{"paper_id":"38b137c8-a3df-4bf9-9155-e2a2ab501ff1","body_text":"Use of liquid paraffin in Septoplasty | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Use of liquid paraffin in Septoplasty Sathyaki D C, Shwetha Naidu, Nalina P A, Leela Tejaswini R M This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5780109/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives Nasal obstruction due to deviated nasal septum is a common problem encountered by otolaryngologists. Septoplasty is the surgical procedure which has been performed in the treatment of the same. This study was conducted to evaluate the efficacy of post operative topical application of liquid paraffin and saline nasal douching. Methods This is a prospective, randomized study. Forty patients with symptomatic deviated nasal septum were included in the study, 20 of them were advised topical application of liquid paraffin and the rest were advised saline nasal douching. Results The difference in the functional outcome of both the irrigation was insignificant. There was a significant difference with respect to formation of crust and synechae. Liquid paraffin had better outcome. Conclusion Topical application of liquid paraffin resulted in prevention of crusting and synechae. Post Septoplasty Nasal douching Alkaline douching Introduction Nasal obstruction is the most common symptom an otolaryngologist encounters in hi clinical practice. Deviated nasal septum is the most common cause of nasal obstruction. It also causes improper aeration of paranasal sinuses leading to sinusitis. Septoplasty is the most common surgery performed to treat deviated nasal septum. Topical therapies play an integral role in the management of sinonasal disease, and high volume irrigation delivery is more effective for achieving distribution to the sinuses than other topical delivery methods such as nasal sprays, nebulizers, or atomizers. Saline irrigations have been recommended in a number of clinical scenarios, including chronic rhinosinusitis and postoperative care. High volume irrigations have also shown benefits for medication delivery, such as with mupirocin and budesonide. The improvement of sinus irrigation penetration thus increasingly becomes an important outcome of septoplasty. In efforts to improve these outcomes, the efficacy of topical irrigations delivery to target sinuses is an area of active research. Previous studies have shown that nasal irrigant may not reliably penetrate all sinuses and its effectiveness in postoperative cases varies and may depend on the degree of surgery, e.g. ostia size 1 . This study was performed to compare the efficacy of saline nasal douching with that of topical application of liquid paraffin in post septoplasty patients. Aims and objectives: To compare the efficacy of saline nasal douching against topical application of liquid paraffin. Materials and methods 40 patients who underwent septoplasty in a tertiary care centre from January 2016 to December 2016 were included in this study. They were divided into two groups of 20 patients each. Saline nasal douching was advised in one group and topical liquid paraffin in the other. Endoscopic septoplasty was performed in all patients. Patients were followed up for 6 months. Inclusion criteria: Patients with symptomatic deviated nasal septum. Exclusion criteria: 1. age less than 12 years 2. patients with asymptomatic deviated nasal septum 3. patients with acute rhinitis or allergic rhinitis Results Age distribution: 10 patients were present in liquid paraffin group and 5 in saline douching group in the age group of below 20 years. In the age group of 21–30 years there were 3 patients in liquid paraffin group and 6 patients in the other. In the age group of 31–40 years there were 6 patients in liquid paraffin group and 7 in the other. In the age group of above 40 years there were 3 patients (Table: 1) Table 1 Age in years Liquid Paraffin Saline douching Total < 20 10(50%) 5(25%) 15(37.5%) 20–30 3(15%) 6(30%) 9(22.5%) 31–40 6(30%) 7(35%) 13(32.5%) 41–50 1(5%) 2(10%) 3(7.5%) Total 20(100%) 20(100%) 40(100%) Mean ± SD 22.95 ± 11.18 27.85 ± 10.71 25.40 ± 11.09 Sex distribution: There were 13 female patients each in both the groups and 7 male patients each in both the groups (table: 2) Table 2 Gender Liquid Paraffin Saline douching Total Female 13(65%) 13(65%) 26(65%) Male 7(35%) 7(35%) 14(35%) Total 20(100%) 20(100%) 40(100%) Crusting was present in 6 patients in saline douching group. P-value was 0.02 which was significant (Table: 3). Table 3 Formation of crust Liquid Paraffin Saline douching Total Absent 20(100%) 14(70%) 34(85%) Present 0(0%) 6(30%) 6(15%) Total 20(100%) 20(100%) 40(100%) Formation of synechae was seen in 12 patients in saline nasal douching. It was not present in patients who used liquid paraffin. P-value was less than 0.001 which was also significant. Fisher exact test was used (Table: 4). Table 4 Presence of Synechae Liquid Paraffin Saline douching Total Absent 20(100%) 8(40%) 28(70%) Present 0(0%) 