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Caudal Septoplasty for Treatment of Septal Deviation: Aesthetic and Functional Correction of the Nasal Base
Abstract
To describe our technique in the treatment of significant caudal septal deviation; to evaluate the effectiveness of our technique of caudal septoplasty in the treatment of caudal septal deviations.
Retrospective review of cases taken from a database of more than 2000 patients who underwent rhinoplasty performed by 1 surgeon in a private facial plastic surgery practice.
Medical charts were reviewed to determine the rate of preoperative nasal obstruction in 59 (95%) of 62 patients as well as nasal obstruction postoperatively 11 (17%) of 62 (P < .001). Photographs were reviewed to determine the severity of caudal deviation and the postoperative result. By photographic evaluation, we found that all but 3 patients had significant improvement in their postoperative appearance. Twenty-six patients had no evidence of residual asymmetry. The rate of revision was 5 (8%) of 62 patients.
The caudal septoplasty technique is effective, relatively easy to perform, and shows long-term reliability in correcting caudal septal deviation. In properly selected patients, the technique is effective in improving cosmesis and nasal airflow.
... Caudal deviations can also result in under projection, twisting of the nose, and dorsal depressions [5]. The caudal deviation presents among 5%-8% of patients with deformities [8,9]. The caudal deviation is caudal deviation, including an S-shaped deviation [10]. ...
... The caudal septoplasty was reported to be relatively easy to be performed, effective, and had long-term reliability in the correction of caudal septal deviation. It is effective in resolving the nasal obstruction and improving the nasal airflow as well as improving cosmesis [9]. The caudal septoplasty also was shown to be safe and effective and resulted in patient satisfaction [7]. ...
... Translocation of the caudal end deviation to the other side of the anterior septal spine without weakening the caudal septum is used in most patients with mild to moderate to caudal deviation [5]. In one study [9], it was reported that the translocation technique resulted in excellent results. The study included the data of sixty-two patients who performed standard septoplasty, and after performing the septoplasty, the deviated caudal septum was simply repositioned to the contralateral side or the midline of the anterior septal spine. ...
Caudal end septal deviation is a common deformity; it results in functional and aesthetic problems. There are several techniques for the correction of the caudal deviations. Here we highlight caudal septal deviation and its management. The participated authors searched for articles related to the current subject and included 10 articles to write this article. The information was organized under main titles. After the discussion of the subject, we could conclude that the caudal septal deviation causes problems in the function of the individual, such as obstruction of the nasal airway. It also causes ethical problems that may affect the patient satisfaction. The gold standard management for the correction of the caudal septal deviation is septoplasty. There are several techniques involved in the management process. The use of a certain technique depends on the severity of the condition.
... Patients with caudal septal deviation account for 5% to 8% of patient with nasal septal deviation. 1,2 Caudal septal deviation may result in nasal obstruction, a crooked nose, columellar irregularities, and nostril asymmetry. 3 Incomplete correction of the caudal septal deviation has been known as one of the main reasons for persistent septal deviation after primary septoplasty. ...
... Many techniques, such as cross-hatching incision, horizontal mattress suture, septal batten graft, wedge resections, swing door, and cutting and suture, have been used in managing caudal septal deviation. 2,[5][6][7][8] Each technique was used alone or in combination and reported 82% to 96.5% postoperative symptom improvement. 2,[5][6][7][8] However, caudal septal deviation is difficult to correct because the intrinsic cartilage memory is hard to overcome. ...
... 2,[5][6][7][8] Each technique was used alone or in combination and reported 82% to 96.5% postoperative symptom improvement. 2,[5][6][7][8] However, caudal septal deviation is difficult to correct because the intrinsic cartilage memory is hard to overcome. Furthermore, these techniques are also known to cause complications, including weakening of cartilages, overcorrection, and subsequent nasal deformity. ...
Objective:
Correction of the caudal septum deviation is the most difficult part of the septoplasty and a common cause of revision septoplasty. The purpose of this study was to present authors' preliminary results in the treatment of patients with caudal septal deviation using the septal cartilage traction suture technique.
Study design:
Prospective, single center, observational study.
Materials and methods:
Sixty-seven patients with a caudal septal deviation underwent septal cartilage traction suture technique with endonasal septoplasty. After removal of excessive caudal cartilage, the caudal L-strut was sutured at two or more points using 5-0 Vicryl on the modified Killian incision site. Subjective outcomes using visual analog scales (VAS) and Nasal Obstruction Symptom Evaluation (NOSE) scale, objective endoscopic examination, and acoustic rhinometry data were assessed.
Results:
There was significant symptomatic improvement in the VAS and NOSE scale at 1, 3, and 6 months postsurgery. Complete correction in the endoscopy was observed in the 91.0% of patients at 3 months postsurgery. The results of acoustic rhinometry increased from 0.3 and 4.3 preoperatively to 0.7 and 7.7 at 3 months postoperatively. Furthermore, no patient experienced septal hematoma, septal perforation, and loss of nasal tip support at 6 months follow-up.
Conclusions:
The septal cartilage traction suture technique obtained significant improvement in subjective and objective outcomes in patients with caudal septal deviation. This technique is a simple, safe, and effective method to treat caudal septal deviation.
Level of evidence:
4 Laryngoscope, 2020.
... The Pastorek method is a modified swinging door technique where the caudal cartilage septum is flipped over the nasal spine to act as a door-stop holding the septum in the midline, followed by suturing to fix the cartilage septum to the nasal maxillary spine. 17 In the Sedwick technique, the caudal cartilage septum is located in the midline and sutured in that new position. 17 A caudal strut is placed to the columella with a suture. ...
... 17 In the Sedwick technique, the caudal cartilage septum is located in the midline and sutured in that new position. 17 A caudal strut is placed to the columella with a suture. The septum is secured to the spine in 1 location in these technique and we believe this can lead to rotation of the septum to the left or right like a door hinge. ...
... In the Kridel ''tongue in groove'' technique, the caudal cartilage septum is placed into the groove between the medial crura. 15,17 In the Chung technique, 2 to 8 suture were done through the bony batten graft and anterior nasal spine. 18 In the notching technique, the septum is secured to spine in 2 locations with separate fixation sutures. ...
Objectives:
Various techniques have been described to correct caudal septum dislocations but the issue has not been resolved conclusively. This study aimed to describe a suture technique that can be used to correct and stabilize the caudal septum on the maxillary spine and also to evaluate the effects on patientsymptoms.
Methods:
Fifty-two patients with caudal septal dislocation were included in this study. Nineteen of the patients underwent open septoplasty and 33 patients underwent endonasal septoplasty. The caudal cartilage septums were fixed to the maxillary spine with horizontal mattress suturing in all patients. The patient followed up between 3 and 24th month. The modified "NOSE" survey was used to assess surgical outcome in all patients. The degree of septal correction was also classified.
Results:
Complete correction was achieved in the postoperative period in 96% of the patients. The status was near complete correction in 2 (3.8%) of the patients. But in these 2 patients, degree of caudal septal dislocation was corrected from severe to moderate after surgery and the fixation suture side is correct and stable. Postoperative modified NOSE survey scores were lower than the preoperative scores in all open and endonasal septoplasty groups (P <0.05). NOSE 2 (nasal blockage or obstruction) and NOSE 4 (trouble sleeping) scores were higher in patients with higher follow-up duration in open septoplasty group.
Conclusion:
Suturing technique is quite suitable for caudal septum dislocations and can easily be used in open and endonasal septoplasty. This suture reduces postoperative NOSE scores and the patients are satisfied with the results of the surgery. The septal stability may decrease in open septoplasty group with the longer post-operative duration. However, wide exposure can be ensured with an open septorhinoplasty approach. We concluded that it will be better to use endonasal septoplasty in appropriate cases and suture with nonabsorbable sutures.
... I n the current facial plastic surgery literature, published rates for revision septorhinoplasty procedures are limited to a small number of retrospective studies, [1][2][3][4][5][6][7][8][9][10][11][12] often focused on specific surgical techniques from a single institution or single surgeon. Many of these studies [1][2][3][4][5][6][7][8][9][10][11] are also limited by small sample sizes and short duration of follow-up time, making it difficult to draw clinical conclusions. ...
... I n the current facial plastic surgery literature, published rates for revision septorhinoplasty procedures are limited to a small number of retrospective studies, [1][2][3][4][5][6][7][8][9][10][11][12] often focused on specific surgical techniques from a single institution or single surgeon. Many of these studies [1][2][3][4][5][6][7][8][9][10][11] are also limited by small sample sizes and short duration of follow-up time, making it difficult to draw clinical conclusions. The most generalizable studies 1,5 available in the rhinoplasty literature focus on cosmetic rhinoplasties from surgeons in a single practice or institution, with revision rates of 9.8% and 11%. ...
... In the literature focusing on specific rhinoplasty techniques, the revision rate varied from 4% to 15.5%. 3,4,7,8 In the septoplasty literature, a large study 9 of 2168 septoplasties by any technique showed a revision rate of 3.2% among experienced surgeons, while studies 10,11 focusing on specific septoplasty techniques showed higher revision rates of 7% to 8%. [9][10][11] In addition, there may be an underestimation of the revision rates reported in the literature because the authors of single-surgeon or single-institution studies [1][2][3][4][5][6][7][8][9][10][11] review their own respective data and do not include patients who seek revision surgery at another institution, thereby lowering the reported revision rates. ...
