Outcome of In Situ Septoplasty and Extracorporeal Subtotal Septal Reconstruction in Crooked Noses: A Randomized Self-Controlled Study.

IMPORTANCE: Severe dorsal deviations in crooked noses are treated by either in situ septoplasty with asymmetric spreader grafts (ISS) or extracorporeal subtotal septal reconstruction (ECS). To our knowledge, except one retrospective study, there is no other that compares the objective and subjective results of these two treatment modalities. OBJECTIVE: The aim of this study was to compare the aesthetic and functional outcomes of ECS and ISS in crooked noses. DESIGN, SETTING AND PARTICIPANTS: This study was carried out on 40 patients (ISS in 20 patients and ECS in 20 patients) who underwent external rhinoplasty surgery due to crooked noses between May 2014 and January 2016. While performing rhinoplasty on the patients, the decision of whether to use the ECS or ISS technique was randomized in a sequential fashion. MAIN OUTCOMES AND MEASURES: Surgical outcomes were assessed and compared using the anthropometric measurement of photographs with Rhinobase software. Subjective assessments of nasal obstruction and aesthetic satisfaction were evaluated with a visual analog scale. RESULTS: There was a significant difference between rhinion deviation angle, supratip deviation angle (SDA) and tip deviation angle pre- and postoperatively in the ECS group, whereas in the ISS group, except SDA, all other postoperative angles were significantly improved from preoperative values (p = 0.218). The nasal tip projection in the ECS and ISS groups was 29.48, 31.5 preoperatively and 29.78, 31.26 postoperatively. The mean postoperative nasal tip projection value (p > 0.005) did not change significantly compared to the preoperative value in both groups. The mean postoperative value of nasolabial (p = 0.226) angle did not change significantly compared to the mean preoperative one in the ECS group. However, in the ISS group, the mean postoperative value of nasolabial (p = 0.001) angle significantly improved compared to the mean preoperative value. There was significant improvement in both groups, while improvements in both functional and aesthetic outcomes were much higher in the extracorporeal group. None of the patients had postoperative nasal obstruction that required revision surgery. One patient underwent revision rhinoplasty due to an irregularity on the nasal dorsum in the ECS group. CONCLUSIONS AND RELEVANCE: This is the first study that compares subjective and objective aesthetic and functional outcomes of crooked nose surgery according to two common septoplasty techniques in a randomized self-controlled fashion. This study was effective in both objectively and subjectively comparing the functional and aesthetic aspect of the patients submitted to two common different techniques of treatment of nasal deviations in crooked nose patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Association of Oral Health-related Quality of Life with Periodontal Status and Treatment Needs.

PURPOSE: To evaluate the association of oral health-related quality of life (OHRQoL) with periodontal parameters and treatment needs in a Turkish population and compare the OHRQoL of patients with gingivitis and periodontitis. MATERIALS AND METHODS: The present study had a cross-sectional design. The study population consisted of 404 patients with periodontitis (n = 130), gingivitis (n = 141) or periodontal health (n = 133). Patients' sociodemographic information as well as periodontal parameters such as plaque index (PI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL) and the community periodontal index of treatment needs were recorded. The impact of oral health on the patients' quality of life was assessed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. RESULTS: The OHIP-14 scores in subjects with gingivitis and periodontitis were higher than in periodontally healthy individuals (p < 0.05). Although the total OHIP-14 scores in subjects with periodontitis were higher than those for the subjects with gingivitis, no statistically significant difference existed between the gingivitis and periodontitis groups (p > 0.05). When characterised according to periodontal treatment needs (TN), the total and individual domain OHIP-14 scores were highest in subjects at the TN3 level. The total OHIP-14 scores of subjects correlated with periodontal status, BOP, PD ≥ 4 mm (% of sites), CAL ≥ 4 mm (% of sites) and TN. CONCLUSIONS: Our results disclosed that the adverse effects on OHRQoL perceived by patients were similar in subjects with gingivitis and periodontitis. When planning treatment, it should be kept in mind that the pain and physical discomfort domains of the individual subscales are of primary importance to the patients. However, longitudinal studies are needed to clarify the relationship between periodontal status and OHRQoL.