Back-and-forth endoscopic septoplasty

Analysis of the technique and outcomes

Matteo Trimarchi, Chiara Bellini, Salvatore Toma, Mario Bussi

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: To describe our clinical experience in 218 consecutive patients undergoing endoscopic back-and-forth septoplasty (EBFS), examining surgical indications, technique, and follow-up. Methods: From January 2005 to November 2008, 218 patients underwent EBFS at the Department of Otorhinolaryngology, San Raffaele Hospital, Milan, Italy. The indication for EBFS in this series was nasal airway obstruction (NAO). Patients were studied with nasal rigid endoscopy and in some cases computed tomography (CT) was used to exclude rhinosinusitis. The most common concomitant diagnoses included allergic rhinitis and turbinate hypertrophy. EBFS facilitates the interruption of perichondrial and periosteal bridges, which are more represented in the anterior portion of the septum between the caudal quadrangular cartilage and the vomeropremaxillary crest. Septal splints were positioned. No nasal packing was required. Results: No cases required conversion to a traditional headlight approach, and no intraoperative complications were encountered. Intraoperative mucosal microlacerations occurred in 77.98% of cases; suturing was required in only 8.25% of cases. Of 218 patients, 74.77% experienced resolution of NAO, while 16.06% experienced only improvement; 9.17% noted the persistence of symptoms. Complications included transient dental pain/hypesthesia (6.88%), septal hematoma (5.04%), synechiae formation (2.29%), epistaxis (1.83%), septal perforation (1.83%), cheek swelling (0.45%), and septal abscess (0.45%). Conclusion: EBFS as a variation of endoscopic septoplasty (ES) represents a viable procedure with good outcomes and a low rate of complications. The technique allows lysis of tissue fibers while preserving the integrity of mucosa at the critical area using less force and reduces the probability of mucosal tears, based on embryologic knowledge of anatomical dissection.

Original languageEnglish
Pages (from-to)40-44
Number of pages5
JournalInternational Forum of Allergy and Rhinology
Volume2
Issue number1
DOIs
Publication statusPublished - Jan 2012

Fingerprint

Nasal Obstruction
Nose
Turbinates
Epistaxis
Splints
Hypesthesia
Cheek
Intraoperative Complications
Otolaryngology
Tears
Hematoma
Abscess
Hypertrophy
Italy
Endoscopy
Cartilage
Dissection
Tooth
Mucous Membrane
Tomography

Keywords

  • Back and forth technique
  • Endoscopic septoplasty
  • Endoscopy
  • Nasal septum
  • Septoplasty
  • Septoplasty technique

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology
  • Medicine(all)

Cite this

Back-and-forth endoscopic septoplasty : Analysis of the technique and outcomes. / Trimarchi, Matteo; Bellini, Chiara; Toma, Salvatore; Bussi, Mario.

In: International Forum of Allergy and Rhinology, Vol. 2, No. 1, 01.2012, p. 40-44.

Research output: Contribution to journalArticle

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abstract = "Background: To describe our clinical experience in 218 consecutive patients undergoing endoscopic back-and-forth septoplasty (EBFS), examining surgical indications, technique, and follow-up. Methods: From January 2005 to November 2008, 218 patients underwent EBFS at the Department of Otorhinolaryngology, San Raffaele Hospital, Milan, Italy. The indication for EBFS in this series was nasal airway obstruction (NAO). Patients were studied with nasal rigid endoscopy and in some cases computed tomography (CT) was used to exclude rhinosinusitis. The most common concomitant diagnoses included allergic rhinitis and turbinate hypertrophy. EBFS facilitates the interruption of perichondrial and periosteal bridges, which are more represented in the anterior portion of the septum between the caudal quadrangular cartilage and the vomeropremaxillary crest. Septal splints were positioned. No nasal packing was required. Results: No cases required conversion to a traditional headlight approach, and no intraoperative complications were encountered. Intraoperative mucosal microlacerations occurred in 77.98{\%} of cases; suturing was required in only 8.25{\%} of cases. Of 218 patients, 74.77{\%} experienced resolution of NAO, while 16.06{\%} experienced only improvement; 9.17{\%} noted the persistence of symptoms. Complications included transient dental pain/hypesthesia (6.88{\%}), septal hematoma (5.04{\%}), synechiae formation (2.29{\%}), epistaxis (1.83{\%}), septal perforation (1.83{\%}), cheek swelling (0.45{\%}), and septal abscess (0.45{\%}). Conclusion: EBFS as a variation of endoscopic septoplasty (ES) represents a viable procedure with good outcomes and a low rate of complications. The technique allows lysis of tissue fibers while preserving the integrity of mucosa at the critical area using less force and reduces the probability of mucosal tears, based on embryologic knowledge of anatomical dissection.",
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