Importance
Estimates of the rate of revision septorhinoplasty and the risk factors associated with revision are unknown because the current published literature is limited to small, retrospective, single-surgeon studies with limited follow-up time.Objectives
To determine the rate of revision for septorhinoplasty surgery and to determine the risk factors associated with revision.Design, Setting, and Participants
Retrospective cohort analysis of 175 842 patients undergoing septorhinoplasty between January 1, 2005, and December 31, 2009, from the Healthcare Cost and Utilization Project’s State Inpatient Databases, State Ambulatory Surgery and Services Databases, and State Emergency Department Databases from California, Florida, and New York. Revisit information for these patients was then collected from the 3 databases between January 1, 2005, and December 31, 2012, with a minimal follow-up time of 3 years; and study analysis done January 1, 2005, to December 31, 2012.Main Outcomes and Measures
Revision surgery after an index septorhinoplasty was the main outcome measure, and the rate of revision was calculated within subgroups of patients based on different demographic and clinical characteristics. A multivariable model was then used to determine independent risk factors for the performance of revision surgery.Results
The study cohort comprised 175 842 participants who underwent septorhinoplasty procedures; mean (SD) age was 41.0 (15.3) years, and 57.0% were male. The overall revision rate for any septorhinoplasty procedure was 3.3% (5775 of 175 842) (99% CI, 3.2%-3.4%). After separating the patients into primary septorhinoplasty and secondary septorhinoplasty groups, the primary group had an overall revision rate of 3.1% (5389 of 172 324), while the secondary group had an overall revision rate of 11.0% (386 of 3518). Patient characteristics associated with an increased rate of revision include younger age (5.9% [633 of 10 727]), female sex (3.8% [2536 of 67 397]), a history of anxiety (3.9% [168 of 4350]) or autoimmune disease (4.4% [57 of 1286]), and surgery for cosmetic (7.9% [340 of 4289]) or congenital nasal deformities (8.9% [208 of 2334]).Conclusions and Relevance
The study results, derived from a large cohort of patients with long follow-up time, suggest that the rate of revision septorhinoplasty is low, but certain patient characteristics are associated with higher revision rates. These data provide valuable preoperative counseling information for patients and physicians. This study also provides robust data for third-party payers or government agencies in an era in which physician performance metrics require valid risk adjustment before being used for reimbursement and quality initiatives.Level of Evidence
3.
... Even though they are not the most frequent, caudal or anterior nasal septum deviations result in a lot of nasal tip complaints as they are both obstructive and aesthetic. Only 5%e10 % of patients with a deviated nasal septum also exhibited caudal deviations [2]. ...
... Our aesthetic results were to some extent better than those of Sedwick and colleagues, who evaluated the aesthetic surgical results using a 4-point scale [1, little or no photographic evidence of residual caudal septal deviation (total improvement); 2, marked improvement; 3, only mild or no improvement; and 4, condition made worse]. Their results showed that 23 out of 62 patients gave grade I (37.1 %), 33 patients gave grade II (35.2 %), and only three patients gave grade III [2]. This difference may be due to the different number of patients included in both studies. ...
... Additionally, open techniques are more invasive and time-consuming, so new methods are still being researched and reported [2]. Caudal septal repositioning, spreader grafts, wedging, scoring, morselizing, suture techniques, "tongue-in-groove technique," batten grafts (cartilage or bone), extracorporeal septoplasty, polydioxanone splints, and costal cartilage grafts were described in the literature to manage CSD [3][4][5][6][7]. Nasal spine mobilization, osteotomy reshaping, drilling, septal fixation, or unilateral side-to-side septal strut grafts are other strategies for caudal septal correction [8][9][10]. ...
... They also reviewed 26 studies between 1997 and 2017 and detected the popular surgical techniques as grafting (53.8%), swinging door technique (30.8%), and extracorporeal septoplasty (26.9%) [10]. Sedwick et al. [4] reported that nasal obstruction had disappeared in 82% (n = 51) of the patients according to patients' opinion with swinging door technique during SRP. Also, they also found nasal airway improvement in patients with postoperative nasal obstruction, but five (8%) patients underwent revision surgery due to synechiae (n = 2) and esthetically discontent during the follow-up period. ...
Background
Caudal septum deviation (CSD) causes functional and aesthetical problems, and conventional septoplasty techniques have still been discussed for management of CSD. This study aimed to investigate the effect of caudal chondro-mucoperichondrial flap (CCMF) to correct CSD.
Methods
A retrospective study was designed. Patients with the diagnosis of CSD were included in the study consecutively. Preoperative and postoperative first sixth and 12th month Nasal Obstruction Symptom Evaluation (NOSE) and the Rhinoplasty Outcome Evaluation (ROE) questionnaire scores, revision rates within the first postoperative year, and complication rates were identified.
Results
The mean duration of the operation was 55.9 ± 16.0 min in 77 patients. The preoperative NOSE score was detected as 10.6 ± 4.3 in all patients and decreased to 1.6 ± 1.9 in the postoperative 12th month (p < 0.001 CI: 8.2–9.7). The preoperative ROE score was detected as 6.4 ± 3.1 in all patients and increased to 18.9 ± 3.4 in the postoperative 12th month (p < 0.001 CI: 11.7–13.3). Type of CSD was detected as a significant predictor for preoperative and postoperative NOSE and ROE scores according to linear regression analysis. Revision SRP was performed in only one (1.3%) patient during 12-month follow-up.
Conclusions
CCMF is a useful alternative to management of CSD. In addition, the CSD classification developed in this study can be a useful for future studies. However, the experience of the surgical method by different surgeons will yield more meaningful results.
Level of evidence: Level IV, Therapeutic.
... Caudal septal deviation is de ned as deviation of the anterior most portion of the nasal septum [9]. Caudal septal deviation may be a major cause of nasal obstruction and cause signi cant cosmetic deformities of the nasal base [10,11]. Deviated caudal septum may change the lobular and columellar relationship and has a signi cant effect on tip position and symmetry [10]. ...
... Caudal septal deviation may be a major cause of nasal obstruction and cause signi cant cosmetic deformities of the nasal base [10,11]. Deviated caudal septum may change the lobular and columellar relationship and has a signi cant effect on tip position and symmetry [10]. However, the correction of caudal septal deviation may be di cult because small residual deviation may cause severe nasal obstruction and the intrinsic cartilage-bending memory is hard to overcome [11]. ...
Purpose: Septoplasty is one of the most common surgical procedures performed by otolaryngologist. There are various causes of persistent septal deviation after primary septoplasty. The purpose of this study was to identify the associated factors affecting the failure of the primary septoplasty, and to investigate operative techniques for correcting residual septal deviation, as well as surgical outcomes.
Methods: Seventy-four adult patients underwent revision septoplasty for persistent septal deviation was included. The level of hospital where primary septoplasty was performed, type of septal deviation, persistent deviated septal portion, and techniques used to correct the residual deviation were evaluated. Subjective outcomes using visual analog scale (VAS) and acoustic rhinometry data were assessed.
Results: The first septoplasty was performed mainly in primary and secondary hospital. C-shape was more common than S-shape deviation in the anteroposterior and cephalocaudal dimensions. The most common areas of persistent septal deviation were caudal septum (44.6%) followed by multiple sites (20.3%). Correcting techniques included excision of remnant deviated portion (70.3%), septal cartilage traction suture (27.0%), spreader graft (13.5%), and crossing suture (6.8%). There was significant symptomatic improvement in the VAS at 6 months postsurgery. The minimal cross-sectional area and nasal cavity volume of the convex side were significantly increased after revision septoplasty.
Conclusion: The patients underwent septoplasty in primary and secondary hospital were more likely to undergo revision septoplasty. Caudal septum was the most common sites of persistent septal deviation. Preoperative careful evaluation for caudal septal deviation characteristics and selection of the appropriate surgical techniques may lead to reduction of the need for revision septoplasty.
... www.nature.com/scientificreports/ Caudal septal deviation is a deviation of the most anterior part of the nasal septum; it may cause severe nasal obstruction and significant cosmetic deformities of the nasal base [9][10][11] . A deviated caudal septum may change the relationship between the lobule and columella, thereby significantly affecting nasal tip position and symmetry 10 . ...
... Caudal septal deviation is a deviation of the most anterior part of the nasal septum; it may cause severe nasal obstruction and significant cosmetic deformities of the nasal base [9][10][11] . A deviated caudal septum may change the relationship between the lobule and columella, thereby significantly affecting nasal tip position and symmetry 10 . Correction of such a deviation may be difficult; even a small residual deviation may cause severe nasal obstruction and the intrinsic cartilage-bending memory is hard to break 11 . ...
Septoplasty is one of the most common otolaryngological surgical procedures. The causes of persistent septal deviation after primary septoplasty vary. The purpose of this study was to identify factors associated with failure of primary septoplasty, operative techniques that correct residual septal deviation, and surgical outcomes. Seventy-four adults who underwent revision septoplasty to treat persistent septal deviations were enrolled. The level of hospital in which primary septoplasty was performed, type of septal deviation, septal portion exhibiting persistent deviation, and techniques used to correct the deviation were evaluated. Outcomes were measured subjectively using a visual analog scale (VAS), and objectively using acoustic rhinometry. The first septoplasties were usually performed in primary and secondary hospitals. C-shaped deviations were more common than S-shaped ones in both the anteroposterior and cephalocaudal dimensions. The most common region of persistent septal deviation was the caudal septum (44.6%), followed by multiple sites (20.3%). The corrective techniques included excision of the remnant deviated portion (70.3%), septal cartilage traction suturing (27.0%), spreader grafting (13.5%), and cross-suturing (6.8%). The VAS score improved significantly 6 months after surgery. The minimal cross-sectional area and nasal cavity volume of the convex side increased significantly after revision septoplasty. Patients who underwent septoplasty in primary and secondary hospitals were more likely to require revision septoplasty. The caudal septum was the most common site of persistent septal deviation. Careful preoperative evaluation of the caudal septal deviation and selection of an appropriate surgical technique may reduce the need for revision septoplasty.
