Concordancia clínico - radiográfica en pacientes sometidos a septoplastia en una clínica especializada. Lima, Perú / Clinical-radiographic concordance in patients undergoing septoplasty in a specialized clinic. Lima, Perú

Introducción y objetivo: En los casos de rinoplastia con desviación septal, el diagnóstico clínico por parte del especialista es parte medular de la conducta a tomar, ya sea clínica o quirúrgica, debido a que la obstrucción nasal que suele ocasionar esta patología es uno de los síntomas más frecuentes, siendo esta la primera indicación de cirugía nasal no estética. El objetivo del presente trabajo es determinar la concordancia entre el diagnóstico clínico y radiográfico en pacientes sometidos a septoplastia en una clínica especializada de Lima, Perú, durante el periodo 2020 - 2021. Material y método: Estudio observacional, cuantitativo, analítico de concordancia retrospectivo. Mediante muestreo no probabilístico por conveniencia, se toman todos los pacientes con diagnóstico clínico de desviación septal y estudios radiográficos intervenidos quirúrgicamente de septoplastia en dicho centro, obteniendo 124 historias clínicas que cumplieron los criterios de inclusión. Se calculó el porcentaje de concordancia entre estas dos métricas y se estimaron las estadísticas kappa de Cohen ponderadas y no ponderadas en todas las muestras y luego por configuración. Resultados: Con una media de 33 años de edad, encontramos que la mayoría eran mujeres (55.28%) sin predilección por el grado de desviación significativa. El diagnóstico clínico que predominó fue grado moderado (54.84%) y el diagnostico radiológico, el severo (49.19%). La gnosología principal fue la congénita (38.8%), seguida de la adquirida (34.7%); aun así, no existe relación significativa entre el sexo y el tipo de desviación encontrada. Encontramos concordancia insignificante entre el diagnóstico clínico y el radiográfico en todas sus formas. Conclusiones: En nuestro estudio, no hubo concordancia entre el diagnóstico clínico y radiológico con respecto al grado o severidad de la desviación septal. (AU)

Background and objective: In cases of rhinoplasty with septal deviation, the clinical diagnosis by the specialist is a core part of the conduct to be taken, whether clinical or surgical, because nasal obstruction, which is usually caused by this pathology, is one of the most frequent symptoms, this being the first indication of non-aesthetic nasal surgery Objective: To determine the concordance between clinical and radiographic diagnosis in patients undergoing septoplasty in a specialized clinic in Lima, Peru, during the period 2020 - 2021. Methods: Observational, quantitative, retrospective, analytical study of concordance. By non-probabilistic sampling by convenience, all patients with clinical diagnosis of septal deviation and radiographic studies who underwent septoplasty surgery in our clinic were considered. A total of 124 medical records were obtained that met the inclusion criteria. The percentage of concordance between these two metrics was calculated, and we estimated weighted and unweighted Cohen's kappa statistics across all samples and then by configuration. Results: With a mean age of 33 years, it was found that the majority were women (55.28%) without a predilection for the degree of significant deviation; the predominant clinical diagnosis was moderate degree (54.84%) and the radiological diagnosis was severe (49.19%). The main gnosology was congenital (38.8%), followed by acquired (34.7%), even so, there is no significant relationship between sex and the type of deviation found. An insignificant concordance was found between clinical and radiographic diagnosis in all its forms. Conclusions: In our study, there was no concordance between clinical and radiological diagnosis with respect to the degree or severity of septal deviation. (AU

Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation / Efeito da septoplastia no desempenho miocárdico ventricular esquerdo em pacientes com desvio de septo nasal

Abstract Introduction: Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. Objective: The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. Methods: This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. Results: Significantly higher left ventricular myocardial performance index (0.52 ± 0.06 vs. 0.41 ± 0.04, p < 0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p < 0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p < 0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p = 0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p = 0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p < 0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p =0.224). Conclusion: Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.

Resumo Introdução: O desvio do septo nasal é a principal causa de obstrução das vias aéreas superiores. A obstrução crônica das vias aéreas superiores pode causar lesão miocárdica devido à hipóxia crônica. Os efeitos da septoplastia nas funções diastólica e sistólica do ventrículo esquerdo não são bem conhecidos. O índice de desempenho miocárdico é um parâmetro confiável e fácil de aplicar que reflete as funções cardíacas sistólica e diastólica. Objetivo: Investigar o efeito da septoplastia nasal no índice de desempenho miocárdico em pacientes com desvio de septo nasal. Método: Este estudo prospectivo consistiu em 50 pacientes consecutivos submetidos a septoplastia devido a desvio de septo nasal significativo sintomático em S ou C. A ecocardiogarfia transtorácica foi feita em todos os pacientes antes e 3 meses após a septoplastia. Os índices de desempenho miocárdico calculados foram comparados. Resultados: Um valor de indice de desempenho miocárdico ventricular esquerdo significantemente maior (0,52 ± 0,06 vs. 0,41 ± 0,04, p < 0,001), tempo mais longo de relaxamento isovolumétrico (95,0 ± 12,5 vs. 78,0 ± 8,6 ms, p < 0,001), tempo mais longo de contração isovolumétrica (45,5 ± 7,8 vs. 39,5 ± 8,6 ms, p < 0,001), tempo de desaceleração mais longo (184,3 ± 32,5 vs. 163,6 ± 45,4 ms, p = 0,004), maior razão de pico de velocidade transmitral precoce e tardia (E / A) (1,42 ± 0,4 vs. 1,16 ± 0,2, p = 0,006) e menor tempo de ejeção (270,1 ± 18,3 vs. 286,5 ± 25,8 ms, p < 0,001) foram observados antes da septoplastia quando comparados aos valores obtidos 3 meses após a septoplastia. A fração de ejeção sistólica do ventrículo esquerdo foi semelhante antes e após a septoplastia (63,8 ± 2,8% vs. 64,6 ± 3,2%, p = 0,224). Conclusão: A cirurgia de septoplastia não apenas reduz os sintomas em pacientes com desvio de septo nasal, mas também pode melhorar o desempenho ventricular esquerdo. Assim, o tratamento precoce do desvio de septo nasal é sugerido para prevenir possíveis eventos cardiovasculares futuros.

