Evaluating surgical outcomes of conventional versus endoscopic septoplasty using subjective and objective methods.

OBJECTIVES: The aim of the study is to compare the pre- and post-operative symptomatology, endoscopic findings, and nasal patency and to evaluate the postoperative outcomes of conventional compared to endoscopic septoplasty (ES). MATERIALS AND METHODS: This prospective study was conducted at Rajindra Hospital, Patiala, Punjab, India, on 50 patients aged between 18 and 60 years having symptomatic deviated nasal septum and refractory to medical treatment. The patients were divided into two groups: Group A, which included 25 patients in whom conventional septoplasty (CS) was performed, and Group B, which included 25 patients in whom ES was conducted. The postoperative assessment was carried out at once weekly for 1 month and twice weekly for another 2 months. RESULTS: Nasal obstruction was relieved in 79.1% cases belonging to Group A and 91.3% cases to Group B. Headache was relieved in 62.5% cases belonging to Group A and 93.3% cases to Group B. Postnasal drip was relieved in 73.3% cases in Group A and 94.1% cases in Group B. The results were found to be statistically significant. An improvement in visual analog scale score was observed in both groups, but statistically significant difference was seen at 2nd and 4th week. Postoperative nasal patency improvement was observed in both groups by the Gertner plate, and the results were found to be statistically significant. Postoperative hemorrhage was observed in 24% cases in Group A and 12% cases in Group B. Septal perforation, septal hematoma, and mucosal tear were observed in 4%, 4%, and 8% of cases, respectively, in Group A. No such complication was reported in Group B. CONCLUSION: ES is more effective in terms of relief of symptoms and improvement of nasal patency. It is best for isolated spur, posterior deviation, and revision surgery, but anterior caudal dislocation is best handled with CS. Both these techniques should be taken as an adjuvant to each other.

Risk factors for intraoperative saddle nose deformity in septoplasty patients.

INTRODUCTION: Septoplasty is one of the most common otolaryngologic procedures. Previous studies have reported that the overall rate of significant change in cosmetic appearance of the nose after septoplasty ranged from 0.4 to 3.4%, and saddle nose was the most commonly cited deformity. In this study, we evaluated the risk factors for intraoperative saddle nose in a group of septoplasty patients. METHODS: This case-control study (1:2 case:control) was conducted based on retrospective chart review. Intraoperative saddle nose was observed in 108 (5.1%) of 2106 patients who underwent septoplasty in our center between January 2008 and December 2017. The control group consisted of 216 randomly selected, hospital-matched septoplasty patients who had no intraoperative saddle nose deformity in the same period. The demographic data, preoperative endoscopic findings, and surgical procedures of the two groups were analyzed to identify possible risk factors of intraoperative saddle nose deformity. RESULTS: The mean ages of the two groups were 34.8 years (saddle group) and 33.2 years (control group). In multivariate logistic regression analysis, clinical risk factors associated with intraoperative saddle nose were female gender (OR 3.39; 95% CI 1.76-6.54; p < 0.01), severe caudal septal deviation (OR 2.22; 95% CI 1.30-3.79; p = 0.003), and intraoperative finding of septal cartilage fracture (OR 3.96; 95% CI 1.92-8.19; p < 0.01). CONCLUSIONS: Severe caudal septal deviation, intraoperative fracture of septal cartilage, and female gender were risk factors for intraoperative saddle nose deformity in our study population.

Caucasian Mediterranean patients seeking rhinoplasty-Anthropometric measurements and prevalence of major deformities.

