METHODS
This prospective study was conducted at the Otolaryngology Department of
Health Sciences University, Sanliurfa Mehmet Akif Inan Training and
Research Hospital between January 2017 and December 2019. The
institutional ethical review board of the same hospital approved this
study. All adult patients referred to the otolaryngology department with
nasal septal deviation and underwent septoplasty were included. Patients
with a previous history of nasal surgery, patients older than 45, and
patients who required another nasal surgery such as rhinoplasty were
excluded. Since the risk of septal perforation is inherently higher in
more complicated septoplasty procedures, patients with excessive septal
deviation were not included for homogeneity purposes.3Also, patients who changed their smoking habits during the one-year
preceding surgery and those who were lost to follow-up after surgery
were excluded. Written informed consent was obtained from all patients
fulfilling the inclusion criteria.
Patients who give a social history of smoking at least 1 pack of (i.e.
twenty) cigarettes and/or one hookah per day regularly during the last
year before the surgery were defined as smokers. Study participants were
divided into four groups based on their tobacco consumption status:
Non-smokers, patients smoking cigarettes only, patients smoking hookah
only, and patients smoking both cigarettes and hookah. The same
experienced surgeon performed all surgical procedures using the same
septoplasty technique. The surgeon was blinded to the group of the
patients. Silicone nasal septal splints were placed internally and
removed on the 3rd postoperative day. All patients
underwent a complete examination, including nasal endoscopy daily after
the surgery by a physician blinded to their tobacco consumption status.
Healing was considered complete when there was no longer any intranasal
crusting, granulation tissue, polyps, mucosal infection, adhesions, or
synechiae at the surgical site, and the patient returned to daily
activities without nasal blockage. The septal perforation diagnosis was
based on a complete nasal examination, including anterior rhinoscopy and
nasal endoscopy. All patients were followed until they completely
healed; healing times and presence or absence of septal perforation were
recorded for all study participants. The study groups were compared in
terms of healing times and frequency of septal perforation.