... Often these defects cause both an aesthetic distortion of nasal base and nasal obstruction. 2 Metzenbaum was the first to describe a procedure for the correction of the caudal septum. He recognised the importance of its preservation for nasal support. ...
... Pastorek described modified swinging door technique in which caudal septum is flipped over nasal spine. 2,7 Even small anterior deviations cause nasal obstruction because they are located exactly in the narrowest portion of the nasal cavity, the nasal valve. 8 In our series, the nasal obstruction markedly improved after correction of the caudal deviation. ...
p class="abstract"> Background: Deviation of the caudal end of the nasal septum is one of the significant challenges encountered in septal surgery. Deviated caudal septum changes lobular and columellar relationships and has a significant effect on tip position and symmetry. Metzenbaum was the first to describe the technique for the mobilisation of the caudal end in a swinging door fashion. Our study aims to highlight the procedure and its advantages.
Methods: This prospective study was conducted in Department of ENT and Head and Neck Surgery, Adichuchanagiri Institute of Medical Sciences, BG Nagara, between January 2018 to January 2019. 30 patients above 18 years of age, presenting with isolated deviation of the caudal end of the nasal septum were included in the study. A detailed clinical and photodocumentation was done and the results were analysed as follows.
Results: The postoperative surgical results were evaluated using a 4 point scale. 26 (86.7%) patients gave a score of 1 on the 4 point scale suggesting that they were completely satisfied with the results. Whereas 3 (10%) patients gave a score of 2 on our 4 pt scale. 1 (3.3%) patient felt that there was only a minimal improvement after the surgery hence gave a score of 3 on the 4 point scale.
Conclusions: We conclude that Metzenbaum’s technique is very effective in treating caudal septal deviations. Reviving the Metzenbaum’s procedure will help reduce the failure rate in surgeries for correction of caudal septal deviation.</p
... Higher scores meant serious nasal obstruction. According to the NOSE Scale results, the patients were categorized as mild (1)(2)(3)(4)(5), moderate (6-10), severe (11)(12)(13)(14)(15), or extreme (16)(17)(18)(19)(20). ...
... 12,13 Endonasal septoplasty technique is a common method to correct the nasal septal deviation by removing part of the nasal septal cartilage and perpendicular plate of the ethmoid bone. Although ES technique has been confirmed to have some benefits in the patients who have anterocaudal septal deviation, 14 it is not enough to correct severe caudal septal deviation and nasal cavity stenosis with those repositioning and suturing methods. If the septum is radical dysmorphia, even the caudal aspect is reset to the midline will not enough to treat the nasal obstruction. ...
Objective
The aim of this study was to compare the functional and aesthetic outcomes of endonasal septoplasty (ES) and extracorporeal septal reconstruction (ESR) in anterocaudal septal deviation.
Methods
In this study, patients (n = 46) who underwent nasal septoplasty surgery due to anterocaudal septal deviation during February 2015 to August 2017 were analyzed; 23 patients underwent ES and the others (n = 23) underwent ESR. The decision of whether to use the ES or ESR was randomized by random number table method. Nasal obstruction symptoms evaluation (NOSE) scores, total nasal resistance (TNR), aesthetic visual analog scale (VAS), nasal anatomical angles, and incidence of complications were used to assess the patients in 2 groups.
Results
The NOSE scores, TNR, aesthetic VAS, tip deviation angle (TDA), nasolabial angle (NLA), nasofrontal angle (NFA) in the ESR group were significantly improved from preoperative to postoperative 1 year, whereas in the ES group, except aesthetic VAS, NLA, NFA, all other postoperative outcomes were improved from preoperative values. The objective and subjective postoperative results of ESR group were better than the ES group except TDA. The incidence of complications was not significantly different between the 2 groups.
Conclusion
Our study have compared the nasal functional and aesthetic outcomes of 2 septoplasty techniques in a randomized controlled trial. The ESR technique is more effective than ES technique in correcting functional and aesthetic disorders caused by anterocaudal septal deviation.
... Other possible complications include haemorrhage, vestibulitis, haematoma, adhesions and septal cartilage perforation. [2,5,6] To reduce the incidence of complications after septoplasty, the methods used are transfixation suture to the septum and septal splinting. [6] Palatal perforation is an extremely rare complication and literature review revealed very few cases including a case of soft palate perforation consequent to undiagnosed submucous cleft palate. ...
... [2,5,6] To reduce the incidence of complications after septoplasty, the methods used are transfixation suture to the septum and septal splinting. [6] Palatal perforation is an extremely rare complication and literature review revealed very few cases including a case of soft palate perforation consequent to undiagnosed submucous cleft palate. [4] Gokdemir et al. from Turkey reported palatal perforation in a 34 year old patient who had a high palatal vault. ...
... 1 The first description of a treatment for a caudal septal deviation was Metzenbaum's "swinging door" method, which was published in 1929. 2 Later, extended spreader grafts, batten grafts, and the tongue-in-groove method (with Mustardé-type sutures) were used, often in combination with cartilage wedging, scoring, and morselizing. [3][4][5][6][7][8] Authors who advocated that caudal septal deviation repair should be performed with total reconstruction suggested extracorporeal septoplasty. [9][10][11] Eventually, open septoplasty became the preferred procedure for repairing caudal septal deviations, but as medicine has turned toward minimally invasive procedures as the favored option whenever possible, the traditional, more aggressive open methods are being used less often. ...
... Later, several authors modified Metzenbaum's technique by providing nasal spine fixation of the caudal septum. [3][4][5] However, shifting the septum toward one side of the nasal spine is not the only problem encountered with caudal deviations; in many patients, the most caudal point of the septum cannot even reach the nasal spine because it is of insufficient length, usually because of fracture. Therefore, the swinging-door technique and its modified forms would remain insufficient in most patients with a caudal septal deviation. ...
We conducted a retrospective study to compare open and endonasal (closed) approaches to extracorporeal reconstruction of severe caudal septal deviations. From January 1, 2010, through December 31, 2013, 78 patients with severe caudal septal deviation underwent corrective surgery at our hospital. Of this group, 33 patients (mean age: 32 yr) underwent extracorporeal septoplasty via an open approach, and 45 patients (mean age: 35 yr) underwent treatment with a new procedure that we developed: subtotal extracorporeal septoplasty through a closed approach, which we call "marionette septoplasty." In addition to demographic data, we compiled information on surgical time, the duration of postoperative edema, the degree of postoperative pain, and differences between pre- and postoperative nasal function and tip support in both groups. We found that our marionette septoplasty procedure required significantly less surgical time and resulted in a significantly shorter duration of postoperative edema than did open septoplasty, while there was no statistically significant difference between the two procedures in the degree of pain. Following surgery, nasal function in both groups improved significantly, without any significant difference between the two. Finally, we documented improved tip support in all 78 patients. Our results show that marionette septoplasty produces the same functional results as does open septoplasty while requiring less surgical time and shortening the healing period.
... Although nasal packing stabilizes the septum and thus reduces the risk of post-operative deviation [8], this practice can also cause hypoxemia and hypercapnia [9]. Furthermore, since nasal packing causes nasal obstruction, the resulting obligatory mouth breathing may have systemic effects such as insomnia, breathing difficulty, decreased oxygen levels in the blood, and toxic shock syndrome [10]. 1 2 1 1 1 This study argues that by having a deeper understanding of the systemic effects of nasal packing on patients' vital signs, healthcare workers can improve how they manage patients and keep them comfortable postoperatively. Although otorhinolaryngologists usually know the local effects and complications of nasal packing, they often underestimate its systemic effects, which may cause morbidity for the patient. ...
Background
Since bilateral nasal packing entails nasal and airway obstruction, this practice consequently leads to oral breathing. The resulting hypoxemia may then negatively impact vital signs, including blood pressure (BP), blood oxygen saturation (SpO2), and heart rate (HR). These systemic effects have a detrimental effect on patients.
Objective
The objective of this study is to observe the effects of bilateral nasal packing on patients’ post-operative vital signs.
Materials and methods
This prospective study was conducted in the department of otolaryngology - head and neck surgery over a six-month period. The study included 83 post-operative patients with nasal surgery, in which bilateral merocele nasal packing was performed. The patients’ pulse oximetry, systolic and diastolic BP, and HR were recorded four times the night before and after surgery. A statistical analysis was performed, and the mean values, standard deviation, and range were calculated. A paired sample t-test was also applied. The results are presented in figures and tables.
Results
The mean age of the participants was 27.65 ± 10.72 years, and 56 (67.5%) were male. Septoplasty was the most common surgery performed, with 63 participants having undergone this procedure (75.9%). When the pre-operative mean values of systolic and diastolic BP, SpO2, and HR were compared with the post-operative mean values, when a bilateral nasal pack was in place, a significant increase was found in all, with a p-value of <0.001 in each.
Conclusion
Bilateral nasal packing affects patients’ vital signs by significantly increasing diastolic and systolic BP and decreasing SpO2. The HR is also significantly increased when packing is in place.
... Adequate management is challenging because of its importance to nasal function and the final cosmetic result. Many surgical options exist to correct and align this structure (10). Despite the various maneuvers currently available for treatment, this issue remains controversial (11,12). ...
