Search Results (37)

Background: The main cause of chronic nasal obstruction in ENT practice is represented by the deviated nasal septum. Septoplasty remains the gold standard treatment, performed using either conventional or endoscopic techniques. Methods: A narrative review of the literature was conducted using PubMed and Google Scholar for studies published between May 1999 and October 2024. Eligible studies included adult patients (≥16 years) undergoing conventional or endoscopic septoplasty, with at least one reported outcome measure: NOSE, VAS, or SNOT-22 scores; operative time; or complication rates. Results: Across multiple clinical studies, both conventional and endoscopic septoplasty provided significant improvements in nasal airflow and symptom relief. Endoscopic septoplasty was consistently associated with superior intraoperative visualization, more precise correction of posterior deformities and isolated septal spurs, and lower rates of intraoperative and postoperative complications. Complication rates were low overall for both approaches. Conclusions: Current evidence supports both conventional and endoscopic septoplasty as effective treatments for nasal obstruction due to septal deviation. However, endoscopic septoplasty offers distinct advantages in terms of visualization, operative efficiency, and safety, making it an increasingly preferred technique. Full article

Background/Objective: Precise preprocedural planning is essential for the safety and efficacy of structural heart interventions. Conventional imaging modalities, while informative, do not allow for direct and accurate visualization, limiting procedural predictability. We aimed to develop and validate a high-resolution micro-computed tomography (microCT)-based reverse modeling workflow that integrates digital reconstructions of metallic cardiac devices into patient imaging datasets, enabling accurate, patient-specific virtual simulation for procedural planning. Methods: Clinical-grade transcatheter heart valves, septal defect occluders, patent ductus arteriosus occluders, left atrial appendage closure devices, and coronary stents were scanned using microCT (36.9 μm resolution). Agreement was assessed by intra-class correlation coefficients (ICC) and Bland–Altman analyses. Device geometries were reconstructed into 3D stereolithography files and virtually implanted within multislice CT datasets using dedicated software. Results: Devices were successfully reverse-modeled with high geometric fidelity, showing negligible dimensional deviations from manufacturer specifications (mean ΔDistance range: −0.20 to +0.20 mm). Simulated measurements demonstrated excellent concordance with postprocedural imaging (ICC 0.90–0.96). The workflow accurately predicted clinically relevant parameters such as valve-to-coronary distances and implantation depths. Notably, preprocedural simulation identified a case at high risk of coronary obstruction, confirmed clinically and managed successfully. Conclusions: The microCT-based reverse modeling workflow offers a rapid, reproducible, and clinically relevant method for patient-specific simulation in structural heart interventions. By preserving anatomical fidelity and providing detailed device–tissue spatial visualization, this approach enhances preprocedural planning accuracy, risk stratification, and procedural safety. Its resource-efficient digital nature facilitates broad adoption and iterative simulation. Full article

Rhinogenic contact point headache (RCPH) represents a diagnostic challenge due to different anatomical presentations and unstandardized imaging markers. This prospective multicenter study involving 120 patients aimed to develop and validate a CT-based imaging framework for RCPH diagnosis. High-resolution CT scans were systematically assessed for seven parameters: contact point (CP) type, contact intensity (CI), septal deviation, concha bullosa (CB) morphology, mucosal edema (ME), turbinate hypertrophy (TH), and associated anatomical variants. Results revealed CP-I (37.5%) and CP-II (22.5%) as predominant patterns, with moderate CI (45.8%) and septal deviation > 15° (71.7%) commonly observed. CB was found in 54.2% of patients, primarily bulbous type (26.7%). Interestingly, focal ME at CP was independently associated with greater pain severity in the multivariate model (p = 0.003). The framework demonstrated substantial to excellent interobserver reliability (κ = 0.76–0.91), with multivariate analysis identifying moderate–severe CI, focal ME, and specific septal deviation patterns as independent predictors of higher pain scores. Our imaging classification system highlights key radiological biomarkers associated with symptom severity and may facilitate future applications in quantitative imaging, automated phenotyping, and personalized treatment approaches. Full article