OBJECTIVE: To describe the average values of the nasal anthropometric measurements of Caucasian Mediterranean patients seeking rhinoplasty and evaluate the major nasal deformities. DESIGN: Prospective, observational and cross-sectional study. SETTING: Centro Hospitalar do Porto. PARTICIPANTS: A 100 Caucasian Mediterranean patients seeking rhinoplasty. OUTCOMES: Standardized photography was used to obtain nasal anthropometric measurements and to evaluate the major nasal defects. Data regarding age, gender, skin type and Fitzpatrick scale were also collected. RESULTS: There was a statistically significant difference in the means values of palpebral fissure, intercanthal width, upper lip height, nasal root width, morphological nose width, nose height, nasal tip projection and nasofrontal-hump and nasofrontal-supratip angles between females and males. The major nasal deformity was dorsal hump (78.0%), followed by rinomegalia (53.0%) and boxy bulbous tip (47.0%). CONCLUSION: The present study shows statistically significant gender differences between anthropometric nasal measurements and the mean values are greater than standard values obtained on general population. This might be one of the reasons why Caucasian Mediterranean patients seek aesthetical rhinoplasty. On both genders, dorsal hump, rinomegalia and boxy bulbous tip were the major nasal defects. This emphasize the importance of rhinoplasty techniques designed to reconstruct nasal dorsum and nasal tip on Caucasian Mediterranean patients. To the best of our knowledge, our study is the first study of digital anthropometric nasal analysis and evaluation of major nasal defects specifically in Caucasian Mediterranean patients who applied for rhinoplasty. With this results, we provide a reference material for the evaluation of the Caucasian and Mediterranean patient when planning a cosmetic nasal surgery.

Endoscopic versus conventional septoplasty: objective/subjective data on 276 patients.

PURPOSE: Endoscopic approach represents a valid alternative to conventional septoplasty. The aim of this study is to analyze the objective and subjective data on 276 patients, who underwent traditional (147) or endoscopic (129) septoplasty. METHODS: This is a prospective observational study on 276 consecutive patients affected by deviated nasal septum (DNS), who underwent isolated septoplasty between 2011 and 2018. 147 of them were treated using an "open" approach, while 129 were treated with an endoscopic approach. The two groups were compared 3 months after surgery: the objective results (complications such as bleeding, hematoma, pain, synechiae, septal tears and incomplete correction), objective (rhinomanometric data) and subjective measurements (NOSE questionnaires). RESULTS: Both techniques are effective in decreasing nasal obstruction and discharge. Complications such as pain, synechiae, early postoperative bleeding, septal tears and incomplete correction are less frequent in the endoscopic group (p < 0.05). The rhinomanometric analysis reveal improvement in both groups without statistical differences. Subjective questionnaires show a good symptoms relief with an improved quality of life in all 276 patients without statistical difference between the two gropus. CONCLUSIONS: Both techniques are effective in reducing nasal obstruction and related symptoms with fewer overall complications in the endoscopic approach. The endoscope provides improved field of view, less mucosal damages and a more anatomic dissection. Finally, such approach can be a valuable teaching tool for assistants, residents and students.

The Composite Spreader Flap.

Background: The effect of a spreader flap on the keystone area and the upper bony vault depends on the structural strength and cephalic extent of upper lateral cartilages, both of which can be significantly variable among individuals. Objectives: The authors present a novel cephalically extended osseocartilaginous composite spreader flap technique that was designed to overcome the limitations of a conventional spreader flap on the keystone area upper bony vault, in patients with cephalically short and structurally weak upper lateral cartilages and thin nasal bones. Methods: This study was a retrospective review of the recorded perioperative information to investigate the frequency of the use of the composite spreader flap technique and perioperative parameters that relate to postoperative dorsal deformities. One-hundred-seventy-six consecutive primary open approach rhinoplasty cases performed by the first author (O.B.) between November 2015 and February 2017 were included in the study. Patient data were obtained from rhinoplasty data sheets, standardized photographs, and postoperative physical examinations. Results: Of the 176 cases who underwent primary open approach rhinoplasty whose data were reviewed for the purpose of this study, 38 (32 females, 6 males) had dorsal reconstruction with the use of a composite spreader flap. Seventeen patients had a deviated nose with an asymmetric bony pyramid. In 8 patients, the composite spreader flap was used unilaterally. No patients in the composite spreader flap group had a postoperative dorsal deformity or required surgical revision. Conclusions: Composite flap preparation extends the reliability and the reach of the spreader flap technique beyond its previous borders.

The Effect of Spreader Graft and Mattress Suture Technique on Rhinoplasty in Patients With Nasal Hump Smaller Than 3 mm.

