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      Nasal septum suture combined with inferior turbinate coblation after septoplasty: Does it improve quality of life and reduce complications?

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          Abstract

          Objective

          Nasal packing is routinely applied after septoplasty. Patients, however, report feeling very uncomfortable while the packing is in place. The aim of this study was to compare the effects of nasal septum suture combined with inferior turbinate coblation to the effects of nasal packing after septoplasty.

          Methods

          In this study, 135 patients undergoing septoplasty were divided into 3 groups: group 1 patients had microdebrider with packing, group 2 received coblation with packing and group 3 had coblation with suture. Early postoperative quality of life and complications were compared between the 3 groups.

          Results

          The patients in group 1 experienced the most postoperative nasal pain, headache, dysphagia, sleep disturbance and bleeding on the night of surgery; while the patients in group 3 experienced the fewest symptoms. No difference in epiphora was observed between the 3 groups. More pain and bleeding were experienced when comparing the pack removal (Group 1 and 2) with the clearance of the nasal cavity (Group 3). We noted one case of postoperative bleeding in group 1, one septal hematoma in group 1 and a second septal hematoma in group 2. No such postoperative complications were found in group 3.

          Conclusion

          Nasal septum suture combined with inferior turbinate coblation was not only associated with less pain, increased patient satisfaction and an improved quality of life; but also reduced postoperative complications. Our results confirm that it is a more comfortable, reliable alternative to the more common nasal packing.

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          Most cited references20

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          A safe, alternative technique for inferior turbinate reduction.

          Submucous resection of the inferior turbinates is a conventional technique for reducing their size to achieve patent nasal airways in situations where an enlarged turbinate contributes to airway obstruction. Many techniques and complications have been described in the past. We describe a new inferior turbinate reduction technique performed with powered instrumentation and assess its success and complication rates. A prospective study of 120 consecutive patients who underwent submucous resection of the inferior turbinates with a microdebrider. Patient questionnaires were used for subjective assessment of symptoms before and after the procedure. We graded each patient's inferior turbinates for size from I to III before and 6 weeks after surgery for objective analysis. The common complications of standard submucous resection of inferior turbinates include excessive resection, postoperative bleeding, and crusting. The advantage of the microdebrider technique is the precise control of the amount of tissue and location of tissue that is removed on a submucosal plane. The complications encountered with this technique are limited to postoperative bleeding that occurred in 1.6% of patients. There was no crusting or excessive removal of tissue. The results show that submucous resection of inferior turbinates with a microdebrider is a safe method of achieving turbinate size reduction with minimal morbidity.
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            The efficacy of nasal septal surgery.

            Nasal septal deformity is a frequent clinical entity, and septoplasty comprises one of the most common procedures performed by otolaryngologists today. Its efficacy seems intuitive, however the literature reveals relatively few papers confirming its utility. In this study, all patients undergoing septal reconstruction (excluding septorhinoplasty) at three major teaching hospitals in Vancouver during the years 1988 to 1990 were reviewed retrospectively in a two-pronged study. Information was collected concerning symptoms, physical findings and surgical technique. In the second phase, patients were contacted by telephone in a blinded fashion. Data was collected concerning patient satisfaction regarding various parameters including initial and ultimate symptom resolution, acceptance of nasal packing and postoperative complications. The following conclusions may be drawn: 1) Septoplasty was successful in relieving nasal obstruction in 70.5% of patients. 2) Turbinate surgery including outfracturing appears to significantly improve the outcome of surgery. 3) Rhinitis, including allergy, congestion, postnasal drip and rhinorrhea did not significantly affect success in relieving nasal obstruction. 4) Nasal packing did not significantly affect the outcome, but was the most frequently complained of aspect of the surgery. Therefore, we do not feel nasal packing is necessary.
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              Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: a long-term follow-up with subjective and objective assessment.

              To assess the efficacy and morbidity of bipolar radiofrequency thermal ablation of the inferior turbinates in patients with nasal obstruction caused by turbinate hypertrophy. Prospective, nonrandomized study and outpatient treatment. Twenty patients (age range, 23-77 y; median age, 52 y) enrolled in the study. There was one dropout. All the patients had nasal blockage despite medical treatment. Bipolar radiofrequency thermal ablation was delivered to inferior turbinates at 100 kHz with a voltage root mean square value of 168 to 182. The preoperative and postoperative nasal functions were investigated by immediate and long-term visual analogue scale (VAS) scores of symptom parameters, olfactory thresholds, saccharine transit time, rhinomanometry, and acoustic rhinometry. The follow-up was conducted at 1 week and 3, 6, and 12 months. The VAS scores of subjective complaints (nasal discharge, itching, sneezing, crusting) decreased, and the VAS scores of evaluation of the effectiveness (frequency of nasal obstruction, degree of nasal obstruction, and patient satisfaction) increased statistically significantly in the 12-month follow-up without relapses. There were no adverse effects on nasal epithelial clearance time and olfactory functions. In rhinomanometry the changes in total nasal resistance and response to the vasoconstrictor agent were not statistically significant. In acoustic rhinometry the change in the sum of both nasal cavity volumes from nostril to 5 cm was statistically significant 6 and 12 months after the treatments. The difference between the preoperative and postoperative vasoconstrictive effect was not statistically significant. The bipolar radiofrequency thermal ablation of inferior turbinates is a promising alternative, which should be considered when planning inferior turbinate interventions.
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                Author and article information

                Contributors
                Journal
                World J Otorhinolaryngol Head Neck Surg
                World J Otorhinolaryngol Head Neck Surg
                World Journal of Otorhinolaryngology - Head and Neck Surgery
                KeAi Publishing
                2095-8811
                2589-1081
                17 March 2017
                March 2017
                17 March 2017
                : 3
                : 1
                : 44-48
                Affiliations
                [1]Department of Otorhinolaryngology Head and Neck Surgery, The People's Hospital of Peking University, Xi Zhi Men Nan Da Jie 11#, Beijing, 100044, China
                Author notes
                []Corresponding author. minwang333@ 123456sina.com
                Article
                S2095-8811(17)30017-3
                10.1016/j.wjorl.2017.02.002
                5683602
                0a7b7e27-7d1b-4a0e-b265-e0cd055db22d
                © 2017 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 31 January 2017
                : 6 February 2017
                Categories
                Research Paper

                septoplasty,nasal septal suture,inferior turbinate coblation,nasal packing

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