Background/Objectives: Complete blood count tests are inexpensive and widely available and may help identify low-grade inflammation in otolaryngologic (Ear, Nose and Throat, ENT) diseases, such as facial paralysis and hearing loss. This study aimed to describe the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), eosinophil-to-lymphocyte ratio (ELR), and lymphocyte-to-monocyte ratio (LMR) in ENT diseases and to provide preliminary evidence supporting further research. Methods: Data from 62 patients with ENT diseases were analyzed in a cross-sectional design. Results: The prevalence of ENT diseases was higher in women (63%) and adults (85.5%), highlighting vertigo, hearing loss, and septal deviation. Most marker values were within normal ranges; however, NLR values were elevated in patients with either septal deviation or vertigo, and ELR values were increased in cases of allergic or infectious rhinitis and sinusitis. In contrast, LMR values were at the lower normal limits in patients with septal deviation. Conclusions: These findings highlight the need for further studies to clarify the role of these biomarkers in chronic conditions and morphological alterations associated with ENT diseases, using more complex study designs. Full article

Introduction: Cleft lip and/or palate (CLP) is frequently associated with persistent nasal obstruction, often due to structural deformities unaddressed by primary surgical repair. While subjective assessment tools are commonly used to evaluate nasal patency, they underestimate functional impairment, particularly nasal valve collapse. This study aims to objectively evaluate nasal obstruction and identify its anatomical causes in CLP patients after primary rhinoplasty. Methods: We conducted an observational study involving 21 children aged 8–16 with CLP who had undergone primary cheilorhinoplasty but not secondary nasal surgery. Each participant underwent clinical evaluation, nasal endoscopy, acoustic rhinometry, and active anterior rhinomanometry (AAR), both before and after nasal decongestion. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used to assess subjective symptoms. Obstructive sites were diagnosed based on established criteria combining endoscopic and functional findings. Results: Objective nasal obstruction was identified in 80.9% of patients, with nasal valve collapse observed in 66.7%, most commonly among unilateral and bilateral CLP subtypes. External nasal valve collapse was the predominant form (57.1%), followed by internal valve involvement (38.1%). Notably, the NOSE score did not reliably correlate with the AAR results, underlining the limitations of subjective assessment tools. Structural anomalies such as septal deviation (52.5%) and turbinate hypertrophy (23.8%) were also prevalent. Conclusions: This study highlights nasal valve collapse as a major, underrecognized contributor to persistent nasal obstruction in CLP patients after primary repair. Objective assessment methods like AAR and targeted endoscopy should be routinely integrated into secondary rhinoplasty planning. These findings advocate for a personalized approach to secondary nasal reconstruction in CLP patients, integrating objective functional data into surgical planning. Such strategies align with personalized medicine principles by tailoring interventions to individual anatomical and physiological characteristics. Full article

Background/Objectives: Leishmania spp. are protozoan parasites transmitted by female sandflies (Phlebotomus or Lutzomyia). Clinical manifestations depend on species and host immunity. While cutaneous and visceral forms prevail, mucocutaneous involvement—particularly isolated nasal septum leishmaniasis—is rare and frequently misdiagnosed as an inflammatory, infectious, or neoplastic condition. Risk factors associated with mucocutaneous leishmaniasis include systemic or local immunodeficiency, prior renal transplantation, treatment with chronic inhaled steroids, residence in endemic areas or travel to such regions, and previous Leishmania infections. Immunosuppressed patients are at higher risk for atypical presentations and delayed diagnosis, which can result in extensive tissue destruction. Early clinical suspicion, histopathological confirmation, and prompt therapy are essential to prevent permanent mucosal damage. Therefore, a multidisciplinary approach is needed for adequate evaluation and effective treatment. Methods: A 67-year-old man with rheumatoid arthritis on methotrexate reported a two-year history of right-sided nasal obstruction and ulceration that failed to respond to antibiotics. He did not present systemic symptoms. Results: Facial CT revealed a septal deviation; the patient underwent septoplasty, and biopsy confirmed Leishmania amastigotes. Serology (rK39 immunochromatographic test) was positive. He was treated with liposomal amphotericin B at 4 mg/kg/day for five days, followed by miltefosine at 100 mg/day orally for 14 days. At an eight-week follow-up, the nasal mucosa was fully healed, obstruction was resolved, and there was no evidence of recurrence. Conclusions: Although nasal septum leishmaniasis is uncommon, it should be considered in the differential diagnosis of chronic nasal lesions, especially in immunocompromised patients or those from endemic regions. Definitive diagnosis requires biopsy with histological or molecular confirmation. Combined liposomal amphotericin B and miltefosine therapy yields high cure rates and prevents mucosal destruction. Early recognition is critical to avoid diagnostic delays and long-term sequelae. Full article

