Extracorporeal Septoplasty Research Articles

Outcomes of Extracorporeal Septoplasty and Its Modifications in Treatment of Severe L-Strut Septal Deviation: A Systematic Review and Meta-analysis.

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. 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. 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. 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 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. 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. 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). 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.

Three Dimensional Rhinoplasty and Nasal Airway Improvement in Cleft-Nose Deformity.

Septorhinoplasty is particularly challenging among revision surgeries for cleft sequelae. The challenge of cleft septorhinoplasty is mainly due to the complex anatomy of nose, deformity of each of its components and the difficulty and lack of clarity in surgical management. From 2014 to 2017, 26 patients with cleft lip nose deformity were operated by the same cleft team. The study was conducted to assess the improvement in nasal airway and appearance following secondary rhinoplasty with extracorporeal septoplasty. Post operatively each patient was evaluated using the standard modified rhinoplasty outcome evaluation questionnaire, a validated instrument that aids in stratifying patients according to their subjective response. All patients reported great relief of nasal obstruction and improved breathing. More than 80% of our patients were satisfied with improved aesthetics and reported better self-confidence. Secondary cleft rhinoplasty with extracorporeal septoplasty surgery significantly improves the cosmesis and nasal airway opening, subsequently giving them improved self-confidence.

Severe deviated nose treatment: importance of preserving the dorsal septal remnant.

To compare the surgical outcomes of modified extracorporeal septoplasty and anterior septal reconstruction for the management of the severe deviated nose. In a prospective cohort study, we selected 86 patients referred for septorhinoplasty to a tertiary center in May 2015-April 2017 with a primary complaint of nasal obstruction and deformity. They had moderate-to-severe septal deviation and severely deviated noses, particularly in the dorsum. Forty-three patients underwent each procedure. The cohorts were age- and sex-matched, and were operated at a similar time point. Surgical outcome was assessed and compared using anthropometric measurement of photographs, acoustic rhinometry, and The Nasal Obstruction Septoplasty Effectiveness questionnaire (including a visual analog scale). In all patients, MCA1 (initial minimum cross-sectional area) and MCA2 (minimum cross-sectional area after topical decongestion of the nasal mucosa), anthropometric angles (nasolabial, nasofacial and tip projection), and The Nasal Obstruction Septoplasty Effectiveness questionnaire significantly improved after surgery in both groups (p = 0001), with no significant difference in improvement between two groups. However, anthropometric angles and minimal cross-sectional area were better in anterior septal reconstruction group. Both methods are effective in patients with a severely deviated nose for correction of deviation and obstruction. Anterior septal reconstruction is the preferable method in patients with more deviation.

Review and update on extracorporeal septoplasty.

To examine the recent literature on extracorporeal septoplasty. The literature suggests that extracorporeal septoplasty is an effective approach for both functional and cosmetic treatment of moderate to severe deformities of the caudal and dorsal septum. The procedure can be performed via an endonasal or external approach based on the nature of the deformity and the experience of the surgeon, although recent literature highlights various advantages of an external approach. The use of polydioxanone foil as a scaffold for septal reconstruction is widely accepted, and can enhance the technical performance of this technique. Although reported complication rates are low, tip deprojection and rotation have been observed in cases where extracorporeal septoplasty is performed without simultaneous rhinoplasty. Extracorporeal septoplasty is a useful technique in the armamentarium of surgeons addressing deviations of the dorsal and caudal septum.

Tongue-in-Groove Technique for Rhinoplasty: Technical Refinements and Considerations.

A key concept in successful rhinoplasty surgery is maintaining or increasing tip support, and addressing tip projection and rotation. The tongue-in-groove (TIG) technique is a method to achieve this goal using sutures to create a strong connection between the septum and medial crura to change tip rotation and projection. Criticisms of this method include that it may cause stiffness of the nasal tip and columellar retraction. TIG is routinely used by the authors during anterior septal reconstructions (a modified extracorporeal septoplasty technique), as well as in primary and revision aesthetic and functional rhinoplasties. Through this review, technical aspects of the TIG technique are discussed, as well as how pitfalls of the technique can be avoided, as illustrated by several rhinoplasty patient examples.

Extracorporeal septoplasty with internal nasal valve stabilisation.

SUMMARYAmong various septoplasty techniques, the extracorporeal one is used for severe deformities of the caudal septum and consists essentially in removal of the nasal septum followed by correction of deformities. Reconstruction of the neo-septum is carried out by repositioning the septal fragments in a straight position. The disadvantages of this surgical technique are the septal haematoma, oedema of the mucosa in the valve area and some types of abnormalities of the middle third of the nose such as saddling of the dorsum. All of these conditions can be associated with various degrees of functional disorders. To prevent these possible complications, we developed a suture technique to fix the caudal portion of the neo-septum and avoid alterations or narrowing of the internal nasal valve. The purpose of this study is to describe extracorporeal septoplasty results with this suture technique in stabilising the internal nasal valve. From January 2011 to December 2013, a retrospective review of adult patients treated with extracorporeal septoplasty was performed at the ENT department of Imola Hospital. Pre- and post-operative evaluations were carried out by rhinomanometry and acoustic rhinometry. Statistical analysis was performed with commercially available software (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). 133 cases fulfilled inclusion criteria and were enrolled. A significant improvement was evident after surgery based on the results of rhinomanometry and acoustic rhinology. Extracorporeal septoplasty with stabilisation of the internal nasal valve is an effective and reproducible surgical technique that yields optimal functional results.

