RESUMEN
OBJECTIVES: In onco-hematological diseases, the incidence of paranasal sinuses infection dramatically increase and requires a combination of medical and surgical therapy. Balloon dilatation surgery (DS) is a minimally invasive, tissue preserving procedure. The study evaluates the results of DS for rhinosinusitis in immunocompromised patients. METHODS: A retrospective chart review was conducted in 110 hematologic patients with rhinosinusitis. Twenty-five patients were treated with DS technique and 85 patients with endoscopic sinus surgery (ESS). We considered the type of anesthesia and the extent of intra- and postoperative bleeding. Patients underwent Sino-Nasal Outcome Test (SNOT-20) to evaluate changes in subjective symptoms and global patient assessment (GPA) questionnaire to value patient satisfaction. RESULTS: Local anesthesia was employed in 8 cases of DS and in 15 of ESS. In 50 ESS patients, an anterior nasal packing was placed and in 12 cases a repacking was necessary. In the DS group, nasal packing was required in 8 cases and in 2 cases a repacking was placed (P=0.019 and P=0.422, respectively). The SNOT-20 change score showed significant improvement of health status in both groups. However the DS group showed a major improvement in 3 voices: need to blow nose, runny nose, and facial pain/pressure. The 3-month follow-up GPA questionnaire showed an higher satisfaction of DS group. CONCLUSION: Balloon DS represents a potentially low aggressive treatment and appears to be relatively safe and effective in onco-hematologic patients. All these remarks may lead the surgeon to consider a larger number of candidates for surgical procedure.
RESUMEN
In this prospective study, we have proposed a new method to straighten the caudal septum using a modified spreader graft interlocked on the convex side. A single-interlocked graft inserted by 2 through-and-through serial sections of the quadrangular cartilage (applied over the misshapen convex side previously scored on the concave side) facilitated adjustment of the distal septum intraoperatively. The strip of cartilage of the desired height and width acted as a spring graft and may be placed at the desired height of the caudal septal area to exactly counteract the eventual tendency of the most deviated area to warp over time. All 15 patients treated had improvement of their nasal airway and in their postoperative appearance of the external and internal nose. Our technique is easy to perform and shows long-term reliability in correcting caudal septal deviation, demanding a wider application to confirm its effectiveness on a larger series of patients.