From the Division of Plastic Surgery, University of Wisconsin; and the Department of Plastic Surgery, Cairo University.
Plast Reconstr Surg. 2018 Dec;142(6):1583-1592. doi: 10.1097/PRS.0000000000004989.
Nasal surgery is one of the most common operations performed by plastic surgeons. The link between functional nasal surgery and improvement in nasal breathing is well established, but there are other metrics that have been shown to improve as a result of anatomical correction of the nose. Current literature suggests that surgery to remove nasal mucosal contact points can reduce symptoms in chronic headache patients. The authors conducted a systematic literature review to determine the validity of this hypothesis.
A systematic search of the literature was performed using the terms "headache," "rhinogenic headache," "contact point," "migraine," and "surgery/endoscopy."
The authors identified 39 articles encompassing a total of 1577 patients who underwent surgery to treat mucosal contact point headaches. Septoplasty and turbinate reduction were the most commonly performed procedures, often in combination with endoscopic sinus surgery. Analysis of the combined data demonstrated improvement in the reported severity of patient symptoms, with 1289 patients (85 percent) reporting partial or complete resolution of headaches postoperatively. Average visual analogue scale scores and number of headache days in patients undergoing nasal surgery were reduced from 7.4 ± 0.9 to 2.6 ± 1.2 (p < 0.001) and 22 ± 4.3 days to 6.4 ± 4.2 days (p = 0.016), respectively. Improvement in headache symptoms was significantly associated with a positive response to preoperative anesthetic testing, and with inclusion of endoscopic sinus surgery as part of the surgery.
Functional nasal surgery is a viable option to improve headache symptoms in appropriately selected patients.
鼻科手术是整形外科医生最常进行的手术之一。功能性鼻科手术与改善鼻呼吸之间的联系已得到充分证实，但也有其他指标表明，通过纠正鼻子的解剖结构可以得到改善。目前的文献表明，去除鼻黏膜接触点的手术可以减轻慢性头痛患者的症状。作者进行了系统的文献回顾，以确定这一假设的有效性。
使用“头痛”、“鼻源性头痛”、“接触点”、“偏头痛”和“手术/内窥镜”等术语对文献进行系统搜索。
作者共确定了 39 篇文章，其中包括 1577 例接受手术治疗黏膜接触点头痛的患者。鼻中隔成形术和鼻甲切除术是最常进行的手术，通常与鼻内镜鼻窦手术联合进行。对合并数据的分析表明，患者报告的症状严重程度有所改善，1289 例患者（85%）报告术后头痛部分或完全缓解。接受鼻科手术的患者平均视觉模拟评分和头痛天数从 7.4 ± 0.9 降至 2.6 ± 1.2（p < 0.001）和 22 ± 4.3 天降至 6.4 ± 4.2 天（p = 0.016）。头痛症状的改善与术前麻醉测试的阳性反应以及鼻内镜鼻窦手术作为手术的一部分显著相关。
功能性鼻科手术是一种改善选择适当的患者头痛症状的可行方法。
