Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7.

INTRODUCTION: The influence of isolated nasal septum deviation (NSD) in the Eustachian Tube (ET) function is still undetermined. OBJECTIVE: compare ET function between patients with severe NSD and patients with adequate nasal patency in terms of symptomology and objective exams and assess the impact of septoplasty in ET function in patients with severe NSD. METHODS AND METHODOLOGY: a prospective study was conducted. In the first phase of the study, two opportunistic samples were selected: 35 patients with severe NSD for group A and 35 patients with adequate nasal patency for group B. Both groups were evaluated through Nasal obstruction Subjective Questionnaire (NOSE) and ET dysfunction questionnaire 7 (ETDQ7) -, and through two objective exams to assess ET function - tympanometry, and tubomanometry (TMM); results were compared between group A and B. In the second phase of the study, the patients from group A underwent septoplasty and were re-evaluated through ETDQ7, tympanometry and TMM; results were compared before and after surgery. RESULTS: we found a statistically significant difference between patients with NSD and patients with adequate nasal patency in NOSE and ETDQ7 (higher scores in the latter), and TMM (worse results in patients with NSD); the difference in tympanometry was not statistically significant. The side of the NSD did not correlate with the side of the dysfunction. After septoplasty, patients from group A had statistically significant lower scores in ETDQ7 and a lower proportion of patients with findings compatible with ET dysfunction using TMM. CONCLUSION: according to our results, severe NSD alone is a cause of ET dysfunction; septal surgery might improve ET function in these patients.

Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7.

INTRODUCTION: The influence of isolated nasal septum deviation (NSD) in the Eustachian Tube (ET) function is still undetermined. OBJECTIVE: compare ET function between patients with severe NSD and patients with adequate nasal patency in terms of symptomology and objective exams and assess the impact of septoplasty in ET function in patients with severe NSD. METHODS AND METHODOLOGY: a prospective study was conducted. In the first phase of the study, two opportunistic samples were selected: 35 patients with severe NSD for group A and 35 patients with adequate nasal patency for group B. Both groups were evaluated through Nasal obstruction Subjective Questionnaire (NOSE) and ET dysfunction questionnaire 7 (ETDQ7) -, and through two objective exams to assess ET function - tympanometry, and tubomanometry (TMM); results were compared between group A and B. In the second phase of the study, the patients from group A underwent septoplasty and were re-evaluated through ETDQ7, tympanometry and TMM; results were compared before and after surgery. RESULTS: we found a statistically significant difference between patients with NSD and patients with adequate nasal patency in NOSE and ETDQ7 (higher scores in the latter), and TMM (worse results in patients with NSD); the difference in tympanometry was not statistically significant. The side of the NSD did not correlate with the side of the dysfunction. After septoplasty, patients from group A had statistically significant lower scores in ETDQ7 and a lower proportion of patients with findings compatible with ET dysfunction using TMM. CONCLUSION: according to our results, severe NSD alone is a cause of ET dysfunction; septal surgery might improve ET function in these patients.

Evaluation of choroidal thickness measurements in patients with marked nasal septal deviation.

INTRODUCTION: Chronic upper airway obstruction due to marked nasal septal deviation may cause chronic hypoxia. It may change the balance of the sympathetic-parasympathetic system and may affect blood flow in the choroid. OBJECTIVE: To assess choroidal thickness measurements of patients with marked nasal septal deviation. METHODS: The patients who had nasal obstruction symptoms diagnosed with marked nasal septal deviation by anterior rhinoscopy and nasal endoscopy and scheduled for septoplasty were included in the study. The control group consisted of age, sex and body mass index-matched healthy individuals. The choroidal measurements at the central fovea and 1000µm away from the fovea in the nasal and temporal regions were performed using enhanced depth imaging optical coherence tomography. RESULTS: In the study group, 52 eyes of 26 patients with a mean age of 26.34±8.14 years were examined. In the control group, 52 eyes of 28 healthy individuals with a mean age of 26.69±7.84 years were examined. There was no statistically significant difference in terms of choroidal thickness measurements between the groups (p>0.05). CONCLUSION: Our results suggest that marked nasal septal deviation may not lead to significant hypoxia and sympathetic activation, resulting in deterioration of the choroidal blood flow and consequent choroidal thickening.

Breaking paradigms in severe epistaxis: the importance of looking for the S-point.

INTRODUCTION: Since the introduction of nasal endoscopy into the field of Otorhinolaryngology, the treatment paradigm for cases of severe epistaxis has shifted toward early and precise identification of the bleeding site. Although severe epistaxis is usually considered to arise from posterior bleeding, an arterial vascular pedicle in the superior portion of the nasal septum, around the axilla projection of the middle turbinate, posterior to the septal body, frequently has been observed. That vascular pedicle was named the Stamm's S-point. OBJECTIVE: The aim of this study was to describe the S-point and report cases of severe epistaxis originating from it. METHODS: A retrospective case series study was conducted. Nine patients with spontaneous severe epistaxis, where the S-point was identified as the source of bleeding, were treated between March 2016 and March 2017. RESULTS: Male predominance (77.8%) with age average of 59.3 years old were reported. Most cases presented comorbidities (88.9%) and were not taking acetylsalicylic acid (66.7%). A predominance of left sided involvement (55.6%) and anteroposterior bleeding being the principal initial presentation (77.8%) was seen. Six patients (66.7%) presented with hemoglobin levels below 10g/dL, and four (44.4%) required blood transfusion. Cauterization of S-point was performed in all patients, with complete resolution of bleeding. No patient experienced recurrence of severe epistaxis. CONCLUSION: The Stamm's S-point, a novel source of spontaneous severe epistaxis, is reported, and its cauterization was effective and safe. Otolaryngologists must actively seek this site of bleeding in cases of severe epistaxis.

