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Background Lateral crura surface problems are one of the most difficult challenges in nose tip surgery. Closed preservation rhinoplasty (CPR) is a revolutionary concept that keeps nose tip flexibility and elasticity. By solving lateral crura surface problems and keeping tip flexibility the surgeon will accomplish a sharper supraalar groove transition between the dorsum and the tip. Objectives The convex-concave lateral crura deformity (CCLCD) or S-shaped lateral crura is one of the biggest constraints to accomplishing a beautiful tip and dorsum-tip transition (DTT). This deformity is the reason for the commonly called parenthesis deformity of cephalic malposition. This LLC convex-concave shape creates a C-shaped shadow. This DTT is one of the key areas for accomplishing natural results, and it depends on different nose structures, not just the lower lateral cartilages (LLC). Methods A total of 560 rhinoplasty cases were studied retrospectively between September and December 2023. Three hundred and twenty patients had at least 1 year of follow-up. Patients had follow-up at 2 weeks, 1 month, 3 months, 6 months, and 1 year after surgery. No secondary rhinoplasty was included. Only 2 secondary septoplasty cases were included, without any nose skin undermining in the previous surgery. Surgical details were documented, including the 6 fundamental steps of this technique: (1) mucosal lower lateral incision, (2) dorsum subperichondral dissection and vertical scroll release, (3) lateral crura tail caudal release, lateral crura steal and slide-under flap lateralization, (4) upper lateral caudal resection, (5) vertical scroll reconstruction, and (6) turning point extension graft. Results Three hundred and twenty patients had at least 1 year of follow-up. In total, 516 patients underwent a closed approach and 47 patients an open approach. All patients had subperichondral dissection of the hump envelope. All patients who underwent a closed approach had a low-strip letdown dorsal preservation technique. All patients who underwent an open approach had a structural technique with spreader flaps or grafts at the keystone area. All the patients underwent osteotomies with a piezoelectric device. Twenty-three revisional surgeries were necessary. Conclusions CPR taught us how important ligament and soft tissue preservation are. We learned that the less damage you do to the nose soft tissues and scaffold, the less support you need for it. Surgeons have been overgrafting the lateral crura to solve postoperative problems mainly because of dissection problems and lack of lateral crura support. This paper describes how to solve lateral crura surface problems, keeping the tip flexible and elastic, and also creating a nice and natural supraalar groove transition, by applying 6 surgical maneuvers. Level of Evidence: 4 (Therapeutic) [ABSTRACT FROM AUTHOR]

Septoplasty is among the most frequently performed procedures in the field of otorhinolaryngology. Adhesion is known to be the most common complication occurring after septoplasty. Post-surgical insertion of silicone splints is a widely used measure for the prevention of postoperative complications. Recently, we encountered a case where the silicone splint was dislocated and further displaced to the level of the upper esophageal sphincter. Although it was safely removed using fiberoptic gastroendoscopy, delayed removal could have induced other serious sequelae. Since no similar cases have been previously reported, we believe that this may be a very rare complication induced by a loose absorbable suture. Therefore, we suggest that otorhinolaryngologists should pay attention to the fixation of a silicone splint with sutures under appropriate tension to prevent the dislocation of the silicone splint and its subsequent sequelae. [ABSTRACT FROM AUTHOR]

Headache and facial pain are very common and distressing complaints. Due to its multifactorial origin often it remains undiagnosed and inadequately treated. One very important cause which is missed in daily practice by primary physicians is rhinogenic contact point headache. In this study, we will elicit how effective surgical treatments are for rhinogenic contact point headaches when other causes are ruled out. [ABSTRACT FROM AUTHOR]

Surgical techniques that are safe and effective in adults can produce bad results in children. The study was done To present the results of septoplasty and functional septorhinoplasty (FSR) in children in order to restore the anatomy and function of the nose. In a prospective study done in a tertiary care hospital between May, 2016 and November, 2022, twenty-five children (14 males and 11 females) aged 8 to 14 years having significant nasal obstruction due to deviated septum with or without external nasal deviation were included in this study. Septoplasty was done in 16 patients and FSR was done in 9 patients by endonasal technique. Surgical outcomes were evaluated by comparing preoperative and postoperative photographs, NOSE scores, anterior rhinoscopy and subjective satisfaction. The follow-up period ranged from 15 to 90 months with a mean follow-up period of 43 months. Out of the 25 patients, the mean NOSE scores preoperatively and postoperatively were 72 and 22 (a significant improvement of mean 50.00 with p-value of < 0.05). Anterior rhinoscopy postoperatively showed that 19 patients (76%) had a straight septum while 6 patients (24%) had some residual deviation. Subjective patient satisfaction was "much improved" in 13 (52%) patients, and "improved" in 12 (48%) patients. In photographic evaluation of 9 patients with external nasal deviation the result was very good in 3, good in 5 and average in 1 patient. Septoplasty and FSR in children resulted in significant improvements in nasal airway and external nasal deviation. [ABSTRACT FROM AUTHOR]

