Marangi Giovanni Francesco, Segreto Francesco, Signoretti Matteo, Cazzato Vito, Persichetti Paolo
From the Division of Plastic Surgery, Campus Bio-Medico University, Rome, Italy.
Ann Plast Surg. 2018 Jul;81(1):55-61. doi: 10.1097/SAP.0000000000001444.
Nasal septal deviation is one of the major causes of nasal respiratory flow disorders. During the rhinoseptoplasty, the septum can be treated through a closed traditional access or through an open access. To date, there are still no objective functional indications of the best access to use in rhinoseptoplasty. For this reason, we evaluated, objectively and subjectively, the functional efficiency of open access and compared it with that of closed access. The aim is to highlight any functional outcome differences between the 2 types of access.
The study involved up to 50 patients, from January 2006 to June 2017; 20 patients underwent modified extracorporeal rhinoseptoplasty with open access, and 30 patients underwent modified extracorporeal rhinoseptoplasty with closed access. We evaluated the nasal obstruction by using the validated questionnaire Nasal Obstruction Symptoms Evaluation (subjective method) and by performing the anterior active rhinomanometry (objective method). Both evaluations were performed in 3 different times: preoperative period, 3 months, and 6 months after surgery.
In the open cohort, the rhinomanometric analysis showed a statistically significant increase between preoperative period and sixth month after surgery; however, the nose score had a statistically significant increase in both 3 and 6 months after surgery. At 3 months after surgery, the rhinomanometric score was higher in patients with closed access than patients with open access; this difference has disappeared at 6 months after surgery. At 3 and 6 months after surgery, the improvement in the Nasal Obstruction Symptoms Evaluation average score was greater in patients with open access compared with patients with closed access. No complications were observed.
Based on the results obtained from our work, we can declare that open access is a functionally valid procedure. At 6 months after surgery, the 2 accesses have a comparable functional efficacy.
鼻中隔偏曲是鼻呼吸气流紊乱的主要原因之一。在鼻中隔成形术中，鼻中隔可通过传统的闭合入路或开放入路进行处理。迄今为止，在鼻中隔成形术中使用哪种最佳入路仍没有客观的功能指征。因此，我们对开放入路的功能效率进行了客观和主观评估，并将其与闭合入路进行比较。目的是突出两种入路之间的任何功能结果差异。
该研究纳入了2006年1月至2017年6月期间的50例患者；20例患者接受了改良体外鼻中隔成形术开放入路，30例患者接受了改良体外鼻中隔成形术闭合入路。我们使用经过验证的问卷《鼻阻塞症状评估》（主观方法）并通过进行前鼻主动鼻阻力测量（客观方法）来评估鼻阻塞情况。两种评估均在3个不同时间进行：术前、术后3个月和6个月。
在开放入路组中，鼻阻力测量分析显示术前至术后6个月有统计学显著增加；然而，鼻评分在术后3个月和6个月均有统计学显著增加。术后3个月，闭合入路患者的鼻阻力测量评分高于开放入路患者；这种差异在术后6个月消失。术后3个月和6个月，开放入路患者的《鼻阻塞症状评估》平均评分改善程度大于闭合入路患者。未观察到并发症。
根据我们工作获得的结果，我们可以宣称开放入路是一种功能有效的手术方法。术后6个月，两种入路具有相当的功能疗效。
