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Laser procedure effective in correcting nasal blockages associated with deviated septum

The JAMA Network Journals

CHICAGO - A new laser procedure that requires only local anesthetic is effective in treating nasal passageway obstructions associated with a deviated nasal septum, according to an article in the July-September issue of The Archives of Facial Plastic Surgery, one of the JAMA/Archives journals. The procedure uses heat generated by a laser to soften cartilage abnormalities so that they can be flattened or shaped to clear the nasal passages.

The septum is the cartilage wall that divides and separates the nostrils. People who have a deviated septum may have a hole in the septum, or other malformations that can block the nasal passageways and can cause varying degrees of difficulty with breathing. Traditional surgery to solve these problems uses a scalpel to cut away flaps inside the nose and reshape the cartilage manually. Stitches are needed to close the surgical wounds. The procedure is costly and the patient may need time off from work to recover. The new procedure uses a laser to heat the malformations until they are soft enough to be pressed or formed so that they aren't blocking the nasal passageways.

Yuri Ovchinnikov, M.D., of Moscow State University, Russia, and colleagues used the laser procedure on 110 patients between 11 years old and 66 years old. Patients were followed up for an average of 18 months.

The laser outpatient procedure lasted 6 to 8 minutes. The researchers found that 84 (76 percent) patients had an improvement in their airways, and with symptoms associated with nasal blockages. The authors write, "After 7 to 10 days, the septal cartilage in all patients tended to recover some of the initial deformity (shape-memory effect). Two to 3 weeks later, the cartilage started to restraighten. The septum reached a stable shape after 3 to 4 weeks. This shape change remained stable throughout the observation period (2 to 3 years)."

In 27 (24 percent) of the patients, abnormalities treated with the laser procedure resumed their original shapes. The authors found that these patients had spurs or other abnormalities, didn't receive uniform heating of the cartilage and had other disorders, like rhinitis, a chronic allergic condition causing breathing problems, nasal irritation and runny nose.

The researchers conclude "Our results in 110 patients using this new laser-based procedure to reshape the nasal septum may provide an alternative to classic operations for reducing morbidity, operating room times, and the economic impact of time lost from work."

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(Arch Facial Plast Surg. 2002;4:180-185. Available post embargo at archfacial.com)

Editor's Note: This study was supported by a grant from the U.S. Civilian Research & Development Foundation (Arlington, Va) and by grants from the Russian Foundation for Basic Research (Moscow).

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