Association of periodontitis with tinnitus: A population-based cohort study in Taiwan.

AIM: Tinnitus, ringing in the ears, is speculated to be driven by inflammation. This study examined whether periodontitis is a risk factor for tinnitus using Taiwan's National Health Insurance Research Database. MATERIALS AND METHODS: Among the 79,456 patients who visited for dental concerns, 11,055 patients who were diagnosed with periodontitis and underwent periodontal treatment between 2000 and 2015 were enrolled in Group 1. After matching for sex, age, and index year, 11,055 patients with periodontitis who received no treatment were enrolled in Group 2. Similarly, 11,055 participants without periodontitis were included as controls. RESULTS: At the end of the follow-up, 412 and 404 participants in the two periodontitis groups and 321 participants in the control group had tinnitus. Cumulative risk for tinnitus in Group 1 or 2 was significantly greater than in the control group. More periodontitis patients than controls developed tinnitus (adjusted hazard ratios were 1.71 (95% confidence interval [CI]: 1.49-1.97, p < .001) and 1.64 (95% CI: 1.37-1.86, p < .001) in Groups 1 and 2, respectively). The risks were not significantly different between Groups 1 and 2. Similar findings were obtained after excluding data for the first 1 or 5 years. CONCLUSIONS: The study findings indicate that periodontitis is associated with tinnitus.

A rapid and accurate technique for the identification of the recurrent laryngeal nerve.

OBJECTIVE: We studied the anatomic relationship between the recurrent laryngeal nerve (RLN) and the third tracheal ring, which was very important for rapid identification of RLN in our hands. METHODS: This study was initially performed using 8 fresh cadavers (4 female and 4 male). The transverse nerve location from the third trachea and the depth from its anterior surface were measured. We further observed the topography of RLN in relation to the trachea in 60 patients, between November 2008 and January 2011, at the Tri-Service General Hospital and Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan, with 46 lobo-isthmectomies and 14 total thyroidectomies. The time spent in identifying the RLN was also recorded. RESULTS: Among cadaver groups, the transverse distance (width) and the vertical distance (depth) averaged 3.3 and 17.6 mm, respectively. Among the clinical cases, the width and depth averaged 4.4 and 14.6 mm, respectively. The depth measured in males was significantly deeper than that in females (22.3 vs 13.2 mm) (P < .05). The time spent in identifying the RLN after starting dissection in the RLN triangle was not statistically significantly different between the cadaver group and the clinical group (10.6 ± 5.7 seconds and 15.5 ± 17.7 seconds, respectively; P > .05). The median time was 9 and 10 seconds, respectively. There was no statistically significant side-to-side difference in terms of the time spent in searching for the RLN. CONCLUSION: Using the third ring as guidance, our inferior-superior technique offers an extra benefit in identifying the RLN safely and quickly, as compared to the conventional inferior approach.

The Management in Patients With Bilateral Vocal Fold Immobility: 15 Years' Experience at a Tertiary Centre.

OBJECTIVE: In order to correct the varying vocal fold positions to meet the various clinical requirements in patients with bilateral vocal fold immobility, we present pertinent surgical methods to treat them. MATERIALS AND METHODS: From 2005 to 2020, 115 patients diagnosed with bilateral vocal fold immobility were addressed for ventilation in 89 patients and for phonation in 26 patients. In the ventilation surgery group, all the neurogenic subjects received mere suture lateralization (SL) procedures and the mechanical ones underwent arytenoid release (AR) plus SL procedures if the cricoarytenoid joint fixation (CAJF) could be confirmed before operation. In the phonation group, neurogenic subjects received nonsurgical treatment and the mechanical ones underwent AR plus arytenoid adduction (AA) procedure. The decannulation rate and respiratory comfort rate for each subgroup will be calculated and the phonatory tests were conducted. RESULTS: In the ventilation group, 55% (49/89) of subjects received related surgeries. Mere SL offered 40 successful decannulation or respiratory comfort in 42 neurogenic subjects (95.2%). The single episode rate was high as 95%. An AR plus SL procedure also obtained 100% of decannulation or respiratory comfort with a single episode of surgical procedure if the CAJF could be confirmed preoperatively. In the phonation group, 15% (4/26) of subjects received appropriate surgeries. Single AR plus AA procedures also led to 100% (4/4) of the appropriate candidates serviceable sound. CONCLUSION: SL procedure keeping intact laryngeal mucosa usually offered permanent glottis enlarging effect or decannulation with a single episode of procedure. The use of arytenoid release for CAJF has led to remarkable advances in the ultimate surgical outcomes of both the ventilation and phonation in terms of decreasing revision surgeries. LEVELS OF EVIDENCE: level 4.