Objectives: Despite the various approaches currently available to treat CSD, this issue still needs to be resolved. Different methods and techniques to manage caudal septal dislocation with good results and according to each patient. This article reviewed the other surgical modalities for correcting caudal septum dislocation with the effectiveness of currently practiced modalities. Searching strategy: We reviewed relevant literature and used PubMed and Google Scholar. Published articles in English were included in the search. The unique and compound keywords used were caudal septum dislocation. The primary search resulted in many reports from all databases and search engines, followed by the exclusion of irrelevant articles. Findings: Different surgical modalities for correcting caudal septum dislocation have been described to correct caudal septum dislocations. Several techniques and maneuvers for surgical correction of caudal septal displacement are mentioned in the literature; nevertheless, there are different opinions and preferences regarding which approach to use. Conclusion and recommendations: An ideal caudal septoplasty should be minimally invasive and improve nasal obstruction. Surgical correction of a deviated septum can be performed using the traditional open endonasal approach, the endoscopic approach, or the open septorhinoplasty approach. In Saudi Arabia, many patients are seeking caudal septal deviation correction. However, there is a need for more trained surgeons, and it is recommended that all levels of training be considered.
... Out of the 101 patients, 36 underwent septoplasty alone and of these two returned, resulting in a revision rate of 5.6 %, which is similar to that of the larger population sample. The remaining 66 had an additional turbinate reduction The revision rates for septoplasty alone in published literature is widely accepted to range from 5 % to 8 % (19,20) .Thus, ARI's revision rate of 5.3% is at the low end of that range. However, there is no corresponding figure available addressing the revision nasal surgery rates for septoplasty with concomitant turbinate manipulation as no studies presently use the need for revision surgery as an outcome measure for assessing effectiveness. ...
Objective: Septoplasty is an accepted and common surgical intervention to improve the nasal airway. However, the role of concomitant surgery on the inferior turbinate remains debated. This study aims to investigate if the inferior turbinate surgery at the time of septoplasty would impact on the likelihood of revision nasal surgery - septoplasty or septorhinoplasty. Study design: Retrospective review of consecutive patients undergoing septoplasty with or without inferior turbinate reduction over 12 years (1998 - 2010) at Aberdeen Royal Infirmary. Methods: Patients were identified from the theatre log books and were excluded if they underwent any other nasal procedure. Data collected include demographics, type of primary surgery, and grade of surgeon along with revision nasal surgery in this cohort. Results: 2168 eligible patients with a mean age of 39 years were investigated. Two groups were identified: Group A, with 788 patients who underwent septoplasty only, and Group B, in which 1380 patients underwent septoplasty with concomitant inferior turbinate reduction. The majority of operations were performed by the surgeons in training. The incidence of revision surgery was 5.1 % (21 revision septoplasties and 19 corrective septorhinoplasties) in Group A compared to 2.2 % (20 revision septoplasties and 10 corrective septorhinoplasties) in Group B. Conclusion: Based on this study, it would appear that concomitant inferior turbinate reduction may decrease the likelihood of revision nasal surgery.
... 1,2 A number of techniques have been described to straighten and stabilize the C or S-shaped deformities involving this L-strut, including spreader grafts, caudal septal repositioning, scoring incisions, suture fixation to the nasal spine, partial or complete replacement by autogenous septal or rib cartilage, and even autologous septal bone grafts. [3][4][5][6][7][8][9][10] Even with these various approaches, correction of twisted dorsal and caudal septum without weakening or compromising the middle vault and nasal tip support is still quite challenging. ...
... 1,2 A number of techniques have been described to straighten and stabilize the C or S-shaped deformities involving this L-strut, including spreader grafts, caudal septal repositioning, scoring incisions, suture fixation to the nasal spine, partial or complete replacement by autogenous septal or rib cartilage, and even autologous septal bone grafts. [3][4][5][6][7][8][9][10] Even with these various approaches, correction of twisted dorsal and caudal septum without weakening or compromising the middle vault and nasal tip support is still quite challenging. ...
Summary: Although a wide range of surgical techniques have been proposed to
straighten the deviated cartilaginous nasal dorsum and maximize nasal function,
recurrence is common because of cartilage memory and scar contractures. An
extended L-shaped spreader graft, a permanent support, was developed to correct
functional and aesthetic problems, to prevent recurrence, and to maintain the
correction of the septum stable and strong. This technique was utilized in 16 cases
of deviated cartilaginous dorsum. All patients were subjected to a detailed history,
physical examination, CT scan of the nose, and photographic documentation preoperatively.
The patients were followed up during a period of 3 months to 4 years.
According to physical examination, postoperative photography, and patients’ satisfaction,
the final results were categorized as excellent, good, or poor. The results
were as follows: 14 patients (87.5%) were classified as excellent, as their noses
were completely straight, and this was consistent with physical examination and
postoperative photographs. Two patients (12.5%) were classified as good because
there was a minimal residual deviation according to either photographs or clinical
examinations. This minimal deformity was not experienced by the patients. In conclusion,
consistent, reproducible results were achieved with using the autologous
extended L-shaped spreader graft for controlling and maintenance of the dorsal
and caudal septal deviation after correction. It is one piece of L-shaped graft of
autogenous cartilage fixed to the original septal L-strut. It is regarded as an anatomical
graft that provides sustained cephalocaudal support, preserves pliability of
the lobule, and maintains stability as an independent stabilizer for the native strut.
... To our knowledge, this is the first study in the literature to discuss and report the current practices and perceptions of otolaryngologists in Saudi Arabia in dealing with caudal septal dislocation. Caudal septal dislocation is challenging to repair, with many proposed techniques aiming to achieve the most desirable aesthetic and functional outcomes [8]. Failure to address caudal septal dislocation appropriately can result in many devastating functional and cosmetic consequences, resulting in possible need for revisional surgery. ...
... Metzenbaum was one of the first to describe a procedure for correction of the caudal septum [15]. The caudal septum is dislocated from the attachment of the anterior nasal spine by wedge resection of the excessive vertical cartilage along the maxillary crest and fixed with an absorbable suture to the periosteum on the opposite side of the nasal spine using a figure-of-eight suture [16]. This method has been modified by Pastorek and Becker, who introduced the "doorstop" technique [17]. ...
Purpose of Review
Septoplasty is one of the most commonly performed surgical procedures in otolaryngology. However, correction of the caudal septal deviation is the most difficult part of the septoplasty and a common cause of revision septoplasty. The aim of this paper is to review the various operative techniques described in the literature for caudal septal deviation, as well as surgical outcomes.
Recent Findings
Many techniques, such as swinging door method, cross-hatching incision, scoring incision, septal batten graft, horizontal mattress suture, cutting and suture, crossing suture, septal cartilage traction suture, and anterior septal reconstruction have been used in managing caudal septal deviation. Each technique was used alone or in combination and reported 82 to 96.5% postoperative symptom improvement.
Summary
There are a variety of operative techniques to correct caudal septal deviation. Both relatively simple suture techniques and more difficult techniques showed good surgical outcomes. Appropriate patient evaluation and selection of surgical techniques are important, and multiple surgical techniques may be considered simultaneously as necessary.
... The pressure of nasal packs may provide additional stimulation to these receptors [22]. Nasal packing causes complete nasal obstruction leading to oral breathing and may contribute to the development of sleep-disordered breathing which leads to a further decrease in oxygen saturation [24,25]. Other causes of venous admixture (e.g., pneumonia or right-to-left shunting) were ruled out based on an unremarkable medical history and physical examination, and radiology. ...
Background
Nasal obstruction is a significant medical problem. This study aimed to examine the effect of nasal obstruction and nasal packing on arterial blood gases and pulmonary function indices, and the impact of the elimination of nasal obstruction on preoperative values.
Results
The mean age of the study population was 26.6 ± 10.1 years, males represented 50.8%. Spirometric indices showed statistically significant improvement (preoperative forced expiratory volume in 1st second 66.9 ± 13.9 vs 79.6 ± 14.9 postoperative and preoperative forced vital capacity 65.5 ± 12.7 vs 80.4 ± 13.8 postoperative). Oxygen saturation was significantly lower during nasal packing (95.6 ± 1.6 preoperative vs 94.7 ± 2.8 with nasal pack), and significant improvement (97.2 ± 1.4) was observed after removal of the nasal pack. Nasal obstruction scores significantly improved.
Conclusion
The results of this study indicate that either simple nasal obstruction or nasal packing may cause hypoxemia and abnormalities in lung function tests. Hypoxemia was more evident with nasal packing.
... In the case of severe caudal septal deviation, a swing door or cutting and suture technique were employed. 6,7 Silicone nasal splints were placed in the nasal cavities and secured to the nasal septum using a transseptal silk suture. All patients were seen in clinic 5 to 7 days following surgery for nasal splint removal. ...
Objective/Hypothesis
The Nasal Obstruction Symptom Evaluation (NOSE) is a disease specific quality of life instrument developed and validated in adults. The objective of this study is to evaluate the validity of the NOSE scale for pediatric nasal obstruction. We also examined the effect of septoplasty with bilateral inferior turbinate reduction in this population.
Study Design
A validation study at a tertiary care children's hospital.
Methods
Thirty‐eight pediatric patients who underwent septoplasty and bilateral inferior turbinate reduction between 2014 and 2018 were included. Patients were administered the NOSE instrument on the day of their clinic evaluation, the day of surgery, and at their 6 to 8‐week post‐operative appointment. A sample of 40 pediatric patients with non‐rhinologic complaints was also included. Confirmatory factor analysis was performed to evaluate the factorial validity of the NOSE instrument.
