Advantages of Computed Tomography (CT) in Endoscopic Septopasty

Background and objective: Nasal obstruction is the most frequent presentation to the otolaryngologist all over the world. Symptoms are multisystem involvement such as headache, epistaxis, ophthalmological, otological, upper and lower respiratory tract infections;and many more. Septoplasty is commonly performed for nasal septal deviation as a primary indication of nasal airway obstruction. Physical examination, anterior rhinoscopy and nasal endoscopy are considered the gold standard for detecting septal deviation. Computed tomography (CT) can also be used to evaluate the nasal septum, anatomical variants and unveils the associated sinonasal diseases. This study aimed to find out the advantages of CT in endoscopic septoplasty for all out benefits to the patients. Patients and methods: 168 patients of nasal septal deviation were selected from 2015 to 2018 in the Bangladesh Medical and Popular Medical College Specialized Hospital. Age ranged between 10 years to 70 years of age. CT scanning in both coronal, axial and sagittal sections had been done in all patients after proper history taking, physical examination, anterior rhinoscopy and nasal endoscopy. Endoscopic septoplasty alone and/or other ancillary procedures were performed in all 168 patients under general anesthesia. Results: Amongst 168 patients, male was 116 (69%) and female was 52 (31%) with a ratio 2.2:1. Maximum 58 (35%) reported in 31 to 40 years and 48 (29%) was found in 21 to 31 years of age. Hypertrophied inferior turbinate (HIT) 54 (32%) and 48 (29%) concha bullosa (CB) were associated with 168 septal deviation. Associated pathologies like maxillary antral cyst 68 (40%) and maxillary sinusitis 62 (37%) were documented. Conclusion: CT scanning unveils the abnormal anatomic variants and associated sinonasal pathologies along with nasal septal deviation. Endoscopic septoplasty, correction of the anatomical variants and complete surgical clearance of the sinonasal pathologies can give the patient a grand success.

Styloid Process Is the Robust Landmark for Identification of the Facial Nerve during Parotid Surgery

Objective: To identify the facial nerve trunk (FNT) very easily. quickly and accurately considering the styloid process as the robust anatomically consistent landmark during parotid surgery. Patients and Methods: This prospective study was conducted between January 2010 to December 2022 at a Tertiary care hospital. It included 130 patients: 84 (65%) males and 46 (35%) females with a mean age of 43.52 ± 15.63 years. Patients presented with pleomorphic adenoma (90), chronic sialectasis (05), parotid cyst (03), parotid sinus (01), mucoepidermoid carcinoma (28), adenoid cystic carcinoma (02) and squamous cell carcinoma (01) were subjected to superficial parotidectomy and total parotidectomy. The outcome was evaluated regarding the clinical success of facial nerve function that considered the location of the styloid process in the triangle technique for identification of the FNT during parotid surgery. Results: All 130 patients underwent superficial and total parotidectomy. The facial nerve trunk was successfully identified as the location of the styloid process in the triangle technique in all the patients with no intra-operative complications. Operative time ranged from 50 to 180 minutes with a mean time 90.70 ± 15.68 minutes. Dysfunction of the angle of the mouth due to the deficit of the marginal mandibular nerve (MMN) was noted in 5 patients (3.8%), 02 had difficulty in eye closure (1.5%). No patient reported surgical site infection, skin flap necrosis and hematoma in this series. Conclusion: Styloid process is the prominent robust landmark in the triangle technique for the identification of facial nerve trunk with relative ease, safety and accuracy in the parotid surgical procedure. This can be a very useful method to locate the FNT and minimize facial nerve injury during parotid surgery.