Surgical Outcomes of Bony Batten Grafting to Correct Caudal Septal Deviation in Septoplasty
Surgical Outcomes of Bony Batten Grafting to Correct Caudal Septal Deviation in Septoplasty
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DOI：
10.1001/jamafacial.2017.0092
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发表时间：
2017-11-01
影响因子：
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通讯作者：
Jang, Yong Ju
中科院分区：
文献类型：
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作者：
Kim, Do-Youn;Nam, Sung Hoon;Jang, Yong Ju
重要性 最近，用板条移植物矫正尾部鼻中隔偏曲已得到普及。然而，很少有报道记录该技术的手术结果，特别是在鼻中隔成形术中使用骨板条移植物。 目的 评估骨板条移植术用于治疗鼻中隔成形术中尾部鼻中隔偏曲的手术结果。 设计、设置和参与者 这项回顾性队列研究评估了 141 名从 9 月份开始使用骨板条移植物进行鼻中隔尾部偏差患者的医疗记录2011年1月1日至2016年2月29日，在三级转诊医院。患者被分为初次手术组和二次手术组。患者还被分为鼻中隔成形术加鼻甲手术组和仅鼻中隔成形术组。对偏差矫正进行内镜评估，并分析术后并发症。 主要结果和措施 使用鼻阻塞症状评估 (NOSE) 评分，通过电话访谈评估患者满意度和症状改善情况。 结果 141 名患者中（24 名女性 [17%] 和 117 名男性 [83%]；平均 [SD] 年龄，32.8 [12.9] 岁），86 例(61%) 在术后调查中认为他们的症状有很大改善； 50（35.5%），改善； 4（2.8%），无变化； 1 (0.7%) 更糟。与术前评分 (70.5 [26.7]; 95% CI, 66.0-75.0; P < .001) 相比，所有患者术后平均 (SD) NOSE 评分 (28.7 [22.0]; 95% CI, 25.0-32.4) 均显着改善。 116 名接受初次手术的患者（平均 [SD] NOSE 评分，28.2 [21.9]）和 25 名接受二次手术的患者（平均 [SD] NOSE 评分，30.8 [24.3]；P = .34）之间的手术结果没有观察到显着的组间差异。鼻甲手术组的 102 名患者（平均 [SD] NOSE 评分，28.1 [20.8]）和仅鼻中隔成形术组的 39 名患者（平均 [SD] NOSE 评分，30.4 [23.7]；P = .65）之间的手术结果没有显着差异。在内镜检查手术结果时，128 名患者（90.8%）的鼻中隔呈直形，13 名患者（9.2%）的情况有所改善，但仍有尾偏。术后并发症包括间隔血肿4例、嗅觉减退2例、软骨炎1例；所有患者均得到成功治疗。四名患者因功能矫正不完整或希望进行鼻整形术而需要进行翻修手术。结论和相关性使用骨板条移植物进行鼻中隔成形术可有效矫正尾部鼻中隔偏斜，具有良好的手术效果和可接受的并发症发生率。
IMPROTANCE Correction of caudal septal deviation with a batten graft has been popularized recently. However, few reports have documented the surgical outcomes of this technique, especially the use of bony batten grafts in septoplasty.OBJECTIVE To evaluate the surgical outcomes of bony batten grafting for the management of caudal septal deviation in endonasal septoplasty.DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study evaluates the medical records of 141 patients with caudal septal deviation who underwent septoplasty using bony batten grafts from September 1, 2011, through February 29, 2016, at a tertiary referral hospital. Patients were divided into primary and secondary surgery groups. Patients were also divided into the septoplasty plus turbinate surgery and the septoplasty only group. Endoscopic assessment of deviation correction was performed, and postoperative complications were analyzed.MAIN OUTCOMES AND MEASURES Patient satisfaction and symptom improvement were evaluated via telephone interviews by using the Nasal Obstruction Symptoms Evaluation (NOSE) scores.RESULTS Of the 141 patients (24 women [17%] and 117 men [83%]; mean [SD] age, 32.8 [12.9] years), 86 (61%) rated their symptoms in the postoperative survey as much improved; 50 (35.5%), improved; 4 (2.8%), no change; and 1 (0.7%), worse. All patients had significantly improved mean (SD) postoperative NOSE scores (28.7 [22.0]; 95% CI, 25.0-32.4) compared with preoperative scores (70.5 [26.7]; 95% CI, 66.0-75.0; P < .001). No significant intergroup differences were observed in surgical outcome between the 116 patients undergoing primary surgery (mean [SD] NOSE score, 28.2 [21.9]) and 25 undergoing secondary surgery (mean [SD] NOSE score, 30.8 [24.3]; P = .34). No significant difference in surgical outcome was found between the 102 patients in the turbinate surgery group (mean [SD] NOSE score, 28.1 [20.8]) and 39 in the septoplasty only group (mean [SD] NOSE score, 30.4 [23.7]; P = .65). On endoscopic examination for surgical outcome, 128 patients (90.8%) had a straight septum and 13 (9.2%) had improved but residual caudal deviation. Postoperative complications included septal hematoma in 4 patients, hyposmia in 2, and chondritis in 1; all patients were treated successfully. Four patients required revision surgery because of incomplete functional correction or a desire for rhinoplasty.CONCLUSIONS AND RELEVANCE Septoplasty using bony batten grafts is useful for correcting caudal septal deviation with favorable surgical outcomes and an acceptable complication rate.