« Previous Article
Next Article »

Original Research (Original Article) 


Mohammed Saad Eldin et al, 2019;3(10):077–082.

International Journal of Medicine in Developing Countries

Radiofrequency-assisted septorhinoplasty: a retrospective single descriptive study among Saudi patients

Mohammed Saad Eldin1, Abdulrahman Abdullah Alomari2*, Fahad Muidh Aljuaid2, Faisal Khalaf Almalki2, Abdulaziz Fahad Altowairqi2, Mohammed Aiman Halawani2, Ahmad Abdullah Alsulami2

Correspondence to: Abdulrahman Abdullah Alomari

*Umm Al-Qura University, Makkah, Saudi Arabia.

Email: alomariabdulrahman12 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 18 July 2019 | Accepted: 06 August 2019


ABSTRACT

Background:

Nasal obstruction can be due to anatomical or structural abnormalities, such as inferior turbinate hypertrophy and nasal septal deviation. Also, chronic rhinosinusitis and allergic rhinitis cause nasal congestion and decrease airflow. Patients with septal deviation may complain of snoring, sneezing, sleep apnea, nasal discharge, nasal obstruction, or oral breathing. This work was aimed to compare between radiofrequency-assisted septorhinoplasty and traditional septorhinoplasty.


Methodology:

A retrospective cohort study was conducted during the period from 01/06/2016 to 01/06/2017 at King Abdullah Medical City, Makkah, Saudi Arabia. All adult patients ≥ 18 years of age attending to ENT clinic with nasal deformity underwent functional septorhinoplasty by simple dissection or radiofrequency were interviewed to assess their satisfaction in Olfaction, Aestheticism, and Breathing, using patient's and doctor's satisfaction scales. Also, postoperative complications and time of the operation were evaluated.


Results:

Among a total of 66 participants included in this study, 18 (27.3%) of participants were females, while 48 (72.7%) of them were males. The study found a relationship between the type of procedure and shape of the nose post-operatively depending on patient’s satisfaction score (p-value = 0.001), and there was a relation between type of procedure and form of the nose post-operatively depending on doctor’s satisfaction score (p-value = 0.000078).


Conclusion:

Radiofrequency-assisted septorhinoplasty is an innovation in the field of septorhinoplasty. Using the Soft Palate wand handle for sub-Superficial Musculoaponeurotic System layer dissection and in septal dissection, until reaching to the anterior nasal spine, it took a short duration of time in a bloodless field which gave good result in terms of patient’s satisfaction score without any major or minor complications.


Keywords:

Radiofrequency, septorhinoplasty, retrospective single descriptive study, Saudi patients.


Introduction

Nasal airway obstruction is one of the most common otorhinolaryngologic complaints [1]. Nasal obstruction negatively affects patients’ quality of life [24]. Nasal obstruction can be due to anatomical or structural abnormalities, such as inferior turbinate hypertrophy and nasal septal deviation [5]. Also, chronic rhinosinusitis and allergic rhinitis cause nasal congestion and decrease airflow [6,7]. Nasal septal deviation has a prevalence ranging from 19% to 65% due to different definition criteria [8,9]. Patients with septal deviation may complain of snoring, sneezing, sleep apnea, nasal discharge, nasal obstruction, or oral breathing [10]. Many studies were conducted previously about the use of radiofrequency ablation in turbinate hypertrophy and other lesions in the nose, but we could not find any study about applying this technique in septorhinoplasty in our literature review. The septorhinoplasty technique was used in our cases, the dissection, duration, complications, and patient’s satisfaction were fully described, and our study aimed to compare radiofrequency-assisted septorhinoplasty and traditional septorhinoplasty. The Coblation technology combines radiofrequency energy and saline to create a plasma field. The plasma field persists at a relatively low temperature as it precisely ablates the targeted tissue while minimizing damage to surrounding areas. “Co-” stands for “controlled” and “-blation” is from the word, “ablation,” which is the process of reducing the size of something; when the sun melts an iceberg, the process is called “ablation.” It should be noted that Coblation is a chemical process, not a thermal process. The 100–200 μm plasma field allows precise volumetric removal of soft tissue with minimal thermal damage to untargeted tissue. An electrical field is generated between the active electrode(s) and the return electrode. The electrical field interacts with surrounding fluid (e.g., saline) to excite electrolytes and molecules in the solution, creating a high-density energy field called plasma. The vapor layer resides between the active electrode and the saline. The plasma is formed within milliseconds and is held continuously while activated. Features of the soft palate (SP) wand handle: (1) Retractable saline delivery sheath eliminates the need for saline gel typically used by other wand handles. (2) Electrode configuration to enhance coblation-channeling for immediate tissue removal combined with thermal lesion creation [11].