INTRODUCTION: Rhinoplasty is a common plastic surgery that potentially has some complications such as postoperative deformities and breathing problems. A humpy nose is among the main reasons for rhinoplasty. Nasal valve (the narrowest part of the nasal airway) collapse may be occurred after nasal hump removal. Spreader graft is essential after more than 3 mm nasal hump removal. But the value of this graft is unknown for patients with nasal hump smaller than 3 mm. Mattress suture is another technique for widening the nasal valve angle. This study compares the effects of spreader graft and mattress suture technique on postoperative deformity and nasal valve patency in patients with nasal hump smaller than 3 mm as compared with control group (no graft and suture). METHODS: In this clinical trial study 210 patients who underwent rhinoplasty with 2 different techniques involved. Their postoperative deformity and nasal valve patency were evaluated by subjective (questionnaire and digital photography) method before and after rhinoplasty during 6 months follow-up. RESULTS: Statistically, nasal obstruction had no significant difference before and after rhinoplasty and no significant difference was observed between spreader graft and mattress sutures (P > 0.05), but significantly better results than control group (P < 0.05). CONCLUSION: In this study the results of nasal valve patency of 2 techniques were similar. Because of several considerations in spreader graft technique such as needing to septoplasty in this technique even in patients without septal deviation that causes longer surgical duration, excessive blood loss, it is recommended to use Mattress suture in patients with nasal hump smaller than 3 mm.

Nasal airway obstruction: Prevalence and anatomic contributors.

Surgical treatments for nasal airway obstruction (NAO) are commonly offered as part of otolaryngology practice. Anatomic causes include septal deviation, inferior turbinate hypertrophy, and nasal valve collapse (NVC). This study was performed to determine the prevalence of anatomic contributors to NAO. A total of 1,906 patients with sinonasal complaints were surveyed by 50 otolaryngologists in varying U.S. geographic regions. Patients were first evaluated using the Nasal Obstruction Symptom Evaluation (NOSE) instrument to assess the NAO symptoms and their severity. Physicians then examined patients for the presence of the three anatomic contributors. Presence of septal deviation and turbinate hypertrophy was assessed through an internal nasal exam with direct or endoscopic visualization based on the physician's standard methodology for diagnosis. Presence of NVC was determined by the modified Cottle maneuver. Among all patients surveyed, prevalence was 67% for NVC, 76% for septal deviation, and 72% for inferior turbinate hypertrophy. We found that 64% of the patients (n = 1,211) had severe/extreme NOSE scores (≥55), representing the most likely nasal obstruction candidates for intervention. In these patients, the prevalence of NVC, septal deviation, and inferior turbinate hypertrophy was 73, 80, and 77%, respectively. Eighty-two percent of the 236 patients with severe/extreme NOSE scores who reported prior septoplasty and/or inferior turbinate reduction had NVC. Our study revealed a comparable prevalence of all three anatomic contributors across all patients and the subset with severe/extreme NOSE scores, highlighting the importance of evaluating the lateral nasal wall as a component of NAO treatment strategy.

Isolated sphenoid sinus fungus ball: a retrospective study conducted at a tertiary care referral center in Korea.

Fungus ball (FB) is the most common form of extramucosal fungal rhinosinusitis involving one or more paranasal sinuses. The sphenoid sinus is an uncommon site of this disease. Here, we present our 20-year experience of managing isolated sphenoid sinus FB (SSFB). We retrospectively reviewed a series of 47 cases of isolated SSFB encountered between 1996 and 2015 with reference to the chronological incidence, demographics, clinical features, radiological findings, treatment modalities, and outcome. Recently, the number of patients with isolated SSFB has increased markedly. The mean age of the patients in this study was 63.1 years (range 26-84 years), and there was significant female predominance. The most common symptom was headache (72.3%), which was localised in various regions. On the other hand, nasal symptoms presented at a relatively low rate. On computed tomography, the most common findings were total opacification, calcification, and sclerosis of the bony walls. There was no significant difference in the presence of SSFB between the ipsilateral and contralateral sides of the nasal septal deviation and concha bullosa. Magnetic resonance imaging demonstrated an isointensity on T1-weighted images and marked hypointensity on T2-weighted images. Treatment consisted of endonasal endoscopic sphenoidotomy with complete removal of the FB. The prognosis was good, with no recurrence after a mean follow-up of 13.2 months. Isolated SSFB is a rare disease, but its prevalence is increasing. Although the clinical presentation is usually vague and nonspecific, SSFB should be considered in patients with unexplained headache, especially in elderly women. Endoscopic sphenoidotomy is a reliable treatment with low morbidity and recurrence rates.

Puzzle-Formed Modified Turkish Delight for Nasal Dorsum Augmentation.