Aim: We present a new, simple, and effective method for the closure of nasal septal perforations based on prolonged isolation of the surgical site. Nasal septal perforation usually results after rhinological surgical operations, primarily to correct septum deviation. When symptomatic, conservative and surgical treatments are required. Current techniques more often attempt direct mucosal closure by mobilizing local nasal mucosal flaps with or without interposed grafts. The reported success rates are sufficiently high approaching ≥ 90%. Method: Our current practice includes the insertion of a temporalis fascia graft between the septal mucosal flaps to cover the perforation, avoiding any effort to achieve mucosal closure. Instead of using sophisticated techniques and multiple synthetic grafts, we propose that the entire septum remains protected after perforation repair for 6 weeks between two thin silicone sheets which permit surgical site inspection and mucosal regrowth. We present our experience with 10 consecutive patients, two of whom had fairly large defects. Results: All cases, except one, had a successful outcome with complete closure of the defect after one year's follow up. No serious complications were reported and the silicone sheets were well tolerated by the patients. Conclusion: Our method is simple and consequently fast, resulting in high success rates, low morbidity, and high tolerance from the patients. Key Messages: • Nasal septum perforations must be repaired occasionally. So far, sophisticated surgical techniques are proposed. • Using a simple surgical technique with a temporalis fascia graft yields the same success rates as with a sophisticated vascular flap provided the surgical site is isolated for a long period. • Silicone sheets permit surgical site inspection and protection of the mucosa during the regrowth process. • Prolonged isolation and protection of the surgical site is the key for a successful repair irrelevant the surgical technique or the graft. [ABSTRACT FROM AUTHOR]

Neonatal nasal obstruction can cause significant functional impairment because neonates are obligatory nasal breathers in the first three months of life. Some neonates with nasal septum issues may be asymptomatic or exhibit mild symptoms that could resolve as they grow in the first few years of life. However, in cases of patients with an uncorrected deviated nasal septum, it can have physiological, anatomical, cosmetic, and psychological impacts. Many studies have reported different approaches to correct neonatal deviated nasal septum, including observation, stenting, close reduction, and septoplasty. Herein, we present two cases aged 14 days and 35 days old with severe symptoms of deviated nasal septum, balloon dilatation septoplasty, a minimally invasive approach, was employed, with low-risk complications and good outcomes. Up to this date, this approach has not been reported in this age group. [ABSTRACT FROM AUTHOR]

The Herlyn-Werner-Wunderlich syndrome is a rare congenital disorder with uterus didelphys, unilateral obstructed hemivagina and ipsilateral renal agenesis, more common on right side. HWW syndrome usually presents at puberty with symptoms like pelvic pain, dysmenorrhea and palpable mass due to the associated hematocolpos or hematometra. Delayed presentation in adulthood as infertility can occur in case of incomplete vaginal septum. Short term complications like pyohematocolpos, pyosalpinx, or pelviperitonitis, and long-term complications, such as endometriosis, increased risk of abortion and infertility can occur. Ultrasound is the initial investigation which demonstrates uterine anomaly, renal agenesis and hematocolpos.Magnetic resonance imaging (MRI) is the imaging modality of choice which helps in confirmation of diagnosis, delineation of vaginal septum, communication between 2 cavities and associated pathologies like adenomyosis better.Vaginal septum resection is the treatment of choice for obstructed hemivagina with hematocolpos.We present you a case of 43 years female with cyclical dysmenorrhea starting few years after menarche with uterine didelphys, left sided vaginal septum with hematocolpos and left renal agenesis. Along with this, diffuse bilateral adenomyosis was present which is uncommonly associated with this anomaly as obstruction is at the level of vagina. Patient was diagnosed late due to misdiagnosis and later treated with septal resection for hematocolpos and with hormonal medications for adenomyosis.

Background: Septoplasty is the treatment for the symptomatic Deviated Nasal Septum. There has been a drift from septal resection to mucosal preservation to conservation of possible septal framework in the septoplasty surgeries. The endoscopic technique is modern evolution of the septoplasty surgery. This study has been undertaken to evaluate the conventional and endoscopic approaches of the septoplasty surgeries and aid in statistical informative data to ongoing researches for better outcome comparison. Aims and Objectives: To compare conventional and endoscopic techniques of Septoplasty and to find out which technique is better on the basis of various intraoperative and postoperative objectives. Material and Methods: A prospective randomized comparative study was conducted with a sample size of total 60 patients; 30 in each group. Both the groups were statistically compared for various predefined intraoperative and postoperative objective to determine the better technique of septoplasty. Results: Endoscopic technique was better than conventional in terms of ease for surgical process, time taken for the surgery, intra operative blood loss, visualization of the pathology and postoperative residual deviation. Conclusions: Endoscopic technique was found better in terms of less intra operative complication like bleeding, better visualization, better illumination, magnification, more conservative approach, ease of surgery, less time duration of surgery and less postoperative residual deviation with limitation of binocular vision and bimanual work. Endoscopic septoplasty is modern alternative technique to conventional septoplasty and is a good teaching tool also.

Neonatal nasal obstruction can cause significant functional impairment because neonates are obligatory nasal breathers in the first three months of life. Some neonates with nasal septum issues may be asymptomatic or exhibit mild symptoms that could resolve as they grow in the first few years of life. However, in cases of patients with an uncorrected deviated nasal septum, it can have physiological, anatomical, cosmetic, and psychological impacts. Many studies have reported different approaches to correct neonatal deviated nasal septum, including observation, stenting, close reduction, and septoplasty. Herein, we present two cases aged 14 days and 35 days old with severe symptoms of deviated nasal septum, balloon dilatation septoplasty, a minimally invasive approach, was employed, with low-risk complications and good outcomes. Up to this date, this approach has not been reported in this age group.

