December 2018 #PRSJournalClub Wrap-Up: Can Functional Nasal Surgery Treat Chronic Headaches?

by Gianfranco Frojo, MD
Plastic Surgery Resident
Saint Louis University School of Medicine


The December edition of #PRSJournalClub provided an interactive discussion of the systematic reviewentitled “Can Functional Nasal Surgery Treat Chronic Headaches?”. The authors conducted a systematic review of the literature regarding surgical management of rhinogenic headaches. The article from the University of Wisconsin authors Ahmed Afifi, MD, Rebecca Farmer, MD, and Ravi Garg, MD represented one of the first publications in the PRS journal to review this topic.  The article can be found here.

In the study, Farmer et al. discuss several potential surgical triggers sites in the literature and the surgical procedures performed for potentially addressing these intranasal abnormal mucosal contact points.  The study is a systematic review of 39 studies, predominantly retrospective chart reviews, with a total of 1577 patients who underwent functional nasal surgery for treatment of headaches, all studies reporting the performance of septoplasty or turbinate reduction. Eighteen of the 39 studies also included endoscopic nasal surgery. With respect to outcomes for patients in all studies, 48% of patients reported complete resolution of headaches after surgery, 37% of patients reported significant improvement in severity or decrease in frequency of symptoms. Fifteen percent of all patients reported no change in severity of frequency of symptoms. The authors further analyzed a subgroup of patients who underwent functional nasal surgery without endoscopic surgery to examine the possibility that contributions from underlying sinus disease may have contributed to outcomes. Within this subgroup, forty five percent of patients reported complete cure, 41% of patients reported partial resolution, and 14% of patients reported no change in symptoms. The authors concluded that functional nasal surgery can improve chronic rhinogenic headaches.

The article was discussed by the current 2018 Resident Ambassadors to the PRS Editorial Board – Nicole Phillips (@DrNikkiPhillips) was the lead moderator for the discussion. The journal club’s special guest was Justine C. Lee, MD, PhD (@drjustineleemd). Listen to the podcast discussion below:

In a #PRSHotTopic video, Editor-in-Chief Dr. Rod J. Rohrichdiscusses his article. This short video can be found here:

An engaging and thought-provoking online discussion also took place on the #PRSJournal Facebook page over a two-day period (December 14-15), where established plastic surgeons and residents were able to ask questions and get answers from the authors of the article themselves! Don’t worry if you missed it! A summary of the interesting discussion is provided here.

We hope you enjoy the top highlights from the discussion and look forward to seeing you at the next #PRSJournalClub on Facebook!

Sincerely,

Gianfranco

This December #PRSJournalClub article (as well as other Journal Club selections from December), selected classic pairings and videos, and the entire Facebook Q&A are archived on PRSJournal.com here.

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