Structural deficiencies of the nasal dorsum are most commonly of congenital, traumatic, or iatrogenic etiology. Various grafts, including autografts, homografts, and synthetic materials, have been used to this end and are described in the literature.Autologous septal cartilage is the most commonly used graft material when limited augmentation rhinoplasty is planned. However, it is difficult to retain sufficient cartilage to allow of such augmentation in instances where most of the septal cartilage has been used. The authors place moderately crushed cartilage beneath a monolayer of surgicel when performing limited nasal dorsum augmentation. The aim of the present study is to describe authors' approach and its utility by reviewing other methods reported in the literature.

Prevalence and Risk Factors of Chronic Rhinosinusitus, Allergic Rhinitis, and Nasal Septal Deviation: Results of the Korean National Health and Nutrition Survey 2008-2012.

IMPORTANCE: Chronic rhinosinusitis (CRS), allergic rhinitis (AR), and nasal septal deviation (NSD) are frequent rhinologic diseases that consume considerable health care resources. OBJECTIVE: To determine the prevalence and risk factors of CRS, AR, and NSD in Korea. DESIGN, SETTING, AND PARTICIPANTS: This study analyzed 5-year cross-sectional data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008-2012. A total of 35 511 participants, who underwent an interview regarding nasal symptoms and a nasal examination, were enrolled and subsequently divided into 3 groups: children (aged 7-12 years), adolescents (aged 13-19 years), and adults (aged ≥20 years). MAIN OUTCOMES AND MEASURES: Adult CRS was classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Diagnosis of AR was based on symptoms and serum levels of specific IgE for 3 allergens, including Dermatophagoides farinae. The precise prevalence of AR was reestimated by multiplying the reciprocal of D farinae frequency based on a conventional skin prick test. Nasal septal deviation was diagnosed via nasal endoscopy after nasal decongestion. This study estimated the association of the 3 diseases with demographic data, including sex, age, obesity, level of education, socioeconomic status, residence, smoking, and alcohol. RESULTS: The prevalence of CRSwNP and CRSsNP in 28 912 adults was 2.6% and 5.8%, respectively. An association was found between CRSwNP and age (odds ratio [OR], 1.03; 95% CI, 1.02-1.04; P < .001), lower level of education (OR, 1.40; 95% CI, 1.02-1.92; P = .04), and obesity (OR, 1.46; 95% CI, 1.16-1.84; P = .001). Symptom-based and allergy test result-based AR had a prevalence of 27.5% (n = 35 511) and 16.1% (n = 2298), respectively. The reestimated prevalence of AR was 18.5% for all ages. Urban residence increased the risk of AR (OR, 1.21; 95% CI, 1.06-1.38; P = .005), but age was associated with a decreased risk (OR, 0.99; 95% CI, 0.98-0.99; P < .001). The prevalence of NSD was 48.0% and increased with age. In addition, NSD was a risk factor for CRSsNP (adjusted OR, 1.16; 95% CI, 1.02-1.32; P = .03) but not for CRSwNP. CONCLUSIONS AND RELEVANCE: In KNHANES 2008-2012, older age was associated with increased risk for CRSwNP and NSD but associated with a decreased risk for AR. Obesity was another risk factor for CRSwNP.

Endonasal extended columellar strut in Asian rhinoplasty.

BACKGROUND: Recently, sculpturing of projected and sharp nasal tips, as is usual in the white population, has been of great concern in Asian rhinoplasty. However, tip surgery in Asians should be performed in a different way due to anatomic differences. The authors used an endonasal rhinoplasty to correct the position of lower lateral cartilage by adopting a modified columellar strut. This novel technique of an endonasal extended columellar strut (EECS) could project the nasal tip significantly while avoiding hard fixation. This study aimed to evaluate the usefulness of the EECS in Asians. MATERIALS AND METHODS: A retrospective study was performed with 40 patients who underwent EECS from March 2012 to August 2014. Photographs taken preoperatively and postoperatively were analyzed. The tip projection, the ratio of the length of the infratip lobule to the total length of the tip, and a columellar labial angle change were measured. Overall, surgical outcomes were rated into three grades (excellent, good, and fair) by two experienced rhinoplasty surgeons (J.Y.K., M.S.C.). All the patients were asked to rate their cosmetic satisfaction by using a visual analog scale (10 points). RESULTS: Postoperative nasal tip projection significantly increased, from 24.2 to 26.7 mm (p < 0.01). The ratio of the length of the infratip lobule to the total length of the tip mildly increased, from 0.45 to 046 in men, and remained unchanged, at 0.48, in women. The columellar labial angle significantly increased, from 86.9° to 93.7° (p < 0.01). Surgical outcomes were rated by two experienced surgeons as excellent (40%), good (42%), and fair (18%). Subjectively, patients graded their satisfaction at ∼ 8.7 on the visual analog scale. CONCLUSION: This novel EECS technique enabled satisfactory tip projection in Asians while maintaining a natural ratio of infratip lobule to total length of tip and leaving no external scar.