Abstract Background The value of endoscopic septoplasty for patients with deviated nasal septum and allergic rhinitis has not been systematically summarized. This study aims to assess the impact of surgical intervention on quality of life through a meta-analysis. Methods We conducted a comprehensive search of PubMed, CNKI, EMBASE, and the Cochrane Library for studies on the treatment of patients with deviated nasal septum and allergic rhinitis up to 2024. Studies that were duplicates, lacked full text, had incomplete data, or involved animal experiments, commentaries, or systematic reviews were excluded. Meta-analysis was performed using STATA 16.0. Results The total nasal symptom score (TNSS) in patients who received endoscopic surgery was considerably reduced compared to those treated with spray therapy alone, indicating a significant improvement (SMD = -21.29, 95% CI: -26.26, -116.33). Classic symptoms of allergic rhinitis, including rhinorrhea (SMD=-9.97, 95% CI: -16.97, -2.98), nasal obstruction (SMD=-27.25, 95% CI: -41.12, -13.38), nasal itching (SMD=-10.32, 95% CI: -13.16, -7.48), and sneezing (SMD=-12.66, 95% CI: -14.99, -10.34), showed significant improvement. There was no significant difference in the incidence of complications between the two treatments (OR = 1.01, 95% CI: 0.49, 2.10). Conclusion Patients with a deviated nasal septum and allergic rhinitis benefit more from septoplasty. However, the procedure should be performed cautiously by experienced clinicians, taking into account the specific condition of the nasal septum.

Background: The application of transseptal suturing as an alternative to intranasal splints in preventing postoperative complications, such as synechia, and maintaining nasal septal stability following Septoplasty, remains controversial. This meta-analysis aims to systematically compare the effectiveness and safety of transseptal suturing with intranasal splints after Septoplasty. Methods: A comprehensive systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. The review included randomized clinical trials (RCTs) identified through a database search in July 2023, comparing postoperative complications following Septoplasty with the transseptal suturing technique versus intranasal splints. Results: Eight published RCTs involving 570 participants were included in the meta-analysis. The analysis revealed no significant difference between the transseptal suturing and intranasal splint techniques following Septoplasty in postoperative complications, including postoperative hemorrhage, synechia, septal hematoma, septal perforation, local infection, crusting, and residual septal deviation. Conclusions: Transseptal suturing can be applied following Septoplasty as an alternative to intranasal splints without increasing the rate of postoperative complications. Level of Evidence I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 [ABSTRACT FROM AUTHOR]

Key Points Nasal valve treatment with TCRF results in NAO symptom improvement in the presence of septal deviation. Severe septal deviation does not impact the beneficial effect of TCRF nasal valve treatment. Symptoms improve with TCRF nasal valve treatment even if septal deviations involve the nasal valve. [ABSTRACT FROM AUTHOR]

Nasal packing is one of the common procedures done following various intranasal surgeries in order to prevent the various complications that can arise post-operatively. Some of the complications noted include bleeding from the nose, septal hematoma, septal abscess and formation of mucosal adhesions. There are different types of nasal packing materials available. Few of the commonly used nasal packing material are ribbon gauzes impregnated with antibiotics, merocel, gel foam, glove fingers and Vaseline gauze. This study compared the effectiveness of Merocel nasal packing with Glove finger nasal packing after Septoplasty and Polypectomy. Merocel, a widely used expandable non-absorbable material, was compared with conventional ribbon gauze packs inserted into glove fingers. Results showed no significant differences in post-operative bleeding, pain, discomfort, mucociliary clearance, or late complications between the two groups. However, a slightly earlier return of mucociliary clearance in patients packed with Glove finger nasal packs was observed. Therefore, it can be concluded that both Merocel and Glove finger nasal packs are equally effective in managing post-operative complications following these procedures. [ABSTRACT FROM AUTHOR]