Late gadolinium enhancements (LGEs) appear in asymptomatic individuals as septal stripes, which mimic abnormal LGEs in patients with dilated cardiomyopathy (DCM). We aimed to evaluate the frequency and extent of LGE variation in asymptomatic individuals and to compare it with those of DCM group. This retrospective study included asymptomatic and DCM groups who underwent CMR imaging. LGE was defined as a myocardial signal intensity higher than five standard-deviations of normal myocardium. LGE was evaluated in right ventricular insertion points (RVIPs) and mid-interventricular septum. A total of 273 asymptomatic individuals (age, 54.3 ± 5.8 years, 209 males) and 100 patients with DCM (age, 55.3 ± 4.9 years, 73 males) were included. LGE was observed in 99.3% of asymptomatic and 100% of DCM groups. The average number of myocardial segments with LGE was distinguishable between asymptomatic and DCM groups (5.5 ± 1.7 vs. 7.6 ± 2.2; p < 0.001). The thickness of LGE differed between two groups in mid-septum (4.5 ± 1.3 mm vs. 5.7 ± 1.8 mm; p < 0.001), upper RVIP (6.1 ± 1.9 mm vs. 8.7 ± 2.7 mm; p < 0.001), and lower RVIP (6.4 ± 2.3 mm vs. 8.6 ± 2.8 mm; p < 0.001). Considerable overlap was observed in LGE between asymptomatic and DCM groups despite different LGE characteristics between them. LGEs within normal range should not be interpreted as abnormal findings in the evaluation of myocardial diseases including DCM. Full article

Background/Objectives: Septoplasty is a commonly performed surgical procedure aimed at correcting nasal septal deviations, to improve nasal airflow and respiratory function. Traditional approaches to septal correction rely on either direct visualization or endoscopic guidance. Recently, a novel technology known as exoscopy has been introduced into surgical practice. Exoscopy is an “advanced magnification system” that provides an enlarged, three-dimensional view of the operating field. In this article, we present our experience with exoscope-assisted septoplasty, developed over the last two years, and compare it with our extensive experience using the endoscopic approach. Methods: Our case series includes 26 patients, predominantly males and young adults, who underwent exoscope-assisted septoplasty. We discuss the primary advantages of this technique and, most importantly, provide an analysis of its learning curve. The cohort of patients treated using the exoscopic approach was compared with a control group of 26 patients who underwent endoscope-guided septoplasty, randomly selected from our broader clinical database. Finally, we present a representative surgical case that details all phases of the exoscope-assisted procedure. Results: Our surgical experience has demonstrated that exoscopy is a safe and effective tool for performing septoplasty. Moreover, the learning curve associated with this technique exhibits a rapid and progressive improvement. Notably, exoscopy provides a substantial educational benefit for trainees and medical students, as it enables them to share the same visual perspective as the lead surgeon. Conclusions: Although further studies are required to validate this approach, we believe that exoscopy represents a promising advancement for a wide range of head and neck procedures, and certainly for septoplasty. Full article

Background: Septoplasty is a widely performed surgical procedure to correct nasal septal deviations and improve respiratory function. One of its most significant complications is septal perforation, which can severely impact the patient’s quality of life. This study evaluates the use of bovine pericardium grafts to enhance mucosal healing, thereby reducing the risk of postoperative septal perforation in cases with intraoperative bilateral mucosal defects. Methods: A retrospective study was conducted on patients who underwent septoplasty between January 2018 and January 2025 in whom bovine pericardium grafts were interposed due to the presence of bilateral opposing mucosal defects. Epidemiological and surgical variables were recorded, and outcomes and complications were analyzed. Results: Out of the 4151 septoplasties performed, 30 cases (0.72%) required bovine pericardium interposition. The mean patient age was 42.87 years. Postoperative absence of septal perforation was confirmed in 90% of cases, with only three postoperative perforations, all asymptomatic and approximately 2 mm in size. Complications were recorded in three patients (10%), all of which were resolved with conservative treatment and without sequelae. Conclusions: For the first time in routine surgical practice, bovine pericardium emerges as a viable option for preventing postoperative septal perforation in cases with bilateral opposing mucosal defects. With a high closure rate and a low incidence of adverse events, this material represents a promising tool in septal surgery. Full article

