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To carried out a retrospective analysis of 60 patients who underwent endoscopic septoplasty over a period of two old ages.

Patients and Methods: The medical records of the 60 patients who underwent endoscopic septoplasty during the period December 2008 and November 2009 at the King Hussein Medical Center ( Amman- Jordan ) were reviewed for surgical indicants, intraoperative technique and findings, and postoperative complications.

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Consequences: Nasal obstructor was the most common presenting symptom, being found in 55 ( 91.6 % ) patients. 37 Out of 60 instances were performed in concurrence with endoscopic fistula surgery. In 23 instances, endoscopic septoplasty was performed entirely as the primary process.

Nasal endoscopic rating located rhinal septum divergences in the undermentioned order ; 29 of the divergences were loosely based warps ( 48.3 % ) , whereas 23 of the septate malformations were goads ( 38.3 % ) . In 8 patients ( 13.3 % ) more than 1 type of septate malformation was encountered.

No major complications in the immediate post-operative period. Minor complications, such as bleeding occurred in one patient ( 1.6 % ) and septate haematoma in one patient ( 1.6 % ) .

Decision: Endoscopic septoplasty is an effectual technique that can be performed safely entirely or in combination with endoscopic fistula surgery with minimum extra morbidity. It provides important clinical and first-class learning tool when used in concurrence with video proctors over traditional attacks.

Cardinal words: Septoplasty, Endoscopy, Nasal septum

Correspondence should be addressed to: : Dr. Nemer Al-Khtoum. P.O. Box 1834 Amman 11910 Jordan. E-mail ; nemer72 @ gmail.com

* Otolaryngology Specialist, King Hussein Medical Center.

Introduction

Surgery on a deviated nasal septum have progressed from extremist remotion of gristle and mucous membrane ( Krieg, 1889 ) and extremist remotion of gristle merely by submucous resection ( Freer, 1902 and Killian, 1904 ) to the modern techniques of septoplasty ( Cottle, 1947 ) . [ 1,2 ] .

Today there is an accent on the saving of construction to supply equal support of the rhinal model and to defy the effects of marking. Further polishs in the diagnosing and intervention of rhinal obstructor are possible with the usage of the endoscope.

Nasal endoscopy is an first-class method for the precise diagnosing of pathological abnormalcies of the rhinal septum. It permits the correlativity between these abnormalcies and the sidelong nasal wall [ 3 ] . While rhinal endoscopy is typically used for diagnosing and intervention of fistula disease, endoscopy can be combined with powered instrumentality to execute rhinal septate surgery.

Over the last two decennaries, the applications for endoscopy in the field of rhinology have evolved beyond functional endoscopic fistula surgery ( FESS ) . Septoplasty, which is among the three most normally performed processs in rhinolaryngology [ 4 ] , is peculiarly good suited to endoscopic application.

Endoscopic septoplasty as a minimally invasive technique can restrict the dissection and minimise injury to the rhinal septate flap under first-class visual image. This is particularly valuable for the patient holding had old rhinal septate surgery [ 5, 6 ] .

In this article, we carried out a retrospective analysis of 60 patients who underwent endoscopic septoplasty over a period of two old ages.

Material and Methods

A retrospective reappraisal was performed to place all patients who had undergone endoscopic septoplasty during the period December 2008 and November 2009 at the King Hussein Medical Center.

The medical records of the 60 endoscopic septoplasty patients were reviewed for surgical indicants, intraoperative technique and findings, and postoperative complications.

Technique For Endoscopic Septoplasty

The patient is positioned, prepared, and draped for septoplasty. Under endoscopic visual image with a 0 grade endoscope, the undermentioned stairss are performed: Topical oxymetazoline is applied for decongestion ; 1 % Lidocaine with 1:100,000 adrenaline is injected subperichondrially along the septum and at the greater palatal hiatus bilaterally. A perpendicular scratch was made caudal to the divergence. For a loosely deviated septum, a standard Killian or hemitransfixion scratch is used. For more posterior stray malformations, the scratch may be placed more posteriorly in the immediate locality of the malformation, rid ofing immaterial flap lift.

Mucoperichondrial flap lift is performed with a Cottle lift under direct endoscopic visual image with a 0-degree endoscope. The flap elevated was limited as it was raised from over the most deviated part of the nasal septum, i.e. posteriorly, without upseting the anterior normal septum. Septal gristle was incised parallel but posterior to the flap scratch and caudal to the divergence. If the divergence was found to be chiefly bony the scratch was made at the bony-cartilaginous junction. The contralateral mucoperichondrial flap lift is so performed. Flap lift is continued bilaterally until the complete extent of the septate malformation has been dissected.