Quilting sutures compared with sponge packing in septolplasty and turbinoplasty.

INTRODUCTION: There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications. OBJECTIVE: The purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty. MATERIAL AND METHODS: Seventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients' pain and bleeding on removal of the packing were evaluated. RESULTS: Both techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal. CONCLUSION: The use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty.

Comparación entre una sutura transfixiante y el taponamiento nasal en la septoplastia y turbinoplastia / Quilting sutures compared with sponge packing in septolplasty and turbinoplasty

Introducción: No existe un consenso sobre la necesidad del taponamiento nasal después de una septoplastia. El uso de los taponamientos ha sido propuesto con el fin de reducir las hemorragias, sinequias o hematomas después de este procedimiento. A pesar de estas ventajas la evidencia del uso de un taponamiento nasal es baja. Adicionalmente este procedimiento no es agradable para el paciente y puede tener complicaciones.ObjetivoEl propósito de este estudio es investigar la eficacia de la sutura transfixiante o transeptal comparada con el taponamiento nasal. Analizar el control de la epistaxis, hematomas y sinequias después de una septoplastia.Material y métodosSetenta y seis pacientes con indicación de septoplastia y turbinoplastia con radiofrecuencia fueron incluidos en el estudio. Pseudoaleatoriamente se utilizó una sutura transfixiante en 50 pacientes y taponamiento nasal en 26 pacientes después de la cirugía. En los 2 grupos se comparó el porcentaje de epistaxis, hematomas y sinequias. Además, el dolor y la epistaxis de los pacientes al retirar el taponamiento nasal.ResultadosTanto la sutura transfixiante como el taponamiento nasal tienen resultados similares en cuanto al control de las epistaxis, sinequias y hematomas después de la septoplastia con radiofrecuencia de cornetes. Los pacientes con taponamiento nasal presentaron dolor y epistaxis autolimitada en el momento de retirar el taponamiento nasal.ConclusiónEl uso de la sutura transfixiante después de una septoplastia y turbinoplastia con radiofrecuencia es igual de eficaz que el taponamiento nasal para el control de epistaxis, sinequias y hematomas. (AU)

Introduction: There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications.ObjectiveThe purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty.Material and methodsSeventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients’ pain and bleeding on removal of the packing were evaluated.ResultsBoth techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal.ConclusionThe use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty. (AU)

The effects of intraday operation time on pain and anxiety of patients undergoing septoplasty / Os efeitos do tempo de cirurgia intradia na dor e ansiedade de pacientes submetidos à septoplastia

Abstract Introduction Anxiety and pain levels of septoplasty patients may vary according to intraday operation time. Objective To investigate the effects of septoplasty operation and intraday operation time on anxiety and postoperative pain. Methods Ninety-eight voluntary patients filled out the hospital anxiety and depression scale to measure the anxiety level three weeks before, one hour before and one week after surgery. Forty-nine patients were operated at 8:00 am (morning group); other 49 were operated at 03:00 pm (afternoon group). We used a visual analogue scale to measure postoperative pain. Preoperative and postoperative scores were compared, as were the scores of the groups. Results Median hospital anxiety and depression scale scores one hour before the operation [6 (2-10)] were significantly higher compared to the median scores three weeks before the operation [3 (1-6)] (p < 0.001), and one week after the operation [2 (1-6)] were significantly lower compared to the median scores three weeks before the operation [3 (1-6)] (p < 0.001). Hospital anxiety and depression scale scores one hour before the operation were significantly greater in the afternoon group [8 (7-10)], compared to the morning group [4 (2-6)] (p < 0.001). Postoperative first, sixth, twelfth and twenty-fourth-hour pain visual analogue scale scores were significantly higher in the afternoon group compared to the morning group (p < 0.001). Conclusion Septoplasty might have an increasing effect on short-term anxiety and postoperative pain. Performing this operation at a late hour in the day might further increase anxiety and pain. However, the latter has no long-term effect on anxiety.

