Caudal Septum Research Articles

Causes and management of persistent septal deviation after septoplasty

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.

Biomechanics of Septal L-Strut on Lamb Head Models.

It is very crucial to know the biomechanics of the septal cartilage and adjacent structures during septoplasty. The aim of this study was to investigate the strength changes of different L-strut models after mucoperichondrium elevation, application of septal extension grafts and spreader grafts on an experimental lamb model. Ten lamb heads were dissected according to a dissection protocol and septal resistances were measured with the newton meter at six zones. Three different L-strut types were designed, and all the L-strut models were created at different widths of 15mm, 10mm, and 5mm. In addition, effects of two different types of septal extension grafts and spreader grafts were compared. After mucoperichondrium elevation and harvesting the septum cartilage, there was a significant decrease in the septum resistance (p <0.05). As the width of the L-strut decreased, the septum strength decreased significantly (p <0.05). There was no significant difference between three chondrotomy types at different widths (p >0.05). There was no significant difference between the overlapping SEG and end-to-end SEG in terms of septum resistance (p >0.05). This was the first study to measure septal resistance in lamb heads. The mucoperichondrium and L-strut width were important structures for maintaining septal resistance. Chondrotomy style was not crucial, but as the width of the L-strut increased, the septal resistance increased. The septal extension grafts regardless of suturing style and the spreader grafts added strength to the caudal septum.

Quantification of Bending Tolerance of the Cartilaginous Nasal Septum: Computer-Based Measurements

Objective: Nose deformity, including nasal deviation, is conspicuous since it locates in central face area. Regarding this and its prevention, nasal septum is one of the important supporting structures. Understand bending tolerance of the cartilaginous septum not only helps mitigate secondary deformity from surgical intervention, but also provides baseline information for further study regarding the nasal septum.Materials and Methods: Nineteen fresh cadavers were dissected to expose the cartilaginous nasal septum. It was connected with the set-up computer system for detection of electrical signal at 1-mm septal bending from the midline. Mechanical load (bending load) was applied over the dorsal septum to quantify its bending tolerance. The data of bending tolerance and Pearson’s correlation were reported.Results: The mean of septal thicknesses is 1.5 ± 0.4 with the average bending load of 19.0 ± 11.2 g. The majority of the septal thicknesses (15/19; 78.9%) of the dissections are within the range of 1.1 – 2.0 mm with bending load of 18.2 ± 8.9 g on average. There is a moderately positive association between septal thickness and bending load, the Pearson’s correlation coefficient is 0.602 (95%CI from 0.204 to 0.830) with p-value of 0.006.Conclusion: The overall nasal septum and the septum with thickness between 1.1 – 2 mm are able to tolerate loading over distal part of caudal septum about 19.0 and 18.2 g, respectively. Septal thickness shows moderately positive correlation with bending load.

Evolution of the Septal Extension Graft in Endonasal Rhinoplasty: Long-term Efficacy and Reliability.

Proper nasal tip projection and rotation have a strong impact on nasal aesthetics. Septal extension graft (SEG) is one of the tools employed to improve tip projection and rotation when performing rhinoplasty. This graft typically overlaps the existing caudal septum in the midline position, lengthening it and facilitating the repositioning of the tip. The authors sought to describe the technical evolution of the SEG in endonasal rhinoplasty and evaluate the reliability and long-term efficacy of the current technique. The authors evaluated presurgical and postsurgical photographs of the nasolabial angle and nasal proportions in 60 patients who underwent endonasal rhinoplasty with SEG. The study demonstrated a clear improvement in tip projection and rotation at the 1-year follow-up. The mean preoperative nasolabial angle was 93.75° ± 9.45° compared with 101.1° ± 5.3° following surgery. Although both were normally distributed, the range of the postoperative nasolabial angle was narrower than 1-year preoperatively (standard deviation = 5.3° vs 9.45°, respectively). The Crumley ratio, utilized to describe nasal proportions, presented significant changes in nasal proportions: 3.84 preoperatively and 4.04 postoperatively (95% confidence interval = -0.24 to -0.149; P < 0.001). The utilization of SEG in endonasal rhinoplasty has significantly changed since first described in 2006. The adaptations made to this technique render it more reliable, and our study demonstrates its efficacy in improving tip projection and rotation over the long-term.