Subjects and Methods

A retrospective cohort study was performed on 66 adult patients older than or equal to 18 years old attending ENT clinic with nasal deformity underwent functional septorhinoplasty by simple dissection or radiofrequency at King Abdullah Medical City (KAMC), from 01/06/2016 to 01/06/2017. Patients younger than 18 years old, who are attending for aesthetic purpose only were excludeds. The patients were classified into two groups; each group consisting of 33 participants, group A underwent simple dissection, and group B underwent radiofrequencyassisted septorhinoplasty. After taking consent from the patients, a questionnaire was given to the patients to assess patient’s satisfaction score from 1 to 5 about olfaction, aestheticism, and breathing. One means bad, two means not satisfied, three methods acceptable, four means good, and five means excellent. Also, any postoperative complications such as skin discoloration, pain, septal hematoma, nasal edema, and septal perforation was assessed by the study team. The time of the operation was estimated to compare the effectiveness of the two methods. The study questionnaire was translated into Arabic by a bilingual translator. Questionnaire components included (age, gender, type of procedure either radiofrequency-assisted septorhinoplasty or blunt dissection, date of operation, patient’s satisfaction, and doctor’s satisfaction scores). Data collection and entry were performed through interviews. Microsoft Office Word 2016 was used to create graphs. Statistical analysis was performed using the Statistical Package of social science (SPSS), V21. The study considered p<0.05 to be statistically significant, and used 95% confidence intervals (CI).

Simple dissection

Simple dissection involved inverted V-shaped incision at the narrowest part of the columella; then dissection of the envelope skin upward until the mucoperichondrial flap of the lower lateral cartilage. Further dissection above the mucoperichondrial flap, using a no. 15 blade scalpel. The team did incision at the caudal part of the upper lateral cartilage until they reached the perichondrium. Then, by blunt dissection, the team dissected under the mucoperichondrium, also they went more posterior to sub mucoperiosteum of the nasal bone and dissected bilaterally by blunt dissection to expose the nasal bone. Then, the team started to examine from the caudal part of the septum anteriorly until the body of the septum ‘submucoperichondrial flap’ until the perpendicular plate of the ethmoid. After that, they started to dissect under the mucoperiosteum of the vertical plate of ethmoid by blunt dissection using suction dissector instrument. Then, they began to do tunnel under the mucoperiosteal of the vomerizing crest from caudal to cephalic, and the team connected the inferior tunnel with the superior tunnel. Now with blunt dissection, they exposed the septal cartilage, the perpendicular plate of ethmoid and vomer crest. Then, the team started to dissect the soft tissue around the anterior nasal spine by scissor; it took about 18 minutes to reach to the anterior nasal spine from the nasal septum with blunt dissection.