Resumo Introdução Os níveis de ansiedade e dor em pacientes submetidos à septoplastia podem variar de acordo com o tempo de cirurgia intradia. Objetivo Investigar os efeitos da cirurgia de septoplastia e do tempo de cirurgia intradia na ansiedade e dor pós-operatória. Métodos Noventa e oito pacientes voluntários preencheram a Hospital Anxiety and Depression Scale (HADS) para medir o nível de ansiedade três semanas antes, uma hora antes e uma semana após a cirurgia. Quarenta e nove pacientes foram operados às 8h (grupo da manhã) e 49 foram operados às 15h (grupo da tarde). Usamos a Escala Visual Analógica para medir a dor pós-operatória. Os escores pré e pós-operatórios foram comparados, assim como os escores dos grupos. Resultados As medianas dos escores da HADS uma hora antes da operação [6 (2-10)] foram significativamente mais altas em comparação com as medianas dos escores da HADS três semanas antes da operação [3 (1-6)] (p < 0,001) e as medianas dos escores da HADS uma semana após a operação [2 (1-6)] foram significativamente mais baixas em comparação com as medianas dos escores três semanas antes da operação [3 (1-6)] (p < 0,001). Os escores da HADS uma hora antes da operação foram significativamente mais altos no grupo da tarde [8 (7-10)], em comparação ao grupo da manhã [4 (2-6)] (p < 0,001). Os escores da EVA para dor na primeira, sexta, 12ª segunda e 24ª hora do pós-operatório foram significativamente mais altos no grupo da tarde em comparação com o grupo da manhã (p < 0,001). Conclusão A septoplastia pode ter um efeito crescente sobre a ansiedade em curto prazo e na dor pós-operatória e a feitura dessa cirurgia em hora mais tardia pode aumentar ainda mais a ansiedade e a dor. No entanto, isso não tem efeito em longo prazo na ansiedade.

Early clinical outcomes of ınferior turbinate radiofrequency and lateralization combined with septoplasty / Resultados clínicos iniciais da utilização de radiofrequência e lateralização das conchas nasais inferiores combinadas à septoplastia

Abstract Introduction: Mechanical obstruction is the most common form of nasal obstruction. Among the types of mechanical obstructions, septum deviation and inferior turbinate hypertrophy are the most prevalent. Objective: This study evaluated the early clinical outcomes of inferior turbinate radiofrequency and inferior turbinate lateralization combined with septoplasty in the treatment of nasal obstruction symptoms. Methods: The research retrospectively evaluated data from 33 patients (24 male, nine female) undergoing septoplasty and inferior turbinate radiofrequency (RF group) and 32 patients (24 male, eight female) treated with septoplasty and inferior turbinate lateralization (LAT group), who were admitted, with complaints of nasal obstruction, to the University of Health Sciences, Department of Otorhinolaryngology, between January 1, 2017 and January 1, 2018. The patients' preoperative and 6-month postoperative symptoms were evaluated via the Nasal Obstruction Symptom Evaluation, the NOSE scale. Results: The mean preoperative NOSE scores were 10.3 ± 4.2 in the RF group and 10.9 ± 4.9 in the LAT group, and the mean six-month postoperative scores were 1.09 ± 1.3 in the RF group and 1.2 ± 1.3 in the LAT group. There was no significant difference in NOSE scores between the two groups (p > 0.05). Conclusion: The data obtained in this study show that both methods result in similar outcomes in terms of relieving nasal obstruction symptoms in patients requiring inferior turbinate intervention. Therefore, the researchers believe that, in each case, the intervention method should be selected at the discretion of the patient and surgeon(s).

Resumo Introdução: A obstrução mecânica é a forma mais comum de obstrução nasal. Entre os tipos de obstruções mecânicas, o desvio do septo e a hipertrofia de conchas inferiores são os mais prevalentes. Objetivo: Avaliar os resultados clínicos iniciais da aplicação de radiofrequência nas conchas inferiores e a lateralização delas combinada com septoplastia no tratamento dos sintomas de obstrução nasal. Método: O estudo avaliou retrospectivamente dados de 33 pacientes (24 homens, nove mulheres) que foram submetidos a septoplastia e aplicação de radiofrequência no concha inferior (grupo RF) e 32 pacientes (24 homens, oito mulheres) submetidos a septoplastia e lateralização de concha inferior (grupo LAT), que foram admitidos com queixas de obstrução nasal na University of Health Sciences, Departamento de Otorrinolaringologia, entre 1° de janeiro de 2017 e 1° de janeiro de 2018. Os sintomas pré-operatórios e pós-operatórios de 6 meses dos pacientes foram avaliados pela escala NOSE, do inglês Nasal Obstruction Symptom Evaluation. Resultados: Os escores médios pré-operatórios da escala NOSE foram 10,3 ± 4,2 no grupo RF e 10,9 ± 4,9 no grupo LAT e os escores médios pós-operatórios de seis meses foram 1,09 ± 1,3 no grupo RF e 1,2 ± 1,3 no grupo LAT. Não houve diferença significante nos escores da escala NOSE entre os dois grupos (p > 0,05). Conclusão: Os dados obtidos neste estudo mostram que ambos os métodos têm resultados semelhantes em termos de alívio dos sintomas de obstrução nasal em pacientes que necessitam de intervenção nas conchas inferiores. Portanto, os pesquisadores acreditam que, em cada caso, o método de intervenção deve ser selecionado a critério do paciente e do cirurgião.