Caudal Septoplasty: A Useful Cartilage Stump on Anterior Nasal Spine

Caudal septal deviation is an important cause of nasal obstruction and is a major cause of nasal septal surgery. Although reinforcing and straightening the deviated nasal septum with bone fragment or cartilage is known to be quite effective, such procedure is complicated and time-consuming as it consists of three steps; ‘separation,’ ‘correction,’ and ‘reposition and fixation.’ In this article, we introduce a new technique that can reliably position the caudal septum along the midline and simplify the surgical process into two steps: ‘separation’ and ‘correction and fixation.’

Management of the Deviated Caudal Septum

Management of the Deviated Caudal Septum

Role of Derotation Suture in Bulbous Tip Correction in Asian Rhinoplasty

In bulbous tip correction, consideration should be given to the presence of cephalic malposition of lower lateral cartilage as well as volume reduction. Derotation suture is a suture technique for tip lengthening but may contribute to bulbous tip correction through the caudal reposition of lower lateral cartilage.From 2016 to 2018, a total of 50 Asian patients underwent bulbous tip correction with derotation suture. The derotation suture was performed by suture the most convex part of lower lateral cartilage as a spanning suture to the caudal septum with caudal traction of the lateral crus. The chart and pre and postoperative photographs were analyzed to evaluate the effectiveness and complication of the surgery.In most (96%) patients, there was a significant improvement in tip bulbosity and supratip fullness. Complications included tip drooping (4%), nostril asymmetry (2%), and undercorrection (4%) and no pinching deformity occurred.In correction of bulbous tip of Asians with cephalic malposition of lower lateral cartilage, derotation suture is a useful method to create an ideal shaped nasal tip.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

A Useful Tool for Various Problems in Nasal Tip: The Cephalic Transdomal Suture.

Surgical manipulation of the nasal tip is a critical point in functional and aesthetic rhinoplasty procedure. Cephalic strip excision from the lower lateral cartilages, elongation or shortening the caudal septum, structural grafting for supporting the medial and lateral crura are major structural moves in building a durable cartilaginous framework. However, it is suture techniques that make up the final touch in fine tuning of the shape, projection, definition, and angulation (rotation) of the nasal tip over this framework.Problems with fine-tuning of the nasal tip include inadequate or excessive definition, or projection resulting with bulbous or boxy appearance can be overcome reversibly with correctly placed sutures. One of the most decisive sutures in this context is transdomal sutures. Incorrect placement of which can result with too narrow or too wide nostril apices, as well as a cephalic malposition deformity of the lower lateral cartilages, botching an otherwise perfectly executed rhinoplasty procedure.In this article, cephalad placement of the transdomal sutures, and its relevance is disclosed in 223 consecutive cases of primary rhinoplasty.

Open Rhinoplasty: A Personal Evolution of Technique.

