Becker Samuel S, Dobratz Eric J, Stowell Nicolas, Barker Daniel, Park Stephen S
Department of Otolaryngology and Head and Neck Surgery, University of Virginia Health System, P.O. Box 800713, Charlottesville, Virginia, USA.
Am J Rhinol. 2008 Jul-Aug;22(4):440-4. doi: 10.2500/ajr.2008.22.3200.
Patients with nasal obstruction from septal deviation commonly undergo septoplasty to improve nasal airflow. Some patients suffer from persistent obstruction after their primary septoplasty and may undergo a revision septoplasty to improve their nasal passageway. Our objective was to identify patients who underwent revision septoplasty and to identify their sources of persistent nasal obstruction.
Patients who underwent septoplasty at our institution between 1995 and 2005 were reviewed. Data is collected on demographics, comorbidities, age at septoplasty, associated and concomitant procedures, surgical approach, and anatomic site of obstruction.
Five hundred forty-seven patients met inclusion criteria including 477 who underwent primary septoplasty and 70 who underwent revision surgery. Nineteen percent of nonrevision patients underwent nasal valve surgery along with their primary septoplasty versus 4% of patients in the revision group. Fifty-one percent of revision patients had nasal valve surgery at revision surgery. Patients who underwent sinus surgery along with primary septoplasty were less likely to undergo revision septoplasty. History of facial trauma, obstructive sleep apnea, site of deviation, and performance of inferior turbinate surgery did not affect the likelihood of revision septoplasty.
A significant number of patients who undergo revision septoplasty also have nasal valve collapse. We recommend that in addition to septal deviation and inferior turbinate hypertrophy, nasal valve function be fully evaluated before performing septoplasty. This will help to ensure a complete understanding of a patient's nasal airway obstruction and, consequently, appropriate and effective surgical intervention.
鼻中隔偏曲导致鼻塞的患者通常会接受鼻中隔成形术以改善鼻气流。一些患者在初次鼻中隔成形术后仍有持续性鼻塞，可能会接受鼻中隔成形术翻修以改善鼻道。我们的目的是识别接受鼻中隔成形术翻修的患者，并确定其持续性鼻塞的原因。
回顾了1995年至2005年在我们机构接受鼻中隔成形术的患者。收集了关于人口统计学、合并症、鼻中隔成形术时的年龄、相关和伴随手术、手术方式以及梗阻解剖部位的数据。
547名患者符合纳入标准，其中477名接受了初次鼻中隔成形术，70名接受了翻修手术。19%的未翻修患者在初次鼻中隔成形术时同时进行了鼻瓣膜手术，而翻修组患者这一比例为4%。51%的翻修患者在翻修手术时进行了鼻瓣膜手术。初次鼻中隔成形术时同时进行鼻窦手术的患者进行鼻中隔成形术翻修的可能性较小。面部创伤史、阻塞性睡眠呼吸暂停、偏曲部位以及下鼻甲手术的实施情况均不影响鼻中隔成形术翻修的可能性。
大量接受鼻中隔成形术翻修的患者也存在鼻瓣膜塌陷。我们建议，除了鼻中隔偏曲和下鼻甲肥大外，在进行鼻中隔成形术前应全面评估鼻瓣膜功能。这将有助于确保全面了解患者的鼻气道阻塞情况，从而进行适当有效的手术干预。