The incidence of nasal septal deviation and its relation with chronic rhinosinusitis in patients undergoing functional endoscopic sinus surgery.

OBJECTIVE: To investigate the correlation of nasal septal deviations and chronic rhinosinusitis. METHODS: The study was conducted at Department of Otolaryngology, Head and Neck Surgery, Boali Hospital, Sari, Iran from January 2012 to September 2014 and comprised subjects aged from 5 to 68 years who had undergone elective functional endoscopic sinus surgery for chronic rhinosinusitis. SPSS 17 was used for statistical analysis. RESULTS: Of the 60 subjects in the study, 41(68.3%) were males and 19(31.7%) females with overall median age of 27. Nasal septal deviation was found in 49(81.7%) subjects; 11(18.3%) had it in both right and left sides, 16(26.7%) in right alone and 22(36.7%) in the left side. The commonest type of septal deviations in the left side were posteroinferior 10(16.66%) and anteroinferior 7(11.7%). In the right side, the corresponding numbers were 9(15%) and 7(11.7%). CONCLUSIONS: Nasal septal deviations are of particular interest in majority of patients with chronic rhinosinusitis.

Acute nasal fracture management: A prospective study and literature review.

OBJECTIVES/HYPOTHESIS: Functional and cosmetic deformities are common after nasal injuries and at times necessitate advanced surgery to reverse the effects of trauma. This study was designed to study the factors related to nasal injury and patient parameters in influencing the acute management of nasal injuries and its outcome. STUDY DESIGN: Prospective study. METHODS: Nasal injuries from County Waterford in Southeast Ireland were referred to a new Cost-Neutral Nasal Fracture Clinic. The first 400 patients from this prospective audit, referred to Waterford Regional Hospital from August 2009 through December 2010, were included in this study. Twenty-one variables, including satisfaction scores using Visual Analog Scale (VAS), were studied. Data was obtained at each stage of management, from initial assessment in ears, nose, and throat (ENT) casualty to being seen and further reviewed in consultant-based specialty clinic. RESULTS: Men outnumbered women 72: 28, and the mean age was 26.89 (0.4 years-87 years). Patients presenting time to the ENT casualty after the injury ranged between 1 and 90 days (mean 10.5 days). The interval between injury and intervention was on an average 6.1 days. Accident (41%) and soccer (46%), among the sports group, were predominantly related to nasal injury. The overall satisfaction rate was 77.5% for breathing and 85.6% for cosmesis. One hundred twenty-seven (31.8%) patients were referred to and managed from the septorhinoplasty clinic. Overall, 11% required septorhinoplasty. Patient satisfaction was seen in manipulation performed up to 5 weeks postinjury. CONCLUSION: Our databank is the largest prospectively studied series of nasal-fracture management from Ireland. The incidence of nasal fracture in the southeast of Ireland is 0.37%. Age, gender, mode of injury, and type of sport influenced the satisfaction rates in this study. This type of service may not be practical in all ENT departments, but a regional center may be an idea worth considering.

Primary acquired nasolacrimal duct obstruction: is it really related to paranasal abnormalities?

PURPOSE: To investigate whether there is an association between primary acquired nasolacrimal duct obstruction and paranasal computed tomography (CT) findings. MATERIALS AND METHODS: The study cohort consisted of paranasal CT images from 40 patients being treated for unilateral primary nasolacrimal duct obstruction (PANDO) and the reformatted coronal temporal CT images of 71 control subjects who attended the ENT clinic with the complaint of vertigo and tinnitus. A radiologist masked to the clinical situation of participants, investigated the paranasal CT findings of the PANDO and control patients retrospectively. The side, localization, and angle of the septal deviation as well as the thickness and lateralization angle of the inferior turbinate's were recorded. Additionally maxillary and ethmoid sinusitis, concha bullosa, Agger nasi cell formation, and osteomeatal complex status were evaluated. RESULTS: No significant difference was found between the paranasal abnormality incidence in the PANDO and non-PANDO sides of the patients or the control group. Only the side of the septal deviation correlated with the side of the PANDO (p = 0.008). CONCLUSIONS: The incidence of PANDO may not be directly related to paranasal abnormalities. Further large-scale studies should be performed to clarify the relationship between paranasal abnormalities and PANDO.