Results
Of the 78 patients included, the mean age was 15.4 years (SD 3.4). In the confirmatory factor analysis, factor loadings were all significant and ranged from 0.95 to 0.99. Internal consistency reliability using Omega and maximal reliability H indices were well above recommended standards (Omega = 0.983 and maximal H = 0.988). Test–retest reliability was also adequate. Mean NOSE scores significantly improved following surgery (from 96.7 [SD 6.2] to 8.8 [SD 7.8]; mean difference = −87.9; 95% CI: −84.5, −91.3; P < .001). Similar improvements were observed across age groups.
Conclusions
The NOSE scale is a valid and reliable quality of life instrument for pediatric patients with nasal obstruction. Nasal septoplasty with bilateral turbinate reduction substantially improved symptoms of nasal obstruction.
Level of Evidence
4 Laryngoscope, 2021
... Out of all the records, 53.8% reported a post-operative photographic analysis of the nose. Of these, 21.4% [8,11,28] used photography as the only tool to quantify post-operative improvement, for both functional and esthetic outcomes. None used the SCHNOS. ...
Background:
Surgical correction of caudal septal deviation is a technically challenging step of functional rhinoplasty. Multiple surgical techniques have been described in the literature but comparing the efficacy of each in relieving obstruction presents a challenge. Outcome measures are necessary to adequately compare techniques. This study aims to describe the current caudal septoplasty techniques of Otolaryngologists and Facial plastic and reconstructive surgeons (FPRS), as well as their use of outcome measures, and to compare these practices with surgical trends described in the literature.
Methods:
An online survey was sent to three Otolaryngology and FPRS associations in Canada and the United States. A systematic review was conducted on SCOPUS and PubMed to classify the caudal septoplasty techniques described in the literature and the outcome measurement tools used.
Results:
Our survey identified that caudal septoplasty is more commonly performed by surgeons with an FPRS training background. The most common techniques were the swinging door technique (69.5%), extracorporeal septoplasy (46.7%), cartilage scoring (45.3%), and splinting with bone (25.4%). Despite using a vast array of surgical techniques, North American physicians rarely rely on standardized outcome assessment tools. Patient reported outcome measures (PROMs) are used almost twice as frequently in the literature as they are by surgeons in their clinical practice.
Conclusion:
We recommend that future studies of caudal septoplasty include an assessment of both form and function using a validated PROM such as the Standardized Cosmesis and Health Nasal Outcomes Survey.
... Modifications of this technique have been introduced to correct caudal septal deformities with suture fixation to the ANS. 13,14 These techniques are only effective in cases where the septum is straight but ''tilted'' to one side. The present research utilized two different techniques in this particular deformity: the sliding technique and the bar graft with the CEG technique. ...
Introduction:
The caudal extension graft is usually a cartilage graft that overlaps the caudal margin of the nasal septum. A combination of the caudal extension graft and the tongue-in-groove technique is used to stabilize the nasal base, set tip projection, and refine the alar-columellar relationship.
Objectives:
In this study we present some new modifications to the placement of caudal extension grafts in rhinoplasty.
Methods:
This study is a retrospective review of a prospectively collected database of 965 patients who underwent septorhinoplasty from June 2011 to July 2015. Of these, 457 patients required a caudal extension graft and were included in the study. Minimum follow-up was 13.2 months with a mean follow-up time of 17.4 months.
Results:
In most cases, comparison of photographs before and after surgery were satisfactory and showed improved contour. Minor deformity was detected in 41 patients and 11 patients needed revision surgery.
Conclusion:
With these modifications the surgeon can employ the caudal extension graft even in angulated caudal septal deviations. A variety of methods have been proposed for correction of caudal nasal deviation.
... The reported cases had misdiagnosed submucousal cleft palate or high arched palate. [1][2][3] Here, we present a patient with palatal perforation after septoplasty which had no submucousal cleft palate or high arched palate. ...
Nasal septoplasty is a common procedure performed in plastic surgery and otorhinolaryngology. Many complications after septoplasty have been reported. Palatal perforation is one of the rarest complications with only a few cases reported in the literature. The reported cases had misdiagnosed submucousal cleft palate or high arched palate, but a patient with palatal perforation after septoplasty is presented here which have had neither evidence of submucousal cleft palate nor high arched palate.
... The prevalent sites of persistent septal deviation in failed septoplasty were not frequently addressed [2,[7][8][9]. A few studies reported that the common sites of residual deviation are dorsal or caudal septum. ...
Objectives:
To investigate the common causes of persistent septal deviation in revision septoplasty and to report the surgical techniques and results to correct them.
Methods:
A total of 100 consecutive patients (86 males) who had revision septoplasty due to persistent septal deviation from 2008 and 2014 were included in the study. Their mean age was 35.6 years and the mean follow-up duration was 9.1 months. Presenting symptoms, sites of persistent septal deviation, techniques used to correct the deviation, and surgical.
Results.:
were reviewed.
Results:
The mean interval between primary and revision surgery was 6.2 years. Forty-eight patients received revision septoplasty and 52 received revision septoplasty combined with rhinoplasty. Nasal obstruction was the most presenting symptom in almost all patients. The most common site of persistent septal deviation was middle septum (58%) followed by caudal septum (31%). Correcting techniques included further chondrotomy and excision of deviated portion in 76% and caudal batten graft in 39%. Rhinoscopic and endoscopic exams showed straight septum in 97% and 92 patients had subjective symptom improvement postoperatively.
Conclusion:
Middle septum and caudal septum were common sites of persistent deviation. Proper chondrotomy with excision of deviated middle septum and correction of the caudal deviation with batten graft are key maneuvers to treat persistent deviation.
... These are postoperative pain, aspiration of packing material, postoperative infection, nasal discomfort, sleep disturbance, respiratory and circulatory system problems, discomfort and bleeding during removal and toxic shock syndrome. 3,4 To prevent from these complications nasal suturing techniques have been described as an alternative. 5 Still there is no consensus about the results of these techniques.This study is conducted to compare the operative and postoperative results of two nasal different packing materials and nasal suturing technique. ...
... When straightening septal deviation resulting from slight deformities, releasing the peripheral connections of the septal cartilage, and its mere repositioning may be adequate [2,4]. In more severe deformities, the deviation can be straightened by fixing straight cartilage or bone grafts to the septal cartilage with stitches [5][6][7][8][9][10][11][12]. ...
Background
This paper presents a method in which bone or cartilage grafts are fixed to the septal cartilage with cyanoacrylate-based tissue adhesive for the treatment of septal deviation. A prospective study was designed to show the effectiveness of the technique. Methods
Cyanoacrylate-based tissue adhesive was used to fix the cartilage or bone grafts onto the septal cartilage to straighten deviated septal cartilage in 77 patients. Regarding the patients’ preoperative and postoperative nasal respiration, the following were assessed: (1) Nasal Obstruction Symptom Evaluation (NOSE) scales, (2) patient satisfaction with postoperative nasal respiration using visual analog scoring, and (3) computerized tomographic images. ResultsThe patients were followed up for 29 months on average. Patients’ respiration-related problems resulting from septal deviation were relieved in all but four patients. Clinically and radiologically, the straightened septums preserved their new forms, and it was detected with computerized tomography that the bone grafts had acquired permanency. In addition, the NOSE scores improved significantly compared to their preoperative levels. Conclusions
In cases in which the use of bone or cartilage grafts is chosen to straighten the deviated septal cartilage, fixation of grafts with cyanoacrylate (CA) tissue adhesive is a quick, instantly effective, and reliable method. CA, which enables the subsurface of the graft to have complete contact with the septal cartilage, provides extra benefit by transferring all of the reformative forces of the grafts to the septal cartilage. Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
... 14 The deviated cartilage in this area may be addressed using scoring incisions, and fixing it to maxillary crest with suturing techniques. 15 In addition, swing door technique that separates caudal septum from maxillary crest, and sutures it on the other side of the crest can be used. 3 Caudal septal batten grafts may be used particularly when the caudal septum is completely malformed. ...
Objectives:
Septoplasty is the most frequently performed surgical procedure in patients with nasal obstruction. However, nasal obstruction may persist or recur after septoplasty in some patients. In this study, the authors aimed to determine the causes of nasal obstruction after septoplasty.
Methods:
Fifty consecutive patients who admitted to our clinic with the complaints of persistent or recurrent nasal obstruction after primary septoplasty and had revision surgery between 2011 and 2015 were included in this study. Demographic data and physical examination findings of the patients were recorded.
Results:
There were 33 men (66%) and 17 women (34%) with a mean age of 37.3 ± 10.5 (range, 21-57) years. Deviation of perpendicular plate of ethmoid bone (44%), inferior turbinate hypertrophy (36%), concha bullosa (26%), caudal septal deviation-nostril asymmetry (20%), and alar collapse (6%) were the pathologies that were unaddressed during primary surgery. The iatrogenic causes of nasal obstruction after septoplasty were collumellar retraction-nasal tip ptosis (46%), nasal synechiae (20%), nasal septal perforation (10%), and saddle-nose/flat nose deformity (10%).
Conclusions:
Iatrogenic deformities due to surgery and pathologies ignored during primary surgery may cause persistent/recurrent nasal obstruction after primary septoplasty. A detailed physical examination and objective tests showing the site of nasal obstruction, an extensive surgical plan that covers all diagnosed pathologies, and a careful postoperative care must be undertaken to prevent undesired postoperative results.
Objectives
This study aimed to evaluate quality-of-life and satisfaction outcomes in patients undergoing the MES using the Portuguese version of the Nasal Obstruction Symptom Evaluation (NOSE-p) and Rhinoplasty Outcome Evaluation (ROE), and also to evaluate the frequency of possible complications of this technique.