Lesão de septo nasal em recém-nascidos hospitalizados: estudo descritivo exploratório / Nasal septal injury in hospitalized newborns: exploratory descriptive study

OBJETIVO: Identificar e descrever o perfil de recém-nascidos que apresentaram lesão de septo nasal em uso de Ventilação Não Invasiva e o tratamento utilizado. MÉTODO: Pesquisa descritiva, exploratória, com coleta retrospectiva de dados em prontuários de recém-nascidos hospitalizados entre janeiro/2020 a dezembro/2021, por meio de um instrumento estruturado, com análise de frequência descritiva simples. RESULTADOS: A lesão de septo nasal foi identificada em 19,0% dos recém-nascidos, com idade gestacional entre 30-35 semanas e peso ao nascer <1.500 gramas. O Estágio da lesão mais frequente foi I, tratado com Askina spray + rodízio de prongas, seguida de Hidrocoloide + Dersani Hidrogel, entre 1-7 dias (36,4%). CONCLUSÃO: A equipe de enfermagem depara-se com dificuldades na abordagem ao recém-nascido submetido a ventilação não invasiva com pronga, tornando-se relevante investir em sua qualificação e em protocolos assistenciais de cuidados com a pele para o desempenho de uma assistência segura e humanizada.

OBJECTIVE: To identify and describe the profile of newborns who presented nasal septal injury using Noninvasive Ventilation and the treatment used. METHOD: Descriptive, exploratory research, with retrospective data collection in medical records of newborns hospitalized between January/2020 and December/2021, through a structured instrument, with simple descriptive frequency analysis. RESULTS: Nasal septal injury was identified in 19.0% of newborns, with gestational age between 30-35 weeks and birth weight <1,500 grams. The most frequent stage of injury was I, treated with Askina spray + prong rotation, followed by Hydrocolloid + Dersani Hydrogel, between 1-7 days (36.4%). CONCLUSION: The nursing team encounters difficulties in the approach to newborns submitted to noninvasive ventilation with prong, making it relevant to invest in their qualification and in care protocols for skin care and for the performance of safe and humanized care.

Disease-specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction.

INTRODUCTION: Septal deviations might cause nasal obstruction and negative impact on the quality of life of individuals. The efficacy of septoplasty for treatment of septal deviation and the predictors of satisfactory surgical outcomes remain controversial. Technical variability, heterogeneity of research samples and absence of a solid tool for clinical evaluation are the main hindrances to the establishment of reliable statistical data regarding the procedure. OBJECTIVE: To evaluate the clinical improvements in the disease-specific quality-of-life between patients submitted to septoplasty with bilateral outfracture of the inferior turbinate under sedation and local anesthesia in a tertiary hospital and to assess possible clinical-epidemiological variables associated with functional outcome. METHODS: Fifty-two patients consecutively submitted to septoplasty with bilateral outfracture of the inferior turbinate for treatment of nasal obstruction filled in forms regarding clinical and epidemiological information during enrollment and had their symptom objectively quantified using the Nose Obstruction Symptom Evaluation (NOSE) scale preoperatively and one and three months after the procedure. Statistical analysis aimed to determine overall and stratified surgical outcomes and to investigate correlations between the clinical-epidemiological variables with the scores obtained. RESULTS: Statistically significant improvement in the preoperative NOSE questionnaire compared to the scores obtained three months after surgery was demonstrated (p<0.001, T-Wilcoxon), with strong correlation between the preoperative score and the postoperative improvement during this period (r=-0.614, p<0.001, Spearman). After one month, patients reached in average 87.15% of the result obtained at the study termination. Smokers and patients with rhinitis and/or pulmonary comorbidity showed increased average preoperative NOSE scores, although without statistical significance (p>0.05). Gender, age, history of rhinitis and presence of pulmonary comorbidity did not influence significantly surgical outcomes (p>0.05). Smokers presented greater reduction in NOSE scores during the study (p=0.043, U-Mann-Whitney). CONCLUSION: Septoplasty with bilateral outfracture of the inferior turbinate has proven to significantly improve disease-specific quality-of-life and this favorable outcome seems to occur precociously.

Sandwich graft technique outcomes in medium and large size nasal septal perforations / Resultados da técnica de enxerto sanduíche em perfurações do septo nasal de médio e grande porte

Abstract Introduction: Surgical treatment of medium and large sized nasal septal perforation is challenging. Techniques with and without interposition grafts are used. Objective: The aim of this study is to explain how we apply the sandwich graft technique that we use in medium and large nasal septal perforations as well as to present the results. Methods: We retrospectively reviewed the patients who were operated with the sandwich graft technique between January 2014 to December 2018 and followed up for at least 6 months. The demographic data, symptom scores, examination, and surgical findings of the patients were taken from the hospital records. Surgical outcomes were presented according to both perforation etiologies (idiopathic or iatrogenic) and sizes (Group A: < 2cm, Group B: ≥ 2 cm). Results: We reviewed 52 cases and 56 surgeries. The average diameter of the perforations was 19.2 mm. The success rate after initial surgeries was 84.6% (44/52). After 4 revision surgeries, the perforation was closed in 88.5% of the cases (46/52). Success rates for Group A and Group B were 90.0% and 86.4%, respectively (p = 0.689). The success rates in idiopathic and iatrogenic cases were 93.3% and 86.5%, respectively (p = 0.659). Conclusion: This study showed that the success rate of sandwich graft technique was higher in medium-sized perforations than large-sized ones and in idiopathic perforations compared to iatrogenic ones, but the latter rate was not statistically significant. This demonstrated that perforation size was not as important in the sandwich graft technique as in flap techniques.

