RESUMO
Abstract 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.
Resumo Introdução: Os desvios septais podem causar obstrução nasal e impacto negativo na qualidade de vida dos indivíduos. A eficácia da septoplastia para o tratamento do desvio septal e os preditores de resultados cirúrgicos satisfatórios continuam controversos. A variabilidade técnica, a heterogeneidade das amostras de estudo e a ausência de uma ferramenta sólida para avaliação clínica são os principais obstáculos ao estabelecimento de dados estatísticos confiáveis sobre o procedimento. Objetivo: Avaliar a melhora clínica na qualidade de vida específica da doença entre pacientes submetidos a septoplastia e fratura bilateral da concha inferior sob sedação e anestesia local em um hospital terciário e possíveis variáveis clínico-epidemiológicas associadas ao desfecho funcional. Método: Cinquenta e dois pacientes consecutivamente submetidos a septoplastia e fratura bilateral da concha inferior para o tratamento da obstrução nasal preencheram formulários com informações clínicas e epidemiológicas durante a inclusão no estudo e tiveram seus sintomas quantificados objetivamente utilizando a escala de Avaliação de Sintomas de Obstrução Nasal (Nose Obstruction Symptom Evaluation - NOSE) no pré-operatório e um e três meses após o procedimento. A análise estatística objetivou determinar resultados cirúrgicos globais e estratificados e investigar correlações entre as variáveis clínico-epidemiológicas e os escores obtidos. Resultados: Foi demonstrada uma melhora estatisticamente significativa nos escores obtidos no questionário NOSE três meses após a cirurgia (p < 0,001, T-Wilcoxon), quando comparado com os escores obtidos no pré-operatório, com uma forte correlação entre o escore pré-operatório e a melhora pós-operatória durante esse período (r = -0,614, p < 0,001, Spearman). Após um mês, os pacientes atingiram em média 87,15% do resultado obtido ao término do estudo. Fumantes e pacientes com rinite e/ou comorbidade pulmonar apresentaram valores médios pré-operatórios do escore NOSE aumentados, embora sem significância estatística (p > 0,05). Sexo, idade, história de rinite e presença de comorbidade pulmonar não influenciaram significativamente os resultados cirúrgicos (p > 0,05). Os fumantes apresentaram maior redução nos escores de NOSE (p = 0,043, U-Mann-Whitney). Conclusão: A septoplastia e a fratura bilateral da concha inferior demonstraram melhorar significativamente a qualidade de vida específica da doença e este resultado favorável parece ocorrer de forma precoce.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Qualidade de Vida , Conchas Nasais/cirurgia , Obstrução Nasal/cirurgia , Obstrução Nasal/psicologia , Deformidades Adquiridas Nasais/cirurgia , Deformidades Adquiridas Nasais/psicologia , Septo Nasal/cirurgia , Período Pós-Operatório , Doença Crônica , Estudos Prospectivos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
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.
Assuntos
Obstrução Nasal/psicologia , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/psicologia , Deformidades Adquiridas Nasais/cirurgia , Qualidade de Vida , Conchas Nasais/cirurgia , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Introduction: Several surgical techniques emphasizing sutures on the lower lateral cartilage have been studied by surgeons as instruments to improve nasal tip remodeling. It is already known that the domal divergence angle and its definition angle can be modified by lateral intercrural suture (LIS). Techniques for measuring these structures are not yet standardized. Objectives: Assess the efficacy of LIS using polydioxanone 40 absorbable thread by interdomal distance and systematize the LIS technique to improve nasal tip definition. Materials and Methods: This prospective study measured and analyzed interdomal distances measured preoperatively and perioperatively compared with 3- and 6-month postoperative measurements. Results: LIS was efficient on reducing interdomal distances. Conclusion: LIS is statistically safe and efficient and has low morbidity when utilized in patients with mild to moderate deformities, because it reduces the domal divergence angle, effectively sustaining the nasal tip...
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Humanos , Feminino , Adulto , Procedimentos Cirúrgicos Nasais , Rinoplastia , Técnicas de SuturaRESUMO
Introduction Several surgical techniques emphasizing sutures on the lower lateral cartilage have been studied by surgeons as instruments to improve nasal tip remodeling. It is already known that the domal divergence angle and its definition angle can be modified by lateral intercrural suture (LIS). Techniques for measuring these structures are not yet standardized. Objectives Assess the efficacy of LIS using polydioxanone 4-0 absorbable thread by interdomal distance and systematize the LIS technique to improve nasal tip definition. Materials and Methods This prospective study measured and analyzed interdomal distances measured preoperatively and perioperatively compared with 3- and 6-month postoperative measurements. Results LIS was efficient on reducing interdomal distances. Conclusion LIS is statistically safe and efficient and has low morbidity when utilized in patients with mild to moderate deformities, because it reduces the domal divergence angle, effectively sustaining the nasal tip.