12(60%) 12(30%) Total 20(100%) 20(100%) 40(100%) Discussion Postoperative debridement is considered as an important means of facilitating the healing of nasal mucosa, it has been shown to prevent the development of crusting and adhesions in the middle meatus. On the other hand, patients may experience postoperative unpleasant. In fact, frequently debridement has been associated with more postoperative pain. So the necessity has not been identified. During the healing process of mucosa after septoplasty, large crusting and clot may trap mucosa, which will reinfect the sinuses. The old blood itself may be a good culture medium for bacteria. The crusts may act as bridges across which scar formation may occur, leading to an obstructed postoperative cavity. And retained bone fragments that are denuded of mucosa maybe the cause for reinforce 1 . Seiberling etal foundintraoperative saline irrigations are effective in reducing the load of pathogenic bacterial within the treated sinus. Although at that point in time it was unclear whether this will have a clinical impact in the postoperative outcome of the patient, it was assumed that healing will be improved with a decrease in bacterial load within the sinus mucosa. In that study, they broadened their objectives to evaluate whether mupirocin irrigations given as a one time dose at the time of surgery would reduce bacterial load to a greater extent than saline irrigations alone. Their results demonstrated that intraoperative mupirocin irrigations effectively reduced the amount of S. aureus detected within the treated sinus mucosa at 7–10 days post-surgery. When compared to normal saline irrigations, mupirocin appears to have greater efficacy in reducing bacterial counts as detected by quantitative rPCR. Furthermore, mupirocin appears to be more effective in patients with CRS without polyps although larger numbers are needed to reach statistical significance 2 . Hashemi etal found that saline nasal irrigation prevented recurrence of polyp in patients who underwent endoscopic sinus surgery 3 . Zhao etal advocated visualisation of nose and paranasal sinuses through computational fluid dynamics pre and post-surgery to get better results 4 . Many surgeons document weekly debridement may reduce crusts in the nose, nasal congestion, and postoperative infections. It is known that crusts act as bridges over which adhesion can grow. Severe crusting may also cause nasal blockage. Debridement of the nasal cavity reduces crusts and postoperative adhesions significantly compared with saline irrigation only. Use of topical liquid paraffin has not been reported in the previous studies. So we have compared its efficacy with that of saline nasal douching in this study. Conclusion Post-operative debridement is an important step in treatment of patient who undergo nasal surgeries. It prevents post-operative infection. In our study we concluded that topical application of liquid paraffin is more effective in prevention of crusting in the nasal cavity which in-turn leads to better ventilation and drainage in nasal cavity and paranasal sinuses. Declarations Ethics approval: obtained by Kodagu institute of medical sciences. Consent to participate was obtained. Funding: None References Shi L, Feng Y, Cui W, Yan K, Lv M, Hong Z etal. Effect evaluation of repeated debridement after endoscopic sinus surgery. International journal of clinical and experimental medicine. 2015;8(1):928-33. Seiberling KA, Aruni W, Kim S, Scapa VI, Fletcher H, Church CA. The effect of intraoperative mupirocin irrigation on Staphylococcus aureus within the maxillary sinus. International forum of allergy and rhinology. 2013 Feb;3(2):94-8. Hashemi SM, Mokhtarinejad F, Karim M, Okhovat SH. Does amphotericin B nasal douching help prevent polyp recurrence following functional endoscopic sinus surgery. Journal of respiratory medical sciences. 2011 January;16(1):74-8. Zhao K, Craig JR, Cohen NA, Adappa ND, Khalili S, Palmer JN. Sinus irrigations before and after surgery-Visualization through computational fluid dynamics simulations. Laryngoscope. 2016 March;126(3):90-3. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5780109\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":401498615,\"identity\":\"7c9461a3-6cab-4d06-b0a7-4e83e90c2d4b\",\"order_by\":0,\"name\":\"Sathyaki D C\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYHACNiBO4AFixgcMDAegggb4dDDDtTAbkKQFhNkkEFrwAPn288ce89SkyTCwJz+r5qm5I8fPwPzwAUPBHZxaDM4ksxvzHMvhYeB5Znab59gzY8kGNmMDBoNnuLUwJLNJ87BV8DBI5LDd5mE7nLjhAA/QhQaHcTus/zFQyz+IlmKef0RoYbgBtIW3LQeshZm3jQgtBjcem0nO7UsD+cUYyDhsLNkM9EsCXoclPpN48y3ZHhhiDz+8+XZYjp+9+eGDD3/wOAwImIDxyGB/AMpgYGaAxBM+wPgDnTEKRsEoGAWjABkAAFuSS/jlf6G1AAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Sathyaki\",\"middleName\":\"D\",\"lastName\":\"C\",\"suffix\":\"\"},{\"id\":401498616,\"identity\":\"57cad3bd-29f7-4254-9207-5918531cdea9\",\"order_by\":1,\"name\":\"Shwetha