Methods
We conducted a single-center prospective study with patients who had the indication for MES, from May 2016 to September 2020 at the Facial Plastic Surgery Clinic of Otolaryngology Department of the Hospital de Clinicas de Porto Alegre. The primary outcome was the relative postoperative change in NOSE-p. Secondary outcome was the variation in ROE, a validated quality-of-life questionnaire for rhinoplasty patients.
Results
Of the 31 patients submitted to extracorporeal septorhinoplasty who were evaluated, twenty-seven patients were included. Preoperative and postoperative NOSE-p scale scores were 65.2 ± 29.9 and 23.5 ± 26.7, respectively (mean differences of 42.04; [95% CI 27.35–56.73]; p < 0.0001). Pre and postoperative ROE scores were 38.3 ± 24.3 vs. 67.29 ± 29.7, respectively (mean differences of −29.02; [95% CI −40.5 to −17.5]; p = 0.0001). Residual septal deviation was verified in 2 patients (7.4%).
Conclusion
Most of the patients submitted to modified extracorporeal septoplasty had a significant improvement in quality of life scores of nasal obstruction, with good aesthetical outcomes and low indices of postoperative complications.
Level of evidence
Level 3.
Background
The American Board of Plastic Surgery (ABPS) has collected data on cosmetic surgery from member surgeons since 2003. These data offer valuable information on national trends in clinical practice.Objectives
The present study was performed to analyze trends in rhinoplasty over the last decade.Methods
Tracer data were compared between two cohorts 2012–2016 (early cohort “EC”) and 2017–2021 (recent cohort “RC”). Data included patient demographics and surgical techniques. Results were considered in the context of current EBM-based guidance in the plastic surgery literature.ResultsData from 730 rhinoplasties (270 EC and 460 RC) were analyzed. The median age was 30 years, and the most common patient concern was the nasal dorsum (79%). In the RC group, fewer patients voiced concerns about tip projection (58% vs 43%, p = 0.0002) and more complained of functional airway problems (38% vs 49%, p = 0.004). An open approach was most common (83%). Septoplasty (47% vs 52%, p = 0.005), caudal septum repositioning (14% vs 23%, p = 0.002), and tip rotation maneuvers (32% vs 49%, p < 0.0001) became more popular. There was also an increase in the use of spreader grafts (35% vs 45%, p = 0.01) and columellar strut grafts (42% vs 50%, p = 0.04), while there has been a decrease in alar base resection (17% vs 10%, p = 0.007) and non-cartilaginous dorsum/radix augmentation (9% vs 4%, p = 0.02).ConclusionsABPS tracer data provide an excellent resource for the objective assessment of procedures in plastic surgery. The present study is the first to highlight evolving trends in rhinoplasty over the last 10 years.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Background
Caudal septal repair is hard to confront in otolaryngology and plastic surgeon, due to cartilage memory. It causes nasal obstruction or esthetical problems to the nasal base and columella. Although different modalities have been described for the treatment of this abnormality, these techniques not only improve the function but also preserve or improve the appearance of the nose.
Objective
The objective was to discuss the different surgical conservative procedures that can be used to treat alterations of the caudal septum and change the position of the cartilage in the midline and find which is the best.
Patients and Methods
A descriptive study was conducted on 40 patients who aged 20–40 years, had attended the Otolaryngology Outpatient Clinic in Al Karama Teaching Hospital, Baghdad, Iraq, between October 2016 and March 2020, and with a history of obstructed nose; conservative nasal septal surgery was done for them depending on the severity.
Results
Regarding the result of the type of surgery, the patients were satisfied with their esthetic and functional perfection; patients with preoperative nasal obstruction reported improved breathing. In scoring technique with (NOSE) score pre and postoparative results were 58.21 and 22.66, in reshaping technique were 60.66 and 17.21 as a pre and postoparative results and in batten graft the results were 62.34 and 20.26 as a pre and postoparative results alternatively. Reshaping and batten graft techniques are better results than the scoring technique.
Conclusion
The study outcomes that the approaches for improvement of caudal septal deviation are safe and effective. The approach of surgery will depend on the severity of the deviation.
Importance: Septorhinoplasties are performed for functional, aesthetic, or a combination of these indications. As a nonvital intervention, cost-effectiveness may be questioned. Objective: To determine the cost-effectiveness of septorhinoplasty. Design and Setting: The literature was reviewed for revision rates (RRs) and health utility values (HUVs) for both septorhinoplasty and revision septorhinoplasty. Age-specific mortality rates and life expectancies were used. Costs were gathered from international settings and analyzed in an adapted Markov model. Intervention: Septorhinoplasty versus no intervention. Main Outcomes and Measures: Cost-efficiency was calculated for different willingness-to-pay thresholds in a probabilistic sensitivity analysis. The effect of different parameters (costs, RRs, HUVs, age, gender) were reviewed and addressed in a sensitivity analysis for an incremental cost-effectiveness ratio (ICER) willingness-to-pay threshold of 1216 to 50,000/QALY threshold). The sensitivity analysis showed high robustness of the cost-effectiveness for various scenarios. Conclusions and Relevance: Septorhinoplasty is a highly cost-effective treatment.
Nasal airway obstruction is a very common phenomenon that can significantly decrease patients' quality of life. This review article summarizes in an evidence-based fashion the diagnosis and treatment of nasal airway obstruction. The nasal airway may be obstructed at the level of the nasal valve, septum, nasal turbinates, sinonasal mucosa, or nasopharynx. Nasal valve obstruction and septal deviations are usually treated surgically depending on the level of valve obstruction. Isolated turbinate hypertrophy is usually managed medically as part of the treatment of rhinitis, with surgery reserved for cases refractory to medical care. Sinonasal and nasopharyngeal conditions are treated according to the diagnosis.
Background:
In unilateral cleft nasal deformity, the skeletal, and cartilaginous framework of nose is deformed. The anterior nasal spine (ANS) is usually displaced to the non-cleft-side. In cleft orthognathic surgery, ANS relocation can help correct the deviated ANS and nasal septum and might lead to an improved esthetic and functional outcome.
Methods:
Patients with unilateral cleft lip who underwent two-jaw orthognathic surgery between July 2016 and July 2020 were reviewed retrospectively. During conventional two-jaw orthognathic surgery, the ANS was separated from the maxilla. The separated ANS with the attached septum was fixed on the maxillary midline by wiring. Computed tomography scan was used to measure the septal deviation angle and septal deviation from the midline.
Results:
The septal deviation from the maxillary midline decreased following surgery (preoperative versus postoperative: 4.6 ± 1.0 mm versus 3.2 ± 1.2 mm; P = 0.016). The coronal septal deviation angle was widened after ANS relocation, although the transverse septal deviation angle remained unchanged (coronal septal deviation angle, preoperative versus postoperative: 146.7 ± 12.6 versus 159.8 ± 7.6; P = 0.01; transverse septal deviation angle, preoperative versus postoperative: 156.5 ± 11.7 versus 162.8 ± 7.7; P = 0.128).
Conclusions:
This study suggests that simultaneous ANS relocation with orthognathic surgery is a viable option for cleft-related deformities, considering the resultant caudal septum straightening and stable structural support observed in the long-term.
Although a wide range of surgical techniques have been proposed to straighten the deviated cartilaginous nasal dorsum and maximize nasal function, recurrence is common because of cartilage memory and scar contractures. An extended L-shaped spreader graft, a permanent support, was developed to correct functional and aesthetic problems, to prevent recurrence, and to maintain the correction of the septum stable and strong. This technique was utilized in 16 cases of deviated cartilaginous dorsum. All patients were subjected to a detailed history, physical examination, CT scan of the nose, and photographic documentation preoperatively. The patients were followed up during a period of 3 months to 4 years. According to physical examination, postoperative photography, and patients' satisfaction, the final results were categorized as excellent, good, or poor. The results were as follows: 14 patients (87.5%) were classified as excellent, as their noses were completely straight, and this was consistent with physical examination and postoperative photographs. Two patients (12.5%) were classified as good because there was a minimal residual deviation according to either photographs or clinical examinations. This minimal deformity was not experienced by the patients. In conclusion, consistent, reproducible results were achieved with using the autologous extended L-shaped spreader graft for controlling and maintenance of the dorsal and caudal septal deviation after correction. It is one piece of L-shaped graft of autogenous cartilage fixed to the original septal L-strut. It is regarded as an anatomical graft that provides sustained cephalocaudal support, preserves pliability of the lobule, and maintains stability as an independent stabilizer for the native strut.
Objectives:
Correcting the caudal septum deviation is one of the most difficult parts of the septoplasty. The aim of the present study was to evaluate the efficiency and usefulness of traction suture method in caudal septum deviations.
Methods:
Medical records of 35 patients who underwent endonasal septoplasty using traction suture method for caudal septum deviation in August 2017-February 2019 period were studied retrospectively. Preoperative nasal obstruction symptom evaluation (NOSE) scores of the patients were compared with postoperative sixth month NOSE scores. Besides, preoperative nasal examination findings of the patients were compared with the ones in postoperative period.
Results:
Average age of the 35 patients (9 women and 26 men) in the study was 26.3 ± 10.1 years. Postoperative observations revealed that a straight septum was achieved in 31 patients (91.1%). Average pre- and postoperative NOSE scores were 85.1 ± 20.4 and 22.4 ± 4.2, respectively (P < 0.0001). Nasal obstruction was "much improved" in 19 patients (54.2%) and "improved" in 12 (37.1%), while 4 patients (8.6%) reported "no change." None of the patients developed postoperative complications.