Resumo Introdução: O tratamento cirúrgico da perfuração do septo nasal de médio e grande porte ainda é um desafio. Várias técnicas são usadas, com e sem enxertos de interposição. Objetivo: Descrever o uso da técnica de enxerto sanduíche que usamos nas perfurações de septo nasal de médio e grande porte e apresentar os resultados. Método: Revisamos retrospectivamente os prontuários de pacientes que foram operados com a técnica de enxerto sanduíche entre janeiro de 2014 e dezembro de 2018, com acompanhamento por pelo menos seis meses. Os dados demográficos, escores de sintomas, exames e achados cirúrgicos dos pacientes foram extraídos dos registros hospitalares. Os resultados cirúrgicos foram apresentados de acordo com as etiologias (idiopática ou iatrogênica) e os tamanhos da perfuração (Grupo A: < 2cm, Grupo B: >2cm). Resultados: Revisamos 52 casos e 56 cirurgias. O diâmetro médio das perfurações foi de 19,2 mm. A taxa de sucesso após as cirurgias iniciais foi de 84,6% (44/52). Após quatro cirurgias de revisão, a perfuração foi fechada em 88,5% dos casos (46/52). As taxas de sucesso para os Grupos A e B foram, respectivamente, 90,0% e 86,4% (p = 0,689). As taxas de sucesso nos casos idiopáticos e iatrogênicos foram, respectivamente, 93,3% e 86,5% (p = 0,659). Conclusão: Este estudo mostrou que a taxa de sucesso da técnica de enxerto sanduíche foi maior nas perfurações de médio porte do que nas de grande porte e nas perfurações idiopáticas do que nas iatrogênicas, mas sem significância estatística. Esse dado demonstrou que o tamanho da perfuração não foi tão importante na técnica de enxerto sanduíche quanto nas técnicas com uso de retalho.

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.

Difficult septal deviation cases: open or closed technique?

INTRODUCTION: The aim of this study is to compare the functional aspects of open technique (OTS) and endonasal septoplasty (ENS) in "difficult septal deviation cases". METHODS: 60 patients with severe nasal obstruction from S-shaped deformities, multiple deformities, high deviations etc. were included in the study. The OTS was used in 30 patients and the ENS was performed in 30 patients. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered preoperatively and at first month following surgery. Patients were also evaluated for pain postoperatively with Visual Analog Scale (VAS). RESULTS: The mean NOSE score was decreased 62.5-11.0 in the OTS group and 61.3-21.33 in the ENS group. Improvement of the symptoms following the two surgical techniques is similar and no statistically significant difference was found between both techniques. Also there was no statistically significant difference in postoperative pain between the OTS and ENS groups evaluated by VAS. CONCLUSION: ENS is as successful as the OTS in management difficult septal deviation cases. In patients with severe septal deformities type of the surgical technique should be selected according to the surgeon's experience and the patient's preference.

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.

Management of coexistent sinonasal pathology in patients undergoing endoscopic cerebrospinal fluid rhinorrhea repair / Manejo de doenças nasossinusais coexistentes em pacientes submetidos a tratamento cirúrgico endoscópico de fístula liquórica

Abstract Introduction Patients who undergo endoscopic cerebrospinal fluid rhinorrhea repair may occasionally present with coexistent sinonasal pathology which may or may not need to be addressed prior to surgical repair. Some patients may develop new onset nasal morbidity related to endoscopic repair. Objective To study the prevalence and management of additional sinonasal pathology in patients who undergo endoscopic repair of cerebrospinal fluid rhinorrhea Methods A retrospective review of patients who underwent endoscopic cerebrospinal fluid leak repair was conducted to note the presence of coexistent sinonasal morbidity preoperatively and in the followup period. Results Of a total of 153 patients who underwent endoscopic closure of cerebrospinal fluid leak, 97 (63.4%) were female and 56 (36.6%) males. Most patients (90.2%) were aged between 21 and 60 years, with a mean of 40.8 years. Sixty-four patients (41.8%) were found to have coexistent sinonasal morbidity preoperatively, the commonest being symptomatic deviated nasal septum (17.6%), chronic rhinosinusitis without polyps (11.1%) and chronic rhinosinusitis with polyps (3.3%). Rare instances of septal hemangioma (0.7%) and inverting papilloma (0.7%) were also seen. Postoperatively, there was cessation of cerebrospinal fluid rhinorrhea in 96.7% which rose to 100% after revision surgery in those with recurrence. Resolution of coexistent sinonasal pathology occurred in all patients with followup ranging from 10 to 192 months. New onset sinonasal morbidity which developed postoperatively included synechiae between middle turbinate and lateral nasal wall (5.9%) and sinonasal polyposis (1.3%). Conclusion Patients who undergo endoscopic cerebrospinal fluid leak repair may have coexistent sinonasal pathology which needs to be addressed prior to or along with repair of the dural defect. New onset sinonasal morbidity, which may arise in a few patients postoperatively, may require additional treatment. A protocol for the management of coexistent sinonasal conditions ensures a successful outcome.