Quilting sutures compared with sponge packing in septolplasty and turbinoplasty. / Comparación entre una sutura transfixiante y el taponamiento nasal en la septoplastia y turbinoplastia.

INTRODUCTION: There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications. OBJECTIVE: The purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty. MATERIAL AND METHODS: Seventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients' pain and bleeding on removal of the packing were evaluated. RESULTS: Both techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal. CONCLUSION: The use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty.

Síndrome de Tapia posterior a cirugía nasal

Resumen El síndrome de Tapia es una complicación poco frecuente secundaria a la manipulación de la vía aérea. Se caracteriza por haber una lesión concomitante de los pareas craneales X (nervio vago) y XII (nervio hipogloso), usualmente por compresión o sobredistensión de estos. Inicialmente puede hacernos sospechar una lesión central, al haber compromiso de dos nervios craneales bajos en forma simultánea, pero la gran mayoría de los casos descritos son lesiones periféricas. De los procedimientos asociados a esta complicación, los que lideran en frecuencia son los de cabeza y cuello, por lo que es de gran importancia tenerlo en conocimiento en el desarrollo de nuestra práctica clínica. Nuestro paciente presentó esta complicación tras una septoplastía con turbinectomía sin complicaciones en el sitio operatorio, ni anestésicas. Se manejó con fonoaudiología y corticoides orales, con recuperación completa a los cuatro meses de posoperatorio.

Abstract Tapia's Syndrome is a rare complication secondary to airway manipulation. It is characterized by a concurrent lesion of cranial nerve pairs X (vagus nerve) and XII (hypoglossal nerve), usually attributed to compression or stretching of these nerves. Initially, it may lead us to suspect a central lesion, as there is simultaneous involvement of two low cranial nerves, but the vast majority of cases described are peripheral lesions. The procedures most frequently associated with this complication are head and neck surgery, which is why it is very important to bear this in mind in the development of our clinical practice. Our patient showed Tapia's syndrome following septoplasty with turbinectomy without complications in the operative site nor under anesthesia. He was treated with phoniatric and oral corticoids, recovering completely four months after surgery.

Rinoplastía y rinoseptoplastía funcional: mejorando la función nasal más allá de la cirugía del tabique y los cornetes nasales / Functional rhinoplasty and septorhinoplasty: improving nasal function beyond septal and turbinate surgery

Resumen La obstrucción nasal es una de las causas más frecuentes de consulta otorrinolaringológica general. Diversas estructuras juegan un rol en la mantención de una adecuada función respiratoria nasal, incluyendo el tabique, los cornetes, las paredes laterales y las alas nasales. La cirugía del tabique y de los cornetes inferiores son los procedimientos más comúnmente realizados y aunque son efectivos en un gran porcentaje de los casos, en ocasiones se deben intervenir otras estructuras nasales para corregir adecuadamente la obstrucción. La cirugía con fines primariamente funcionales de las válvulas nasales externa e interna, de la punta y/o de la pirámide ósea se ha denominado "rinoplastía funcional". Dada la importancia de estas estructuras para la recuperación de una adecuada permeabilidad nasal estática y dinámica, el diagnóstico y manejo quirúrgico de estas condiciones debe ser de dominio del otorrinolaringólogo.

Abstract Nasal obstruction is one of the most frequent complaints in general otorhinolaryngology practice. Different structures have a role in maintaining an adequate nasal breathing function, including the septum, turbinates, lateral sidewalls and nasal alae. Surgery of the nasal septum and inferior turbinates are the most commonly performed procedures and, although effective in most cases, occasionally other nasal structures must be intervened to correctly address the sites of obstruction. The term "functional rhinoplasty" has been coined for surgery of the external and internal nasal valves, nasal tip and/or bony pyramid, with primarily functional objectives. Given the importance of these structures for restoring an adequate static and dynamic nasal patency, diagnosis and management of these conditions must be dominion of the otorhinolaryngologist.

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal / A influência do extrato de folha de hera seca na secreção nasal após remoção de tampão nasal pós-septoplastia

Abstract Introduction: After post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections. Objective: The aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections. Methods: The study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination. Results: The group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients' assessment (p < 0.001) and by nasal endoscopic examination (p = 0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required. Conclusion: The use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.