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Introduction: Refinement of the nose tip can be accomplished by a variety of techniques, but currently, the use of sutures in the nasal tip with conservative resection of the alar cartilage is the most frequently recommended approach. Objective: To classify the nasal tip and to demonstrate the interdomal suture applied to nasal tip refinement in the Caucasian nose, as well as to provide a simple and practical presentation of the surgical steps. Method: Development of surgical algorithm for nasal tip surgery: 1. Interdomal suture (double binding suture), 2. Interdomal suture with alar cartilage weakening (cross-hatching), 3. Interdomal suture with cephalic removal of the alar cartilage (McIndoe technique) based on the nasal tip type classification. This classification assesses the interdomal distance (angle of domal divergence and intercrural distance), domal arch width, cartilage consistency, and skin type. Interdomal suture is performed through endonasal rhinoplasty by basic technique without delivery (Converse-Diamond technique) under local anesthesia Conclusion: This classification is simple and facilitates the approach of surgical treatment of the nasal tip through interdomal suture, systematizing and standardizing surgical maneuvers for better refinement of the Caucasian nose...
Assuntos
Humanos , Cartilagens Nasais/cirurgia , Nariz/cirurgia , Rinoplastia/instrumentação , Técnicas de Sutura/tendênciasRESUMO
Introdução: Diversas técnicas podem ser realizadas para melhorar a definição da ponta nasal como ressecção cartilaginosa, colocação de enxertos ou suturas. A realização de suturas na ponta nasal proporciona resultados estéticos satisfatórios com menor morbidade1-5. Objetivo: Avaliar a sutura intercrura lateral realizada na cartilagem lateral inferior, através de rinosseptoplastia endonasal por técnica básica sem delivery, para diminuição do ângulo de divergência domal no nariz caucasiano e consequente melhora na definição da ponta nasal. Método: Realizado estudo prospectivo com 64 casos nos quais foi confeccionada sutura no bordo cefálico da cartilagem lateral inferior na junção entre a cúpula e crus lateral, utilizando-se fio P.D.S. (Polydioxanorie®) incolor 4"0" com agulha curva cortante. Resultado: Foram analisadas e comparadas as fotos do pré - operatório e do pós -operatório com 6 meses de evolução. Em todos os casos foi atingida uma melhora na definição da ponta através da sutura intercrura lateral. Conclusão: A sutura intercrura lateral da cartilagem lateral inferior mostrou ser factível para uma melhor definição da ponta no nariz caucasiano podendo ser realizada por rinoplastia endonasal sem delivery...
Introduction: Several techniques can be performed to improve nasal tip definition such as cartilage resection, tip grafts, or sutures. Objective: To evaluate the outcome of lateral intercrural suture at the lower lateral cartilage by endonasal rhinoplasty with a basic technique without delivery in decreasing the angle of domal divergence and improving the nasal tip definition. Method: This prospective study was performed in 64 patients in which a suture was made on the board head of the lower lateral cartilage in the joint between the dome and lateral crus, using polydioxanone (PDS) with sharp, curved needle. Results: In all of the cases, better definition of the nasal tip was achieved by intercrural suturing for at least 6 months postoperatively. Conclusion: Lateral intercrural suture of the lower lateral cartilage provides improved nasal tip definition and can be performed by endonasal rhinoplasty without delivery in the Caucasian nose...
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Etnicidade , Cartilagens Nasais , Rinoplastia , Técnicas de Sutura , SeguimentosRESUMO
INTRODUCTION: Several techniques can be performed to improve nasal tip definition such as cartilage resection, tip grafts, or sutures. Objctive: To evaluate the outcome of lateral intercrural suture at the lower lateral cartilage by endonasal rhinoplasty with a basic technique without delivery in decreasing the angle of domal divergence and improving the nasal tip definition. METHOD: This prospective study was performed in 64 patients in which a suture was made on the board head of the lower lateral cartilage in the joint between the dome and lateral crus, using polydioxanone (PDS) with sharp, curved needle. RESULTS: In all of the cases, better definition of the nasal tip was achieved by intercrural suturing for at least 6 months postoperatively. CONCLUSION: Lateral intercrural suture of the lower lateral cartilage provides improved nasal tip definition and can be performed by endonasal rhinoplasty without delivery in the Caucasian nose.
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INTRODUCTION: Refinement of the nose tip can be accomplished by a variety of techniques, but currently, the use of sutures in the nasal tip with conservative resection of the alar cartilage is the most frequently recommended approach. OBJECTIVE: To classify the nasal tip and to demonstrate the interdomal suture applied to nasal tip refinement in the Caucasian nose, as well as to provide a simple and practical presentation of the surgical steps. METHOD: Development of surgical algorithm for nasal tip surgery: 1. Interdomal suture (double binding suture), 2. Interdomal suture with alar cartilage weakening (cross-hatching), 3. Interdomal suture with cephalic removal of the alar cartilage (McIndoe technique) based on the nasal tip type classification. This classification assesses the interdomal distance (angle of domal divergence and intercrural distance), domal arch width, cartilage consistency, and skin type. Interdomal suture is performed through endonasal rhinoplasty by basic technique without delivery (Converse-Diamond technique) under local anesthesia. CONCLUSION: This classification is simple and facilitates the approach of surgical treatment of the nasal tip through interdomal suture, systematizing and standardizing surgical maneuvers for better refinement of the Caucasian nose.