Background Various techniques are employed for septal perforation repair but success rates still vary. Numerous mucosal flaps are used for septal perforation closure; however, a scaffold is essential for proper positioning and enhanced mucosal growth. Objectives The aim of this study was to assess the effectiveness of utilizing a septal bone/cartilage composite graft (BC unit) to close septal perforations in rhinoplasty patients and evaluate patient satisfaction. Methods This case series included patients with septal perforation undergoing rhinoplasty and perforation repair between 2019 and 2023. BC units were used to cover the cartilaginous perforations in all patients. Patients were followed for a minimum of 1 year, assessing surgical results and postoperative satisfaction with the 10-item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). Results In this study, 31 patients (22 female, 9 male), with a mean [standard deviation] age of 34.80 [10.31] years (range, 19-59 years), were enrolled. Nine had previousl undergone septoplasty, while four had undergone septorhinoplasty. The preoperative perforation size ranged from 6 to 27 mm (mean, 14.1 mm). At final follow-up, 26 cases (83.8%) achieved complete closure, while 3 had incomplete closures, and 2 experienced reperforation. Analysis revealed a notable mean decrease of 31.93 [26.47] in obstruction domain scores (SCHNOS-O) and a mean decrease of 44.19 [25.37] in cosmesis domain scores (SCHNOS-C). Conclusions Septal perforation repair and rhinoplasty can be safely and effectively performed concurrently with BC units for suitable candidates. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Rhinoplasty, a common surgical procedure for nose reshaping, demands meticulous preoperative evaluation and precise execution. When coupled with septoplasty to address medical issues stemming from a deviated nasal septum, these procedures can lead to noteworthy postoperative complications. These encompass early issues like epistaxis and hematoma, as well as long-term challenges such as scarring and aesthetic deformities. Strategies like steroids and tranexamic acid are employed to prevent and manage these complications. A contentious aspect in postoperative care is the use of nasal packing. While some argue it aids healing and hemostasis, others avoid it due to patient discomfort. This review assesses the pros and cons of postoperative nasal packing following rhinoplasty and septoplasty. A thorough literature review spanning 2000–2023 yielded 30 relevant articles from 62. Discussion reveals that nasal packing offers limited benefits in reducing bleeding, edema and ecchymosis. In conclusion, the decision to employ nasal packing in rhinoplasty and septoplasty should be made carefully, considering patient comfort and surgical context. Evidence suggests that nasal packing may not consistently provide significant advantages and could lead to adverse outcomes. Nasal splints offer similar advantages and may be considered viable alternatives. Surgeons should tailor their approach to individual patient needs, with further research needed to refine postoperative management for these procedures. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Objective: Nasal septoplasty is one of the most performed procedures within ENT. Nasal obstruction secondary to a deviated nasal septum is the primary indication for functional septoplasty. Since the coronavirus disease 2019 pandemic, waiting lists have increased and are now long. This study assessed patients on the waiting list for septoplasty and/or inferior turbinate reduction surgery using the Nasal Obstruction Symptom Evaluation instrument. Method: Patients on our waiting list for septoplasty and/or inferior turbinate reduction surgery were reviewed using a validated patient-reported outcome measure tool to assess symptom severity. Results: Eighty-six out of a total of 88 patients (98 per cent) had Nasal Obstruction Symptom Evaluation scores of 30 or more. In addition, 78 (89 per cent) and 50 (57 per cent) patients were classified as having 'severe' or 'extreme' nasal obstruction, respectively. Two patients scored less than 30 and were classified as having non-significant nasal obstruction. Conclusion: The Nasal Obstruction Symptom Evaluation instrument is a quick and easy way to validate septoplasty waiting lists. In this study, two patients were identified who no longer required surgery. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this study was to evaluate the effects of nasal septum deviation and inferior turbinate hypertrophy on nasal obstruction by utilizing the Nose Obstruction Symptom Evaluation (NOSE) values and paranasal sinus computed tomography (PSCT) findings for correct preoperative evaluation. Methods Ninety-six patients (57 males and 39 females) aged between 18 and 54 years (mean age, 30.3 ± 9.7 years) participated in this study. Among them, 56 patients underwent septoplasty combined with inferior turbinate outfracture, while 40 patients underwent septoplasty alone. Preoperative nasal examinations were performed on all patients. The direction, location, nasal septum deviation classification, and inferior turbinate hypertrophy size classification were carefully evaluated and compared with the NOSE survey results. PSCT of 56 patients were evaluated and classified by calculating the coronal location of septum deviation, the axial location of septum deviation, the coronal angle of septum deviation, and the axial angle of septum deviation. Results A positive correlation was found between the coronal location of the septal deviation and the preoperative NOSE 2, and the NOSE total, and the difference of postoperative and preoperative NOSE (p = 0.032, p = 0.007, p = 0.021, respectively). There was a statistically significant relationship between the coronal location of the septal deviation classification and the NOSE preoperative total values (p = 0.26). A negative statistically significant correlation was found between inferior turbinate hypertrophy and preoperative NOSE 5 values (p = 0.029). Conclusion We conclude that the combination of PSCT and the NOSE scale is helpful in determining the severity of nasal obstruction prior to surgery. Specifically, we found that nasal septum deviations located in the anterior and coronal planes have a greater impact on nasal obstruction compared to deviations in the axial plane. Inferior turbinate fracture does not provide more benefit than septoplasty alone in treating patients’ nasal obstruction. These findings emphasize the importance of a comprehensive approach in addressing nasal obstruction for optimal patient outcomes.

Relevance. Septoplasty is one of the most popular surgical operations in otolaryngology and plastic surgery.The surgical technique of performing the operation is widely variable: endoscopic, endonasal and open operations are possible. Nasal septum repair methods can be divided into two categories: Killian septectomy and Cottle septoplasty. This surgical technique leads to typical complications, one of the most common being heavy bleeding. In patients with combined septoplasty and turbinoplasty, septal hematoma, hyposmia, prolonged healing due to infection, and adhesions are much more common.The aim of the study was to analyze the development of complications after septoplasty.Materials and methods. A retrospective analysis of clinical cases after septoplasty was performed for the period from 2022 to 2023 in the city of Irkutsk, Russian Federation. During this period, 34 patients met the study criteria. Surgical treatment included endonasal septoplasty with turbinoplasty.Results. When constructing a logistic analysis, a significant predictor of bleeding was found to include an operation duration of more than 100 minutes (OR 53.9; 95 % CI 1.02; 941.0; p = 0.049). A model with good predictive value was obtained (AUC = 0.73). The sensitivity and specificity of the test are 50 % and 96.88 %, respectively. The overall confidence level is 94.12 %.Conclusion. The information obtained about the predictors of postoperative bleeding after septoplasty allows us to predict these negative outcomes and prevent their development using active hemostatic procedures. Active use of tranexamic acid for patients at risk for postoperative bleeding will reduce the likelihood of this complication.