Resumo Introdução: Após a remoção do tampão nasal pós-septoplastia, ocorre produção de secreção nasal, predispondo infecções locais e, por vezes, sistêmicas. Objetivo: O objetivo foi determinar se a aplicação do extrato padronizado de folhas de hera seca após a remoção do tampão nasal influencia a redução da secreção nasal e diminui a ocorrência de infecções locais. Método: O estudo incluiu 70 pacientes pós-septoplastia (divididos em dois grupos iguais) cujo tampão nasal foi retirado no terceiro dia após o procedimento. O grupo I foi tratado com xarope padronizado de extrato de folha seca de hera juntamente com irrigação nasal regular por cinco dias após a remoção do tamponamento nasal, enquanto ao grupo II foi recomendado apenas lavagem nasal. No sexto dia após a remoção do tampão nasal, a quantidade de secreção nasal foi determinada pela escala EVA (escala visual analógica) e pelo exame endoscópico nasal. Resultados: O grupo tratado com xarope de extrato seco de folhas de hera apresentou secreção nasal significativamente menor tanto pela avaliação subjetiva dos pacientes (p < 0,001) quanto pelo exame endoscópico nasal (p = 0,003). O exame de acompanhamento pós-cirúrgico no sexto dia após a remoção do tampão nasal não mostrou desenvolvimento de infecção local nos pacientes do grupo I, enquanto que no grupo II, cinco apresentaram sinais de infecção local (14,29%) com necessidade de antibioticoterapia. Conclusão: O uso do extrato padronizado de folhas secas de hera após a remoção do tampão nasal reduz significativamente a produção de secreção nasal.

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal.

INTRODUCTION: After post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections. OBJECTIVE: The aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections. METHODS: The study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination. RESULTS: The group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients' assessment (p<0.001) and by nasal endoscopic examination (p=0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required. CONCLUSION: The use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.

The effect of different nasal irrigation solutions following septoplasty and concha radiofrequency: a prospective randomized study / Efeito de diferentes soluções para irrigação nasal após septoplastia e radiofrequência das conchas nasais: estudo prospectivo e randomizado

Abstract Introduction Nasal irrigation solutions are widely used following endonasal surgery. These irrigation solutions remove infective debris and crusts, reducing the probability of synechia formation, and accelerate mucosal healing. Objective The aim of the present study was to compare the effects of nasal irrigation solutions with different contents following septoplasty and concha radiofrequency. Methods The present study was a prospective, randomized, controlled simple blind study of 120 patients who underwent septoplasty and bilateral concha radiofrequency. Patients were divided into four groups according to the nasal irrigation solution used: tap water, buffered isotonic saline, saline with xylitol, and hypertonic sea water. Patients were examined on the 7th and 15th postoperative days. A saccharine test was applied to determine mucociliary activity preoperatively and on the 7th and 15th postoperative days. Patients were asked about drying and obstruction using a 10 cm visual analog scale. In addition, patients were examined to determine the crusting score. Results There was no significant difference found in the preoperative and 7th and 15th postoperative days' mucociliary clearance times among the four groups. The crusting score was found to be significantly lower in the hypertonic sea water group (p < 0.001). Drying and obstruction on the 7th and 15th postoperative days were found to be significantly more comfortable in the hypertonic sea water group (p < 0.001). Conclusion Hypertonic sea water is the recommended irrigation solution, as it is associated with less crusting, drying, and obstruction in the nose for the postoperative period following septoplasty and concha radiofrequency.

Resumo Introdução Soluções para irrigação nasal são amplamente usadas após cirurgias endonasais. Essas soluções removem os resíduos e crostas, reduzem a probabilidade de formação de sinéquias e aceleram a cicatrização da mucosa. Objetivo O objetivo do presente estudo foi comparar os efeitos das soluçoes para irrigaçao nasal com diferentes conteudos apos septoplastia e turbinoplastia com radiofrequencia. Método O presente estudo foi um estudo cego simples, randomizado, controlado e prospectivo de 120 pacientes submetidos a septoplastia e turbinoplastia bilateral com radiofrequencia. Os pacientes foram divididos em quatro grupos de acordo com a soluçao nasal utilizada: agua da torneira, soluçao salina isotonica tamponada, soluçao salina com xilitol e agua do mar hipertonica. Os pacientes foram examinados no 7° e 15° dias do pos-operatorio. O teste de sacarina foi utilizado para determinar a atividade mucociliar pre-operatoria e no 7° e 15° dias do pos-operatorio. Os pacientes foram questionados sobre a sensaçao de secura e obstruçao nasais utilizando uma escala visual analógica de 10 cm. Alem disso, os pacientes foram examinados para determinar o escore em relaçao a crostas. Resultados Não houve diferença significativa entre o pré-operatório e o sétimo e 15° dias do pós-operatório dos tempos de clearance mucociliar entre os quatro grupos. Verificou-se que o escore em relação a crostas foi significativamente menor no grupo que usou água do mar hipertônica (p < 0,001). As sensações de secura e obstrução nasais no sétimo e 15° dias do pós-operatório mostraram-se significativamente mais confortáveis no grupo água do mar hipertônica (p < 0,001). Conclusão A água de mar hipertônica é a solução de irrigação recomendada, pois está associada a menor incidência de crostas, secura e obstrução nasais no pós-operatório de cirurgia de septoplastia e das conchas nasais com radiofrequência.