Head and neck cancers manifested as deep neck infection.

The incidence of head and neck cancers in patients with an initial presentation of deep neck infection is unclear and may be underestimated. Thus, the aim of this study was to assess the incidence of head and neck cancers initially manifested as deep neck infection. Also, the possible risk factors and pathophysiology are discussed. This study was a retrospective medical chart review in a tertiary referral center. A total of 81 consecutive patients admitted with a diagnosis of deep neck infection over a 46-month period were analyzed. The demographic data, physical examinations, laboratory findings, radiographic studies, and pathology report were analyzed. Among the 81 deep neck infection patients, head and neck cancers were histologically demonstrated in four patients (4.9%) with the initial symptom of a painful neck mass. The incidence of head and neck cancer initially manifested as deep neck infection was found to increase in patients aged over 40 years (6.7%; 3/45 vs. 2.8%; 1/36). A detailed history of all patients with deep neck infection should be taken. Furthermore, endoscopic examination, thyroid examination and routine pathological examination should be performed, especially in those aged over 40. Also, careful explanation to the patient and his/her family about the possibility of underlying head and neck cancer (incidence 1-5%) may be needed. If the neck swelling diminishes, but does not disappear completely after full course of antibiotics, repeated fine needle aspiration, endoscopy, or image study should be considered.

Evaluation of the feasibility of the vidian neurectomy using computed tomography.

For around 50 years, various approaches to the vidian neurectomy have been advocated. This indicates that there is no single surgical technique that is superior to all others. In this report, we analyze the included angle between the posterior end of middle turbinate and the anterior opening of the vidian canal. The aim of this paper is to use preoperative CT scanning to find a key anatomical structure to predict the feasibility of the vidian neurectomy. A retrospective research was performed. A total of 63 patients with 106 endoscopic vidian neurectomies between September 2006 and April 2010 were selected. The study population included 50 men and 13 women, with a mean age of 28. A paranasal sinus CT scan was obtained and analyzed. The included angle was measured and compared to the operating success rates. In the successful group (78 sides, 73.58%), the included angle from axial and coronal CT imaging was 30.2 ± 4.9° and 26.4 ± 9.1°, respectively. In the 28 failed sides (26.42%), the value was 33.8 ± 4.8° and 44.3 ± 8.1°, respectively. Statistical analysis confirmed that the difference between those two groups was significant (P < 0.05). The present study reports the relationship between the vidian canal and the middle turbinate, which is represented by their included angle. The findings support the decision to intervene the surgical side with a smaller angle, because of the significantly higher success rate.

Vidian Neurectomy for Management of Chronic Cluster Headache.

BACKGROUND: Management of chronic cluster headache (CCH) remains a challenging endeavor, and the optimal surgical approach for medically refractory CCH remains controversial. OBJECTIVE: To conduct a preliminary evaluation of the efficacy and safety of vidian neurectomy (VN) in patients with medically refractory CCH. METHODS: Between March 2013 and December 2015, 9 CCH patients, all of whom had failed to respond to conservative therapy, underwent VN with a precise nerve cut and maximal preservation of the sphenopalatine ganglion. Data included demographic variables, cluster headache onset and duration, mean attack frequency, mean attack intensity, and pain disability index measures pre- and through 12-mo postsurgery. RESULTS: Seven of the 9 cases (77.8%) showed immediate improvement. Improvement was delayed by 1 mo in 1 patient, after which the surgical effects of pain relief were maintained throughout the follow-up period. One patient (11.1%) did not improve after surgery. One year after VN, patients' mean attack frequency, mean attack intensity, and pain disability index decreased by 54.5%, 52.9%, and 56.4%, respectively. No patient experienced treatment-related side effects or complications. CONCLUSION: VN is an effective treatment method for CCH patients. Precise Vidian nerve identification and maximal preservation of the sphenopalatine ganglion may achieve good surgical outcomes and dramatically improve quality of life among patients, without significant adverse events.

Laryngeal reinnervation by ansa cervicalis nerve implantation for unilateral vocal cord paralysis in humans.