Examination versus subjective nasal obstruction in the evaluation of the nasal septal deviation.

BACKGROUND: Nasal septal deviation (NSD) is a frequent complaint among patients in an otolaryngology clinic. The prevalence of NSD varies in different populations and NSD classification schemes are complex. METHODS: We aimed to determine the prevalence of NSD in a population of Turkish young males using a new NSD classification method that we developed. We compared the results with patients' complaints. All patients underwent two nasal examinations, which were performed using a nasal speculum with and without administration of vasoconstrictor agents. Inferior Concha Hypertrophy (ICH) was evaluated in the first examination and NSDs were scored during the second examination. All findings were recorded according to our classification scheme. Severity of nasal obstruction was subjectively evaluated by using a visual analogue scale (VAS). RESULTS: We found a significant association between prevalence of NSD and nasal injuries, but there was no association between the mode of delivery and prevalence of NSD. Surprisingly, about 30 % of the participants with NSD had no complaint of nasal obstruction. Although most of the participants in the study had no severe nasal obstruction complaint, we found an association between NSD presence and patient's VAS. CONCLUSION: NSD is very frequent in the Turkish population and most often related to trauma; however, its effect on patient quality of life varies.

Nasal symptoms and clinical findings in adult patients treated for unilateral cleft lip and palate.

The aim of the study was to investigate self-experienced nasal symptoms among adults treated for UCLP and the association to clinical findings, and to evaluate whether palate closure in one-stage or two-stages affected the symptoms or clinical findings. All people with UCLP born between 1960-1987, treated at Uppsala University Hospital, were considered for participation in this cross-sectional population study with long-term follow-up. Eighty-three patients (76% participation rate) participated, a mean of 37 years after the first operation. Fifty-two patients were treated with one-stage palate closure and 31 with two-stage palate closure. An age-matched group of 67 non-cleft controls completed the same study protocol, which included a questionnaire regarding nasal symptoms, nasal inspection, anterior rhinoscopy, and nasal endoscopy. Patients reported a higher frequency of nasal symptoms compared with the control group, e.g., nasal obstruction (81% compared with 60%) and mouth breathing (20% compared with 5%). Patients also rated their nasal symptoms as having a more negative impact on their daily life and physical activities than controls. Nasal examination revealed higher frequencies of nasal deformities among patients. No positive correlation was found between nasal symptoms and severity of findings at nasal examination. No differences were identified between patients treated with one-stage and two-stage palate closure regarding symptoms or nasal findings. Adult patients treated for UCLP suffer from more nasal symptoms than controls. However, symptoms are not associated with findings at clinical nasal examination or method of palate closure.

[Feasibility study of septoplasties and septorhinoplasties in ambulatory surgery]. / Etude de faisabilité des septoplasties et septorhinoplasties en chirurgie ambulatoire.