Radiofrequency-assisted septorhinoplasty

The team started with inverted V-shaped incision and did blunt dissection over the mucoperichondrial flap of the lower lateral cartilage. Then, they did incision at the caudal part of the upper lateral cartilage using no. 15 blade scalpel until they reached the mucoperichondrial flap, and then they used SP hand of radiofrequency at four power and used saline irrigation, which is built in the same hand. The thermal effect is very minimal, about 50 dc. Then, we dissected under the mucoperichondrial flap of the upper lateral cartilage, then under the mucoperiosteal of the nasal bone and the sub-Superficial Musculoaponeurotic System (SMAS) layer of the nasal bone, until we reached the nasal part of the ascending process of the maxilla, hatching the mucoperichondrial flap with a scalpel first. Then, the team started to dissect the caudal part of the septum with radiofrequency-assisted SP hand under the mucoperichondrial flap. After that, they continued dissection until the body of the septum; then they reached to the mucoperiosteum of the perpendicular plate of the ethmoid. The team continued dissection down under the mucoperiosteum of the vomer crest from the anterior nasal spine until the lower part of the perpendicular plate of ethmoid using radiofrequency-assisted dissection. Then, they dissected the soft tissue around the anterior nasal spine, and the consumed time was about 8 minutes from septal dissection until the anterior nasal spine.

So, according to the time and cost effectiveness, the team reduced the time of the operation, and there was minimal bleeding when compared to the blunt dissection, especially at the anterior end of the nasal spine as shown in Figure 1. See data collection tool (Figure 10).


Results

In this retrospective study, among a total of 66 participants, 18 (27.3%) of participants were females, while 48 (72.7%) of them were males (Table 1). The results showed no relation between the type of procedure and adhesion (p-value = 0.473), there was no relation between type of procedure and skin or mucous membranes discoloration, septal hematoma and perforation, nasal edema, fibrotic changes, and pain (p-value = 0.473), and there was no relation between type of procedure and improving patient’s breathing post-operatively (p-value = 0.574). There was a relationship between type of procedure and shape of the nose post-operatively depending on patient’s satisfaction score (p-value = 0.001), and there was a relationship between kind of procedure and form of the nose post-operatively depending on doctor’s satisfaction score (p-value = 0.000078). Detailed description of results were shown in Figures 29.

Figure 1. Radiofrequency-assisted septorhinoplasty versus Simple dissection.

Figure 2.The percentage of gender in our study.

Table 1. Number of male and female in each type of pf.

Type of Procedure Number of Participants "Gender"
Male Female
RF 24 9
Non-RF 24 9

Figure 3.Number of cases complicated by skin changes postoperative in each procedure.

Figure 4.Number of cases complicated by skin adhesions postoperative in each procedure.

Figure 5.Preoperative procedure patient breathing satisfaction in each.

Figure 6.Dostoperative patient breathing satisfaction in each procedure.

Figure 7.Preoperative patient satisfaction of his/her nose in each procedure.

Figure 8.Postoperative patient satisfaction of his/her nose in each procedure.

Figure 9. (A) Pre-operative and (B) Post-operative (*An informed consent was taken from the patient to publish the pictures).


Discussion

The present study was aimed to compare radiofrequencyand non-radiofrequency-assisted septorhinoplasty at King Abdullah Medical City in Makkah, Saudi Arabia. The results showed that there was a significant relationship between the type of procedure and postoperative nose shape depending on patient’s satisfaction score (p-value = 0.001). Also, there was a meaningful relationship between the type of procedure and postoperative nose shape, depending on the doctor’s satisfaction score (p-value = 0.000078). There was no significant relationship between the type of procedure and adhesion (p-value = 0.473). But depending on our results, there was one case showed skin adhesions which underwent non-radiofrequency-assisted septorhinoplasty while no one of those who underwent radiofrequency-assisted septorhinoplasty developed skin adhesion. There was no significant relationship between the type of procedure and skin changes (p-value = 0.473). But depending on our results, two of those who underwent non-radiofrequency-assisted septorhinoplasty developed skin changes, while who underwent radiofrequencyassisted septorhinoplasty showed no skin changes. Finally, there was no significant relationship between the type of procedure and postoperative breathing improvement according to patient’s satisfaction score (p-value = 0.574). Also, there was one reported case of weak breathing postoperatively among those who underwent non-radiofrequency-assisted septorhinoplasty, but no reported cases among those who underwent radiofrequency-assisted septorhinoplasty. By comparing between duration of both procedures, radiofrequencyassisted septorhinoplasty took 8 minutes from the start of dissection until we reached to the anterior nasal spine while non-radiofrequency-assisted septorhinoplasty took about 18 minutes. The limitations of the present study includes: (1) The sample size was small and (2) There are no previously conducted studies on the use of radiofrequency technique in septorhinoplasty.


