Comparison of L‐strut preservation in endonasal and endoscopic septoplasty: a cadaveric study

Abstract

Preservation of an adequate cartilaginous L-strut to prevent complications of septoplasty has been long recognized as critical. However, no previous study has examined the dimensions of the L-strut that remain after septoplasty. We hypothesized that differences in exposure and visualization between endoscopic and endonasal techniques would result in differences in preserved L-strut dimensions. We designed this study to determine L-strut dimensions after performance of septoplasty with endonasal and endoscopic technique. We performed a cadaveric study with 24 heads randomly assigned to undergo endonasal vs endoscopic septoplasty by senior resident surgeons (postgraduate year 4 [PGY-4] and PGY-5). Removal of the skin-soft tissue envelope and mucoperichondrium was performed after septoplasty to permit direct measurement of the L-strut. Minimum and maximum widths were recorded for the caudal and dorsal segments; a single measurement was recorded for the width at the anterior septal angle. Statistical analysis was carried out using the 2-tailed distribution Student t test. There was no significant difference in caudal or anterior septal width between endonasal and endoscopic techniques. There was a statistically significant difference in dorsal segment width for both minimum and maximum values, with endoscopic technique resulting in a narrower dorsal segment than endonasal technique (mean minimum value of 10.8 mm vs 13.2 mm, respectively, p = 0.03; and mean maximum value of 12.6 mm vs 16 mm, respectively, p = 0.01). There was significant variation in resident surgeon performance, with the performance of 1 resident surgeon accounting for the difference in minimum dorsal width. Differences in exposure and visualization between endoscopic and endonasal septoplasty techniques may result in differences in preserved L-strut dimensions. Care should be taken with endoscopic technique to prevent overly aggressive resection of septal cartilage, particularly with learners of this technique.