RESUMO
La nariz es estructuralmente compleja, y esta complejidad da como resultado variaciones de forma nasal. El estudio tuvo como objetivo determinar las desviaciones septales nasales que ocurren en relación con las deformidades nasales externas. Se realizó un estudio transversal en el departamento de oído, nariz y garganta, en nuestro hospital. Todos los individuos que tienen desviación septal con deformidad nasal externa de noviembre de 2017 a noviembre de 2018. Esos pacientes serán evaluados mediante un examen clínico integral de la oreja, la nariz y la garganta. Los síntomas del paciente se clasifican con el cuestionario de prueba china nasal -22. Las deformidades septales se clasificaron utilizando la clasificación Mladina modificada. Las deformidades nasales externas se clasificaron empleando la clasificación de Yong Jo Jang. Aproximadamente, el 43% eran hombres y el 57% eran mujeres. Alrededor del 90% de los pacientes de 21 años a 50 años. Alrededor del 58% de los pacientes eran sintomáticos, mientras que el resto del 42% no tenía síntomas. Al correlacionar los síntomas con el tipo de desviación, se encontró significativamente asociación (P = 0.05). La mayoría de las personas se encuentran en el grupo de mediana edad. Tipo II y IV son los tipos más comunes de NSD, mientras que el tipo I es un final común. El encuentro notable de nuestro estudio es que los pacientes no tenían deformidad
The nose is structurally complex, and this complexity results in nasal shape variations. The study aimed to determine the nasal septal deviations occurrence in relation to external nasal deformities. A crosssectional study was conducted in Department of Ear, Nose and Throat, in our hospital. All the individuals having septal deviation with external nasal deformity from November 2017 to November 2018. Those patients be evaluated by comprehensive clinical examination of ear, nose and throat. Patient's symptoms are rated with Sino-Nasal Test -22 questionnaire. Septal deformities were classified using Mladina classification modified. External nasal deformities were classified employing Yong Jo Jang's classification. Approximately, 43% were males and 57% were females. About 90% of patients aged from 21 years to 50 years. About 58% of patients were symptomatic while the rest 42% were without symptoms. On correlating the symptoms with the type of deviation it was found significantly association (P=0.05). Majority of individuals are in the middle age group. Type II and IV are the most common types of NSD whereas type I is a common END. Noteworthy finding of our study is patients had no deformity.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Deformidades Adquiridas Nasais/patologia , Cartilagens Nasais/anormalidades , Cavidade NasalRESUMO
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⯱â¯28.28). The mean deviated nasal septum angle in patients with nasal obstruction was 8.5°â¯±â¯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.
Assuntos
Obstrução Nasal , Procedimentos Cirúrgicos Nasais , Deformidades Adquiridas Nasais , Humanos , Obstrução Nasal/complicações , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/complicações , Deformidades Adquiridas Nasais/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
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⯱â¯0.06 vs. 0.41⯱â¯0.04, pâ¯<⯠0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, pâ¯<⯠0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, pâ¯<⯠0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, pâ¯=⯠0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, pâ¯=⯠0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, pâ¯<⯠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 â¯=â¯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.
Assuntos
Obstrução Nasal , Deformidades Adquiridas Nasais , Rinoplastia , Humanos , Obstrução Nasal/etiologia , Septo Nasal/lesões , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/complicações , Deformidades Adquiridas Nasais/cirurgia , Estudos Prospectivos , Rinoplastia/efeitos adversos , Resultado do TratamentoRESUMO
Resumo Introdução: O enxerto de extensão caudal é geralmente um enxerto de cartilagem que se sobrepõe à margem caudal do septo nasal. Uma combinação do enxerto de extensão caudal e a técnica de tongue-in-groove é usada para estabilizar a base nasal, definir a projeção da ponta e refinar a relação alar-columelar. Objetivo: Apresentar algumas novas modificações na colocação dos enxertos de extensão caudal na rinoplastia. Método: Revisão retrospectiva de um banco de dados prospectivamente coletado de 965 pacientes que se submeteram a rinosseptoplastia de junho de 2011 a julho de 2015. Desses, 457 pacientes necessitaram de enxerto de extensão caudal e foram incluídos no estudo. O seguimento mínimo foi de 13,2 meses, com tempo médio de seguimento de 17,4 meses. Resultados: Na maioria dos casos, a comparação das fotografias antes e após a cirurgia foi satisfatória e apresentou melhora do contorno. Pequenas deformidades foram detectadas em 41 pacientes e 11 pacientes necessitaram de cirurgia de revisão. Conclusão: Com essas modificações, o cirurgião pode usar o enxerto de extensão caudal mesmo em desvios angulares do septo caudal. Vários métodos têm sido propostos para correção do desvio septo-caudal.
