Evaluation of Improvement in Nasal Obstruction Following Nasal Valve Correction in Patients With a History of Failed Septoplasty
Evaluation of Improvement in Nasal Obstruction Following Nasal Valve Correction in Patients With a History of Failed Septoplasty
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DOI：
10.1001/jamafacial.2015.0978
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发表时间：
2015-09-01
影响因子：
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通讯作者：
Lindsay, Robin W.
中科院分区：
文献类型：
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作者：
Chambers, Kyle J.;Horstkotte, Kate A.;Lindsay, Robin W.
重要的是有鼻中隔偏曲并担心鼻塞的患者经常接受鼻中隔成形术以改善鼻气流。然而，在初次鼻中隔成形术后，一些患者由于鼻瓣膜功能障碍而持续出现症状，可能需要进行鼻瓣膜手术。目的利用鼻阻塞症状评估(NOSE)调查来评估鼻中隔成形术失败后接受鼻瓣膜矫正的患者特定疾病生活质量的变化，并确定可识别的解剖学危险因素在有鼻中隔成形术失败病史的患者中是否更常见。设计、设置和参与者在三级护理医学中心进行的前瞻性观察结果研究。从2012年1月1日至2014年12月31日，40名有鼻中隔成形术病史的患者接受了开放入路的鼻瓣膜矫正术。从2013年1月1日至2015年5月1日进行数据分析，收集并回顾干预后的人口学资料、标准化的鼻部检查以及术前和术后的鼻子评分。主要比较手术前和术后2、4和6个月以上的鼻子评分的结果和指标。结果40例患者中，男性23例(57%)，女性17例(43%)。平均年龄39.3岁。术前鼻检查显示内鼻瓣中重度狭窄38例(95%)，内鼻瓣塌陷19例(48%)，外鼻瓣狭窄18例(45%)，外鼻瓣塌陷16例(40%)。最常见的解剖原因是内鼻瓣狭窄38例(95%)，鼻中隔偏曲26例(65%)，中穹隆狭窄16例(40%)。术前鼻功能评分(SD)为75.7(20.1)分。术后2个月、4个月和大于6个月的平均(SD)鼻部评分分别为31.4(27.2)、34.0(19.8)和22.1(18.8)，与术前相比，各时间点的鼻部评分均有显著改善(P<；.001)。结论鼻瓣膜功能障碍和相关的鼻瓣膜功能障碍仍然是一个被低估的实体，所有鼻中隔偏曲患者，尤其是严重背曲和中穹隆狭窄的患者，在中隔成形术前都应考虑到这一点。在这项研究中，鼻中隔成形术失败的患者中，外科鼻瓣膜矫正术显示鼻塞显著减少，这是通过一项有效的结果测量来衡量的。
IMPORTANCE Patients with a septal deviation and concerns about nasal obstruction often undergo septoplasty to improve nasal airflow. Following primary septoplasty, however, some patients have persistent symptoms due to nasal valve dysfunction and may require nasal valve surgery.OBJECTIVES To evaluate the change in disease-specific quality of life for patients who undergo nasal valve correction after failed septoplasty using the Nasal Obstruction Symptom Evaluation (NOSE) survey and to determine whether identifiable anatomical risk factors are more common in patients with a history of failed septoplasty.DESIGN, SETTING, AND PARTICIPANTS Prospective observational outcomes study conducted at a tertiary care medical center. Forty patients who underwent nasal valve correction through an open approach from January 1, 2012, through December 31, 2014, with a history of septoplasty for nasal obstruction were included. Data analysis was conducted from January 1, 2013, through May 1, 2015.INTERVENTIONS Demographic information, a standardized nasal examination, and preoperative and postoperative NOSE scores were collected and reviewed.MAIN OUTCOMES AND MEASURES Comparison between preoperative and postoperative NOSE scores at 2, 4, and more than 6 months after surgery. RESULTS Forty patients were included in the study; 23 (57%) were male and 17 (43%) were female. The mean age was 39.3 years. Findings from preoperative nasal examination demonstrated moderate or severe internal nasal valve narrowing in 38 (95%) patients, internal nasal valve collapse in 19 (48%), external nasal valve narrowing in 18 (45%), or external nasal valve collapse in 16 (40%). The most common anatomical cause of obstruction was internal nasal valve narrowing in 38 (95%) patients, dorsal septum deflection in 26 (65%), and narrowed middle vault in 16 (40%). The mean (SD) preoperative NOSE score was 75.7 (20.1). Mean (SD) postoperative NOSE scores at 2, 4, and greater than 6 months were 31.4 (27.2), 34.0 (19.8), and 22.1 (18.8), respectively, with significantly improved NOSE scores at each time point compared with before surgery (P < .001).CONCLUSIONS AND RELEVANCE Nasal valve dysfunction remains an underdiagnosed entity and should be considered in all patients with septal deviation before septoplasty, especially in patients with a severe dorsal deflection and a narrow middle vault. In this study, surgical nasal valve correction demonstrated a significant reduction in nasal obstruction, as measured by a validated outcome measure, in patients for whom a previous septoplasty had failed.