Comparative evaluation of FESS and septoplasty with FESS in cases of DNS with chronic maxillary sinusitis

Abstract

Background: Present study compares basic FESS and septoplasty with FESS alone in DNS with maxillary sinusitis.Methods: Sixty patients of DNS with chronic maxillary sinusitis were divided into two groups alternatively. After pre-operative symptoms score and computerized tomography (CT scan), twenty patients underwent FESS with septoplasty (group A) and other 20 underwent FESS alone (group B) under local anaesthesia and topical 4% lignocaine with 1:1000 adrenaline. At 6 weeks, post-operative symptom score and CT scan findings were documented and compared statistically by using unpaired student t-test.Results: Ninety six percent of patients in group A and 87.6% in group B have shown complete improvement in facial pain/pressure. Ninety three percent of patients in group A and 83.3% in group B have shown complete improvement in headache. Ninety percent patients in group A and 63.3% in group B has shown complete improvement in nasal obstruction. Seventy six percent of patients in group A and 63.3% of patients in group B have shown complete improvement in nasal discharge. Eighty six percent and 63.3% of patients in group A and group B respectively were satisfied from the surgery. Ninety three percent of patients in group A and 70% in group B were found to have normal maxillary sinus mucosa on HRCT nose and PNS after 6 weeks following surgical treatment. Hundred percent patients in group A and 96.7% of patients in group B were found to have normal OMC on HRCT nose and PNS 6 weeks after surgery.Conclusions: It was observed that FESS with septoplasty is effective for the treatment of chronic rhinosinusitis with deviated nasal septum on VAS as well as radiologically (the Lund and Mackay staging system: radiologic staging) than FESS alone.

Impact of septoplasty alone or with endoscopic sinus surgery for treatment of chronic rhinosinusitis with deviated septum

“…The study done by Thakur et al 2017 showed that the success rate was higher in patients with septoplasty alone as compared to those in FESS with septoplasty suggesting adequacy of septoplasty alone in management of chronic maxillary sinusitis with DNS [2].…”

“…Chronic rhinosinusitis is one of the most common diseases in many parts of the world. CRS is a clinical diagnosis and imaging is only indicated after adequate medical treatment; therefore, imaging should be interpreted considering history, examination, and response to medical treatment [2]. Nasal septum deviation can disturb nasal physiology, and it can be combined with conchal hypertrophy or other anatomical variations.…”

“…The inflammation nearly always involves the nose; therefore, the term rhino-sinusitis (CRS) is used. Chronic rhinosinusitis is defined as two major symptoms/signs (facial pain/pressure, facial congestion/fullness, nasal blockage, nasal discharge, hyposmia/anosmia, purulence on nasal examination) or one major and two minor symptoms/ signs (headache, fever, halitosis, fatigue, dental pain, cough, ear pain/pressure/fullness) for more than 12 weeks duration [2]. Anatomic variations can lead to obstruction of osteomeatal complex (OMC), which can be enhanced by inflammation and result in compromised mucocilliary clearance; this may result in chronic or recurrent rhino sinusitis.…”

“…The most frequent OMC anatomic variation is septal deviation [3]. Deviated nasal septum leads to increased chance of impaired mucociliary clearance, ostiomeatal complex obstruction, and development of rhinosinusitis [2].…”

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“…In 2005, Bayiz U et al concluded that septoplasty alone can be adequate treatment of chronic rhinosinusitis with septal deviation. 5 However, with the extensive use of endoscope in ENT surgeries, septoplasty combined with FESS has shown better symptom relief 6 . Hence the logical ease of combining FESS with endoscopic septoplasty.…”