Background: Rhinoplasty is a leading cosmetic surgery, with the crooked nose being one of the most complex challenges due to its combination of functional and aesthetic issues. Involving multiple nasal components, a crooked nose remains difficult to correct, with a high recurrence rate. The aim of this study was to analyze the long-term outcomes and stability of the nasal pyramid after surgery through a nasal grid analysis. Methods: A retrospective study was conducted on 360 patients (20 men and 16 women) treated for moderate to severe nasal deviation between January 2014 and January 2020. All patients underwent surgery by the same expert surgeon, with follow-ups extending to at least 24 months. Medical records, physical exams, and standardized photographic evaluations were used to assess outcomes. A nasal grid was adapted to analyze the long-term stability of nasal corrections, focusing on individual post-operative changes. Results: The study involved 360 patients, mostly men aged 22 to 65, with the majority having nasal deviations caused by extrinsic trauma (e.g., sports injuries). Nasal deviations affected various parts of the nose, and all patients underwent follow-up evaluations using a nasal grid to compare pre- and post-operative measurements. The results showed long-term stability in nasal corrections, with minimal changes observed between 1 month and 24 months post-surgery. Only one case had partial recurrence, requiring revision surgery, which was successful. Conclusions: The surgical correction of a crooked nose is complex and requires a personalized approach, particularly for severe septal deviations. Complete anatomical reconstruction, using advanced techniques like extracorporeal septal reconstruction and laser osteotomies, provides stable long-term results. The adapted nasal grid proved to be not only an effective post-operative assessment tool but also shows potential for the pre-operative classification of nasal deformity complexity. Although this study focused on a standardized surgical technique, future comparative analyses with alternative approaches are recommended to further validate the outcomes. Full article

Objectives: The aim of this study is to analyze the correlation between the nasal anatomical variants and the clinical and radiological features of odontogenic sinusitis to demonstrate their possible involvement in the genesis of the disease. Methods: This is a retrospective multicentric study of 70 patients with odontogenic sinusitis (OS). Before surgery, all patients performed the classic and mini 22-item Sino-Nasal Outcome Test (SNOT-22 and SNOT-8) and Lund–Mackay Score (LMS). Each nasal anatomical anomaly was collected, including paradoxical middle turbinate (PMT), chonca bullosa (CB), and nasal septal deviation (NSD) on the same side as the sinusitis. Results: The patients presented a significantly higher SNOT-22 and SNOT-8 score only in case of association with NSD and PMT/CB. Logistic regression showed that the variables were significantly associated (p = 0.02 and 0.04). No significant correlation was found between LMS and anatomical variations. Conclusions: This study showed that nasal anatomical variables are correlated with SNOT-22 and SNOT-8. Having a combination of NSD and CB or PMT, on the same side as an OS, is related to a worse quality of life in patients affected by this disease. Regarding the radiological features of OS, no significant correlation was found between LMS and anatomical variations. Full article

Deviation of the cartilaginous midvault and caudal nasal septum can cause both aesthetic misalignment and functional impairment of the nasal valves. This study explores the technical considerations and outcomes of combining extended spreader graft and septal extension graft in septorhinoplasty to correct these deviations. A retrospective analysis of 24 patients who underwent primary septorhinoplasty between January 2022 and July 2023, performed by a single surgeon, was conducted with a mean follow-up of 11.28 months. Unilateral or bilateral extended spreader grafts and septal extension grafts were placed on the concave side of the deviation. Clinical charts, surgical records, standardized photographs, and acoustic rhinometry data were analyzed for objective and subjective outcomes. Among 24 patients (21 males, 3 females; mean age 35.2 ± 15.0 years), successful correction of C-shaped nasal deviation was achieved with no significant complications observed in the short-term follow-up (p < 0.0001). Functional improvements were observed in nasal volume and minimum cross-sectional area (p < 0.0001). Most patients reported high satisfaction with both functional and aesthetic outcomes. Compared to traditional septorhinoplasty techniques, this combined approach offers a structured method to address both cosmetic and functional concerns. These findings suggest that the combined use of extended spreader grafts and septal extension grafts offers a promising approach for addressing both cosmetic and functional concerns in septorhinoplasty. Full article

