Endoscopic Septoplasty vs Conventional Septoplasty: A Comparitive Study

Case Series

Austin J Otolaryngol. 2023; 9(1): 1129.

Endoscopic Septoplasty vs Conventional Septoplasty: A Comparitive Study

Rukma Bhandary¹; Rohan Shetty²*

¹Associate Professor, Department of Ent, Ajims, Mangalore, India

²Post Graduate, Department of Ent, Ajims, Mangalore

*Corresponding author: Rohan Shetty Department of ENT, AJIMS, Mangalore, #36, 1st Main, 4th Cross, Chinanna Layout, Kavalbyrasandra, R.T.Nagar, Bangalore North, Bangalore, Karnataka - 560032, India Email: Rohshetty1095@gmail.Com

Received: September 20, 2023 Accepted: October 30, 2023 Published: November 06, 2023

Abstract

Introduction: Nasal obstruction due to deviated nasal septum is a common problem encountered by most otolaryngologists. A variety of surgical procedures have been tried in the treatment of the same.

Objective: This study was conducted to evaluate the outcomes and complications of endoscopic and conventional septoplasty and to compare both.

Materials and Methods: This is a prospective, randomized study done in tertiary health center, Mangalore in which 60 patients with symptomatic deviated nasal septum were included in the study. Twenty two of them underwent conventional septoplasty and the remaining thirty eight underwent endoscopic septoplasty.

Results: Endoscopic septoplasty had better outcome with respect to complications and proved as an easier method to correct posterior deviations and isolated spurs. Post operative symptoms were also better in the group which underwent endoscopic septoplasty.

Conclusion: Endoscopic septoplasty allows accurate, conservative repair of obstructive nasal septum deviations, with fewer complications and better functional results compared to conventional septoplasty.

Keywords: Conventional septoplasty; Deviated nasal septum; Endoscopic septoplasty; Septoplasty

Introduction

Nasal obstruction is one of the most common complaints that a otorhinolaryngologist faces in the day to day practice [1]. Deviated nasal septum being the most common cause for the nasal obstruction [1]. It not only causes breathing difficulties but also results in improper aeration of paranasal sinuses predisposing to sinusitis and also results in drying of mucosa leading to crusting and epistaxis [1]. Various surgeries have been proposed for the correction of deviated nasal septum [1]. It has undergone several modifications since its inception [1]. Initially submucous resection of septum was done which was a radical surgery and was associated with lot of complications [1]. Later septoplasty was developed as it had advantages of minimal resection of septum and less complications [1].

With the introduction of endoscope into the field of otolaryngology, there were efforts to use it for the correction of deviated nasal septum targeting the surgical procedure in removing only the deviated portion, spur and maxillary crest [1]. It is more effective with minimal manipulation [1]. And also had the advantage of diagnosing and treating the abnormalities of the lateral wall of the nose at the same sitting [1]. Hence the present study was taken up to compare the two techniques i.e. conventional and endoscopic septoplasty [1]. Preoperative symptom analysis, techniques of surgeries, post operative analysis and complications are presented in this study [1].

Objectives

1. To compare the results post operative of conventional septoplasty with those of endoscopic septoplasty, in cases of septal deviation and septal spurs [1]

2. To compare the improvement in symptoms based on history taken pre and post operation.

3. To compare the complications post operatively of conventional septoplasty with those of endoscopic septoplasty.

4. Informed Consent- Obtained

Methodology

The present study was carried out in the Department of Otorhinolaryngology at a tertiary sector [1]. All patients attending the Out Patient Department of Otorhinolaryngology with symptomatic deviated nasal septum were included in the study [1]. Patients with age less than 10 years, allergic rhinitis, vasomotor rhinitis and with acute infection were excluded [1]. Data was collected by selecting the patients with symptomatic deviated nasal septum willing for surgery [1]. They were divided into two groups; one group undergoing conventional septoplasty and the other endoscopic septoplasty by random selection. 1Sixty patients were included in the study. Twenty two of them underwent the conventional septoplasty and rest of 38 patients underwent endoscopic septoplasty.

Under aseptic precautions ,parts painted and draped.A 0 degree rigid nasal endoscope (4 mm), held in the left hand and nasal cavity was visualized [1]. Anterior nasal packing was done with adrenaline soaked packs. Infiltration given to the septum with lignocaine and adrenaline. An incision was made 2 mm posterior to the caudal end of the septum on the side of the deviation (hemitransfixation) [1]. The initial mucoperichondrial flap was elevated using Freer’s elevator [1]. All the above procedures were done under visualisation with the 0 degree endoscope. Further elevation was done using 0 degree rigid nasal endoscope (4 mm), held in the left hand, keeping the tip of the endoscope between the mucoperichondrial flap and the septal cartilage and suction tip in the right hand, this allowed for better visualisation while elevating [1]. The right hand was used for instrumentation [1]. Flap elevation was done in the correct plane to minimize the bleeding [1], this was achieved by constantly using the suction tip while elevating. In cases with caudal dislocation or anterior buckling of the cartilage, this part was corrected last after correcting the rest of the septum [1]. A spur without any other obvious septal deformity, was resected after incision and exposure made anterior to the spur [1]. In this case the incision and elevation along with dislocation of the spur was made with the help of freer’s elevator .The dislocated part was now removed with the help of lux forceps. IVALON merocel nasal packs were then placed in both nasal cavities with the help of endoscope after significant haemostasis was achieved. Post-operatively patients were put on antibiotics at least for a week, along with analgesics and decongestants [1]. Nasal packs were removed 24 h after the surgery [1].