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Otolaryncologic literature is full of techniques described to correct the deviated nasal septum. The popular operation of submucosal resection has several potential complication. Moreover the dorsal and caudal septal deflections cannot be corrected by it. The modern trend is towards nasal septal reconstruction, so that the whole septum can be approached and reconstructed. We have used the autologous perpendicular plate of ethmoid as permanent nasal septal splint. The ethmoid plate is rigid enough to be used as splint at the same time it is thin and does not add to the bulk. The Ethmoid splints are effective in correcting septal deviation and prevent redeviation of the reconstructed septum. The technique was successfully used in over 100 patients without any significant complication.

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To propose a classification of anatomical variation of the caudal septal deviation and propose strategy for the management of caudal septal deviation by septo-rhinoplasty and to evaluate the efficacy of treatment of different types of caudal septal deviation in terms of aesthetic and functional outcome. The study is a retrospective review of 124 cases with significant anterior caudal deviation causing aesthetic and or functional problems, treated by septo-rhinoplasty within a 5 year period from December 2014 to December 2019, with a minimum follow up of 6 months. Visual analogue scale, photographic evaluation and subjective assessment were used for postoperative outcomes. Significant improvement in the treatment of nasal obstruction was achieved, with mean visual analogue scale score of 7.83 preoperatively to 3.56 postoperatively, Subjective assessment showed marked satisfaction in 96 patients, moderate satisfaction in 21 and no improvement in seven patients of total 124 patients. The rate of revision was (4%). A novel classification of anterior caudal septal deviation is proposed with surgical technique directed for individual deformity and we have achieved very good results.
The nasal septum plays a paramount role in determining nasal aesthetics and nasal function. Surgical management of the nasal septum often presents a challenge to even the most skilled nasal surgeon. A firm understanding of anatomic and physiologic aspects of the nasal septum will allow the rhinoplasty surgeon to better deal with this component of nasal reconstruction.
THE NEED to develop an effective technique for the permanent alteration of the shape of cartilage is apparent to all of us who do reconstructive surgery. Gibson and Davis,1 in a study on the behavior pattern of costal cartilage, showed the presence of interlocking stresses in human costal cartilage in a state of balance, with the outer layer in a state of tension and the inner layer in a state of compression. They also correlated the stress pattern and the cellular arrangement in costal cartilage, demonstrating ways of preventing warping by using balanced cross sections to shape the graft, changing the relationship of these forces upon the cartilage. Frye2 showed that thin cartilage as well as cartilage with better cell differentiation, as determined by the arrangement of the cells in the cartilage, tends to deform more readily when acted upon by an outside force. He demonstrated distortion of
The total submucosal removal of the nasal septum and all less extensive operations present a common technical difficulty. This is the elevation of the mucosa over obstructing and impacting cartilage and bony ridges and spines, especially if these are in the anterior area about the caudal end of the septal cartilage, the premaxillary wings, and the maxillary crests. Failure to identify and include in the elevation the whole of the periosteal and perichondrial layers makes further separation of the mucosa uncertain and difficult and leads to incomplete correction and early or late perforation formation. Correction of the anterior (caudal) portion of the septum is very frequently of prime consideration and its preservation or replacement is particularly essential in septum operations combined with pyramid surgery and when a careful reconstruction or reorganization of the os internum is necessary. Anatomical Considerations The septum cartilage in the white adult averages 3-4 mm. in
The Maxilla-Premaxilla approach to extensive nasal septum surgery
  • M H Cottle
  • C G Fischer
  • T E Gaynon
  • R M Losing