Shripad Harihar Patil^1*, Sham V Rane²

¹Additional Civil Surgeon, ²DLO, District Civil Hospital, Sindhudurg, Maharashtra, INDIA.

Email: visupatil@gmail.com

RESULTS

In present study, 60 patients posted for DNS correction surgery were randomly divided into two groups (n=30), as group C (conventional septoplasty) and the group E (endoscopic septoplasty). Majority of patients were male (61.67 %), from 19-30 and 31-40 years age group (21.67 % each). Age and gender were comparable in both groups and difference was statistically not significant (p>0.05).

Table 1: Age and gender distribution

               In present study majority of patients had various associated lateral wall pathologies such as inferior turbinate hypertrophy, concha bullosa, variation of uncinate process and paradoxical middle turbinate. We compared associated lateral wall pathologies between two groups and difference was statistically not significant (p>0.05).

Table 2: Associated lateral wall pathology prevalence.

In Conventional septoplasty Group, mean duration of surgery was 42.20 ± 5.81 minutes and majorities of surgeries were completed in 41 to 50 minutes (46.67 %). In Endoscopic septoplasty Group, mean duration of surgery was 38.08 ± 6.72 minutes and majorities of surgeries were completed in 31 to 40 minutes (36.67 %). We compared mean duration of surgery between two groups and difference was highly significant (p - 0.001).

Table 3: Comparison of duration of surgery

In Conventional septoplasty Group, major complications noted were U/L flap tear (20 %), bleeding (16.67 %), residual deviation (13.33 %) and septal heamatoma (10 %). In Endoscopic septoplasty Group, major complications noted were U/L flap tear (6.67 %), bleeding (6.67 %), residual deviation (3.33 %) and septal heamatoma (3.33 %). We compared incidence of complications between two groups and difference was statistically significant (p - 0.013). No incidence of septal perforation was noted in either group.

Table 4: Complications

DISCUSSION

 Numerous surgical techniques are available but each surgical procedure has its limitations and cannot deal with all the variants of the deformities of the nasal septum.⁶ In endoscopic septoplasty group, septal pathology, precise correction of the pathology, with less complications were seen. Hospital stay and duration of surgery were significantly less in endoscopic group. For minimal and posterior deviations of the septum, endoscopic septoplasty is better, whereas for anterior deviations, conventional septoplasty could be better choice. In study by Nayak DR et al.,⁷ 78.3% patients had complaint of nasal obstruction. Headache was present in 76.66%, rhinorrhea in 45%, PND in 58.33% and hyposmia in 8.33%. In another study conducted by Gulati et al.,⁸ nasal obstruction was complained by 92% patients, Headache by 58% patients, catarrh in 50 % patients and post-nasal discharge in 30%. Similar findings were noted in present study. Ankita S et al.,⁹ studied 44 patients, randomly divided in two groups, and noted that endoscopic approach showed better overall clinical results, irrespective of the site of deviation. It was noted that correcting posterior deviations required shorter time and had lesser blood loss when operated using the endoscope whereas anterior deviations were dealt faster and had lesser bleeding by the conventional method. There was less pain and morbidity in the postoperative period in the endoscopic group as compared to conventional group. Doomra S et al.,¹⁰ conducted a prospective study on 50 patients having symptomatic deviated nasal septum and refractory to medical treatment. The patients were divided into Group A (underwent conventional septoplasty) and Group B, (underwent endoscopic septoplasty). Nasal obstruction was relieved in 79.1% cases belonging to Group A and 91.3% cases to Group B. Headache was relieved in 62.5% cases belonging to Group A and 93.3% cases to Group B. Postnasal drip was relieved in 73.3% cases in Group A and 94.1% cases in Group B. The results were found to be statistically significant. An improvement in visual analog scale score was observed in both groups, but statistically significant difference was seen at 2nd and 4th week. Postoperative nasal patency improvement was observed in both groups by the Gertner plate, and the results were found to be statistically significant. Postoperative hemorrhage was observed in 24% cases in Group A and 12% cases in Group B. Septal perforation, septal hematoma, and mucosal tear were observed in 4%, 4%, and 8% of cases, respectively, in Group A. No such complication was reported in Group B. Gulati et al.,⁸ reported that there was a statistically significant difference between the two groups as regards nasal obstruction, headache, recurrent rhinorrhea, hyposmia, and postnasal drip (P<0.05). Bothra et al.,¹¹ compared conventional versus endoscopic septoplasty for limited deviations and spur on 80 patients and found no statistically significant difference in surgical outcomes in the conventional and endoscopic surgery groups. However, post-operative complications such as hemorrhage, infraorbital edema and nasal pain were slightly more in the conventional septoplasty group. In a review of literature, Champagne C et al.,¹² noted that endoscopic septoplasty improves visualization of septal deviation, especially in the posterior and inferior area, shortens surgery, and provides a better anatomic result, shorter hospital stay, reduced residual pain, with less residual deviation, and synechia, fewer intraoperative complications (mucosal damage, hemorrhage) and a functional result identical to that of conventional septoplasty. l Nasr et al.,¹³ noted that endoscopic septoplasty showed a better reduction in nasal obstruction than conventional septoplasty; however, the postoperative reduction on the size of the inferior turbinate and NSQ score were highly significant in both groups (P=0.001). Suraneni VR et al.,¹⁴ conducted a study on 100 cases found that complications were seen more in conventional septoplasty as compared to endoscopic septoplasty. In study by Singh A et al.,⁹ found lower incidence of complications in patients undergoing endoscopic septoplasty as compared to conventional septoplasty. Furthermore, Rambabu et al.,¹⁵ in his study on 100 patients undergoing septoplasty, found endoscopic septoplasty superior than conventional septoplasty with fewer complications in the earlier technique. Similar findings can be noted in present study. The conventional surgeries for septal correction improve nasal airway but had various drawbacks such as poor visualization, poor illumination, difficulty in assessing exact pathology, need for nasal packing, and overexposure and over manipulation of the septal framework making revision surgeries difficult.¹⁶ Endoscopic septoplasty is a fast developing concept and gaining popularity. It provides a direct approach to the septal anatomic deformity, allowing minimally invasive procedure with limited septal mucosal flap dissection and removal of a small cartilaginous and/ or bony septal deformity. But endoscopic septoplasty also has got its own drawbacks which includes learning curve, adjustment towards single handed surgery. Despite several benefits, ES can be difficult because of frequent soiling of the lens of the endoscope by blood from the incision site and difficulty in finding enough space for the endoscope and dissectors in narrow septal mucosal tunnels. Endoscopic septoplasty surgery can be combined safely with various surgeries like adenoidectomy, septal perforation repair, septorhinoplasty, endoscopic skull base procedures, endoscopic DCR and endoscopic sinonasal surgery for the optimal results.

CONCLUSION

Endoscopic septoplasty provides better illumination which helps intraoperatively to identify septal deviation accurately, reduces duration of surgery as well as reduced postoperative complications due to limited dissection and lesser trauma to septal cartilage.

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