Naidu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Shwetha\",\"middleName\":\"\",\"lastName\":\"Naidu\",\"suffix\":\"\"},{\"id\":401498617,\"identity\":\"bb4407bd-def4-4812-a631-8fd8d971f4b3\",\"order_by\":2,\"name\":\"Nalina P A\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Nalina\",\"middleName\":\"P\",\"lastName\":\"A\",\"suffix\":\"\"},{\"id\":401498618,\"identity\":\"3ab97344-bfa7-4e16-a797-0bda91f20a45\",\"order_by\":3,\"name\":\"Leela Tejaswini R M\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Leela\",\"middleName\":\"Tejaswini R\",\"lastName\":\"M\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-01-07 09:53:30\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5780109/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5780109/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":75705374,\"identity\":\"06146c80-c7e0-4020-a214-424dadeea96e\",\"added_by\":\"auto\",\"created_at\":\"2025-02-07 10:08:56\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":346136,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5780109/v1/debc29a3-4122-45cf-a22c-76230e282994.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eUse of liquid paraffin in Septoplasty\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eNasal obstruction is the most common symptom an otolaryngologist encounters in hi clinical practice. Deviated nasal septum is the most common cause of nasal obstruction. It also causes improper aeration of paranasal sinuses leading to sinusitis. Septoplasty is the most common surgery performed to treat deviated nasal septum.\\u003c/p\\u003e \\u003cp\\u003eTopical therapies play an integral role in the management of sinonasal disease, and high volume irrigation delivery is more effective for achieving distribution to the sinuses than other topical delivery methods such as nasal sprays, nebulizers, or atomizers. Saline irrigations have been recommended in a number of clinical scenarios, including chronic rhinosinusitis and postoperative care. High volume irrigations have also shown benefits for medication delivery, such as with mupirocin and budesonide. The improvement of sinus irrigation penetration thus increasingly becomes an important outcome of septoplasty. In efforts to improve these outcomes, the efficacy of topical irrigations delivery to target sinuses is an area of active research. Previous studies have shown that nasal irrigant may not reliably penetrate all sinuses and its effectiveness in postoperative cases varies and may depend on the degree of surgery, e.g. ostia size\\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eThis study was performed to compare the efficacy of saline nasal douching with that of topical application of liquid paraffin in post septoplasty patients.\\u003c/p\\u003e \\u003cp\\u003eAims and objectives:\\u003c/p\\u003e \\u003cp\\u003eTo compare the efficacy of saline nasal douching against topical application of liquid paraffin.\\u003c/p\\u003e\"},{\"header\":\"Materials and methods\",\"content\":\"\\u003cp\\u003e40 patients who underwent septoplasty in a tertiary care centre from January 2016 to December 2016 were included in this study. They were divided into two groups of 20 patients each. Saline nasal douching was advised in one group and topical liquid paraffin in the other. Endoscopic septoplasty was performed in all patients. Patients were followed up for 6 months.\\u003c/p\\u003e \\u003cp\\u003eInclusion criteria:\\u003c/p\\u003e \\u003cp\\u003ePatients with symptomatic deviated nasal septum.\\u003c/p\\u003e \\u003cp\\u003eExclusion criteria:\\u003c/p\\u003e \\u003cp\\u003e\\u003cspan\\u003e1. age less than 12 years\\u003cbr\\u003e\\u003c/span\\u003e\\u003cspan\\u003e2. patients with asymptomatic deviated nasal septum\\u003cbr\\u003e\\u003c/span\\u003e\\u003cspan\\u003e3. patients with acute rhinitis or allergic rhinitis\\u003cbr\\u003e\\u003c/span\\u003e\\u003c/p\\u003e\\n\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eAge distribution:\\u003c/p\\u003e \\u003cp\\u003e10 patients were present in liquid paraffin group and 5 in saline douching group in the age group of below 20 years. In the age group of 21\\u0026ndash;30 years there were 3 patients in liquid paraffin group and 6 patients in the other. In the age group of 31\\u0026ndash;40 years there were 6 patients in liquid paraffin group and 7 in the other. In the age group of above 40 years there were 3 patients (Table: 1)\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge in years\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLiquid Paraffin\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSaline douching\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10(50%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15(37.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e20\\u0026ndash;30\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3(15%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6(30%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9(22.