Often there is a need to address the status of the nasal septum during functional endonasal sinus surgery. The outcome of a sinus procedure can be enhanced if the surgeon has better exposure of the operative area or if the patient receives a larger nasal airway, which provides laminar air flow. We present a technique of managing septal deviations and obstructions that adds little additional time to the sinus procedure and allows direct evaluation of the septum with the endoscopes. We describe this relatively simple technique, indications for its use, and results of the first 38 cases.
Reported cases of toxic shock syndrome (TSS) following nasal surgery or functional endonasal sinus surgery (FESS) are uncommon. Classic TSS is a serious multisystem disorder resulting from Staphylococcus aureus phage I toxic shock syndrome toxin 1 (TSST-1), and it is characterized by fever, rash, hypotension, mucosal hyperemia, vomiting, diarrhea, and laboratory evidence of multisystem organ dysfunction. TSS cases following nasal surgery have been associated with nasal packing, mucosal barrier violation, prior S aureus phage I colonization, as well as low antitoxin antibody levels. Of the 1700 FESS procedures performed at our institution, 3 cases were complicated by classic TSS, with 2 additional patients having a postsurgical course compromised by a milder degree of TSS. Diagnostic criteria, clinical presentation, management, and etiology are discussed, and the possibility of a continuum from mild-to-classic TSS is addressed.
Often there is a need to address the status of the nasal septum during functional endonasal sinus surgery. The outcome of a sinus procedure can be enhanced if the surgeon has better exposure of the operative area or if the patient receives a larger nasal airway, which provides laminar air flow. We present a technique of managing septal deviations and obstructions that adds little additional time to the sinus procedure and allows direct evaluation of the septum with the endoscopes. We describe this relatively simple technique, indications for its use, and results of the first 38 cases.
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