Resumo Introdução Pacientes submetidos a tratamento cirúrgico endoscópico de fístula liquórica podem ocasionalmente apresentar coexistência de outras doenças comuns que podem ou não precisar ser tratadas antes do procedimento. Alguns pacientes podem desenvolver nova morbidade nasal relacionada ao tratamento da fístula. Objetivo Estudar a prevalência e o manejo de doenças nasossinusais adicionais em pacientes submetidos ao reparo endoscópico de fístula liquórica. Método Uma revisão retrospectiva de pacientes submetidos ao reparo endoscópico de fistula liquórica foi feita para avaliar a presença de outras morbidades nasossinusais coexistentes no pré‐operatório e no período de seguimento. Resultados De 153 pacientes submetidos ao tratamento endoscópico do fistula liquórica, 97 (63,4%) eram do sexo feminino e 56 (36,6%) do masculino. A maioria dos pacientes (90,2%) tinha entre 21 e 60 anos, com média de 40,8. Verificou‐se que 64 pacientes (41,8%) apresentavam coexistência de morbidade nasossinusal no pré‐operatório, as mais comuns eram desvio de septo nasal sintomático (17,6%), rinossinusite crônica sem pólipos (11,1%) e rinossinusite crônica com pólipos (3,3%). Casos raros de hemangioma septal (0,7%) e papiloma invertido (0,7%) também foram observados. No pós‐operatório, inicialmente obteve‐se fechamento da fístula liquórica em 96,7%, que aumentou para 100% após a cirurgia de revisão nos pacientes com recorrência. A resolução das outras doenças nasossinusais coexistentes foi obtida em todos os pacientes, o seguimento variou de 10 a 192 meses. A ocorrência de uma nova morbidade nasossinusal no pós‐operatório incluiu sinéquias entre a concha média e a parede lateral do nariz (5,9%) e polipose nasossinusal (1,3%). Conclusão Pacientes submetidos a tratamento endoscópico de fistula liquórica podem apresentar coexistência de outras doenças nasossinusais que necessitam de tratamento prévio ou concomitante ao reparo do defeito dural. Outras morbidades nasossinusais que surgem durante o pós‐operatório podem exigir tratamento adicional. Um protocolo para o manejo das condições nasossinusais coexistentes garante um desfecho bem‐sucedido.

Effectiveness of caudal septal extension graft application in endonasal septoplasty.

INTRODUCTION: Septal deviation is a common disease seen in daily otorhinolaryngology practice and septoplasty is a commonly performed surgical procedure. Caudal septum deviation is also a challenging pathology for ear, nose, and throat specialists. Many techniques are defined for caudal septal deviation. OBJECTIVE: To evaluate the effectiveness of caudal septal extension graft (CSEG) application in patients who underwent endonasal septoplasty for a short and deviated nasal septum. METHODS: Forty patients with nasal septal deviation, short nasal septum, and weak nasal tip support who underwent endonasal septoplasty with or without CSEG placement between August 2012 and June 2013 were enrolled in this study. Twenty patients underwent endonasal septoplasty with CSEG placement. The rest of the group, who rejected auricular or costal cartilage harvest for CSEG placement, underwent only endonasal septoplasty without any additional intervention. Using the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) questionnaires, pre- and post-operative acoustic rhinometer measurements were evaluated to assess the effect of CESG placement on nasal obstruction. RESULTS: In the control group, preoperative and postoperative minimal cross-sectional areas (MCA1) were 0.44±0.10cm2 and 0.60±0.11cm2, respectively (p<0.001). In the study group, pre- and postoperative MCA1 values were 0.45±0.16cm2 and 0.67±0.16cm2, respectively (p<0.01). In the control group, the nasal cavity volume (VOL1) value was 1.71±0.21mL preoperatively and 1.94±0.17mL postoperatively (p<0.001). In the study group, pre- and postoperative VOL1s were 1.72±0.15mL and 1.97±0.12mL, respectively (p<0.001). Statistical analysis of postoperative MCA1 and VOL1 values in the study and the control groups could not detect any significant intergroup difference (p=0.093 and 0.432, respectively). In the study group, mean nasolabial angles were 78.15±4.26° and 90.70±2.38°, respectively (p<0.001). CONCLUSION: Endonasal septoplasty with CESG placement is an effective surgical procedure with minimal complication rate for subjects who have a deviated, short nasal septum and weak nasal tip support.

Desviación del septo nasal y función de la trompa de Eustaquio: estudio prospectivo de control de casos basado en timpanometría, tubomanometría y ETDQ-7 / Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7

Introduction: The influence of isolated nasal septum deviation (NSD) in the Eustachian Tube (ET) function is still undetermined. Objective: compare ET function between patients with severe NSD and patients with adequate nasal patency in terms of symptomology and objective exams and assess the impact of septoplasty in ET function in patients with severe NSD. Methods and methodology: a prospective study was conducted. In the first phase of the study, two opportunistic samples were selected: 35 patients with severe NSD for group A and 35 patients with adequate nasal patency for group B. Both groups were evaluated through Nasal obstruction Subjective Questionnaire (NOSE) and ET dysfunction questionnaire 7 (ETDQ7) –, and through two objective exams to assess ET function – tympanometry, and tubomanometry (TMM); results were compared between group A and B. In the second phase of the study, the patients from group A underwent septoplasty and were re-evaluated through ETDQ7, tympanometry and TMM; results were compared before and after surgery. Results: we found a statistically significant difference between patients with NSD and patients with adequate nasal patency in NOSE and ETDQ7 (higher scores in the latter), and TMM (worse results in patients with NSD); the difference in tympanometry was not statistically significant. The side of the NSD did not correlate with the side of the dysfunction. After septoplasty, patients from group A had statistically significant lower scores in ETDQ7 and a lower proportion of patients with findings compatible with ET dysfunction using TMM. Conclusion: according to our results, severe NSD alone is a cause of ET dysfunction; septal surgery might improve ET function in these patients. (AU)