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e31\\u0026ndash;40\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6(30%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7(35%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13(32.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e41\\u0026ndash;50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1(5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2(10%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(7.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e40(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22.95\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27.85\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.71\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e25.40\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eSex distribution:\\u003c/p\\u003e \\u003cp\\u003eThere were 13 female patients each in both the groups and 7 male patients each in both the groups (table: 2)\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGender\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLiquid Paraffin\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSaline douching\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e13(65%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13(65%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26(65%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7(35%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7(35%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14(35%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e40(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eCrusting was present in 6 patients in saline douching group. P-value was 0.02 which was significant (Table: 3).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFormation of crust\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLiquid Paraffin\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSaline douching\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAbsent\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14(70%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e34(85%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePresent\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0(0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6(30%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6(15%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e40(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eFormation of synechae was seen in 12 patients in saline nasal douching. It was not present in patients who used liquid paraffin. P-value was less than 0.001 which was also significant. Fisher exact test was used (Table: 4).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePresence of Synechae\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLiquid Paraffin\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSaline douching\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAbsent\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8(40%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e28(70%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePresent\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0(0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12(60%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12(30%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e40(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003ePostoperative debridement is considered as an important means of facilitating the healing of nasal mucosa, it has been shown to prevent the development of crusting and adhesions in the middle meatus. On the other hand, patients may experience postoperative unpleasant. In fact, frequently debridement has been associated with more postoperative pain. So the necessity has not been identified.\\u003c/p\\u003e \\u003cp\\u003eDuring the healing process of mucosa after septoplasty, large crusting and clot may trap mucosa, which will reinfect the sinuses. The old blood itself may be a good culture medium for bacteria. The crusts may act as bridges across which scar formation may occur, leading to an obstructed postoperative cavity. And retained bone fragments that are denuded of mucosa maybe the cause for reinforce\\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eSeiberling etal foundintraoperative saline irrigations are effective in reducing the load of pathogenic bacterial within the treated sinus. Although at that point in time it was unclear whether this will have a clinical impact in the postoperative outcome of the patient, it was assumed that healing will be improved with a decrease in bacterial load within the sinus mucosa. In that study, they broadened their objectives to evaluate whether mupirocin irrigations given as a one time dose at the time of surgery would reduce bacterial load to a greater extent than saline irrigations alone. Their results demonstrated that intraoperative mupirocin irrigations effectively reduced the amount of S. aureus detected within the treated sinus mucosa at 7\\u0026ndash;10 days post-surgery. When compared to normal