BACKGROUND: Ansa cervicalis (AC)-recurrent laryngeal nerve anastomosis (RLN) is usually not desirable for correction of paralytic dysphonia when it is difficult to find a viable distal stump of the recurrent laryngeal nerve. Nerve implantation of the thyroarytenoid muscle with the ansa cervicalis is a simple alternative method. STUDY DESIGN: Ten patients with unilateral vocal cord paralysis were prospectively designed to receive nerve implantation. A minimum period of 12 months after onset of paralysis was allowed to elapse to permit possible spontaneous reinnervation or compensation. Patients were followed long enough (at least 2 years) to determine if the procedure was successful. All patients were subjected to preoperative and postoperative voice recording, acoustic analysis, and videolaryngoscopy. Some of them underwent laryngeal electromyography. RESULTS: Ten patients underwent nerve implantation of the thyroarytenoid muscles by using the ansa cervicalis, and 8 of 10 (80%) had improved phonatory quality. Laryngeal electromyography showed that the procedure produced satisfactory reinnervation of the thyroarytenoid muscle. CONCLUSIONS: Nerve implantation of the thyroarytenoid muscle by the anso cervicalis is a simple and efficient alternative to nerve transfer if dense scarring at the cricothyroid articulation and lack of a viable distal stump of the recurrent laryngeal nerve preclude the procedure of nerve transfer. But careful selection of the appropriate candidate seems to be the earliest prerequisite for a successful procedure.

Features of muscle tension dysphonia before and after correction of unilateral vocal cord paralysis.

OBJECTIVES: We performed a retrospective, longitudinal study to compare the prevalence of hyperkinetic laryngeal features before and after successful correction in patients with unilateral vocal cord paralysis (UVCP). METHODS: Eighty-six patients with UVCP who had a successful surgical correction were enrolled. Preoperative and post-operative videolaryngostroboscopy images were analyzed, and the muscle tension patterns (MTPs) were rated according to the Morrison-Rammage classification. A 4-item glottal closure index was used for each patient on study entry and for 40 normal subjects as the control group. RESULTS: There was no significant difference in MTP prevalence before (57%) and after (55%) surgical correction for UVCP. Although the glottal closure symptoms were tremendously improved through surgical medialization for UVCP, they persisted and were more prevalent than those in normal individuals. CONCLUSIONS: Persistence of MTPs after correction of UVCP may be due to intractable vocal habits or psychogenic factors.

A secondary middle turbinate co-existing with an accessory middle turbinate: an unusual combination of two anatomic variations.

The anatomy of the nasal cavity lateral wall is quite complex; this is where most anatomical anomalies occur. The secondary middle turbinate, a bony projection that arises from the lateral nasal wall, is a rare variation, differing from the accessory middle turbinate by its distinct developmental origin. We report on an unusual case involving a combination of these two turbinate variations. We believe that detailed knowledge of anatomical anomalies in the sinonasal tract is critical for successful clinical management and important in allowing the surgeon to perform safe functional endoscopic sinus surgery.

Parotid gland-sparing 3-dimensional conformal radiotherapy results in less severe dry mouth in nasopharyngeal cancer patients: a dosimetric and clinical comparison with conventional radiotherapy.

BACKGROUND AND PURPOSE: This study examined the efficacy of parotid gland sparing of three-dimensional conformal radiotherapy (3DCRT) compared with conventional radiotherapy for NPC patients. Both the dose given to the parotids and clinical assessment of dry mouth were conducted. MATERIALS AND METHODS: Dry mouth was assessed for 108 patients treated with conventional technique and 72 treated with 3DCRT. Dose analysis was performed in 48 patients of the 3DCRT group. A dose of 70 Gy was given to the midplane in conventional radiotherapy and to 90% isodose volume in 3DCRT. Prognostic factors affecting the severity of dry mouth were analyzed using Generalized Estimating Equation (GEE). RESULTS: In the 3DCRT group about 50% of the patients' parotid glands received less than 25 Gy. Parallel analysis of dry mouth shows a significant decrease in the incidence of severe xerostomia after 3DCRT. The proportion of patients without dry mouth was also significantly higher in the 3DCRT group than the conventional group at 1-3 years after completion of radiotherapy. Although 3DCRT delivered a higher dose to the tumor, it spared the parotid gland significantly better than the conventional treatment. Late toxicities were mostly similar between the 2 groups while local control in T4 patients and survival were improved for 3DCRT. CONCLUSION: Dosimetrically and clinically 3DCRT is better than conventional technique regarding parotid gland protection.