Introducción: Aún sigue sin determinarse la influencia aislada de la desviación del septo nasal (DSN) en la función de la trompa de Eustaquio (TE). Objetivo: Comparar la función de la TE entre los pacientes con DSN grave y los pacientes con patencia nasal adecuada, en términos de sintomatología y exámenes objetivos, y evaluar el impacto de la septoplastia en la función de la TE en pacientes con DSN grave. Métodos y metodología: Se realizó un estudio prospectivo seleccionándose 2 muestras oportunistas en la primera fase del mismo: 35 pacientes con DSN grave en el grupo A, y 35 pacientes con patencia nasal adecuada en el grupo B. Se evaluó a ambos grupos utilizando los cuestionarios Nasal Obstruction Subjective Questionnaire (NOSE) y disfunción de TE (ETDQ7), así como mediante 2 exámenes objetivos, para evaluar la función de la TE: timpanometría y tubomanometría (TMM), comparándose los resultados entre los grupos A y B. En la segunda fase del estudio, los pacientes del grupo A fueron sometidos a septoplastia y reevaluados mediante ETDQ7, timpanometría y TMM, comparándose los resultados de antes y después de la cirugía. Resultados: Encontramos una diferencia estadísticamente significativa en NOSE y ETDQ7 entre los pacientes con DSN y los pacientes con patencia nasal adecuada (con puntuaciones superiores en este último), y TMM (con peores resultados en los pacientes con DSN), no siendo estadísticamente significativa la diferencia en la timpanometría. El lado de DNS no se correlacionó con el lado de la disfunción. Tras la septoplastia, los pacientes del grupo A reflejaron puntuaciones menores en ETDQ7 con significación estadística, y existió una menor proporción de pacientes con hallazgos compatibles con la disfunción de la TE utilizando TMM. Conclusión: Con arreglo a nuestros resultados, la DNS en solitario es una causa de disfunción de la TE, pudiendo mejorar la septoplastia la función de la TE en estos pacientes. (AU)

Avaliação da Obstrução Nasal em Pacientes Submetidos à Septoplastia com Cirurgia das Conchas Nasais Inferiores Utilizando o Questionário NOSE / Evaluation of Nasal Obstruction in Patients Undergoing Septoplasty with Inferior Nasal Turbinate Surgery Using the NOSE Questionnaire

Introdução: O desvio septal e a hipertrofia das conchas nasais inferiores são as principais causas de obstrução nasal. Uma forma de avaliarmos o grau de obstrução nasal é através do questionário NOSE, o qual é baseado em cinco perguntas com nota de 0 a 04, podendo alcançar 100 pontos. Esse pode ser aplicado no pré-operatório e pós-operatório, servindo para comparação do grau de melhora do paciente em relação à obstrução nasal. Objetivo: O trabalho teve como objetivo aplicar o questionário NOSE para avaliação de grau de satisfação dos pacientes no pós-operatório de cirurgia de septoplastia, associado à técnica cirúrgica das conchas nasais inferiores. Métodos: Os pacientes eletivos para septoplastia e cirurgia das conchas nasais inferiores foram avaliados com o questionário NOSE no pré-operatório e no pós-operatório (07 e 30 dias, 3 e 06 meses e 01 ano). Para análise estatística, foi utilizado o teste de Friedman e de Mann-Whitney. Foram excluídos os pacientes menores de idade e presença de alterações sinusais. Resultados: Um total de 64 pacientes preencheu os critérios de inclusão, sendo excluídos 13 pacientes por perda de seguimento, permanecendo com 51 pacientes. A média de idade foi de 31,33 anos. A maioria dos pacientes era do gênero masculino, 72,5%, e 27,5% do gênero feminino. Houve diferença estatística entre o pré-operatório e o seguimento de 06 meses e 01 ano. Conclusão: O questionário NOSE mostrou que a septoplastia associada à cirurgia das conchas nasais inferiores demonstrou melhora do sintoma de obstrução nasal no pós-operatório, tendo como parâmetro o próprio paciente.

Introduction: Septal deviation and inferior nasal turbinate hypertrophy are the primary causes of nasal obstruction. One way to assess the degree of nasal obstruction is through the NOSE questionnaire, which bases itself on five questions with a score from 0 to 04, and may reach 100 points. Its application can be preoperatively and postoperatively to compare the degree of patient improvement regarding nasal obstruction. Objective: This study aimed to apply the NOSE questionnaire to evaluate the degree of patient satisfaction in the post-operative period of septoplasty associated with the surgical technique of inferior nasal concha. Methods: Elective patients for septoplasty and inferior nasal concha surgery were evaluated with the NOSE questionnaire preoperatively and postoperatively (7 and 30 days, 3 and 6 months, and one year). The Friedman and Mann-Whitney tests were used for statistical analysis. Exclusion of underage patients and the presence of sinus changes. Results: A total of 64 patients met the inclusion criteria, eliminating 13 patients due to loss of follow-up, remaining only 51 cases. The mean age was 31.33 years. Most patients were male, 72.5% and 27.5% were female. There was a statistical difference between the preoperative and the follow-up of 6 months and one year. Conclusion: The NOSE questionnaire showed that septoplasty associated with inferior nasal concha surgery showed improvement of nasal obstruction symptoms postoperatively, using the patient's parameters.