OBJECTIVES: Feasibility assessment of septoplasty and septorhinoplasty as ambulatory procedures, from analysis of the activity of a university ENT department. METHODS: This is a retrospective analysis over 2 years. The demographic data, the distance between the patient's home and the ENT department, the cause of the septal deviation, the exact kind of surgery, the time of the beginning of the anaesthesia, the duration of the surgery, the postoperative data, the complications and the duration of hospitalization were collected. The operating durations were compared according to the sex, to the cause of the septal deviation, to previous surgery or not and to the kind of surgery performed, using Mann-Whitney's test. The correlations between the age, the operating duration and the time of the beginning of the anaesthesia were estimated using Spearman's test. Then, all the criteria of eligibility for an ambulatory surgical procedure were applied to this population, taking into account or not the distance between the patient's home and the ENT department. A financial analysis was realized on the eligible population, comparing the earnings for a traditional hospitalization with an ambulatory one. RESULTS: 424 patients were included, with an average age of 38 years old. 47 patients had an anaesthetic contraindication for the ambulatory surgery. 226 nasoseptal deviations were congenital (53.3%) and 198 post-traumatic (46.7%). 353 patients had never had a nasoseptal surgery (83.25%). The average time of the beginning of the anaesthesia was 10:55 am. The average durations were 75.8 +/- 32 min for septoplasty versus 127.5 +/- 44 min for the other acts (p < 10-5). There was a strong statistical difference of operating durations between a first surgery and a secondary surgical revision; as well as between a congenital cause and post-traumatic one (p < 10-5). There was an inverse correlation between the age and the operating duration (p < 10-4) and a correlation between the age and the time of the beginning of the anaesthesia (p < 10-5). 23 patients (5.42%) suffered from pains, nausea/vomitings and epistaxis within the 6 postoperative hours, that would have prevented them from going back home. 23 patients (5.42%) presented hematoma, infections, scar disunity, pains and faintness between day 4 and day 8 after surgery. In all, considering a distance shorter then an 1 hour drive from the ENT department, 69 patients (16.3%) were eligible retrospectively for an ambulatory surgery; they would have been 154 (40.8%) in the absence of this criteria. The medico-economic earnings would have been about 39,900 euros for 69 patients, for 2 years. CONCLUSION: 17 to 40% of the patients were potentially eligible for an ambulatory procedure, without endangering them.

What motivates secondary rhinoplasty? A study of 150 consecutive patients.

BACKGROUND: There is little evidence-based information on secondary rhinoplasty patient motivations for surgery, satisfaction, or revision rates. METHODS: The charts of 150 consecutive patients (121 women and 29 men) who underwent secondary rhinoplasty between July of 2007 and October of 2008 were reviewed; preoperative deformity severity was graded from 1 to 5. The patients' primary reasons for surgery, patient and surgeon satisfaction, and postoperative depression or body dysmorphic disorder were tallied. RESULTS: The average number of prior operations was 3.6. The most commonly expressed reason (41 percent) for undergoing revision was the development of a new deformity after the primary rhinoplasty. Those patients also had the most severe preoperative deformities (p < 0.02). Other motivations were failure to correct the original deformity (33 percent), an intolerable perceived loss of personal, familial, or ethnic characteristics (15 percent), the desire for further improvement in an already acceptable result (10 percent), and a new or unrelieved airway obstruction (1 percent). Ninety-seven percent of patients were happy with their outcomes. Forty patients (27 percent) were depressed before surgery and three (2 percent) displayed evidence of body dysmorphic disorder postoperatively. The depressed and dysmorphic patients did not have worse deformities than those who were not depressed postoperatively (p < 0.8695). CONCLUSIONS: Most secondary rhinoplasty patients have motivations similar to those of our other reconstructive patients and will be pleased with their surgical outcomes. The most severe preoperative deformities were iatrogenic. The unhappy postoperative patients, including those with body dysmorphic disorder, did not have more severe preoperative deformities than the others (i.e., their deformities alone did not justify their unhappiness).

Clinical profile of idiopathic epistaxis in a hospital.

INTRODUCTION: Epistaxis is a common otolaryngological emergency but most of the cases are idiopathic. This study was done to assess clinical profile in patients with idiopathic epistaxis. METHODS: Patients presenting in ENT outpatient department or emergency with epistaxis and no definite cause were selected. Patients demographic data, present and past history was recorded. All patients underwent anterior rhinoscopy and rigid nasal endoscopy. RESULTS: There were 142 patients with epistaxis without definite cause. Age ranged from 11 to 84 years with mean 32.8 years. Approximately two-third were male. Bleeding from right side was seen in 64 (45.0%) patients. Past history of bleeding was given by 79 (55.6%) patients and out of them 60 (75.9) % had bleeding from same side. Presentation was mostly in months of January to March. Bleeding point was seen in 65 patients. Most of them (37/65) was in Little's area. Deviated nasal septum was seen in 102 patients. More than half of patients with unilateral bleeding were having bleeding from convex side of deviation. Blood pressure was found to be equal or more than 140/90 mm Hg in 55 (38.7%) patients at the time of presentation. Antihypertensive was required in less than half of these patients. CONCLUSION: Idiopathic epistaxis is common in male, in winter season and in right side and from nasal septum. Hypertension may be found at presentation but most of them don't need antihypertensive.