Nerve branches to the posterior cricoarytenoid muscle may complicate the laryngeal reinnervation procedure.

OBJECTIVES/HYPOTHESIS: To better understand the reason for the low success rate of posterior cricoarytenoid (PCA) muscle reinnervation, we attempted to identify the communicating branches that may exist between the nerve branch to the PCA muscle and the other laryngeal adductors in addition to the interarytenoid (IA) muscle. STUDY DESIGN: Quantitative histological assessment. METHODS: Twenty human hemilarynges from patients with laryngeal or hypopharyngeal cancer were obtained after surgery and stained with Sihler's stain, which rendered the muscle translucent while counterstaining the neuroanatomy of the recurrent laryngeal nerve (RLN) inside the larynges. RESULTS: The nerve supply to the PCA muscle was separated into two main branches. One upper branch supplied the horizontal compartment, and the lower branch supplied the vertical/oblique compartment. In 14 specimens, two nerve branches to the PCA muscle arose separately from the RLN. In six specimens, one single main branch arose from the RLN and immediately ramified into two secondary branches. In all specimens except one, the nerve branch to the horizontal compartment was connected to the IA muscle. However, no communicating branches were observed between the nerve to the PCA muscle and the other laryngeal adductors. No anastomosis between nerve branches to the horizontal and vertical/oblique compartments or other variations of nerve distribution were observed. CONCLUSIONS: The communicating branches between the nerve branches to the PCA muscle and the IA muscle may be the only branch, complicating the reinnervation procedure. More investigations are needed to identify variations in the terminal branch distribution from the RLN. LEVEL OF EVIDENCE: NA.

Dose escalation using twice-daily radiotherapy for nasopharyngeal carcinoma: does heavier dosing result in a happier ending?

PURPOSE: To present our experience using a twice-daily radiotherapy (RT) technique, including hyperfractionated and accelerated-hyperfractionated RT, on nasopharyngeal carcinoma (NPC) patients. The dose to the primary tumor was increased in the hope that local control could be increased without the cost of increased late complications. We analyzed acute and late complications and local control and compared the results with the results of NPC patients treated during the same period using conventional once-daily RT. METHODS AND MATERIALS: Between October 1991 and July 1998, 222 histologically confirmed, Stage M0, previously unirradiated NPC patients completed RT at our hospital. Most patients had American Joint Committee on Cancer (AJCC) 1992 Stage III and IV disease. Among them, 88 received altered fractionated, twice-daily RT; 76 patients received hyperfractionated RT and 12 accelerated-hyperfractionated RT. The remaining 134 patients received a conventional once-daily regimen. Hyperfractionated RT was delivered using 120 cGy b.i.d. separated by 6-h intervals throughout the course. For the accelerated-hyperfractionated patients, 160 cGy b.i.d. was given, also at 6-h intervals. The median dose in the twice-daily group was 7810 cGy (range 6840-8200). In the once-daily regimen, RT was delivered using 180-200 cGy q.d. The median tumor dose to the primary tumor was 7000 cGy (range 6560-8100) given during about 8 weeks. The median follow-up time was 70.5 and 72 months for the twice-daily and once-daily groups, respectively. RESULTS: The incidence of acute toxicities was higher in the twice-daily group with more severe mucositis and moist desquamation than in the once-daily group. Both groups had a similar incidence of late complications, except for 3 cases of temporal lobe necrosis in the twice-daily group, all in patients treated with 160 cGy. No difference was noted in recurrence-free local control between the two groups when the individual T stage was compared using AJCC 1992 or 1997 criteria (p = 0.51 and 0.59, respectively). The 5-year local control rate for T1-3 (AJCC 1997) was 93.2% for the twice-daily group and 86.4% for the once-daily group (p = 0.45). In Stage T4 (AJCC 1997) patients, the local control rate dropped drastically to 43.5% and 36.9% for the twice-daily and once-daily groups, respectively. The overall neck control rate at 5 years was 87.3% and 80.3% for the twice-daily and once-daily patients, respectively (p = 0.16). The overall locoregional control rate was 82.7% for the twice-daily group and 66.6% for the once-daily group. The difference was again not statistically significant, but showed a tendency in favor of the twice-daily regimen (p = 0.055). Locoregional failure occurred mainly in Stage T4 patients with central nervous invasion for whom local control was particularly poor, with a failure rate of about 60%. CONCLUSION: The present data suggest that NPC patients can be safely treated using a 120-cGy twice-daily program with a 6-h interval up to 8000 cGy. The accelerated-hyperfractionated technique is not recommended. A large discrepancy in local control between patients with T1-3 and T4 disease was noted. For T1-3 disease, an excellent local control rate >90% was achieved using the twice-daily regimen. In contrast, failure in the T4 patients was as high as 55% in the twice-daily group and reached 65% in the once-daily group. More rigorous treatment is needed using either additional dose escalation or other strategies for T4 NPC patients. With a dose escalation of 1000 cGy using 120-cGy twice-daily RT, a trend toward better locoregional control and disease-specific survival was noted in the twice-daily group. Whether this difference was truly the result of an increased dose needs additional confirmation in studies with larger patient numbers.