Relationship between nasal septum morphology and nasal obstruction symptom severity: computed tomography study / Relação entre a morfologia do septo nasal e a gravidade dos sintomas de obstrução nasal: estudo de tomografia computadorizada

Abstract Introduction The impact of the nasal septum morphology on the severity of obstruction symptoms has not been fully explored. Objective This study aimed to investigate whether the morphology of the deviated nasal septum assessed by computed tomography may explain nasal obstruction severity. Methods The study included 386 patients who were referred to the computed tomography examination of the paranasal sinuses. Patient selection criteria were the absence of facial anomalies, facial trauma, nasal surgery, and sinonasal tumors. Computed tomography images were used to estimate deviated nasal septum prevalence, the prevalence of Mladina's seven types of deviated nasal septum, and to measure the deviated nasal septum angle. Nasal obstruction severity was assessed by the nasal obstruction symptom evaluation, NOSE scale. The relationship between NOSE score, deviated nasal septum morphology, and deviated nasal septum angle was performed by a statistical regression model on the reduced sample of 225 patients. Results The prevalence of deviated nasal septum was 92.7%. Type 7 deviated nasal septum was the most frequent (34.2%) followed by type 5 (26.2%) and type 3 (23.6%). The worst NOSE scores were recorded in the type 2 deviated nasal septum (45.00 ± 28.28). The mean deviated nasal septum angle in patients with nasal obstruction was 8.5° ± 3.24. NOSE scores were not significantly associated with deviated nasal septum types and angles. Conclusion Patients with different types of deviated nasal septum have different NOSE scores. Computed tomography morphology of the deviated nasal septum could not fully explain the severity of nasal obstruction.

Resumo Introdução O impacto da morfologia do septo nasal na gravidade dos sintomas obstrutivos nasais ainda não foi totalmente explorado. Objetivo Investigar se a morfologia do desvio do septo nasal avaliada pela tomografia computadorizada pode explicar a gravidade da obstrução nasal. Método O estudo incluiu 386 pacientes encaminhados para exame tomográfico de seios paranasais. Os critérios de seleção dos pacientes foram: ausência de anomalias faciais, trauma facial, cirurgia nasal e tumores nasossinusais. Imagens de tomografia computadorizada foram usadas para estimar a prevalência de desvios do septo nasal, a prevalência dos sete tipos de desvios do septo nasal de Mladina e para medir o ângulo do desvio septal. A gravidade da obstrução nasal foi avaliada pela escala Nasal Obstruction Symptom Evaluation, NOSE. A relação entre o escore da NOSE, a morfologia e o ângulo do desvio septal foi verificada por um modelo de regressão estatística em uma amostra reduzida de 225 pacientes. Resultados A prevalência de desvios do septo nasal foi de 92,7%. O desvio septal do tipo 7 foi o mais frequente (34,2%), seguido do tipo 5 (26,2%) e do tipo 3 (23,6%). Os piores escores da escala NOSE foram registrados nos desvios septais tipo 2 (45,00 ± 28,28). O ângulo médio do desvio em pacientes com obstrução nasal foi de 8,5° ± 3,24. Os escores da escala NOSE não foram significativamente associados aos tipos e ângulos do desvio septal. Conclusão Pacientes com tipos diferentes de desvios do septo nasal apresentam diferentes escores na escala NOSE. A morfologia do desvio septal à tomografia computadorizada não conseguiu explicar totalmente a gravidade da obstrução nasal.

Alternância de máscara nasal com pronga nasal reduz a incidência de lesão nasal moderada a grave em prematuros em uso de ventilação não invasiva / Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation

RESUMO Objetivo: Investigar a relação entre dispositivos de ventilação não invasiva e incidência de lesão do septo nasal em recém-nascidos pré-termo. Métodos: Este estudo de coorte retrospectivo e unicêntrico incluiu prematuros em uso de ventilação não invasiva. A incidência de lesão nasal foi comparada entre três grupos, de acordo com o dispositivo de ventilação não invasiva (G1 para máscara nasal; G2 para prongas binasais e G3 para alternância entre máscaras e prongas nasais). As lesões nasais foram classificadas de acordo com o National Pressure Ulcer Advisory Panel como estágios 1 - 4. Foram realizadas análises de regressão multivariada para estimar os riscos relativos, a fim de identificar possíveis preditores associados a lesões relacionadas a dispositivos médicos. Resultados: Entre os 300 lactentes incluídos no estudo, a incidência de lesões relacionadas a dispositivos médicos no grupo em uso alternado foi significativamente menor do que a nos grupos de máscara ou prongas de uso contínuo (n = 68; 40,48%; valor de p < 0,01). O grupo de prongas nasais apresentou mais lesões de estágio 2 (n = 15; 55,56%; p < 0,01). A permanência ≥ 7 dias em ventilação não invasiva foi associada a maior incidência de lesões relacionadas a dispositivos médicos, independentemente do dispositivo (63,81%; p < 0,01). Os incrementos diários na ventilação não invasiva aumentaram o risco de lesões nasais em 4% (IC95% 1,02 - 1,06; p < 0,01). Um maior peso ao nascer indicou proteção contra lesões relacionadas a dispositivos médicos. Cada grama extra representou diminuição de 1% no risco de desenvolver lesão do septo nasal (RR: 0,99; IC95% 0,99 - 0,99; p < 0,04). Conclusão: A alternância entre máscaras e prongas nasais reduz a incidência de lesão nasal moderada a grave em comparação com dispositivos únicos. O incremento de dias em uso de ventilação não invasiva parece contribuir para lesões relacionadas a dispositivos médicos, e um maior peso ao nascer é um fator de proteção.

ABSTRACT Objective: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants. Methods: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries. Results: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01). The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04). Conclusion: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.