Assuntos
Rinoplastia , Deformidades Adquiridas Nasais , Cartilagem/transplante , Estudos Retrospectivos , Resultado do Tratamento , Septo Nasal/cirurgiaAssuntos
Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Deformidades Adquiridas Nasais/cirurgia , Nariz/patologia , Retalhos Cirúrgicos/transplante , Humanos , Lactente , Recém-Nascido , Necrose/etiologia , Necrose/patologia , Necrose/cirurgia , Nariz/cirurgia , Deformidades Adquiridas Nasais/etiologia , Deformidades Adquiridas Nasais/patologia , Resultado do TratamentoRESUMO
INTRODUCTION: The caudal extension graft is usually a cartilage graft that overlaps the caudal margin of the nasal septum. A combination of the caudal extension graft and the tongue-in-groove technique is used to stabilize the nasal base, set tip projection, and refine the alar-columellar relationship. OBJECTIVES: In this study we present some new modifications to the placement of caudal extension grafts in rhinoplasty. METHODS: This study is a retrospective review of a prospectively collected database of 965 patients who underwent septorhinoplasty from June 2011 to July 2015. Of these, 457 patients required a caudal extension graft and were included in the study. Minimum follow-up was 13.2 months with a mean follow-up time of 17.4 months. RESULTS: In most cases, comparison of photographs before and after surgery were satisfactory and showed improved contour. Minor deformity was detected in 41 patients and 11 patients needed revision surgery. CONCLUSION: With these modifications the surgeon can employ the caudal extension graft even in angulated caudal septal deviations. A variety of methods have been proposed for correction of caudal nasal deviation.
Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Cartilagem/transplante , Humanos , Septo Nasal/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Abstract Introduction: Nasal obstruction is one of the most prevalent complaints in the population. The main causes of nasal obstruction are inflammatory, infectious or anatomical alterations. Anatomical alterations include nasal septum deviation, turbinate hypertrophy, and nasal valve insufficiency (external and/or internal). The diagnosis of nasal valve insufficiency remains a clinical one and is based on inspection and palpation of the nose, evaluating both its static and dynamic functions. The literature presents several options for the correction of external nasal valve insufficiency. These are chosen according to the choice and experience of each surgeon. Objective: To create a practical algorithm for the treatment of external nasal valve insufficiency that can guide nasal surgeons in their choice of treatment for the different anatomical alterations found in patients with these disorders. Methods: We used the treatment options found in the literature and correlated them with our surgical options for each type of anatomical alteration found. Therefore, we used basically three parameters related to physical examination findings (degree of insufficiency and characteristics of the lower lateral cartilage) and the patient's complaint (present or absent aesthetic complaint regarding the nasal tip). Result: A practical algorithm was developed for the treatment of external nasal valve insufficiency according to the degree of insufficiency (mild-to-moderate or severe), aesthetic complaint of the nasal tip (present or absent) and characteristics of the lower lateral cartilage (size and orientation). Conclusion: Through this simple algorithm, one can use each type of graft and/or maneuver according to the patients' complaints and the anatomical alterations found.
Resumo Introdução: A obstrução nasal é uma das queixas mais prevalentes na população. As principais causas de obstrução nasal são inflamatórias, infecciosas ou alterações anatômicas. As alterações anatômicas incluem: desvio do septo nasal, hipertrofia de conchas nasais e insuficiência da válvula nasal (externa e/ou interna). O diagnóstico da insuficiência de válvula nasal permanece clínico e baseado na inspeção e palpação do nariz, avaliado em funções estática e dinâmica. Temos na literatura diversas opções de correção da insuficiência de válvula nasal externa. Essas são escolhidas de acordo com a opção e experiência de cada cirurgião. Objetivo: Criar um prático algoritmo para o tratamento da insuficiência de válvula nasal externa, que oriente os cirurgiões de nariz na escolha do tratamento para as diferentes alterações anatômicas encontradas nos pacientes portadores dessas alterações. Método: Utilizamos as opções de tratamento encontradas na literatura e relacionamos com as nossas opções cirúrgicas para cada tipo de alteração anatômica encontrada. Dessa forma, utilizamos basicamente três parâmetros relacionados aos achados de exame físico (grau de insuficiência e características da cartilagem lateral inferior) e à queixa do paciente (queixa estética da ponta nasal presente ou ausente). Resultado: Um algoritmo prático para o tratamento da insuficiência de válvula nasal externa, de acordo com o grau da insuficiência (leve-moderada ou severa), a queixa estética da ponta nasal (presente ou ausente) e as características da cartilagem lateral inferior (tamanho e orientação). Conclusão: Através desse simples algoritmo, podemos utilizar cada tipo de enxerto e/ou manobra de acordo com as queixas dos pacientes e as alterações anatômicas encontradas.
Assuntos
Humanos , Rinoplastia , Obstrução Nasal , Algoritmos , Deformidades Adquiridas Nasais , Septo NasalRESUMO
Difficulty in nasal ventilation is one of the most frequently occurring problems in otorhinolaryngology and its correct diagnosis is the key step to solve it. The dysfunctions in the valve area are a frequent cause of chronic nasal obstruction, though commonly ignored. The objective of the study is to analyze the clinical and functional outcomes in a group of patients with septal deviations and valve compromise treated with spreader graft with endonasal approach. Thirty-five patients with septal deviation with compromise of the internal nasal valve (INV; area II of Cottle), treated with spreader graft and a minimum follow-up of 12 months, were included for analysis. Patients were evaluated with video nasosinusal endoscopy, photography, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and rhinomanometry (RM). Postoperative complications were recorded. The results obtained in the pre- and postoperative NOSE scores showed significant differences (p = 0.001), as also in pre- and postoperative RM tests (p < 0.001). Two complications were reported in the 35 patients; thus the complication rate in our sample was 6%. The use of spreader grafts, with endonasal approach, as nasal septum's tutors improved perpendicular septal deviations with compromise of the INV (area II), reaching an effective functional improvement in the nasal airway, with low rate of complications.