Functional comparison after reconstruction with a radial forearm free flap or a pectoralis major flap for cancer of the tongue.

OBJECTIVE: Numerous patients in Taiwan with tongue carcinoma require tongue reconstruction. We compared the abilities of 2 methods of tongue reconstruction to reserve tongue function. STUDY DESIGN AND SETTING: Sixty patients underwent resection of the tumors and reconstruction with a pectoralis major flap or a radial forearm flap. The Chinese articulation test was used to evaluate the place and manner of error production, and a questionnaire on dietary habits was used to evaluate deglutition 6 months to 10 years after reconstruction. RESULTS: Patients with the free flap had more intelligible speech. The questionnaire study showed no significant difference between the 2 groups in swallowing rating. Motility caused by flap pliability increased speech intelligibility more than it did on swallowing function. CONCLUSION: Our experience in a few selected patients shows that the functional outcome of tongue surgery is related to the reconstruction methods used (for speech) and to the extent of tongue resection (for swallowing).

Combination of fascia transplantation and fat injection into the vocal fold for sulcus vocalis: long-term results.

Fat injection and fascia transplantation alone have been used to treat patients with sulcus vocalis. No information is available on the effectiveness of these two procedures used in concert to treat sulcus vocalis. The objectives of this study were to conduct the two procedures together and report the long-term results. This article assesses, retrospectively, the effectiveness of the combination treatment of fascia transplantation and fat injection (FTFI) in patients with sulcus vocalis (n = 22). Perceptual acoustic, phonatory function, and videolaryngostroboscopic data were evaluated before and after FTFI treatment in 18 patients. The mean follow-up time was 16.6 months. Sixteen patients had excellent results, 3 reported improvement, and 3 indicated no change. Phonatory function improved significantly in terms of phonation time, grade, roughness (p < .05), and breathiness (p < .001). The videolaryngostroboscopic rating showed significant improvement in vocal fold vibration amplitude and excursion of the mucosal wave (p < .05). Type 3 sulcus responded better to this treatment than did type 2 (sulcus vergeture). No postoperative complications were noted. The FTFI technique consists of an autogenous implant and delivers positive results. It may be considered as an option for patients with sulcus vocalis. It has been demonstrated to achieve excellent results in a majority of patients and to deliver a better prognosis than fat injection alone. Although resorption of fat and fascia is associated with FTFI, the FTFI procedure may be repeated multiple times.

Clearing microvascular lesions of the true vocal fold with the KTP/532 laser.

Although used for treating vascular malformations, KTP (532 nm) lasers have not been used to treat microvascular lesions of the vocal fold. The efficiency of KTP laser operation in the continuous mode with a 0.4- or 0.6-mm beam (1- to 2-W aim for 3 to 7 seconds delivering a total energy of 3 to 7 J) was studied retrospectively in patients with microvascular lesions of the vocal fold (n = 14). The perceptual acoustic, phonatory function, and videolaryngostroboscopic data were evaluated before and after operation in 10 patients. At follow-up (mean, 7 months), the results were excellent in all patients. Their phonatory function (jitter, shimmer, grade, breathiness, and roughness) significantly improved (p < .01). The videolaryngostroboscopic rating showed significant improvement in the amplitude of vocal fold vibration and excursion of the mucosal wave (p < .05). No postoperative recurrence or complications were noted. The KTP laser operation is a useful, cost-effective, and time-saving procedure and can be considered as an option in management of patients with microvascular lesions of the vocal fold, particularly those with repeated hemorrhages. Because the operation is easy (compared to other surgical methods) and has no major side effects, the prospect of total patient recovery is excellent.