The seroprevalence of hepatitis B, hepatitis C, and human immunodeficiency virus in patients undergoing septoplasty / Soroprevalência de hepatite B, hepatite C e vírus da imunodeficiência humana em pacientes submetidos a septoplastia

Abstract Introduction Worldwide, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus are major health problems. Healthcare workers are at risk of transmitting blood-borne viruses, and surgeons have a higher risk of exposure to blood and higher rates of percutaneous injury than other healthcare workers. Septoplasty is among the 3 most commonly performed otolaryngological surgeries worldwide. Objective To determine the seroprevalence of Hepatitis B surface antigen, Hepatitis C virus antibody, and Human Immunodeficiency Virus antibody in patients undergoing septoplasty with and without turbinate surgery under general anesthesia, and to determine if preoperative testing should be performed in such patients. Methods This retrospective cross-sectional study included 3731 patients that underwent septoplasty with and without turbinate surgery between January 2005 and July 2015. HBsAg, anti-HCV, and anti-HIV seropositivity in the patients was evaluated retrospectively. Results Mean age of the patients was 36 years (range: 11-81 years). In all, 117 (3.6%) patients were positive for HBsAg, 12 (0.3%) were positive for anti-HCV, and 7 (0.2%) were positive for anti-HIV. Conclusions Education of healthcare workers combined with routine preoperative serological testing in patients undergoing septoplasty under general and local anesthesia are needed to increase awareness of hepatitis B and C, and HIV infection among healthcare workers and patients in order to decrease the transmission rate.

Resumo Introdução No mundo todo, os vírus da hepatite B (VHB), da hepatite C (VHC) e da imunodeficiência humana (HIV) são problemas de saúde importantes. Os profissionais de saúde correm o risco de contrair vírus transmitidos pelo sangue e os cirurgiões têm um maior risco de exposição ao sangue e taxas mais elevadas de lesões percutâneas do que os outros profissionais de saúde. A septoplastia está entre as três cirurgias otorrinolaringológicas mais comumente feitas em todo o mundo. Objetivo Determinar a soroprevalência de anticorpos HBsAg, anti-HCV e anti-HIV em pacientes submetidos a septoplastia com e sem cirurgia de concha nasal sob anestesia geral e determinar se deve ser feito teste pré-operatório nesses pacientes. Método Este estudo transversal retrospectivo incluiu 3.731 pacientes submetidos à septoplastia com e sem cirurgia de concha nasal entre janeiro de 2005 e julho de 2015. A soropositividade para HBsAg, anti-HCV e anti-HIV nos pacientes foi avaliada retrospectivamente. Resultados A idade média dos pacientes foi de 36 anos (intervalo: 11-81); 117 (3,6%) foram positivos para HBsAg, 12 (0,3%) para anti-HCV e sete (0,2%) para anti-HIV. Conclusões A educação de profissionais de saúde combinada com testes sorológicos rotineiros pré-operatórios em pacientes submetidos a septoplastia sob anestesia geral e local é necessária para aumentar a conscientização sobre a hepatite B e C e a infecção pelo HIV entre profissionais de saúde e pacientes para diminuir a taxa de transmissão.

Virtual surgery for patients with nasal obstruction: Use of computational fluid dynamics (MeComLand®, Digbody® & Noseland®) to document objective flow parameters and optimise surgical results. / Cirugía virtual para pacientes con obstrucción nasal: empleo de un software basado en dinámica de fluidos (MeComLand®, Digbody® & Noseland®) para documentar parámetros objetivos de flujo y optimizar resultados quirúrgicos.

INTRODUCTION: Computational fluid dynamics (CFD) is a mathematical tool to analyse airflow. We present a novel CFD software package to improve results following nasal surgery for obstruction. METHODS: A group of engineers in collaboration with otolaryngologists have developed a very intuitive CFD software package called MeComLand®, which uses the patient's cross-sectional (tomographic) images, thus showing in detail results originated by CFD such as airflow distributions, velocity profiles, pressure, or wall shear stress. NOSELAND® helps medical evaluation with dynamic reports by using a 3D endoscopic view. Using this CFD-based software a patient underwent virtual surgery (septoplasty, turbinoplasty, spreader grafts, lateral crural J-flap and combinations) to choose the best improvement in nasal flow. OBJECTIVE: To present a novel software package to improve nasal surgery results. To apply the software on CT slices from a patient affected by septal deviation. To evaluate several surgical procedures (septoplasty, turbinectomy, spreader-grafts, J-flap and combination among them) to find the best alternative with less morbidity. RESULTS: The combination of all the procedures does not provide the best nasal flow improvement. Septoplasty plus turbinoplasty obtained the best results. Turbinoplasty alone rendered almost similar results to septoplasty in our simulation. CONCLUSIONS: CFD provides useful complementary information to cover diagnosis, prognosis, and follow-up of nasal pathologies based on quantitative magnitudes linked to fluid flow. MeComLand®, DigBody® and NoseLand® represent a non-invasive, low-cost alternative for the functional study of patients with nasal obstruction.

The effect of different nasal irrigation solutions following septoplasty and concha radiofrequency: a prospective randomized study.