Conclusions:
Traction suture method is a safe, efficient, and useful option to be used by surgeons for caudal septum deviation.
Importance
While extracorporeal septoplasty (ECS) and its modifications have been previously studied, to our knowledge, no systematic review of surgical outcomes and complications of this technique has been performed.
Objective
To evaluate the evidence of surgical outcomes and complications of ECS (including modified techniques) to treat severe L-strut septal deviation defined as deviation within 1.0 cm of the caudal or dorsal septum.
Data Sources
MEDLINE, Embase, CINAHL, CENTRAL, Scopus, and Web of Science databases and reference lists were searched from inception to April 2018 for clinical and observational studies. Search terms included extracorporeal, septoplasty, and septum.
Study Selection
Selection criteria were defined according to the population, intervention, comparison, and outcome framework. Relevant studies were selected by 2 independent reviewers based on abstracts and full texts.
Data Extraction and Synthesis
Data were extracted using standardized lists chosen by the authors according to Cochrane Collaboration guidelines. Data were collected and synthesized with ranges reported, as well as assessment of bias and heterogeneity when applicable. Analysis started in February 2019.
Main Outcomes and Measures
Outcomes assessed included functional nasal airway improvement by objective measurements and subjective measurements (Nasal Obstruction Symptom Evaluation [NOSE] and visual analog scale scores); complications including bleeding, infection, dorsal irregularities, and other functional or cosmetic deficits; and as revision surgery rates.
Results
Of 291 records initially obtained, 31 were considered relevant after review according to PRISMA guidelines. All studies except 1 randomized clinical trial (3.2%) were observational in nature, with 21 retrospective studies (67.7%) and 9 prospective studies (29.0%). Conventional ECS was performed in 16 studies (51.6%), and modified ECS was performed in 15 studies (48.4%). The sample size varied from 10 to 567, and the mean age varied from 22.5 to 46 years. Of 31 studies, 14 (45%) were of good methodology. Meta-analysis was performed on 5 studies reporting change in NOSE scores, with pooled effect of −60.0 (95% CI, −67.8 to −52.2) points, but heterogeneity was high, with I² = 96%. When comparing complications between modified and conventional ECS, the relative risk for infections was 0.95 (95% CI, 0.34-2.7); for bleeding, 0; for nasal dorsal irregularities, 0.29 (95% CI, 0.16-0.53); for other cosmetic complications, 4.3 (95% CI, 0.87-21.1); for other functional complications, 0.47 (95% CI, 0.20-1.1); and for revision operations, 1.4 (95% CI, 0.83-2.3).
Conclusions and Relevance
Of the 31 studies included in this systematic review, less than half were of good methodology, and a significant level of heterogeneity was found regarding type of outcome measure used and reporting of complications. To improve the level of evidence, better study methodology, standardization of surgical outcomes measures, and reporting of complications are needed.
Correction of caudal septal deviation is a challenging issue because of its significant role in tip support mechanisms. Some interventions especially aggressive resection of caudal septum to correct deviation, may compromise external nasal valve, tip ptosis and persistence of nasal obstruction. Many surgical techniques have been suggested to correct this type of nasal septal deviation. This study presents a technique to correct caudal septal deviation without weakening of tip support mechanisms. To evaluate the efficacy of insertion of a transcutaneous columellar strut during correction of caudal septal deviation. The study was performed in patients complaining from nasal obstruction with caudal septal deviation. After intranasal incision and elevation of mucoperichondrial flap, Caudal septum released from anterior nasal spine (ANS) and a band of cartilage removed from inferior and caudal part of septum and septum again fixed to ANS. Through a vertical transcutaneous incision, a cartilaginous strut is placed in columella, between medial crurae. Preoperative and postoperative NOSE score determined and photographs were taken. In 14 patients we performed this technique, the postoperative NOSE score showed significant improvement, (p = 0.001). Nasal breathing improved in all patients without any complication or tip ptosis or worsening of nasal appearance. This septoplasty technique along with placement of transcolumellar strut, is an easy, efficient and complication free method for simultaneously correction of caudal deviation of nasal septum, reinforcing external nasal valve and prevents tip ptosis.
Introduction: "As the septum goes, so goes the nose". A wellknown phrase by Maurice Cottle forms the pillar of septoplasty.
Since the inception of septal surgeries, numerous methods
of septoplasty have been described. But, if not performed
meticulously, may lead to deformity. For a successful surgery,
understanding the anatomy and addressing the anterior nasal
spine and maintaining the tip integrity is vital.
Aim: To study the outcomes of “ROUND ABOUT technique” to
correct deviated nasal septum which focuses on the importance
of anterior spine and hence maintain the tip integrity.
Materials and Methods: This was a prospective, singlecentre outcome study of 35 patients with symptomatic nasal
obstruction. Here, we describe a method of elevating the
mucoperichondrial and mucoperiosteal flaps bilaterally,
without transecting the quadrilateral cartilage of the septum.
The Sino Nasal Outcome Test-22 (SNOT-22) Questionnaire
was administered pre-operatively and after 3 months following
surgery. The post-operative follow-up period ranged from 3 to
6 months (mean= 4.5 months) to evaluate the functional and
aesthetic outcomes of the performed procedure.
Results: A total of 35 patients underwent surgery by this
technique who presented with deviated nasal septum and
variable degrees of nasal obstruction. To assess the statistical
outcome, Paired t-test was applied. Mean SNOT-22 scores
decreased significantly from 40.02 pre-operatively to 18.65
three months after surgery. The results sustained after 6
months (p-value
Objective
To study the effect of nasal packing on blood oxygen saturation.
Materials and methods
Study was conducted on 30 patients of deviated nasal septum, who underwent septoplasty under local anesthesia followed by anterior nasal packing. The pulse oximetry was carried out three times on each patient to record the blood oxygen saturation (SpO 2 ) by using digital pulse oximeter. The first reading of SpO 2 was taken before nasal packing, second after 24 hours of nasal packing and third 3 weeks after surgery. Statistical analysis was done by Chi-square test and paired t-test.
Results
A total of 33.3% patients were below 20 years of age, whereas 60% were between 20 and 30 years of age and 6.7% were above 30 years. Males were 80%. It was observed that preoperative mean SpO 2 was 98.3 ± 0.794%, after 24 hours of nasal packing was 97.17 ± 1.744% and 3 weeks after surgery was 98.87 ± 0.629%. On statistical analysis, the difference in SpO 2 was highly significant (p < 0.001).
Conclusion
The application of nasal packs can be risky in old patients, more so having cardiopulmonary disease. The use of packs with airflow is recommended in these patients who should ideally be monitored with pulse oximetry.
How to cite this article
Singh S, Singh J, Kakkar V, Yadav SPS, Bishnoi A, Kathuria B, Gulati A, Sharma C. To Evaluate the Effect of Nasal Packing on Blood Oxygen Saturation. Int J Otorhinolaryngol Clin 2015;7(2):41-44.
Importance
Estimates of the 30-day hospital revisit rate following septorhinoplasty and the risk factors associated with revisits are unknown in the current literature. Surgical 30-day readmission rates are important to establish, as they are increasingly used as a quality care metric and can incur future financial penalties from third-party payers and government agencies.
Objective
To determine the rate of 30-day hospital revisits following septorhinoplasty and the risk factors associated with revisits.
Design, Setting, and Participants
A retrospective cohort analysis was conducted of 175 842 patients undergoing septorhinoplasty between January 1, 2005, and December 31, 2009, using data from the Healthcare Cost and Utilization Project state inpatient database, state ambulatory surgery database, and state emergency department database from California, Florida, and New York. Information on revisits for these patients was collected from the 3 databases between January 1, 2005, and December 31, 2012. Data analysis was conducted from September 1, 2014, to May 1, 2015.
Main Outcomes and Measures
Hospital revisits within 30 days after an index septorhinoplasty and the primary diagnosis at the time of the revisit were the main outcome measures. The revisit rate was calculated within subgroups of patients based on different demographic and clinical characteristics. A multivariable model was then used to determine independent risk factors for the occurrence of a hospital revisit within 30 days of the septorhinoplasty procedure.
Results
In total, 11 456 of 175 842 patients (6.5%) who underwent septorhinoplasty procedures revisited the hospital within 30 days of the procedure. Most of these revisits (6353 [55.5%]) were to the emergency department. The most common primary diagnosis was bleeding or epistaxis, occurring in 2150 patients (1.2%). Multivariable logistic regression showed that patients aged 41 to 65 years (adjusted odds ratio [aOR], 1.09; 99% CI, 1.02-1.16) or older than 65 years (aOR, 1.23; 99% CI, 1.06-1.43) had an increased revisit rate, as did black patients (aOR, 1.39; 99% CI, 1.16-1.66); those with Medicare (aOR, 1.55; 99% CI, 1.32-1.81) and Medicaid (aOR, 1.63; 99% CI, 1.33-2.01); those with diagnoses of autoimmune disorders or immunodeficiency (aOR, 2.69; 99% CI, 1.20-6.03), coagulopathy (aOR, 2.06; 99% CI, 1.33-3.20), anxiety (aOR, 1.79; 99% CI, 1.55-2.07), and alcohol use (aOR, 1.70; 99% CI, 1.35-2.14); and those who had a conchal cartilage graft (aOR, 2.01; 99% CI, 1.29-3.14).
Conclusions and Relevance
The study results suggest that patients with more medical comorbidities and lower socioeconomic status most commonly returned to the emergency department for surgical complications, such as bleeding or epistaxis, in the 30-day period after the procedure. These data provide valuable preoperative counseling information for patients and physicians. In addition, this study provides data to third-party payers or government agencies in which postprocedure readmissions in the 30-day period are used as a quality care metric affecting reimbursements and financial penalties.