Speech and swallowing function after reconstruction with a radial forearm free flap or a pectoralis major flap for tongue cancer.

BACKGROUND AND PURPOSE: The tongue plays a more significant role in English than in Mandarin, both in apical-palatal consonant production and tense-lax distinction. Theoretically, the same surgical intervention may produce a less significant impact on postoperative Mandarin production. The impact of tongue reconstruction on Mandarin articulation has not been reported. This study compared the tongue function outcome obtained using two methods of tongue reconstruction, radial forearm free flap transfer and pectoralis major flap transfer. METHODS: Twenty-five patients with carcinoma of the tongue underwent tumor resection. The surgical defects were reconstructed using a pectoralis major flap in six patients and a radial forearm flap in 19 patients. Swallowing and speech function were evaluated 6 months to 5 years after the reconstruction. Speech intelligibility and a Mandarin articulation test were used to evaluate the articulation proficiency before and after surgery. Clinical evaluation of deglutition included a questionnaire on dietary habits and a swallowing rating of 1 to 7. RESULTS: Clinical evaluation showed that patients with free flap reconstruction had more intelligible speech (p = 0.014) even after total glossectomy. Assessment of data obtained by clinical questionnaire showed no significant difference between the two groups in swallowing function. Motility due to flap pliability increased speech intelligibility but had little effect on swallowing function. CONCLUSION: Our results suggest that radial forearm flap transfer is better than pectoralis major flap transfer in preserving speech function and that there is no significant difference between the two methods of reconstruction in their impact on swallowing function.

Synchronous double cancers of the hypopharynx: malignant fibrous histiocytoma and squamous cell carcinoma.

We report a unique case of synchronous double hypopharyngeal tumors in a 39-year-old man. The patient presented with a 1-year history of a muffled voice and mild odynophagia. Laryngoscopy detected two grossly different tumors in the hypopharynx: a malignant fibrous histiocytoma (MFH) in the postcricoid area and a squamous cell carcinoma (SCC) in the posterior pharyngeal wall. Chemoradiotherapy was administered, and the patient was free of disease at 23 months of follow-up. Synchronous double cancers of the hypopharynx that feature different oncotypes are very rare, especially those that include an MFH. In fact, to the best of our knowledge, no case of synchronous MFH and SCC of the hypopharynx has been previously reported in the literature. Because the number of reported cases of MFH in the hypopharynx is so small, no consensus exists with respect to the preferred option among the various treatment choices.

Randomized, double-blind, controlled study to evaluate the effect of vidian nerve cauterization on lacrimation.

BACKGROUND: After vidian neurectomy, low reported rates of dry eye syndrome (DES) seemed incompatible with the high success rate of nerve severance in previous studies. This study aimed at understanding of the pathophysiology of lacrimation and evaluating the effect of thermal injury through the distal stump on the sphenopalatine ganglion (SPG) after vidian neurectomy. METHODS: A randomized, double-blind, controlled study was performed to evaluate the DES. Eighty precise vidian neurectomies were randomized in a 1:1 ratio to groups 1 and 2. Group 1 represented the cauterization and was used in both distal and proximal nerve stumps, whereas only the proximal nerve stump was cauterized in group 2 subjects. The DES was evaluated with Schirmer's test and ocular surface disease index (OSDI) before and after surgery at 7-10 days and 30 days, respectively. RESULTS: In group 1, the Schirmer's test showed a mean decline of 20 mm (20/30, 66%) at 7-10 days and 15 mm (15/30, 50%) at 30 days. In group 2, the Schirmer's test revealed significantly lesser dry eye problems, with a mean decline of 16 mm (16/30; 52%) at 7-10 days and 2 mm (2/30; 6%) at 30 days. The significantly less postoperative dry eye problems in group 2 can be shown by the OSDI at 7-10 days, but not at 30 days. The mean follow-up period was 24 months. No recurrence of nasal allergy symptoms was noted in the follow up period. CONCLUSION: The significant advantage of preservation of the SPG function is justified by Schirmer's test, although the effect did not appear to be comparable with the clinical manifestations evaluated by OSDI at 30 days. Nevertheless, the preservation of distal stump from preventive cauterization can still offer better eye ball moisture in the early evaluation of DES.