Rhinoplasty remains one of the most commonly performed aesthetic surgical procedures, and the open approach has gained more popularity.1,2 Closed rhinoplasty can address dorsal hump deformities, with minimal tip modification.1 Meanwhile, the open approach provides undistorted exposure of the nasal anatomy, allowing for greater accuracy in the diagnosis and approach to nasal obstruction or deformity.1–3 Many trainees and young plastic surgeons become accustomed to the way they were taught rhinoplasty. As an otolaryngology resident, I was taught to commence a rhinoplasty with marginal incisions. Once through the vestibular skin, the lower lateral cartilages are revealed and the nasal dorsum and sidewalls are undermined blindly with a Littler scissor. This was imprecise, often leading to out-of-plane dissections and subsequent bleeding. One reform I have made in fellowship under the direction of my program director (P.B.) is to first make the transcolumellar incision. Once the skin–soft tissue envelope is elevated, the medial crura are dissected and followed superolaterally to then dissect the lateral crura. Staying on cartilage with this technique helps the surgeon to stay in the right plane and maintain hemostasis. Next in the sequence of performing a proper rhinoplasty, the anterior septal angle needs to be identified to allow for proper mucoperichondrial dissection and cartilage release.4 It is especially important to start a septoplasty and dorsal work. The anterior septal angle represents the anteriormost projecting point of the septum, contributing to nasal tip support, projection, length, and airway function. In secondary rhinoplasty, its identification is paramount because it is usually one of the landmarks that is preserved, serving as a guide when anatomical planes have been scarred or are even missing.4 In residency, we retracted the domes laterally with single skin hooks to identify the anterior septal angle. This commonly traumatized the nasal cartilages, rendering them prone to damage or avulsion. In addition, the tactile feedback was not optimized. In fellowship, I have learned to handle cartilage delicately with Adson-Brown forceps (Fig. 1). This change has allowed me to preserve the integrity of the cartilages while maintaining proper control and feedback. Adson-Brown forceps are precise because they allow one grasp at a time from a single point.5 Another modification I have made is the process by which I identity the anterior septal angle. In residency, I would turn my Iris scissors parallel between the medial crura to find the caudal septum low as it takes off from the anterior nasal spine. In fellowship, I have transitioned to beginning my dissection superiorly under the direction of the senior author (P.B.) (Fig. 2). The septum has more stability at this position, thus making it less prone to fracture. In addition, we find this location easier to begin the mucoperichondrial dissection.Fig. 1.: Lower lateral cartilages being handled delicately with Adson-Brown forceps while maintaining tactile feedback.Fig. 2.: Dissection of the anterior nasal spine superiorly, allowing for easier identification and mucoperichondrial dissection.Although these nuances may seem subtle, they can impact the final result. Throughout one’s training and subsequent career, surgeons should be encouraged to reform their surgical technique and the use of surgical instruments accordingly. PATIENT CONSENT The patient provided written consent for use of the patient’s images. DISCLOSURE The authors report no financial disclosures or conflicts of interest. Jason E. Cohn, D.O.Sunrise Facial PlasticsLindenhurst, N.Y. Katherine Chemakin, B.S.Albert Einstein College of MedicineBronx, N.Y. Paige Bundrick, M.D.Department of Otolaryngology–Head and Neck SurgeryDivision of Facial Plastic Reconstructive SurgeryOchsner Louisiana State University of HealthShreveport, La.

Technique to Fix the Stubborn Deviated Caudal Septum with an Internal Bone Graft Splint.

Background:Septoplasty, especially of the caudal portion, during cosmetic rhinoplasty is a crucial step in achieving satisfactory straight outcomes for the bony cartilaginous infrastructure and the skin envelope. Many methods are available, which range from septal mucosal resection to internal splinting by bone in a batten fashion; a power tool is usually used. This study describes a simple technique using a nonpower tool to correct the stubborn deviated caudal septum, with a thin available bone.Methods:Patients who underwent cosmetic open septorhinoplasty for crooked nose deformity and did not respond to the traditional septoplasty techniques were included. Bony splint was harvested from the bony septum and fixed to the caudal septum using an 18-gauge needle to create holes to fix the bony splint to the caudal septum through horizontal matrix sutures to correct septal deviation.Results:Six rhinoplasty patients who had significant caudal septal deviation and did not respond to the traditional techniques of septoplasty were included in this study. The patients were successfully treated by using an internal bony batten splint to correct the deviation. No postoperative complications were noted, and none of the patients required a revision surgery.Conclusions:Bony batten graft is not a new concept. It involves correcting the resistant caudal septum deviation by splinting it internally by using power tools and drills to create the holes to fix the bony splint graft. Using an 18-gauge needle to drill the hole is a simple, quick, and effective technique to correct and straighten the septum for resistant cases.

