control group, and the difference was statistically significant (P = .001). The average dose of Tramadol was 0 mg in the Block group and 45 mg in the Control group, and the difference was statistically significant (P = .001). There was a statistically significant difference among the groups with respect to NRS in the first 24 hours postoperatively (P < .05). The number of the patients requiring rescue analgesics was lower in the Block group than the Control group. The difference was statistically significant at the t1, t2, and t5 time intervals (P > .05). CONCLUSIONS: Preoperative SPGB is an effective option to reduce POP and the need for rescue analgesics for patients undergoing SRP. CLINICAL TRIAL NUMBER: NCT04020393.