Objective(s): To determine the frequency of olfactory cleft (OC) stenosis and obstruction on paranasal sinus CT scans in pre-septorhinoplasty of patients who had septal deviation, septopyramidal deformation or nasal obstruction without other sinonasal conditions. Methods: This retrospective study included patients referred to our institution between December 2013 and December 2021 for septorhinoplasty due to nasal obstruction without other sinonasal or neurological conditions. All patients underwent preoperative paranasal sinus CT scan and olfactory testing. OC stenosis was quoted as none, partial, or total (less than 1/3 contact between nasal septum and ethmoid turbinates, 1/3–2/3, more than 2/3, respectively), as well as OC obstruction as none, partial, or complete (obstruction of less than 1/3 of OC, 1/3–2/3, more than 2/3, respectively). Radiologic evaluation was validated by near perfect interobserver agreement. Results: A total of 75 patients (32 women, 43 men) with a mean age of 44.2 ± 15.64 (23–74) years were included, of which 36 were normosmic and 39 hyposmic. OC stenosis was partial in 58.7% (n = 44) of the patients, absent in 28% (n = 21), and total in 13.3% (n = 10), without difference between normosmic and hyposmic patients (p =.66). OC obstruction was absent in 52% (n = 39) and partial in 46.7% (n = 35), without difference between normosmic and hyposmic patients (p =.51). Only one normosmic patient had complete OC obstruction. Conclusion: OC partial stenosis and partial obstruction were frequent findings in pre-septorhinoplasty patients without respiratory mucosa disease and did not influence their olfactory status. Total stenosis and complete obstruction were rarer and require further investigation. Clinical relevance statement: Isolated partial olfactory cleft stenosis and obstruction should be considered normal variants, whereas the impact of complete olfactory cleft stenosis and obstruction on patient's olfactory status remains to be determined. Key Points: • The incidence of olfactory cleft stenosis and obstruction in asymptomatic patients remains unknown, even though it is encountered in clinical practice. • Partial and total olfactory cleft stenosis occurred in 58.7% and 13.3% of the patients; partial obstruction occurred in half of the cases, but complete obstruction was extremely rare. • There are frequent findings of partial olfactory cleft obstruction and stenosis, but complete obstruction and total stenosis should be further investigated. [ABSTRACT FROM AUTHOR]

Objective: To estimate and adjust for rater effects in operating room surgical skills assessment performed using a structured rating scale for nasal septoplasty. Methods: We analyzed survey responses from attending surgeons (raters) who supervised residents and fellows (trainees) performing nasal septoplasty in a prospective cohort study. We fit a structural equation model with the rubric item scores regressed on a latent component of skill and then fit a second model including the rating surgeon as a random effect to model a rater‐effects‐adjusted latent surgical skill. We validated this model against conventional measures including the level of expertise and post‐graduation year (PGY) commensurate with the trainee's performance, the actual PGY of the trainee, and whether the surgical goals were achieved. Results: Our dataset included 188 assessments by 7 raters and 41 trainees. The model with one latent construct for surgical skill and the rater as a random effect was the best. Rubric scores depended on how severe or lenient the rater was, sometimes almost as much as they depended on trainee skill. Rater‐adjusted latent skill scores increased with attending‐estimated skill levels and PGY of trainees, increased with the actual PGY, and appeared constant over different levels of achievement of surgical goals. Conclusion: Our work provides a method to obtain rater effect adjusted surgical skill assessments in the operating room using structured rating scales. Our method allows for the creation of standardized (i.e., rater‐effects‐adjusted) quantitative surgical skill benchmarks using national‐level databases on trainee assessments. Level of Evidence: N/A Laryngoscope, 134:3548–3554, 2024 [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the effects of nasal septum deviation and inferior turbinate hypertrophy on nasal obstruction by utilizing the Nose Obstruction Symptom Evaluation (NOSE) values and paranasal sinus computed tomography (PSCT) findings for correct preoperative evaluation. Methods: Ninety-six patients (57 males and 39 females) aged between 18 and 54 years (mean age, 30.3 ± 9.7 years) participated in this study. Among them, 56 patients underwent septoplasty combined with inferior turbinate outfracture, while 40 patients underwent septoplasty alone. Preoperative nasal examinations were performed on all patients. The direction, location, nasal septum deviation classification, and inferior turbinate hypertrophy size classification were carefully evaluated and compared with the NOSE survey results. PSCT of 56 patients were evaluated and classified by calculating the coronal location of septum deviation, the axial location of septum deviation, the coronal angle of septum deviation, and the axial angle of septum deviation. Results: A positive correlation was found between the coronal location of the septal deviation and the preoperative NOSE 2, and the NOSE total, and the difference of postoperative and preoperative NOSE (p = 0.032, p = 0.007, p = 0.021, respectively). There was a statistically significant relationship between the coronal location of the septal deviation classification and the NOSE preoperative total values (p = 0.26). A negative statistically significant correlation was found between inferior turbinate hypertrophy and preoperative NOSE 5 values (p = 0.029). Conclusion: We conclude that the combination of PSCT and the NOSE scale is helpful in determining the severity of nasal obstruction prior to surgery. Specifically, we found that nasal septum deviations located in the anterior and coronal planes have a greater impact on nasal obstruction compared to deviations in the axial plane. Inferior turbinate fracture does not provide more benefit than septoplasty alone in treating patients' nasal obstruction. These findings emphasize the importance of a comprehensive approach in addressing nasal obstruction for optimal patient outcomes. [ABSTRACT FROM AUTHOR]

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This article is an examination of computational fluid dynamics in the field of otolaryngology, specifically rhinology. The historical development and subsequent application of computational fluid dynamics continues to enhance our understanding of various sinonasal conditions and surgical planning in the field today. This article aims to provide a description of computational fluid dynamics, the methods for its application, and the clinical relevance of its results. Consideration of recent research and data in computational fluid dynamics demonstrates its use in nonhistological disease pathology exploration, accompanied by a large potential for surgical guidance applications. Additionally, this article defines in lay terms the variables analyzed in the computational fluid dynamic process, including velocity, wall shear stress, area, resistance, and heat flux. [ABSTRACT FROM AUTHOR]