saline irrigations, mupirocin appears to have greater efficacy in reducing bacterial counts as detected by quantitative rPCR. Furthermore, mupirocin appears to be more effective in patients with CRS without polyps although larger numbers are needed to reach statistical significance\\u003csup\\u003e\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eHashemi etal found that saline nasal irrigation prevented recurrence of polyp in patients who underwent endoscopic sinus surgery\\u003csup\\u003e\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eZhao etal advocated visualisation of nose and paranasal sinuses through computational fluid dynamics pre and post-surgery to get better results\\u003csup\\u003e\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eMany surgeons document weekly debridement may reduce crusts in the nose, nasal congestion, and postoperative infections. It is known that crusts act as bridges over which adhesion can grow. Severe crusting may also cause nasal blockage. Debridement of the nasal cavity reduces crusts and postoperative adhesions significantly compared with saline irrigation only.\\u003c/p\\u003e \\u003cp\\u003eUse of topical liquid paraffin has not been reported in the previous studies. So we have compared its efficacy with that of saline nasal douching in this study.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003ePost-operative debridement is an important step in treatment of patient who undergo nasal surgeries. It prevents post-operative infection. In our study we concluded that topical application of liquid paraffin is more effective in prevention of crusting in the nasal cavity which in-turn leads to better ventilation and drainage in nasal cavity and paranasal sinuses.\\u003c/p\\u003e \"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eEthics approval: obtained by Kodagu institute of medical sciences.\\u003c/p\\u003e\\n\\u003cp\\u003eConsent to participate was obtained.\\u003c/p\\u003e\\n\\u003cp\\u003eFunding: None\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eShi L, Feng Y, Cui W, Yan K, Lv M, Hong Z etal. Effect evaluation of repeated debridement after endoscopic sinus surgery. International journal of clinical and experimental medicine. 2015;8(1):928-33.\\u003c/li\\u003e\\n\\u003cli\\u003eSeiberling KA, Aruni W, Kim S, Scapa VI, Fletcher H, Church CA. The effect of intraoperative mupirocin irrigation on Staphylococcus aureus within the maxillary sinus. International forum of allergy and rhinology. 2013 Feb;3(2):94-8.\\u003c/li\\u003e\\n\\u003cli\\u003eHashemi SM, Mokhtarinejad F, Karim M, Okhovat SH. Does amphotericin B nasal douching help prevent polyp recurrence following functional endoscopic sinus surgery. Journal of respiratory medical sciences. 2011 January;16(1):74-8.\\u003c/li\\u003e\\n\\u003cli\\u003eZhao K, Craig JR, Cohen NA, Adappa ND, Khalili S, Palmer JN. Sinus irrigations before and after surgery-Visualization through computational fluid dynamics simulations. Laryngoscope. 2016 March;126(3):90-3.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Post Septoplasty, Nasal douching, Alkaline douching\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5780109/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5780109/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eObjectives\\u003c/h2\\u003e \\u003cp\\u003eNasal obstruction due to deviated nasal septum is a common problem encountered by otolaryngologists. Septoplasty is the surgical procedure which has been performed in the treatment of the same. This study was conducted to evaluate the efficacy of post operative topical application of liquid paraffin and saline nasal douching.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eThis is a prospective, randomized study. Forty patients with symptomatic deviated nasal septum were included in the study, 20 of them were advised topical application of liquid paraffin and the rest were advised saline nasal douching.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThe difference in the functional outcome of both the irrigation was insignificant. There was a significant difference with respect to formation of crust and synechae. Liquid paraffin had better outcome.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eTopical application of liquid paraffin resulted in prevention of crusting and synechae.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Use of liquid paraffin in Septoplasty\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-01-15 09:27:09\",\"doi\":\"10.21203/rs.3.rs-5780109/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"99e7b431-f93b-420f-ab41-d3e9bdc600c9\",\"owner\":[],\"postedDate\":\"January 15th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-02-07T10:08:32+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-01-15 09:27:09\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5780109\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5780109\",\"identity\":\"rs-5780109\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}