The little luc ‘s was used to strike the deviated part. Adequacy of the surgical rectification can be assessed by returning the mucosal flaps to the midplane and inspecting the rhinal airway bilaterally while feeling countries of residuary divergence. Once satisfactory rectification has been achieved the flap was repositioned back after suction of blood and borders of the scratch were merely made to lie closely without the demand to suture.

The process ends with packing the rhinal pit with merocele.

Patients were instructed non to blow their olfactory organ and to utilize saline spray to maintain the rhinal mucous membrane moisturized. Trouble control is achieved with paracetamole, and patients were discharged place following battalion remotion after 24 hours of surgery.

Consequences

A entire figure of 60 patients underwent endoscopic septoplasty over a period of two old ages, of these there were 42 males and 18 females. The age of the patients ranged between 18 and 43 old ages with the mean age being 25.2 old ages.

Nasal obstructor was the most common presenting symptom, being found in 55 ( 91.6 % ) patients. The continuance of showing symptoms varied from three months to 8 old ages, with an norm of 39.7 months.

All of these patients had rhinal septate malformations associated with other fistula or rhinal pathology ( i.e. chronic sinusitis, polyps ) . They were treated medically earlier surgery with topical steroids sprays, mucolytics, and antihistamines. All of the patients were studied with endoscopic rhinal rating and CT scan.

37 Out of 60 instances were performed in concurrence with endoscopic fistula surgery. In 23 instances, endoscopic septoplasty was performed entirely as the primary process.

Nasal endoscopic rating located rhinal septum divergences in the undermentioned order ; 29 of the divergences were loosely based warps ( 48.3 % ) , whereas 23 of the septate malformations were goads ( 38.3 % ) . In 8 patients ( 13.3 % ) more than 1 type of septate malformation was encountered.

Our survey found no major complications in the immediate post-operative period. Minor complications, such as bleeding occurred in one patient ( 1.6 % ) and septate haematoma in one patient ( 1.6 % ) .

Discussion

Septoplasty is a normally performed surgical process aimed at alleviating rhinal airway obstructor, frequently in concurrence with other nasal and fistula processs, such as decorative nose job and functional endoscopic fistula surgery ( FESS ) . [ 7 ] Other indicants include rhinologic concern, which is due to annoyance caused by the contact of the septum with the sidelong nasal wall, and chronic sinusitis secondary to septate divergence. The principle for developing an endoscopic technique from a traditional & A ; acirc ; ˆ?headlight & A ; acirc ; ˆA? attack comes from the fact that during common nasal processs, the sawbones & A ; acirc ; ˆ™s position is obstructed due to the narrowing caused by septate goads or septate divergences. [ 8 ]

Endoscopy enables the sawbones to place the goads and take them under direct visual image by executing an scratch exactly over the goad, therefore minimising surgical injury.

Endoscopic septoplasty has been described antecedently by other writers [ 9-12 ] ; nevertheless, the techniques have used traditional septoplasty or fistula surgery instrumentality.

Harmonizing to Brennan et Al. [ 13 ] the ideal aim in septate surgery is lasting rectification of divergence with turning away of any complication. Four basic rules are consistent with this aim: good exposure ; safe lift of flaps ; resection of merely a limited, necessary sum of septum ; and riddance of aetiological dynamic forces. Of these four rules, the first three are best achieved by an endoscopic attack to the septum. The process described in this survey provided a smooth passage from endoscopic fistula surgery to septoplasty. It has the advantage of a targeted attack to the specific septal job, without the demand for exposing inordinate bone and gristle, thereby bettering mending clip and diminishing tissue injury. In our survey, the clip required for surgery could non be analyzed because our instances required different combinations of surgical processs.

Based on our experience in endoscopic septoplasty, there is no difference in the complication rate compared with unfastened septoplasty and it is at least every bit effectual as traditional unfastened techniques in rectifying septate divergences posterior to the nomadic septum. However ; Hwang et Al. [ 5 ] In their retrospective survey of 111 patients undergoing endoscopic septoplasty, reported haematoma in 0.9 % , symptomless perforation in 0.9 % , and synechiae formation in 4.5 % or patients. In their retrospective survey of 116 patients, Chung et Al. [ 6_ ] described transeunt dental pain/hypesthesia in 4.3 % , symptomless septate perforation in 3.4 % , synechiae formation in 2.6 % , epistaxis 0.9 % , septate haematoma in 0.9 % , and relentless septate divergence necessitating alteration septoplasty in 0.9 % . nevertheless in our survey we reported merely bleeding which occurred in one patient ( 1.6 % ) and septate haematoma in one patient ( 1.6 % ) . These rates are commensurate with those reported in the literature for traditional headlamp septoplasty [ 5,6_ ] .

Decision

Endoscopic septoplasty is an effectual technique that can be performed safely entirely or in combination with endoscopic fistula surgery with minimum extra morbidity. It provides important clinical and first-class learning tool when used in concurrence with video proctors over traditional attacks.

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