Rapid hemostasis: a novel and effective outpatient procedure using microwave ablation to control epistaxis of isolated mucosal bulge lesions / Hemostasia rápida: um procedimento ambulatorial novo e eficaz utilizando ablação por micro-ondas para controlar a epistaxe de lesões isoladas protuberantes da mucosa

Abstract Introduction Recurrent epistaxis is commonly encountered in the rhinology outpatient clinic. Under endoscopic guidance, both bipolar cautery and monopolar forceps (combined with suction) have been employed to control the bleeding. However, the use of monopolar forceps requires the placement of grounding pads. Most procedures are currently performed in operating rooms. Objective We investigated outcomes after the use of Microwave Ablation (MWA) to control epistaxis in adults with isolated mucosal bulge lesions. All procedures were performed with patients under local anesthesia in our outpatient clinic. Methods This is a retrospective cohort study. We included 83 adults with epistaxis of isolated mucosal bulge lesions. Microwave ablation was performed in the outpatient clinic to control bleeding, after induction of local anesthesia. The primary outcome was successful hemostasis. The secondary outcomes were the rebleeding rates at weeks 1 and 4 and month 6, and complications (crust or synechiae formation, septal perforation, and/or orbit or brain complications). Results All bleeding points were successfully ablated; hemostasis was achieved within 1-2 min. The mean pain score was 1.83 intra-operatively and 0.95 1 h postoperatively. No patient re-bled, and no severe MWA-related complication (septal perforation, synechiae formation, or orbit or brain complication) was recorded to 6 months of follow-up. Conclusions Endoscopic microwave ablation with patients under local anesthesia is a novel, safe, effective, rapid, well-tolerated, outpatient treatment for adults with epistaxis of isolated mucosal bulge lesions, especially those for whom general anesthesia might be risky, those with electrical implants, and those exhibiting contraindications for arterial embolization.

Resumo Introdução Epistaxe recorrente é comumente encontrada no ambulatório de rinologia. Sob orientação endoscópica, foram empregados tanto o cautério bipolar quanto a pinça monopolar (combinados à sucção) para controlar a condição. No entanto, o uso de pinças monopolares requer a colocação de placas de aterramento. Atualmente, a maioria dos procedimentos é feita em salas de cirurgia. Objetivo Investigamos os resultados após o uso da ablação por micro-ondas (MWA, do inglês Microwave Ablation) no controle da epistaxe em adultos com lesões isoladas protuberantes da mucosa. Todos os procedimentos foram feitos em nosso ambulatório com os pacientes sob anestesia local. Métodos Estudo de coorte retrospectivo. Foram incluídos 83 adultos com epistaxe de lesões isoladas protuberantes da mucosa. A ablação por micro-ondas foi feita no ambulatório para controlar o sangramento, após a administração de anestesia local. O desfecho primário foi uma hemostasia bem-sucedida. Os desfechos secundários foram as taxas de ressangramento, nas semanas 1 e 4 e no mês 6, e complicações (formação de crostas ou sinéquias, perfuração septal e/ou complicações orbitais ou cerebrais). Resultados Todos os pontos de sangramento foram contidos com sucesso; a hemostasia foi alcançada em 1-2 minutos. O escore médio de dor foi de 1,83 no intraoperatório e de 0,95 1 h no pós-operatório. Nenhum paciente apresentou ressangramento e nenhuma complicação grave relacionada à MWA (perfuração septal, formação de sinéquias ou complicações orbitais ou cerebrais) foi registrada em 6 meses de seguimento. Conclusões A ablação endoscópica por micro-ondas com pacientes sob anestesia local é um tratamento ambulatorial novo, seguro, eficaz, rápido e bem tolerado para adultos com epistaxe de lesões isoladas protuberantes da mucosa, especialmente aqueles para os quais a anestesia geral pode ser arriscada, indivíduos com implantes elétricos e aqueles com contraindicações para embolização arterial.

Prevalence and characteristics of S-point bleeding compared to non S-point bleeding in severe epistaxis / Prevalência e características do sangramento no S-point em comparação com outros pontos sangramento na epistaxe grave

Abstract Introduction Stamm's S-point is gaining importance as a bleeding focus in severe epistaxis. However, prevalence and features of S-point bleeding compared to non S-point bleeding have not been studied. Objective To investigate the characteristics of patients with S-point bleeding among those with severe epistaxis and to compare the factors involved in the treatment of epistaxis. Methods We retrospectively analyzed medical records of 268 patients admitted to the otorhinolaryngology department of Konkuk University Hospital and Chung-Ang University Hospital with epistaxis of which the bleeding focus clarified. Patients with anterior nasal bleeding (n = 129) were excluded. The study was conducted at the department of otorhinolaryngology from January 2008 to August 2019. Collected data included patients' demographic information, bleeding focus, body mass index underlying medical and sinonasal diseases, laboratory test results (initial hemoglobin, platelet count, and triglyceride level), use of anticoagulants, direction of epistaxis, initial and final treatments, and need for blood transfusion. Results The prevalence of S-point bleeding was 28.8% of non-anterior bleeding cases. Mean body mass index score was lower in the S-point group (23.41 ± 3.71) compared to the non S-point group (24.93 ± 3.97) (p = 0.039). Underweight patients tended to show a greater incidence of S-point bleeding (15.0%) than non S-point bleeding (2.0%) (p = 0.010). Incidence of anemia was higher in the S-point group (67.5%) than in the non S-point group (36.4%). Anemia (Odds ratio [OR]: 3.635; 95% confidence interval [CI]: 1.669-7.914, p = 0.001) and underweight (body mass index < 18.5, OR: 8.559, CI: 1.648-44.445, p = 0.011) were significantly associated with S-point bleeding. Conclusion Prevalence of S-point bleeding was significant, underlining the importance of examining the S-point in patients with severe epistaxis. Patients with S-point bleeding had lower body mass index scores and a higher incidence of anemia than those with non S-point bleeding.