Study on Septal Correction: Review of Literature and Clinical Findings

Septal reconstruction has many needs and usages. Nowadays, people are very concerned about looking and would like to correct them. Septal reconstruction has been immensely used in the field of cosmetics. A successful septoplasty would lead us to know about the pathology of the septum by which we can avoid further complications. It would be further significant in nasal obstruction or difficulty in breathing. Deviation of the nasal septum can also be corrected by septal reconstruction by various techniques used for septoplasty. Complete septal reconstruction is the best method for extreme S-shaped and wave-like deviations or multiple fractures. The septoplasty is performed endonasal for caudal septal deviation. Traction sutures to rectify the caudal septum deviation is another type of surgery. Septoplasty usually opens the way for all other rhinoplasty procedures, as a straight, stable septum reflects the attractiveness and functionality of the nose. The patient's history and the surgeon's expertise play a favorable outcome. In conjunction with other nose procedures, such as cosmetic rhinoplasty and endoscopic sinus surgery, Septoplasty is frequently done to alleviate nasal airway obstruction or headaches induced by rhinology irritation produced by touch. Endoscopic septoplasty requires the same amount of time and delivers equal, if not better, results than previous procedures. Visualization is vastly improved by endoscopic technology. Isolated deviation, spurs, perforations, and contact sites are examples of distinct septal disorders that can be treated individually using this procedure. In this review article, the importance of traction sutures is mentioned. The article gives us an idea about Septoplasty and how it can be achieved, its complications, risk factors, and a few postoperative points.

Does Full Transfixion Incision Decrease Tip Projection in Endonasal Septoplasty with Spreader Grafts?

The classic teaching is that full transfixion incision decreases nasal tip projection by disrupting the attachment of the medial crura to the caudal septum. A significant decrease in tip projection after endonasal septoplasty with spreader grafts through a full transfixion incision has not been identified at our institution. A retrospective cohort study was performed at our institution. Inclusion criteria consisted of patients undergoing endonasal septoplasty with spreader graft placement and available preoperative and one-year postoperative photos. Patients who had undergone an open approach, cosmetic rhinoplasty, had intercartilaginous incisions, or other procedures to affect tip projection were excluded. A query identified 432 patients, of which 104 patients met inclusion criteria. Of these, 19 had pre and post-operative photographs and were included in the final analysis. Mirror software was utilized to analyze the pre and post-operative photos for tip projection using the Goode method. The change in tip projection was analyzed from both left and right profile photos. The left change in nasal tip projection (or delta) was -0.010 (95% CI -0.003, -0.017) and the right delta was -0.013 (95% CI -0.005, -0.020). In our pilot study of 19 patients, we did not find a clinically significant change in nasal tip projection when a full transfixion incision was used for the approach. In our experience, full transfixion incision is a safe and effective method for improving functional status in patients without causing a significant change in nasal tip projection.

Anterior Nasal Spine Relocation With Cleft Orthognathic Surgery.

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. 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. 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). 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.

The Caudal Septum Pivot Technique for Short Nose Correction.

The short nose represents one of the greatest challenges in rhinoplasty. It is characterized by a reduced distance from the nasal radix to the tip-defining points, often associated with inadequate tip projection. Several techniques have been described for correction of short nose with the common objective of replacing and rebuilding the osteocartilaginous framework. One of the most effective method to correct the short nose is the septal extension graft. The authors describe the caudal septum pivot (CSP) technique, a simple method to elongate short noses by using a graft inserted in the dorsal septum after its division using as pivot the caudal portion, without detaching it from its natural anchorage to the anterior nasal spine. A retrospective analysis was performed reviewing the clinical charts and the operative records of 315 patients who underwent revision rhinoplasty from January 2015 to June 2019; among this group, 34 were considered eligible for the study. The patients (8 men, 26 women; mean age: 25.4 years; age range: 22-53 years) were divided into two groups: in 12 patients (Group 1) the CSP technique was performed, while Group 2 was composed of 22 patients who received a more classic treatment with a septal extension graft. To evaluate the outcomes, nasal length, tip projection, and tip rotation were measured pre- and 1 year postoperatively on digital photographs of each patient. Nasal anthropometric measurements revealed, at 12-month visit follow-up, an improvement in nasal length, tip projection, and nasolabial angle was achieved in all the patients. The comparison of the pre- and postoperative values showed a statistically significant reduction in the nasolabial angle (p < 0.05) and an increase in the tip projection (p < 0.05) and in the nasal lengthening (p < 0.05) in both groups. In authors' experience, the CSP technique could be considered a safe, reliable, and effective alternative technique in selected patients.