Corrective septal surgery for children with nasal obstruction has historically been avoided due to concern about the impact on the growing nose, with disruption of midfacial growth. However, there is a paucity of data evaluating complication and revision rates post-nasal septal surgery in the pediatric population. In addition, there is evidence to suggest that failure to treat nasal obstruction in children may itself result in facial deformity and/or developmental delay. The aim of this systematic review is to evaluate the efficacy and safety of septal surgery in pediatric patients with nasal obstruction. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. MEDLINE, Embase, and the Cochrane Library were searched. Original studies in pediatric patients (<18 years of age) with nasal obstruction were eligible for inclusion. Patients with cleft lip or palate as their primary diagnosis were excluded. Our primary outcomes were patient-reported outcome measures (PROMs), postsurgical complications, and revision rates. Secondary outcomes included surgical technique, anatomical considerations, and anthropometric measurements. Eighteen studies were included (1,080 patients). Patients underwent septoplasty, septorhinoplasty, rhinoplasty, or a combination of procedures for nasal obstruction. Obstruction was commonly reported secondary to trauma, nasal septal deviation, or congenital deformity. The mean age of the patients was 13.04 years with an average follow-up of 41.8 months. In all, 5.6% patients required revision surgery and there was an overall complication rate of 7.8%. Septal surgery for nasal obstruction in children has low revision and complication rates. However, a pediatric-specific outcome measure is yet to be determined. Larger prospective studies with long-term follow-up periods are needed to determine the optimal timing of nasal surgery for nasal obstruction in the pediatric population. [ABSTRACT FROM AUTHOR]

Our aim is to investigate the effects of the submucoperichondrial application of Platelet Rich Plasma (PRP) on nasal mucosal healing after septoplasty surgery. This prospective randomized observational study was conducted between July 2019 and February 2021, with 40 patients aged 18–60 years who underwent closed the only septoplasty operation for similar septal deviations. Patient divided into two group; 21 patients were placed in PRP group to which PRP was applied on all mucosal surface and submucoperichondrial area of septum and 19 patients were placed in control group to which saline solution was applied on same regions. Nasal obstruction score, mucociliary clearance time, presence of nasal crusting, and bleeding time were evaluated on 5th, 10th, 15th day after surgery and compared between groups. Intranasal crusting on day 10 was found to be lower in the PRP group (n :13 68.4 %) than control group (n :7 33.3 %) with a statistically significant difference (p = 0.028). The nasal obstruction score on day 10 and 15 were found to be lower in the PRP group (3,33 ± 2,75, 2,07 ± 2,20) (than the control group (5,44 ± 2,26, 3,37 ± 1,92) with a statistically significant difference (p = 0,003, p = 0,009). The mucociliary clearance rate was found to be higher and the bleeding time was found to be lower in the PRP group, but a statistically significant difference was not observed. Application of submucoperichondrial PRP could have beneficial effects on nasal mucosal repair, nasal crusting, and congestion after septoplasty surgery. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous left atrial appendage occlusion (LAAO) is traditionally performed under general anesthesia with trans‐esophageal echocardiography guidance. Intracardiac echo (ICE)‐guided LAAO closure is increasing in clinical use. The ICE catheter is crossed into LA via interatrial septum (IAS) after the septum is dilated with LAAO delivery sheath. This step can be time‐consuming and requires significant ICE catheter manipulation, which increases the risk of cardiac perforation. Pre‐emptive septal balloon dilation can potentially help with ICE advancement in the LA. We sought to evaluate the effect of pre‐dilation of the IAS with an 8 mm balloon on the ease of crossing the ICE catheter, fluoroscopy time for crossing, and overall procedure time. Methods: The Piedmont LAAO registry was used to identify consecutive patients who underwent LAAO. The initial 25 patients in whom balloon dilation of the IAS was performed served as the experimental cohort, and the 25 consecutive patients before that in whom balloon dilation was not performed served as controls. In the experimental group, after a trans‐septal puncture, the sheath was retracted to the right atrium with a guidewire still in the LA. An 8 × 40 mm Evercoss™ over the wire balloon was inflated across the IAS. The ICE catheter was then crossed into the LA using the fluoroscopic landmark of the guide wire and the ICE imaging. The sheath was then advanced along the ICE catheter via the transseptal puncture (TSP) and the procedure continued. Follow‐up compputed tomography imaging was obtained at 4–8 weeks. Results: Each group consisted of 25 patients. There were no significant differences in baseline characteristics. All procedures were performed successfully under conscious sedation and ICE guidance. There was a significant reduction in the overall procedure time, fluoroscopy time, and time for transseptal puncture to ICE in LA. There was no difference in the size of the acute residual interatrial shunt, as measured via ICE, or the size and presence of iatrogenic ASD at follow‐up. Conclusion: Balloon dilation of TSP is safe and is associated with increased efficiency in ICE‐guided LAAO procedures. [ABSTRACT FROM AUTHOR]