INTRODUCTION: Nasal irrigation solutions are widely used following endonasal surgery. These irrigation solutions remove infective debris and crusts, reducing the probability of synechia formation, and accelerate mucosal healing. OBJECTIVE: The aim of the present study was to compare the effects of nasal irrigation solutions with different contents following septoplasty and concha radiofrequency. METHODS: The present study was a prospective, randomized, controlled simple blind study of 120 patients who underwent septoplasty and bilateral concha radiofrequency. Patients were divided into four groups according to the nasal irrigation solution used: tap water, buffered isotonic saline, saline with xylitol, and hypertonic sea water. Patients were examined on the 7th and 15th postoperative days. A saccharine test was applied to determine mucociliary activity preoperatively and on the 7th and 15th postoperative days. Patients were asked about drying and obstruction using a 10cm visual analog scale. In addition, patients were examined to determine the crusting score. RESULTS: There was no significant difference found in the preoperative and 7th and 15th postoperative days' mucociliary clearance times among the four groups. The crusting score was found to be significantly lower in the hypertonic sea water group (p<0.001). Drying and obstruction on the 7th and 15th postoperative days were found to be significantly more comfortable in the hypertonic sea water group (p<0.001). CONCLUSION: Hypertonic sea water is the recommended irrigation solution, as it is associated with less crusting, drying, and obstruction in the nose for the postoperative period following septoplasty and concha radiofrequency.

Rhinoseptoplasty in children / Rinosseptoplastia em crianças

Abstract Introduction: Untreated septal and/or nasal pyramid deviation in children should be corrected as soon as possible, because they can result in esthetic or functional problems years later. Objective: To report the surgical experience in treating children with nasal septum and/or nasal pyramid deviation. Methods: Review of medical records of 202 children, 124 (61.4%) males and 78 (38.6%) females, between 4 and 16 years of age (M = 11 years) who underwent rhinoplasty and/or septoplasty in a Pediatric Otolaryngology Service of the Dept. of Otolaryngology and Head and Neck Surgery between January 1994 and January 2010. Results: Septoplasty performed in 157 cases (77.7%); rhinoseptoplasty in 23 cases (11.4%), and rhinoplasty in 22 cases (10.9%). Conclusion: Nasal changes should be corrected in children, in order to provide harmonious growth, and prevent severe sequelae found in mouth breathers.

Resumo Introdução: Desvio do septo e/ou da pirâmide nasal em crianças, se não tratado, pode apresentar problemas estéticos ou funcionais após anos, devendo ser corrigido o quanto antes. Objetivo: Relatar experiência cirúrgica no tratamento de crianças com desvio de septo nasal e/ou pirâmide nasal. Método: Revisão de prontuários de 202 crianças, 124 (61,4%) do gênero masculino e 78 (38,6%) do feminino, entre quatro e 16 anos (M = 11 anos), submetidas a rino e/ou septoplastia de janeiro de 1994 a janeiro de 2010, no Serviço de Otorrinopediatria do Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço. Resultados: Septoplastia feita em 157 casos (77,7%); rinosseptoplastia em 23 casos (11,4%) e rinoplastia em 22 casos (10,9%). Conclusão: Alterações nasais devem ser corrigidas em crianças, para proporcionar crescimento harmônico e evitar as graves sequelas encontradas no respirador bucal.

Rhinoseptoplasty in children.

INTRODUCTION: Untreated septal and/or nasal pyramid deviation in children should be corrected as soon as possible, because they can result in esthetic or functional problems years later. OBJECTIVE: To report the surgical experience in treating children with nasal septum and/or nasal pyramid deviation. METHODS: Review of medical records of 202 children, 124 (61.4%) males and 78 (38.6%) females, between 4 and 16 years of age (M=11 years) who underwent rhinoplasty and/or septoplasty in a Pediatric Otolaryngology Service of the Dept. of Otolaryngology and Head and Neck Surgery between January 1994 and January 2010. RESULTS: Septoplasty performed in 157 cases (77.7%); rhinoseptoplasty in 23 cases (11.4%), and rhinoplasty in 22 cases (10.9%). CONCLUSION: Nasal changes should be corrected in children, in order to provide harmonious growth, and prevent severe sequelae found in mouth breathers.

Assessment of nasal obstruction with rhinomanometry and subjective scales and outcomes of surgical and medical treatment. / Evaluación de la obstrucción nasal mediante rinomanometría y escalas subjetivas y medición del éxito terapéutico médico y quirúrgico.

INTRODUCTION: Prospective study of patients with nasal obstruction (NO) in order to measure therapeutic success by anterior active rhinomanometry (AAR), Nasal Obstruction Symptom Evaluation (NOSE) scale and Visual Analogue Scale (VAS) and to establish the correlation between these tests. METHODS: Patients with NO, on whom we performed an AAR, NOSE and VAS scales at baseline and after medical treatment (topical nasal steroid) or surgery (septoplasty, turbinoplasty or septoplasty and turbinoplasty). The nasal flow obtained by the AAR and the score of both subjective scales (NOSE and VAS) were compared and analyzed. RESULTS: A total of 102 patients were included in the study. Surgical treatment resulted in statistically significant differences with the AAR and the subjective scales. While in patients with medical treatment there was an increase in the AAR nasal flow but without statistical significance (P=.1363). The correlation between the AAR, the NOSE and VAS scales was measured finding a strong correlation between the NOSE and VAS scales only (r=.83327). CONCLUSIONS: The patients with NO treated surgically have better results when these are evaluated by AAR or with subjective scales. There is no significant correlation between AAR, NOSE and VAS scales, this is considered to be because the AAR and subjective scales are complementary and measure different aspects of NO. The AAR and subjective scales are useful tools to be used together for the follow up of patients with NO.