Understanding the Use of Polycaprolactone in East Asian Structural Rhinoplasty: Questions and Answers

Surgery as an art in rhinoplasty involves grafting techniques wherein materials (usually autologous) are taken from the septum and supplemented by conchal cartilage. However, not all noses have adequate cartilage material. The quest for materials as possible replacement for human tissue have led to invention of synthetic (e.g. silicone, e-PTFE, porous polyethelene) and non-synthetic products (e.g. processed homograft and xenograft). In this era of advanced medical science, tissue engineering has started the use polycaprolactone (PCL) as a template and scaffold for tissue growth. Because of this characteristic feature, PCL as a mesh has a significant role in structural rhinoplasty.&#x0D; &#x0D; What is structural rhinoplasty?&#x0D; The surgical goal of rhinoplasty is to achieve functional improvement in breathing and aesthetic overall look, most notably the tip. The tip is determined by the final shape of the lower cartilage in its proper location - - but since the lower cartilage is a floating structure supported only by fibrous tissue and ligaments, there is a high incidence of tip drooping post op. So, the idea of structured rhinoplasty was conceptualized in 1997 by Dr. Byrd and popularized by Dr. Toriumi.1,2 A piece of central septum is harvested and fashioned as an extension of the caudal margin of the septum. This is called a septal extension graft (SEG) and the lower cartilage is sutured to the caudal margin of the SEG for better control of the tip. Since then, the technique has been the main workhorse support graft for the tip.3 (Figure 1)&#x0D; &#x0D; Why is structural rhinoplasty needed in East Asian noses?&#x0D; East Asian noses, particularly Southeast Asian noses are usually short and small, with low dorsum and upturned bulbous nose. Tremendous strength in the design of the structural support with its foundation base at the caudal septum should be achieved in order to elongate the nose, counter rotate and project the tip. (Figure 2) This is made possible by using the central harvested cartilage as a SEG attached to the residual strong dorsal and caudal strut.4 (Figure 3)

Caudal Step Maneuver: A Reliable Control of the Tip Projection and Rotation.

Caudal Step Maneuver: A Reliable Control of the Tip Projection and Rotation.

Revisiting the unrepaired unilateral cleft lip and nasal deformity using 3D surface image analysis: A data-driven model and its implications

Current descriptions of the unilateral cleft lip and nasal deformity (uCLND) are based upon limited sample sets and subjective observations. While those descriptions are inconsistent and contradictory, theoretical models, including Hogan's "tilted tripod" and Fisher's "nasal arch forms", have never been tested. Given that favorable outcomes of treatment remain elusive, detailed study of the deformity is critical in devising better treatments. The purpose of this study was to develop a data-driven three-dimensional (3D) model of uCLND that spans the spectrum of presentation and involves a pervasive underlying mechanism. We studied 3D images of 100 infants with unrepaired cleft lip at 6 months of age. Objective assessment included the landmark positions, anthropometric dimensions, and shape-based measures. Cleft severity was stratified by the lateral displacement of subnasale, so that a model could be developed using linear regression. With progressive deviation of subnasale, the non-cleft alar base moved lateral, the cleft alar base was left posterior, and the nasal dorsum followed the caudal septum (deviating towards the non-cleft side). The "twist" resulted in opposing cleft alar dome collapse, non-cleft alar ring constriction (the non-cleft nasal sill narrowed, lateral genu rose, and alar-cheek junction became more acute), and displacement of the philtrum from midline. Our study not only supports theoretical models of uCLND but also clarifies vectors of change and reveals significant non-cleft side alterations. On the basis of our findings, the objectives of treatment should involve centralization of the columella and philtrum and rebalancing the nose by untwisting the orthogonal displacement of the alar bases.

