M.B.Ch.B.
Ph.D. Lecturer of Otolaryngology-Head and Neck Surgery,
Hawler Medical University.
haluk.emin@yahoo.com
Abstract
Background: Septoplasty is one of the commonest nasal surgeries
performed by otolaryngologist. Silicone is the most common
material used for nasal splints. Trans-septal suturing technique
has been described to approximate the mucosal flaps after septal
procedures to reduce the complication rate; however there are
few studies proving the efficacy.
Objective: This study is to elucidate the efficacy of trans-septal
suture method in preventing complications, discomfort and pain
in comparison with intranasal splinting using silicone plates after
septoplasty.
Patients and methods: This is a prospective study of 59 adult
patients underwent Septoplasty, between August 2013-January
2014 in Rizgary Teaching Hospital - Erbil city. Patients were
divided into 2 groups; trans-septal suture and silicone, 29 and 30
patients respectively. Visual analogue scale was used to evaluate
postoperative pain, bleeding, post-nasal drip, dysphagia and
sleep disturbance for three days. Epiphora and septal hematoma
are also evaluated. Septal perforation, crustation, and adhesion
were evaluated at 4th postoperative week.
Results: The severity of pain and post nasal drip were
significantly lower in trans-septal suture group than silicone
group (P< 0.05). The septal hematoma and septal perforation
were not seen in the study. No any significant difference found
concerning epiphora, crustation and adhesion.
Conclusion: we conclude that, suturing can be used safely in
septoplasty specially when the septal deformity is not so
complicated.
Key Word: Septoplasty, trans-septal suturing, silicone.
I.
INTRODUCTION
Septoplasty is a corrective surgical procedure done to
correct or repair any defect of the nasal septum, it is one of the
commonest nasal surgeries performed by otolaryngologist,
alone or in combination with other procedures, such as inferior
turbinoplasty, endoscopic sinus surgery and rhinoplasty (1).
Until the 1960s, submucous septal resection (SMR) as
promoted by Freer and Killian was standard practice in
Western Europe (2). The main criticisms of the SMR were a
high rate of septal perforation, external deformity, the inability
to correct anterior deviations and the difficulty in performing
revision surgery. These criticisms led to the emergence of the
septoplasty operation (3).
The use of postoperative packing has been proposed to
minimize postoperative complications such as haemorrhage,
mucosal adhesions, and septal haematoma. Additionally,
postoperative packing is believed to stabilize the remaining
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[14]
[15]
REFERENCES
Benson Mitchel R, Kenyon G. Septoplasty as a day case
procedure- a two centered study. J Laryngol Otol. 1996; 110
(2): 129-31.
Olphen AF. The septum. In: Michael JG, Nicholas SJ, Ray C,
Linda L, John H, John W. Scott-Brown's otorhinolaryngology:
head and neck surgery.7th ed. London. Hodder Arnold. 2008;
2:1577-80
Low WK,Willat DJ. Submucosus resection for deviated nasal
septum. Singapore Med.J.1992; 33:617-619.
Samad I, Stevens HE. The efficacy of nasal septal surgery. J
Otolaryngol.1992; 21: 88-91.
Roberto G,Fabiano H. Frequency of nasal synechiae after
Septoplasty with turbinectomy with or without the use of nasal
splint. Arch otolaryngol. 2008;12(1):24-27
Salinger S, Cohen D. Surgery of the difficult septum.
ArchOtolaryngol. 1955; 61: 419-421.
Pringle MB. The use of intra-nasal splints: a consultant survey.
Clin Otolaryngol Allied Sci. 1992; 17(6):535-9.
Johnson N. Septal surgery and rhinoplasty. Transactions of the
American Academy of Ophthalmology and Otolaryngology.
1994; 68: 869-873.
Nayak NR, Murty KD. Septal splint with wax plates. J.
Postgrad Med. 1995; 41(3):70-1.
Richard M, Goode L. Magnetic Intranasal Splints. Arch.
Otolaryngol. 1982; 108:319.
Breeze nasal airway splint. Summit Medical. Cited at 2012.
Available
from
http://www.summitmedicalusa.com/products/ent/rhinology/spli
nt-stent.php.
Lee IN, Vukovic L. Hemostatic suture for Septoplasty: How we
do it. J Otolaryngol. 1988; 17: 54-56.
Sessions RB. Membrane approximation by continuous mattress
sutures following Septoplasty. Laryngoscope.1984;94:702-703.
Hari C, Marnane C. Quilting sutures for nasal septum. J
Laryngol Otol. 2008; 122: 522-523.
Dingra PL, Dhingra S. Diseases of Ear, Nose and Throat. 5th
edition. India. Elsevier. 2010.
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
[30]
[31]
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No pain
10
Mild 20
30
Moderate 40
50
Sever 60
70
Sever 60
70
V. sever 80
100
1
2
3
2- Nasal bleeding:
Day
No Bleeding
10
Mild 20
30
Moderate 40
50
V.sever 80
100
V.sever 80
100
1
2
3
3- Post nasal drip
Day
No drip
10
Mild 20
30
Moderate 40
50
Sever 60
Moderate 40
50
Sever 60
70
1
2
3
4- Sleep disturbance:
Day
Non
10
Mild 20
30
70
V.sever 80
100
V.sever 80
100
1
2
3
5- Effects on food intake
Day
No
10
Mild 20
30
Moderate 40
50
Sever 60
70
1
2
3
6- Epiphora
7-Septal hematoma
4 Weeks post op. assessment:
Nasal crustation
Nasal adhesion
Septal perforation
yes
yes
no
no
yes
yes
yes
no
no
no
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