Selection of Surgical Technique and Treatment Outcome of Revision Septoplasty

Abstract

Background and ObjectivesZZThis study was designed to review our experience with patients undergoing revision septoplasty and to evaluate the causes of persistent nasal obstruction and treatment outcomes of revision septoplasty. Subjects and MethodZZThe medical records of 58 patients (53 men) who underwent revision septoplasty by the author of this study between 2006 and 2012 at our institute were retrospectively reviewed. Data on demographics, symptoms, anatomic site of deviation, surgical techniques performed, and postoperative complications were collected. Patient satisfaction scores were graded with a grading scale from 1 (excellent) to 4 (poor). ResultsZZAll of the patients visited our hospital for persistent nasal obstruction after prior septoplasty. Forty-seven patients (81%) showed caudal septal deviation and 11 (19%) showed some other forms of septal deviation. Twenty-one cases (36.2%) were treated with the batten graft with cutting and suture technique, 20 (34.5%) with a batten graft alone, 10 (17.3%) with resection of remnant deviated septal bone and cartilage, 4 (6.8%) with the cutting and suture technique, 2 (3.5%) with a relocation suture, and 1 (1.7%) with a spreader graft. The median patient satisfaction score for 31 patients who answered the telephone interview was 2.06±0.93. ConclusionZZA considerable number of patients who undergo revision septoplasty have remnant or recurrent caudal septal deviation that was not properly corrected in previous surgery. We recommend the batten grafting and the cutting and suture technique for the correction of caudal septal deviation in revision septoplasty.

Endoscopic Intranasal Marsupialization of the Isolated Mucocele in the Inferior Orbit

“…1,2,5,6 However, these external approaches have many disadvantages, including eyelid or upper lip scar, ectropion or entropion of the eyelid, periorbital swelling and pain, diplopia, prolonged operation time, and healing time. 5,7,8 Traditionally, treatment of the paranasal mucoceles is the removal of the mucosal lining and obliteration of the sinus. Recently, endoscopic sinus surgery has been favored over the direct orbital approach for its safety and efficacy in treating mucoceles with a lower morbidity, reduced hospital stay, and reduced mucocele recurrent rate.…”

“…Considering the pathophysiology of the isolated orbital mucoceles differs, and there is no communication with the paranasal sinuses, some authors suggest that treatment requires complete excision or destruction of the ectopic sinus tissue within the orbit by external approaches 1,2,5,6 . However, these external approaches have many disadvantages, including eyelid or upper lip scar, ectropion or entropion of the eyelid, periorbital swelling and pain, diplopia, prolonged operation time, and healing time 5,7,8 . Traditionally, treatment of the paranasal mucoceles is the removal of the mucosal lining and obliteration of the sinus.…”

“…1,2,5,6 However, the complete removal by the external approach has many disadvantages. 5,7,8 Many cases of paranasal sinus mucocele are successfully treated with endoscopic marsupialization. 1,4 In this article, we present a rare case of isolated intraorbital mucocele located in inferior orbit successfully managed by endoscopic marsupialization.…”

“…Although the treatment choice of isolated intraorbital mucocele has not been established because of the rarity of the disease, some authors suggest that the optimum treatment is the complete removal of the mucocele to exclude the possibility of recurrence from remnant mucosa 1,2,5,6 . However, the complete removal by the external approach has many disadvantages 5,7,8 . Many cases of paranasal sinus mucocele are successfully treated with endoscopic marsupialization 1,4 .…”

Horizontal Dorsal Septal Incision for High Deviation Correction During Septoplasty

“…Additionally, the deviation may persist despite the application of the surgical techniques due to rebound memory of the remaining cartilage. 5) In this study, we proposed a horizontal dorsal septal incision of the deviated septum with a mucosal through-and-through suture technique that is performed to secure the corrected cartilage in the designated position in cases of high septal deviation.…”