Application of septal extension graft with autogenous septal cartilage and auricular cartilage in rhinoplasty

Objective: To explore the feasibility of reconstruction of nasal tip with septal cartilage and auricular cartilage. Methods: From September 2018 to October 2019, 17 patients (two males and fifteen females) with low noses underwent rhinoplasty under general anesthesia. The age of the patients ranged from 19 to 39, with an average of 27 years old. Among them, all the 17 cases were primary rhinoplasty. During the operation, autologous nasal septum cartilage was used as septal extension graft to extend the caudal septum, and the auricular cartilage was used to enhance the stability of the strut and to elevate the tip for adjusting the shape of nose by making into spreader graft, columellar strut graft, derotation graft and onlay graft. The nasal dorsum was filled with polytetrafluoroethylene. Digital scanning technology was used to evaluate the nasal structure before and after operation. SPSS 22 software was used to analyze the data with paired t-test. Results: The follow-up was from 6 to 12 months, with an avaerge of 7.6 months. Seventeen patients were satisfied with postoperative nasal morphology and height. There was no infection, prosthesis displacement, skin flap necrosis, no auricle deformation and other complications. Statistical software SPSS 22 performed paired t-test on the preoperative and postoperative data obtained by digital technology: postoperative nasal length and nasal tip protrusion increased compared with that before surgery, and it was statistically significant(length:(3.60±0.77)mm, tip protrusion:(3.61±0.64)mm, t value was -19.203 and -23.132 respectively, both P<0.001). The nasolabial Angle was smaller than that before surgery, and the data were statistically significant(3.40°±2.11°,t=6.635, P<0.001). Conclusion: The nasal tip and nasal septum extension complex constructed by autogenous nasal septal cartilage combined with auricular cartilage can increase the length of nasal tip, increase the height of nasal tip and reduce the angle of nasolabial angle.

Hybrid reconstruction of distal nasal defects.

We present hybrid reconstruction of distal lateral "through-and-through" nasal defects (skin, cartilage, and mucosa) due to resection of tumor and/or infection. Retrospective descriptive study. The study was performed in multicenter clinics between July 2011 and September 2016. 13 patients with full thickness distal nasal defects secondary to tumor and/or infection were included. Defects included dorsal and/or caudal septum, upper lateral cartilage, or inner/outer nasal valve. Caudal-based turn-in flaps were planned and used to repair inner lining of nasal cavity. Conchal and septal cartilages were used as cartilage grafts. Skin defects were reconstructed with lateral nasal artery perforator flaps. All flaps healed uneventfully, without flap loss. Nasal passage collapse, adhesion, or difficulty in breathing were not seen. No hematoma, infection, and deformity at cartilage graft donor areas was observed. During nasal reconstruction, it is mandatory to consider 3D complex and functional structure of nose. The repair of skin defects may not be enough for functional restoration. We believe that single step reconstruction of full thickness nasal defects through hybrid reconstruction may lead to anticipated successful results.

Effectiveness of modified cutting and suture technique for endonasal caudal septoplasty in correcting nasal obstruction and preventing nasal tip projection loss

PurposeCaudal septoplasty is a difficult procedure. The cutting and suture technique is suitable for caudal septoplasty, but a batten graft is always necessary and bears the risk of nasal tip projection loss. We established a modified cutting and suture technique (MCAST), without using a batten graft, and investigated its effectiveness in correcting nasal obstruction and preventing nasal tip projection loss.MethodsWe retrospectively reviewed the medical records of 22 patients who underwent caudal septoplasty using MCAST. Subjective assessment by Nasal Obstruction Symptom Evaluation (NOSE) score and objective assessment by computed tomography (CT) were performed before and after the surgery. For evaluating nasal tip projection, we asked patients about their awareness of external nasal deformity. Additionally, the nasal tip projection was measured by CT and compared before and after surgery.ResultsThe median preoperative NOSE score reduced significantly after MCAST (P < 0.001). On CT, the ratio of the area of the convex side to that of the concave side in the anterior portion of the nasal cavity increased significantly after MCAST (P < 0.001). All patients were unaware of external nasal deformity. There were no significant differences in the mean preoperative and postoperative nasal tip height and nasolabial angle. The mean supra tip height was significantly greater postoperatively than preoperatively (P = 0.02).ConclusionsThe MCAST was useful for correcting nasal obstruction with caudal septal deviation. There was no postoperative loss of nasal tip projection. The MCAST can be suitable for correcting C-shaped caudal deviations without dislocating the caudal septum from the anterior nasal septum.