Resumo Introdução O S-point de Stamm tem ganhado importância como foco de sangramento na epistaxe grave. Entretanto, a prevalência e as características do sangramento no S-point em comparação com o sangramento em outros locais ainda não foram estudadas. Objetivo Investigar as características dos pacientes com epistaxe grave com sangramento no S-point e comparar os fatores envolvidos no tratamento da epistaxe. Método Analisamos retrospectivamente os prontuários médicos de 268 pacientes internados no Departamento de Otorrinolaringologia do Konkuk University Hospital e do Chung-Ang University Hospital com epistaxe cujo foco hemorrágico foi esclarecido. Pacientes com sangramento anterior (n = 129) foram excluídos. O estudo foi feito no Departamento de Otorrinolaringologia de janeiro de 2008 a agosto de 2019. Os dados coletados incluíram informações demográficas dos pacientes, foco hemorrágico, índice de massa corporal doenças médicas e nasosinusais subjacentes, resultados de exames laboratoriais (hemoglobina, contagem de plaquetas e nível de triglicerídeos iniciais), uso de anticoagulantes, direção da epistaxe, tratamentos iniciais e finais e necessidade de transfusão de sangue. Resultados A prevalência de sangramento no S-point foi de 28,8% dos casos de sangramento não anterior. O índice de massa corpórea médio foi menor no grupo com sangramento no S-point (23,41 ± 3,71) em comparação com o grupo não S-point (24,93 ± 3,97) (p = 0,039). Pacientes com baixo peso tenderam a apresentar maior incidência de sangramento no S-point (15,0%) do que sangramento em ponto não S (2,0%) (p = 0,010). A incidência de anemia foi maior no grupo com sangramento no S-point (67,5%) do que no grupo não S-point (36,4%). A anemia (odds ratio [OR]: 3,635; intervalo de confiança de 95% [IC95%]: 1,669-7,914, p = 0,001) e o baixo peso (IMC < 18,5, OR: 8,559, IC95%: 1,648-44,445, p = 0,011) foram significantemente associados com sangramento no S-point. Conclusão A prevalência de sangramento no S-point foi significativa, enfatizou a importância de examinar o S-point em pacientes com epistaxe grave. Pacientes com sangramento no S-point apresentaram escores mais baixos no índice de massa corpórea e maior incidência de anemia do que aqueles com sangramento em locais que não o S-point.

Perfil epidemiológico dos pacientes submetidos à rinoplastia em um centro hospitalar de reabilitação / Epidemiological profile of patients undergoing rhinoplasty in a hospital rehabilitation center

Introdução: A rinoplastia é uma das cirurgias plásticas mais comuns em todo o mundo. O desenvolvimento do conhecimento da anatomia do nariz é um dos ensinamentos mais refinados em cirurgia plástica e exige além de dedicação e estudos, a experiência técnica visual para uma compreensão adequada das estruturas e ligamentos. O objetivo deste estudo é descrever o perfil epidemiológico de pacientes submetidos à rinoplastia em um hospital terciário. Métodos: Foram estudados pacientes submetidos à rinoplastia no serviço de Cirurgia Plástica do Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), de janeiro de 2013 a dezembro de 2019, em pacientes do sistema único de saúde. Resultados: Foram estudados 179 pacientes, sendo a maioria do sexo feminino, com média de idade de 35 anos, como principal causa o trauma, sendo a maioria rinoplastia primária por técnica aberta. Conclusão: O perfil dos pacientes é do sexo feminino, com média de idade de 35 anos, sendo principalmente devido à deformidade nasal após trauma, com abordagem de cirurgias primárias abertas sendo comum a utilização de enxertos de cartilagem.

Introduction: Rhinoplasty is one of the most common plastic surgeries worldwide. The development of knowledge of the nose's anatomy is one of the most refined teachings in plastic surgery. In addition to dedication and studies, it requires visual technical experience for an adequate understanding of structures and ligaments. This study aims to describe the epidemiological profile of patients undergoing rhinoplasty in a tertiary hospital. Methods: Patients who underwent rhinoplasty at the Plastic Surgery Service of the Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), from January 2013 to December 2019, were studied in patients from the single health system. Results: 179 patients were studied, the majority of whom were female, with a mean age of 35 years, as the leading cause of trauma, the majority being primary rhinoplasty using an open technique. Conclusion: The patients' profile is female, with a mean age of 35 years, mainly due to nasal deformity after trauma, with open primary surgery approach and cartilage grafts are common.

Assessment of mucosal changes associated with nasal splint in a rabbit model.

INTRODUCTION: There is no consensus on duration of the nasal splint after nasal septum surgeries. The pressure of nasal splint on the mucosa may cause tissue necrosis and nasal septum perforation. OBJECTIVES: To investigate the histopathological changes of the nasal mucosa caused by nasal splints in a rabbit model. METHODS: No splint was used in group A. Bilateral silicone nasal splints were placed for five, ten, and 15 days in groups B, C, and D, respectively. Biopsy of the nasal mucosa was performed after removal of splint. Histopathologic evaluations were performed. The severity and depth of the inflammation were scored. RESULTS: Group A had a normal histological appearance. Comparison of the results of groups B, C, and D with group A demonstrated statistically significant differences with regards to the severity of histopathological findings. There was no statistically significant difference between groups B and C. There were statistically significant differences between the groups B and D, and also between groups C and D. CONCLUSIONS: Longer duration of nasal splint had a higher risk for septal perforation. Therefore, removal of the splint as soon as possible may be helpful for preventing potential perforations.