Background: Correction of the crooked nose, especially the perpendicular plate of the ethmoid bone, has the potential to cause skull base injury. At present, the safe and effective method for perpendicular plate resection has not been clearly defined through biomechanics. Method: CT scan data of 48 patients with crooked nose and deviated nasal septum were divided into C-type, angular deformity-type, and S-type based on the morphology of the 3D model. Different types of finite element models of the nasal bony septum and skull base were established. The osteotomy depth, angle, and force mode of the PPE resection were simulated by assembling different working conditions for the models. The von Mises stress of the anterior cranial fossa was observed. Results: When the osteotomy line length was 0.5 cm, the angle was at 30° to the Frankfurt plane, and 50 N·mm torque was applied, the von Mises stress of the skull base was minimal in the four models, showing 0.049 MPa (C-type), 0.082 MPa (S-type), 0.128 MPa (angular deformity-type), and 0.021 MPa (control model). The maximum von Mises stress values were found at the skull base when the osteotomy line was 1.5 cm, the angle was 50°, and the force was 10 N along the X-axis, showing 0.349 MPa (C-type), 0.698 MPa (S-type), 0.451 MPa (angular deformity-type), and 0.149 MPa (control model). Conclusion: The use of smaller resection angle with the Frankfurt plane, conservative resection depth, and torsion force can better reduce the stress value at the skull base and reduce the risk of basicranial fracture. It is a safe and effective technique for perpendicular plate resection of the ethmoid bone in the correction of crooked nose. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Septoplasty is used to correct nasal obstruction from nasal septum deviation. However, the long‐term efficacy of septoplasty is unclear, and no literature reviews have examined long‐term outcomes of septoplasty with or without turbinate modification. This systematic review aimed to evaluate the long‐term efficacy of septoplasty with or without turbinate modification in improving nasal obstruction. Data Sources: PubMed, EMBASE, Cochrane CENTRAL. Methods: A systematic review of the literature was conducted using the aforementioned databases. Studies reporting outcomes 12+ months after functional septoplasty with or without turbinate surgery for nasal obstruction were included. Septorhinoplasties, concurrent sinus surgery, pediatric studies, and studies where septoplasty was performed for indications other than nasal obstruction were excluded. Results: After screening, 35 studies with 4,432 patients were included. Mean weighted post‐operative follow‐up time was 29.1 months (range 12–120 months). All studies reported significant improvement in subjective and objective outcomes at long‐term follow‐up compared to baseline. When comparing short‐term (<12 months) to long‐term (≥12 months) outcomes, four studies noticed that subjective outcomes worsened slightly over time, but no study found a significant change in objective outcomes over time. In addition, 23 studies reported patient satisfaction and/or improvement rates, with 75.4% (2,348/3,113) of patients expressing satisfaction/improvement at an average of 27.0 months after surgery. Conclusions: Overall, septoplasty with or without turbinate modification shows significant improvement in obstructive symptoms at long‐term follow‐up per both objective and subjective measures. Whether outcomes may worsen slightly over time remains indeterminate based on mixed results in the literature. Level of Evidence: N/A Laryngoscope, 134:2525–2537, 2024 [ABSTRACT FROM AUTHOR]

A rat biological model of septoplasty was used to study the effect of surgery on passive avoidance conditioning (PAC). Septoplasty was shown to increase anxiety and to reduce exploratory activity in rodents during PAC. A neurochemical analysis of the hypothalamus was carried out immediately after the end of the experiment and showed an increase in norepinephrine (NE) metabolism after septoplasty. The finding was tentatively associated with activation of the hypothalamic-pituitary-adrenal axis. [ABSTRACT FROM AUTHOR]

The nasal septum is a key component of the nasal structure, affecting proper airflow and providing support for the nasal structures. A deviated septum (DSN) can lead to breathing disorders, impaired nasal patency, recurrent nosebleeds, olfactory disorders and frequent upper respiratory tract infections. In competitive sports, where ventilation performance is critical, septal deviation can adversely affect athletic performance. The purpose of this study is to evaluate the effect of septoplasty on patients' physical performance. Methodes This article is based on the available literature found in the Google Scholar, PubMed database with the use of key words such as ,,septoplasty'', ,,nasal septal deviation'', ,,septoplasty quality of life'', ,,nasal septal deviation athletes'', ,,septoplasty sport'', ,,nasal obstruction sport''. Results Conducted studies show that surgical correction of a deviated nasal septum improves physical performance as well as respiratory and cardiovascular functions. Restoring proper airflow through the nose after surgery leads to a noticeable improvement in physical performance, highlighting the significance of septoplasty in enhancing patient comfort and improving athletic outcomes.

Abstract Background High anterior septal deviation is an underreported anatomical variant that can influence the decision to conduct septoplasty throughout FESS and to facilitate after-surgery care. Objective To assess the prevalence and clinical implications of HASD on sinus access. Methods This retrospective, cross-sectional research was performed on patients with symptoms of DNS and CRS who were prepared for FESS. CT scan PNS coronal sections have been requested with three measurements: distance to the septum (SDD), distance to lateral nasal wall (LNW), and septal deviation angle (SDA). Results One-hundred fifty-seven patients were included; 73 of them received septoplasty. There is significant increase in SDD (mm), LNW (mm), SDD/LNW, and SDA (degree) in septoplasty group with significant AUC that predict the need of septoplasty. Characteristic cutoffs were SDD more than or equal 2.55 mm, SDD/LNW more than or equal 0.239, and SDA more than or equal 8.95°. There is significant decrease in polyps and edema in septoplasty group postoperatively compared to preoperative. Conclusion Septoplasty during FESS allows room for endoscopic instrumentation, provides adequate visualization of the surgical field and throughout postoperative care, and can reduce the possibility of failed FESS.