Conclusion

Radiofrequency-assisted septorhinoplasty is an innovation in the field of septorhinoplasty. The present study used the SP hand for sub-SMAS layer dissection, and in septal dissection, until the team reached to the anterior nasal spine, it took a short duration of time in a bloodless field which gave a good result in terms of patient’s satisfaction score without any major or minor complications.


Acknowledgment

The authors are grateful to the Research Center-King Abdullah Medical City for facilitating all research-related procedures and subsequent monitoring, along with valuable adjustments while conducting this study.


List of Abbreviations

KAMC King Abdullah Medical City
SMAS Superficial musculoaponeurotic system
SP Soft palate

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Supplementary Figure

Figure 10. Doctor score and data collection form.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The present study was approved by the institutional review board of King Abdullah Medical City (KAMC), Makkah, Saudi Arabia.


Author details

Mohammed Saad Eldin1, Abdulrahman Abdullah Alomari2, Fahad Muidh Aljuaid2, Faisal Khalaf Almalki2, Abdulaziz Fahad Altowairqi2, Mohammed Aiman Halawani2, Ahmad Abdullah Alsulami2

  1. King Abdullah Medical City, Makkah, Saudi Arabia
  2. Umm Al-Qura University, Makkah, Saudi Arabia

References

  1. Schuman TA, Senior BA. Treatment paradigm for Nasal airway obstruction. Otolaryngol Clin North Am. 2018. 51(5):873–82. https://doi.org/10.1016/j.otc.2018.05.003
  2. Han JK, Stringer SP, Rosenfeld RM, Archer SM, Baker DP, Brown SM, et al. Clinical consensus statement: septoplasty with or without inferior turbinate reduction. Otolaryngol Head Neck Surg. 2015;153(5):708–20. https://doi.org/10.1177/0194599815606435
  3. Baumann I. Quality of life before and after septoplasty and rhinoplasty. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010;9.
  4. Shedden A. Impact of nasal congestion on quality of life and work productivity in allergic rhinitis. Treat Respir Med. 2005;4(6):439–46. https://doi.org/10.2165/00151829-200504060-00007
  5. Nurse LA, Duncavage JA. Surgery of the inferior and middle turbinates. Otolaryngol Clin North Am. 2009;42(2):295–309. https://doi.org/10.1016/j.otc.2009.01.009
  6. Hastan DF, Fokkens WJ, Bachert C, Newson RB, Bislimovska J, Bockelbrink A, et al. Chronic rhinosinusitis in Europe-an underestimated disease. A GA2LEN study. Allergy. 2011;66(9):1216–23. https://doi.org/10.1111/j.1398-9995.2011.02646.x
  7. Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J. 2004;24(5):758–64. https://doi.org/10.1183/09031936.04.00013904
  8. Smith KD, Edwards PC, Saini TS, Norton NS. The prevalence of concha bullosa and nasal septal deviation and their relationship to maxillary sinusitis by volumetric tomography. Int J Dent. 2010;2010. https://doi.org/10.1155/2010/404982
  9. Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. Am J Neuroradiol. 2004;25(9):1613–8.
  10. Seeger J, Zenev E, Gundlach P, Stein T, Müller G. Bipolar radiofrequency-induced thermotherapy of turbinate hypertrophy: pilot study and 20 months' follow-up. Laryngoscope. 2003;113(1):130–5. https://doi.org/10.1097/00005537-200301000-00024
  11. Mith and nephew, coblator II, SP www.smith-nephew.com/australia/ear-nose-and-throat/tonsils--adenoids/coblator-ii-ent/hand [cited 2019 May 21]