Assuntos
Obstrução Nasal , Deformidades Adquiridas Nasais , Rinoplastia , Humanos , Obstrução Nasal/etiologia , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/etiologia , Deformidades Adquiridas Nasais/cirurgia , Período Pós-Operatório , Resultado do TratamentoRESUMO
INTRODUCTION: Nasal obstruction is one of the most prevalent complaints in the population. The main causes of nasal obstruction are inflammatory, infectious or anatomical alterations. Anatomical alterations include nasal septum deviation, turbinate hypertrophy, and nasal valve insufficiency (external and/or internal). The diagnosis of nasal valve insufficiency remains a clinical one and is based on inspection and palpation of the nose, evaluating both its static and dynamic functions. The literature presents several options for the correction of external nasal valve insufficiency. These are chosen according to the choice and experience of each surgeon. OBJECTIVE: To create a practical algorithm for the treatment of external nasal valve insufficiency that can guide nasal surgeons in their choice of treatment for the different anatomical alterations found in patients with these disorders. METHODS: We used the treatment options found in the literature and correlated them with our surgical options for each type of anatomical alteration found. Therefore, we used basically three parameters related to physical examination findings (degree of insufficiency and characteristics of the lower lateral cartilage) and the patient's complaint (present or absent aesthetic complaint regarding the nasal tip). RESULT: A practical algorithm was developed for the treatment of external nasal valve insufficiency according to the degree of insufficiency (mild-to-moderate or severe), aesthetic complaint of the nasal tip (present or absent) and characteristics of the lower lateral cartilage (size and orientation). CONCLUSION: Through this simple algorithm, one can use each type of graft and/or maneuver according to the patients' complaints and the anatomical alterations found.
Assuntos
Obstrução Nasal , Rinoplastia , Algoritmos , Humanos , Septo Nasal , Deformidades Adquiridas NasaisRESUMO
Introducción: las perforaciones septales y su corrección quirúrgica constituyen un reto para los otorrinolaringólogos. En la literatura se describen diferentes técnicas para el cierre de las perforaciones septales; sin embargo, sus resultados en términos de efectividad son muy variables y con pocos pacientes. Desde hace 8 años se viene realizando la técnica de cierre de perforación septal con injertos de cartílago en el servicio de otorrinolaringología del Hospital de San José, y se ha observado una respuesta clínica exitosa. El objetivo del presente estudio fue describir los resultados posoperatorios de los pacientes manejados con la técnica de cierre quirúrgico de perforación septal con injertos de cartílago, en términos de aparición de complicaciones y frecuencia de perforación septal residual. Materiales y métodos: mediante un estudio de cohorte descriptiva se presentan los pacientes manejados con la técnica de cierre quirúrgico de perforación septal con injertos de cartílago de banco o cartílago autólogo. Se incluyen pacientes a partir enero de 2014 a junio 2018. De la historia clínica se extrajeron los datos demográficos, clínicos, complicaciones y presentación de perforación septal residual. Resultados: la tasa de éxito de cierre de perforación septal fue de 78,3 %; siendo las etiologías más frecuentes antecedente de cirugía e idiopática. La complicación más común fue epistaxis en el 26 % de los pacientes, seguida de dolor en el 21,7 % en el posoperatorio mediato, el cual mejoró en los controles posteriores. Conclusión: los resultados con la técnica de cierre de perforación septal con injerto de banco fueron satisfactorios en esta población.
Introduction: septal perforations and surgical correction are a challenge for ENT specialists. Several techniques for closing septal perforations are described in the literature; however, its results in terms of effectiveness are variable and with small sample sizes. The technique of closure of septal perforation with cartilage grafts has been performed for 8 years in the ENT department of Hospital de San José with a successful clinical response. Aims: to describe the postoperative results of patients managed with the technique of surgical closure of septal perforation with cartilage grafts, in terms of complications and frequency of residual septal perforation. Design: descriptive cohort study. Methods: a cohort of patients managed with the surgical closure technique of septal perforation with grafts of bank cartilage or autologous cartilage are described. Patients were included from January 2014 to June 2018. Demographic, clinical data, complications and presentation of residual septal perforation were extracted from the clinical history. Results: The success rate of septal perforation closure was 78.3 %; being the most frequent etiologies antecedent of surgery and idiopathic. The most common complication was epistaxis in 26 % of patients, followed by pain in 21.7 % in the postoperative period, which improved in subsequent controls. Conclusion: the results with the technique of closure of septal perforation with bank grafting were satisfactory in this population.