The aim of the article: To study the influence of absolute and relative metric indicators of the lumen of certain parts of the internal nasal valve on the effectiveness of olfactory and respiratory functions of the nasal cavity. Materials and methods: A comparison of the metric values of the internal nasal valve, air resistance and odor perception in 32 patients after septoplasty was performed, depending on the quality of life and complaints according to SNOT 22. Group 1 consisted of 22 patients who complained of subjective feelings of nasal insufficiency (SNOT 22 – 9-20 scores). Control group consisted of 10 patients who were satisfied with septoplasty results (SNOT 22 – 0-7 scores). Rhinomanometry was performed according to the PARM method, olfactometry was carried out using the Sniffin’ Sticks psychophysical tests, and planimetry on CT was performed in the RadiAnt DICOM Viewer 2022.1 program, using the closed polygon tool. Results: Significant differences in the relative values of the ratio of the upper part of the valve area to the lower part were observed between the two groups of patients. A significant difference in better odor perception was noted in group 2. It was 0.7±0.02 in patients of the control group, and 0.4±0.02 in patients of Group 1. Air resistance in the nasal cavity during unilateral rhinomanometry did not significantly differ (0.28±0.04 and 0.26±0.07 Pa/cm3/sec). The average score during olfactometry in patients of the control group was 11.4±0.13, in patients of Group 1 it was 8.8±0.2, which indicates the presence of hyposmia (p>0.05). Conclusions: The ratio of the areas of the upper and lower parts of the internal nasal valve does not affect the overall airway resistance in the nose, but it can disrupt the distribution of air between the nasal passages. When evaluating the results of septoplasty, in particular, if the patient is not satisfied with nasal breathing, it is important to pay attention to the ventilation of the upper parts of the nasal cavity. One of the markers of its impairment may be hyposmia.

Objective To summarize the clinical characteristics of nasal fracture combined with septal fracture and to analyze the classification and the therapeutic effect of septal fracture. Methods The clinical data and CT images of 91 patients who had undergone surgical reduction of nasal fracture in our department were analyzed retrospectively. All patients were divided into the group of simple nasal fracture (Group A) and the group of nasal fracture combined with septal fracture (Group B), and the differences in gender composition, age, and grading of nasal fracture between the two groups were compared. The occurrence site and the curative effect of nasal septal fracture were analyzed statistically. Results Among the 91 patients with nasal fractures, 36 had concomitant septal fractures (39.6%). There was no significant difference between Group A and Group B in terms of gender composition, while both the age of the patients and fracture grading were significantly higher in Group B than those in Group A. There was 61.1% (22/36) of the septal fractures which occurred in the anterior end of the infranasal bony septum (Type Ⅰ), 30.6% (11/36) in the anterior and middle bony septum (Type Ⅱ), and 8.3% (3/36) through the bony septum and cartilaginous septum (Type Ⅲ ). Patients with septal fractures all obtained satisfied outcomes with closed reduction and postoperative compression. Conclusions Adult and severe nasal fractures are more likely to be accompanied by septal fractures. The nasal septal fractures is more likely to occur at the anterior end of the bony septum, and good clinical results can be achieved by closed reduction. [ABSTRACT FROM AUTHOR]

Context: The prognosis of combined septoplasty and endoscopic dacryocystorhinostomy (En-DCR) for moderate nasal septum deviation (NSD) has not yet been fully investigated. Purpose: To evaluate whether septoplasty improves the prognosis of En-DCR for moderate NSD. Settings and Design: A retrospective cohort study in a real-world clinical setting. Methods: The postoperative FICI DCR ostium grading scores and functional and anatomical information at 1, 2, 3, and 6 months were determined for consecutive patients with chronic dacryocystitis (CD) and moderate NSD who underwent En-DCR. Statistical Analysis Used: Univariate and generalized estimating equation multivariate analyses were used to compare the outcomes of the septoplasty and non-septoplasty groups. Results: En-DCR and septoplasty were concurrently performed for 32 (20.1%, 32/158) cases. The total FICI DCR ostial scores for the septoplasty and non-septoplasty groups were highest at the first (4.97 ± 0.177 vs. 4.97 ± 0.176, P > 0.05) and lowest at the sixth (4.41 ± 1.341 vs. 4.50 ± 1.355, P > 0.05) postoperative months. At the end of follow-up, the two groups showed comparable proportions of pa;tients requiring definitive intervention for the ostium (6.3% vs. 7.1%, P > 0.05), comparabe functional success rates (87.5% vs. 90.5%, P > 0.05) and anatomical success rates (93.8% vs. 92.9%, P > 0.05). Only the non-septoplasty group experienced nasal mucosal adhesions (3.2%, 4/126). Conclusions: In patients with CD and moderate NSD, nasal septoplasty did not impact En-DCR prognosis, but reduced the complications. Skilled surgeons should reconsider septoplasty in the absence of otolaryngological indications. [ABSTRACT FROM AUTHOR]

Functional septo(rhino)plasty incurs a 17–25% rate of revision for persistent symptoms. The main study objective was to assess functional results before and after surgical revision. The secondary objective was to describe the shortcomings or excesses of the prior surgeries, with a-posteriori comparison of efficacy for the surgical techniques requiring revision. A single-center retrospective study included functional salvage septo(rhino)plasties. Data comprised epidemiology, intraoperative anatomic abnormalities indicative of prior surgery, operative correction maneuvers, and pre- and post-intervention NOSE and RhinoQoL scores and satisfaction on VAS. Eighty-two patients were included. Anatomic abnormalities comprised deviated posterior septum (81.7%) and chondroethmoidal junction (58.5%), valve stenosis (54.9%), and obstructive boney spur or crest (46.3%). Prior surgeries comprised 33 submucosal resections, 29 septorhinoplasties, 14 Cottle septoplasties and 5 Killian procedures. Complete septoplasty was performed in 80% of cases, with associated maneuvers in 15%. All scores showed improvement taking the whole population together (P < 10−5), but on subgroup analysis improvement concerned only revision of septorhinoplasty (P < 10−4) and of submucosal resection (P < 10−3), while 17% of patients showed no change in scores. Functional nasoseptal salvage surgery enables most patients to recover respiratory comfort, with the exception of a few cases despite a perfectly straight nasal septum. [ABSTRACT FROM AUTHOR]