How to Cite this Article
Pubmed Style

Eldin MS, Alomari AA, Aljuaid FM, Almalki FK, Altowairqi AF, Halawani MA, Alsulami AA. Radiofrequency-assisted septorhinoplasty: a retrospective single descriptive study among Saudi patients. IJMDC. 2019; 3(10): 77-82. doi:10.24911/IJMDC.51-1563451086


Web Style

Eldin MS, Alomari AA, Aljuaid FM, Almalki FK, Altowairqi AF, Halawani MA, Alsulami AA. Radiofrequency-assisted septorhinoplasty: a retrospective single descriptive study among Saudi patients. http://www.ijmdc.com/?mno=57565 [Access: October 18, 2019]. doi:10.24911/IJMDC.51-1563451086


AMA (American Medical Association) Style

Eldin MS, Alomari AA, Aljuaid FM, Almalki FK, Altowairqi AF, Halawani MA, Alsulami AA. Radiofrequency-assisted septorhinoplasty: a retrospective single descriptive study among Saudi patients. IJMDC. 2019; 3(10): 77-82. doi:10.24911/IJMDC.51-1563451086



Vancouver/ICMJE Style

Eldin MS, Alomari AA, Aljuaid FM, Almalki FK, Altowairqi AF, Halawani MA, Alsulami AA. Radiofrequency-assisted septorhinoplasty: a retrospective single descriptive study among Saudi patients. IJMDC. (2019), [cited October 18, 2019]; 3(10): 77-82. doi:10.24911/IJMDC.51-1563451086



Harvard Style

Eldin, M. S., Alomari, . A. A., Aljuaid, . F. M., Almalki, . F. K., Altowairqi, . A. F., Halawani, . M. A. & Alsulami, . A. A. (2019) Radiofrequency-assisted septorhinoplasty: a retrospective single descriptive study among Saudi patients. IJMDC, 3 (10), 77-82. doi:10.24911/IJMDC.51-1563451086



Turabian Style

Eldin, Mohammed Saad, Abdulrahman Abdullah Alomari, Fahad Muidh Aljuaid, Faisal Khalaf Almalki, Abdulaziz Fahad Altowairqi, Mohammed Aiman Halawani, and Ahmad Abdullah Alsulami. 2019. Radiofrequency-assisted septorhinoplasty: a retrospective single descriptive study among Saudi patients. International Journal of Medicine in Developing Countries, 3 (10), 77-82. doi:10.24911/IJMDC.51-1563451086



Chicago Style

Eldin, Mohammed Saad, Abdulrahman Abdullah Alomari, Fahad Muidh Aljuaid, Faisal Khalaf Almalki, Abdulaziz Fahad Altowairqi, Mohammed Aiman Halawani, and Ahmad Abdullah Alsulami. "Radiofrequency-assisted septorhinoplasty: a retrospective single descriptive study among Saudi patients." International Journal of Medicine in Developing Countries 3 (2019), 77-82. doi:10.24911/IJMDC.51-1563451086



MLA (The Modern Language Association) Style

Eldin, Mohammed Saad, Abdulrahman Abdullah Alomari, Fahad Muidh Aljuaid, Faisal Khalaf Almalki, Abdulaziz Fahad Altowairqi, Mohammed Aiman Halawani, and Ahmad Abdullah Alsulami. "Radiofrequency-assisted septorhinoplasty: a retrospective single descriptive study among Saudi patients." International Journal of Medicine in Developing Countries 3.10 (2019), 77-82. Print. doi:10.24911/IJMDC.51-1563451086



APA (American Psychological Association) Style

Eldin, M. S., Alomari, . A. A., Aljuaid, . F. M., Almalki, . F. K., Altowairqi, . A. F., Halawani, . M. A. & Alsulami, . A. A. (2019) Radiofrequency-assisted septorhinoplasty: a retrospective single descriptive study among Saudi patients. International Journal of Medicine in Developing Countries, 3 (10), 77-82. doi:10.24911/IJMDC.51-1563451086