Fertilidad posterior a la septoplastia histeroscópica de consultorio. Una propuesta de clasificación del septo uterino / Fertility after hysteroscopic septoplasty surgery. A proposed classification for the septum uterine

Resumen ANTECEDENTES: Las malformaciones müllerianas son anomalías del desarrollo de los genitales internos femeninos. La incidencia mundial es de 0.16 a 10%. La más común es el útero septado, consecuencia de una falla en la reabsorción del tabique útero-vaginal. OBJETIVO: Evaluar, en la población estudiada, la repercusión de la septoplastia histeroscópica en la fertilidad de mujeres con útero septado. MATERIALES Y MÉTODOS: Estudio abierto, observacional, retrospectivo y transversal de pacientes de la Clínica de Histeroscopia del Hospital General Dr. Manuel Gea González, con diagnóstico de infertilidad establecido con auxilio de la técnica de acceso por vaginoscopia, según Betocchi, siguiendo el concepto de "ver y tratar". RESULTADOS: Se revisaron 508 expedientes y de estos se seleccionaron 313 de pacientes a quienes se practicó histeroscopia diagnóstica de las que 32 resultaron con septo uterino. Se efectuaron 27 septoplastias histeroscópicas en consultorio y 5 programadas en quirófano. En 27 (84.3%) se logró el embarazo y de éstos 5 mediante fertilización asistida; hubo 8 nacimientos prematuros y 17 a término y 2 abortos diferidos. CONCLUSIÓN: Hoy día la septoplastia histeroscópica es la alternativa de tratamiento del septo uterino debido a su facilidad de realización en el consultorio por personal adiestrado, baja morbilidad, menores costos, rápida recuperación y excelente resultado reproductivo. Se propone una clasificación de acuerdo con el componente del septo.

Abstract BACKGROUND: Müllerian malformations are defined as anomalies development of female internal genitalia. Its incidence worldwide is 0.16% to 10%. The most common of these is the septate uterus which is due to a failure in the reabsorption of uterovaginal septum. OBJECTIVE: To evaluate the impact on fertility hysteroscopic septoplasty in women with uterine septum. MATERIAL AND METHODS: This is an open, observational, retrospective and cross-sectional study. 508 cases of which 313 patients underwent diagnostic office hysteroscopy hysteroscopy clinic were reviewed Hospital General Dr. Manuel Gea González, diagnosed with infertility, you access using the technique vaginoscopic according Betocchi, following the concept of" see and treat ", proceed to perform septoplasty with bipolar energy at that moment. RESULTS: 32 patients were diagnosed with uterine septum. 27 hysteroscopic septoplasty were performed in office and five scheduled in the operating room. 27 of them achieving pregnancy (84.38%) spontaneously regarding perinatal outcomes of those 27 patients who achieved pregnancy 2 had missed abortion, premature 8 were 17 were concluded; 5 required assisted fertilization. CONCLUSION: The hysteroscopic septoplasty is now recommended for the treatment of uterine septum due to ease of performance by trained personnel, low morbidity, the feasibility of its implementation in practice, reduced cost, speedy recovery of patients and excellent reproductive outcome alternative. Classification according to the component of the septum is proposed.

The seroprevalence of hepatitis B, hepatitis C, and human immunodeficiency virus in patients undergoing septoplasty.

INTRODUCTION: Worldwide, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus are major health problems. Healthcare workers are at risk of transmitting blood-borne viruses, and surgeons have a higher risk of exposure to blood and higher rates of percutaneous injury than other healthcare workers. Septoplasty is among the 3 most commonly performed otolaryngological surgeries worldwide. OBJECTIVE: To determine the seroprevalence of Hepatitis B surface antigen, Hepatitis C virus antibody, and Human Immunodeficiency Virus antibody in patients undergoing septoplasty with and without turbinate surgery under general anesthesia, and to determine if preoperative testing should be performed in such patients. METHODS: This retrospective cross-sectional study included 3731 patients that underwent septoplasty with and without turbinate surgery between January 2005 and July 2015. HBsAg, anti-HCV, and anti-HIV seropositivity in the patients was evaluated retrospectively. RESULTS: Mean age of the patients was 36 years (range: 11-81 years). In all, 117 (3.6%) patients were positive for HBsAg, 12 (0.3%) were positive for anti-HCV, and 7 (0.2%) were positive for anti-HIV. CONCLUSIONS: Education of healthcare workers combined with routine preoperative serological testing in patients undergoing septoplasty under general and local anesthesia are needed to increase awareness of hepatitis B and C, and HIV infection among healthcare workers and patients in order to decrease the transmission rate.