Level of Evidence
3.
Unlabelled:
Although not being the most frequent nasal septal deviations, those of the caudal septum account for many complaints. The correction of such defects has always been the subject of much controversy, and several different operative techniques have been described.
Aim:
To assess the efficacy of a surgical technique for correcting caudal septal deviations.
Materials and methods:
Prospective study with preliminary reports of 10 patients who answered a standardized, specific questionnaire (the Nasal Obstruction Symptom Evaluation, or NOSE), underwent acoustic rhinometry and had their noses photographed. Caudal deviations were then corrected through a surgical technique whereby the entire deviated portion is removed and a straight cartilage segment is placed between the medial crura of the alar cartilages, through a retrograde approach, to support the nasal tip. Sixty days after all patients were reassessed.
Results:
As for the NOSE questionnaire, mean pre-operative and post-operative scores were 82.39 and 7.39 respectively (p<0.001). Pre-operative acoustic rhinometry showed mean minimum cross-sectional area (MCA) values of 0.352 and 0.431 cm2, whereas mean post-operative values were 0.657 and 0.711 cm2(p<0.0001).
Conclusions:
The study results prove, both subjectively (patient satisfaction as measured with a standardized questionnaire) and objectively (acoustic rhinometry findings), that the proposed technique for correction of caudal septal deviation is safe and effective.
Back ground and objectives: Septoplasty is conservative approach to nasal septal surgery. In this operation much of the septal framework is retained. Only the most deviated parts are removed, rest of septal framework is corrected and repositioned by plastic means. For some extent in relation to many factors this surgery may become technically difficult to be performed sufficiently thus subsequently resulting in post-operative morbidities on top of local as well as systemic sequel and complications. This study was conducted prospectively to evaluate for these variable patterns of difficulties, in relation to patient's demography, patient's health status, septal contour, and surgical technique. In addition, we tried to study the effect of these suggested difficulties on the outcomes of this common surgical procedure in rhinology. Patients and methods: 663 patients aged 4-63 years of different types of DNS, namely c-shaped, s-shaped, anterior caudal dislocation, and nasal spur with and without external deformities of the nose, presented with variable pictures of clinical presentation of DNS at ENT department - Althowra central hospital and Altarahom private center- Elbyda city -Libya at period in between September 2005 to January 2014 who operated by septoplasty as closed technique. The variable patterns of procedure difficulties were studied and correlated to demographic, anatomical, pathological as well as surgical factors, namely 1) patients age, 2) sex, 3) type of clinical presentation, 4) cause of septal deviation, 5) type of DNS, 6) associated local pathology with deviation 7) recurrent or first attempt of surgery, 8) associated external deformity, and 9) surgical technique which was performed. Patients postoperatively were followed for 3-6 months and assessed for outcomes of the surgery in relation to these recorded difficulties. Results: 25% of patients who underwent the septoplasty procedure elucidated difficult procedure due to certain factors which could be related to patient's general status, or local pathological circumstance, or surgical technique itself. Those patients followed for 3-6 months and 60% of them shown varieties of local complications ranged from local atrophic changes, to synaechia, and septal perforation.
It is not my purpose to describe a new operation for the correction of deflections of the nasal septum, but to give my experience with the methods that I prefer and to mention the additions to their technique and instrumentarium suggested to me by their use. These methods will also be contrasted with the type of another class of operations that has become popular with many, to the exclusion of other procedures. I refer to the straightening of deflections in the way described by M. J. Asch.
While the means advocated in this paper inflict a minimum of traumatism on the nasal interior, the operation of Asch is accompanied by an amount of force and injury out of all proportion to the resistance of the frail partition that is to be straightened. Asch's procedure is intended to accomplish by force under narcosis, in a few minutes, without the aid of
Background Correction of the lower third of the nose is perhaps the most challenging component of performing a rhinoplasty. The tongue-in-groove (TIG) technique provides a method for correcting excess columellar show and maintaining correction of caudal deviation. It is also indicated for controlling nasal tip rotation and projection while preserving the integrity of the lobular cartilaginous complex and may be combined with either the external or endonasal rhinoplasty. It is typically used in combination with other septorhinoplasty maneuvers. The TIG technique consists of a method by which the medial crura are advanced cephaloposteriorly onto the caudal septum into a surgically created space between them. Objective To determine the effectiveness of the TIG technique to aid in correction of columellar show, a deviated caudal septum, and various tip rotation and projection problems. Setting Private practices of 2 authors (R.W.H.K., Houston, Tex, and H.M.T.F., Alexandria, Egypt). Patients The records of 287 patients who underwent TIG rhinoplasties in one private practice from 1989 through early 1999 (n = 203) and in another practice from 1994 through early 1999 (n = 84) were reviewed. Main Outcome Measures Physician judgment of outcome was based on reduction of columellar show, change in tip rotation or projection, narrowing of the columella, and straightening of a deviated caudal septum as indicated in preoperative and postoperative photographs taken of all but 4 of the 287 patients. Patient judgment of outcome was measured by patient requests for revision and patient comments made during follow-up visits. Results Of 287 patients, 278 (97%) had satisfactory to excellent results. Only 9 (3%) required revisions related to the TIG technique. Eight of these 9 did not achieve enough reduction of columellar show or adequate rotation or projection. A repeated TIG technique was used in these 8 patients with satisfactory revision results. One of the 9 was overprojected and required revision. Of the 108 patients who had preoperative caudal septal deviation, none needed further surgery. Conclusions The TIG technique provides a direct, effective solution to columellar show and is a reliable, reproducible method for achieving predictable tip rotation and projection. Furthermore, when used in conjunction with septoplasty techniques, it helps maintain the correction of a deviated caudal septum.
The “buckled” or severely deviated nasal septum has resisted a variety of techniques devised for its correction. This paper will present a new technique which the author has found useful in many of these cases. This method utilizes in reverse the procedure popularized by Mustardfi for managing the protruding ear. Instead of bending the cartilage into a harmonious shape, the bent cartilage is straightened with submucosal permanent sutures. The paper will illustrate this technique. © The American Laryngological, Rhinological and Otological Society, Inc.
Previous in vitro studies have demonstrated that transfection of an activated ras gene induces malignant transformation in epithelial cell lines infected with the human papillomavirus (HPV). The results of these studies support the hypothesis that HPV may cooperate with an activated ras gene in epithelial tumor carcinogenesis. To test this hypothesis in head and neck cancers, we screened 35 oral carcinomas for the presence of HPV DNA and for a mutated H-ras gene.
The design of the study was screening survey type. Twenty-seven oral squamous cell carcinomas and eight verrucous carcinomas were analyzed for the presence of HPV DNA using the polymerase chain reaction, followed by Southern blot and probe hybridization. The tumors were also screened for point mutations of the H-ras gene using the polymerase chain reaction and restriction fragment length polymorphism analysis.
Six (22%) of the 27 oral squamous cell carcinomas demonstrated point mutation in the H-ras gene. In addition, six tumors (22%) were positive for HPV DNA, with three tumors (11%) demonstrating both HPV DNA and H-ras gene point mutation. While the rate of simultaneous HPV infection and ras gene activation by point mutation was 11% in oral squamous cell carcinomas, 25% of oral verrucous carcinomas contained both HPV DNA and mutation in the H-ras gene.
These results suggest a stronger association between HPV infection and activation of the H-ras gene in oral verrucous carcinomas. These results continue to confirm the multihit hypothesis of tumorigenesis and suggest that in some cases of oral cancer at least two of these events are H-ras gene mutation and HPV infection.
To evaluate a new technique for correction of severe caudal septal defects.
For all patients, preoperative photographs were graded with regard to the severity of caudal septal defects. Preoperatively, nasal airway breathing surveys were conducted and nasal tip projection (NTP) measurements were recorded. The caudal septal defects were then repaired with use of the ethmoid bone sandwich grafting technique. Photographs, NTP measurements, and an airway survey were then repeated 6 and 12 months postoperatively. Preoperative and postoperative assessments were compared and analyzed. Lateral nasal roentgenograms were obtained in five of 10 patients to assess resorption of the bone grafts. Complications were noted if present.
Urban medical center.
Ten volunteers with severe caudal septal defects causing both cosmetic and functional problems. All patients had undergone at least one previous submucous resection.
Durability and degree of correction, maintenance of NTP, airway improvement, and morbidity.
After 1 year, all patients maintained satisfactory correction of their caudal septal defect based on postoperative photographic grading and physical examination findings. The NTP was maintained in eight of 10 patients. Two patients experienced loss of NTP after 1 year that was not present 6 months postoperatively. Average airway improvement was 126.7% after 1 year. Postoperative roentgenograms showed only minor (< 10%) bone graft resorption. The only complication was a granuloma.
The ethmoid bone sandwich grafting technique corrected severe caudal septal deviations while maintaining or strengthening structural support of the caudal septal strut without loss of NTP, airway compromise, or morbidity.
Caudal septal deflection can be a challenging nasal deformity. Although there are a number of maneuvers available to manage this functional and aesthetic abnormality, each approach is effective in only a limited number of cases. For over 25 years, the senior author (N.J.P.) has employed a "modified swinging door" technique for treatment of the deviated caudal septum. Using this technique, the septal cartilage along the maxillary crest is dissected free but is not excised. Instead, the caudal septum is flipped over the nasal spine, which acts as a "doorstop" and secures the caudal septum in a straighter position. This maneuver may be useful in the armamentarium of the surgeon managing this potentially difficult technical challenge.
- Metzenbaum M