Background: The nasal septal swell body (NSB) is a thickened area of the nasal septum with erectile tissues, located above the nasal floor. We hypothesized that the presence of the NSB in this space exerts favorable effects to generate laminar nasal airflow by developing its morphology as adjusted to nasal septal deviation (NSD). Patients and Methods: We objectively measured the NSB morphology in 152 patients by computed tomography (CT) and assessed its relationship with the width of the inferior turbinate (IT), the severity of NSD, and the patency of the nasal airflow passage (NAP). Results: In the patients with moderate or severe NSD, the mean widths of the NSB, IT, and NAP were significantly narrower at the convex side compared to the paired concave side, with the degree being more prominent in the severe-NSD group. A positive correlation was observed between the degree of the NSD angles and the difference in the widths of the NSB (r = 0.805) and IT (r = 0.609). Conclusions: These results imply novel roles of the NSB in the maintenance of physiological nasal airflow to generate a laminar airflow from the nostrils toward the middle nasal meatus at a constant rate. Full article

Background/Objectives: Rhinogenic contact point headache (RCPH) is a controversial secondary headache disorder involving mucosal contact points in the nasal sinuses. The efficacy of surgical versus medical management has been debated, with some studies showing excellent long-term outcomes but others citing placebo effects. This study aimed to clarify the correlation with nasal anatomical variation detected by CT and RCPH treatment outcomes. Methods: A prospective cohort study was conducted on 90 RCPH patients undergoing surgery or medical therapy. Patients were diagnosed using CT scans, endoscopy, and lidocaine testing. The surgery group had endoscopic procedures to remove contact points. The medical group received intranasal steroids. Outcomes were measured by visual analog scale (VAS) for pain and headache frequency. Predictors like age, gender, and nasal anatomical variations were analyzed. Results: The surgery group showed significant reductions in VAS scores (6.02 to 2.51, p < 0.001) and headache frequency (9.11 to 3.04, p < 0.001). The medical group did not improve significantly. All nasal subtypes improved with surgery but concha bullosa had worse VAS outcomes (4.0) than septal deviation (1.8, p < 0.001) or spur (1.73, p < 0.001). Multivariate analysis found nasal anomalies predicted postoperative VAS scores (p < 0.001) but not headache frequency (p = 0.255). Conclusions: Surgery demonstrated superiority over medications for RCPH. This study provides new evidence that preoperative CT scans should be considered a non-invasive gold standard for analyzing nasal subtypes as they significantly influence surgical success, with concha bullosa associated with worse pain relief. Larger studies should validate these findings to optimize RCPH management. Full article

Background and Objectives: Orthognathic surgery is used to restore a correct anatomical and functional relationship between the jaws, with postoperative nasal septal deviation (NSD) being a common complication of Le Fort I osteotomy (LF-IO). The aim of this study was to evaluate the occurrence of NSD after LF-IO and to identify possible risk factors. Materials and Methods: Pre- and postoperative cone beam computed tomography (CBCT) scans from 2018 to 2023 of 102 patients after LF-IO were analyzed. After categorizing the preoperative NSDs according to the Mladina classification, the next step was to measure the angle of deviation and classify the severity grades. Pre- and postoperative NSDs were compared using a paired Wilcoxon signed-rank test and postoperative changes in NSD were correlated with surgery-relevant characteristics by calculating Spearman’s correlation coefficients. Results: Postoperatively, an increase in NSD was observed in 62 cases and 35 patients showed a decrease. In both cases with an increase and a decrease in NSD, the preoperatively measured deviations showed a highly significant difference compared to postoperative NSDs (both p < 0.001). Age correlated significantly with increases in deviation (r = 0.28, p = 0.014, CI: −1.0–−0.068) and anterior maxillary displacement showed a significant correlation with a decrease in NSD (r = 0.296, p = 0.042, CI: 0.006–1.0). Gender, cranial and caudal movements of the maxilla had no influence on the results of the NSDs. Conclusions: LF-IO has an influence on NSD and can both intensify and attenuate it. In addition, the risk of an increase in nasal deviation after this surgical procedure rises with the patient’s age and decreases with anterior displacement of the maxilla. Full article