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Introdução: Diversas técnicas podem ser realizadas para diminuir a base nasal (estreitamento), como ressecção de pele vestibular, ressecção de pele columelar, ressecção de pele em elipse do bordo narinário, descolamentos e avançamentos de pele (técnica V-Y de Berstein) e o uso de suturas na cerclagem da base nasal. Objetivo: Avaliar a técnica de cerclagem realizada na base nasal, através de rinosseptoplastia endonasal por técnica básica sem delivery, no nariz caucasiano, diminuindo a distância inter-alar e corrigindo o alar flare com consequente melhora da harmonia nasal no conjunto facial. Método: Realizado estudo retrospectivo através da análise das fotos e documentos clínicos de 43 pacientes, nos quais foi confeccionada a cerclagem da base nasal, através da ressecção de pele em elipse da região do vestíbulo e base nasal (técnica de Weir modificada), utilizando-se fio mononylon® incolor 4"0" com agulha reta cortante. O estudo foi realizado nos anos de 2008 e 2009 no Hospital Instituto Paranaense de Otorrinolaringologia - IPO em Curitiba-Paraná, Brasil. Os pacientes tiveram um follow up que variou de 7 a 12 meses. Resultados: Em 100% dos casos foi atingida uma melhora na harmonia nasal, através da diminuição da distância inter-alar. Conclusão: A cerclagem associada a ressecção mínima de pele vestibular e da base nasal é um método eficaz para o estreitamento da base nasal no nariz caucasiano, com resultados previsíveis e de fácil realização.
Introduction: Several techniques can be performed to reduce the nasal base (narrowing), as skin resection vestibular columellar skin resection, resection of skin in elliptical lip narinary, sloughing of skin and advancements (VY technique of Bernstein) and the use of cerclage sutures in the nasal base. Objective: To evaluate the technique of cerclage performed in the nasal base, through endonasal rhinoplasty without delivery of basic technique, in the Caucasian nose, reducing the distance inter-alar flare and correcting the wing with consequent improvement in nasal harmony in the whole face. Methods: A retrospective analysis by analysis of clinical documents and photos of 43 patients in whom cerclage was made of the nasal base by resecting skin ellipse in the region of the vestibule and the nasal base (modified technique of Weir) using colorless mononylon® 4 "0" with a straight cutting needle. The study was conducted in 2008 and 2009 at Hospital of Paraná Institute of Otolaryngology - IPO in Curitiba, Parana - Brazil. Patients had a follow up ranging 7-12 months. Results: In 100% of cases was achieved an improvement in nasal harmony, by decreasing the inter-alar distance. Conclusion: The encircling with minimal resection of vestibular skin and the nasal base is an effective method for the narrowing of the nasal base in the Caucasian nose, with predictable results and easy to perform.
Assuntos
Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Nariz/cirurgia , Rinoplastia , Técnicas de Sutura , VestibuloplastiaRESUMO
Introdução: Nas rinoplastias, como em outras cirurgias, uma exposição adequada das estruturas manipuladas é fundamental para um bom resultado cirúrgico. Diversas são as técnicas empregadas, e essas variam, principalmente, em razão das alterações anatômicas encontradas. Objetivo: Avaliar quais as técnicas e manobras cirúrgicas mais realizadas em nosso serviço. Método: Análise retrospectiva das descrições de cirurgia dos pacientes submetidos à rinoplastia no Serviço de Otorrinolaringologia do Hospital de Clínicas - UFPR no ano de 2007. Resultados: Foram avaliados 79 pacientes; em 86% foi realizada a rinoplastia com técnica básica, em 6,4% e 7,6% foi realizado "delivery" e rinoplastia externa, respectivamente. Conclusão: Em nosso serviço realizamos rinoplastias com técnica básica na grande maioria dos pacientes.
Introduction: In the rhinoplasty, as in other surgeries, an adequate exposure of the manipulated structures is essential for a positive surgical result. Various techniques are used, and these may vary, mainly, because of the anatomical alterations found. Objective: To evaluate which are the most common surgical techniques and maneuver used in our service. Method: Retrospective analysis of the surgical descriptions of patients submitted to the rhinoplasty in the Otorhinolaryngology Department of the Clinical Hospital - UFPR in the year of 2007. Results: 79 patients were evaluated; in 86% of whom rhinoplasty with basic technique was performed, between 6,4% and 7,6% delivery and external rhinoplasty were used, respectively. Conclusion: In our service we performed basic technique rhinoplasty in the great majority of the patients.