Functional Results of a Modified Extracorporeal Septoplasty With Open Access.

Nasal septal deviation is one of the major causes of nasal respiratory flow disorders. During the rhinoseptoplasty, the septum can be treated through a closed traditional access or through an open access. To date, there are still no objective functional indications of the best access to use in rhinoseptoplasty. For this reason, we evaluated, objectively and subjectively, the functional efficiency of open access and compared it with that of closed access. The aim is to highlight any functional outcome differences between the 2 types of access. The study involved up to 50 patients, from January 2006 to June 2017; 20 patients underwent modified extracorporeal rhinoseptoplasty with open access, and 30 patients underwent modified extracorporeal rhinoseptoplasty with closed access. We evaluated the nasal obstruction by using the validated questionnaire Nasal Obstruction Symptoms Evaluation (subjective method) and by performing the anterior active rhinomanometry (objective method). Both evaluations were performed in 3 different times: preoperative period, 3 months, and 6 months after surgery. In the open cohort, the rhinomanometric analysis showed a statistically significant increase between preoperative period and sixth month after surgery; however, the nose score had a statistically significant increase in both 3 and 6 months after surgery. At 3 months after surgery, the rhinomanometric score was higher in patients with closed access than patients with open access; this difference has disappeared at 6 months after surgery. At 3 and 6 months after surgery, the improvement in the Nasal Obstruction Symptoms Evaluation average score was greater in patients with open access compared with patients with closed access. No complications were observed. Based on the results obtained from our work, we can declare that open access is a functionally valid procedure. At 6 months after surgery, the 2 accesses have a comparable functional efficacy.

Endonasal endoscopic assisted extracorporeal septoplasty in aesthetic reconstruction of crooked nose

Endonasal endoscopic assisted extracorporeal septoplasty in aesthetic reconstruction of crooked nose

The Role of Extracorporeal Septoplasty in Severely Deviated Nasal Septum.

Extracorporeal septoplasty is a valuable tool in the armamentarium of the nasal surgeon for the reconstruction of the severely deviated septum. Extracorporeal septoplasty offers the surgeon the opportunity to correct the septum under direct visualization, shape the nasal vault and address the nasal dorsum with the ultimate goal of providing both form and function for the patient with a complex septal deviation. The study was conducted with the aim to measure the outcomes of extracorporeal septoplasty in severely deviated nasal septum, relief of symptoms (nasal obstruction), surgical complications, if any, revision, if any with objective to evaluate the functional outcome and aesthetic aspects of extracorporeal septoplasty. This was a prospective observational study of 35 patients with severe deviated nasal septum with or without external deformity of nose attending the ENT OPD between Jan 2015 and Jan 2016 at Sri Aurobindo Medical College and Post Graduate Institute, Indore (M.P.). In this study, 17 patients (48.57%) shows excellent improvement on VAS scale, out of which 13 patients shows excellent improvement and 4 patients shows good improvement on photographic assessment. 11 patients (31.43%) show good improvement on VAS as well as photographic assessment and 7 patients (20%) show moderate improvement on VAS scale and fair improvement on photographic assessment. Extracorporeal septal reconstruction is an important surgical option for the correction of the markedly deviated nasal septum. Fixation of the straightened and replanted septum at the nasal spine and dorsal septum border with the upper lateral cartilages is essential. Spreader grafts for stabilization of the internal nasal valve and dorsal onlay grafts to prevent dorsal irregularity are strongly encouraged.

Technical Refinements and Outcomes of the Modified Anterior Septal Transplant.

Severe anterior septal deviation and resultant nasal obstruction represent a difficult surgical task to correct. The goal of surgery is to straighten the anterior dorsal and caudal struts, while maintaining nasal tip and midvault support. This study presents a novel extracorporeal septoplasty technique to straighten the crooked anterior septum. To describe the novel anterior septal transplant technique, which consists of complete resection of the caudal septum and reconstruction with extended spreader grafts and a columellar strut, without a separate caudal septal replacement graft. This study was a retrospective case series at a tertiary academic referral center. Participants were sequential adult patients undergoing anterior septal transplant from January 1, 2008, to December 31, 2015. Patient-reported nasal obstruction using Nasal Obstruction Symptom Evaluation (NOSE) scores and objective photographic analysis. Nasal tip deviation, projection, and rotation were measured. Preoperative and postoperative outcomes were compared. Complications are reported. Seventy-one patients (mean age, 46 years [age range, 16-72 years]; 48 [67.6%] female and 23 [32.4%] male) were included in the case series. Postoperative NOSE scores (mean [SD], 24.00 [24.58]) were significantly better than preoperative NOSE scores (mean [SD], 72.25 [14.55]) (P < .001). A separate cohort of 32 patients (mean age, 42 years [age range, 13-72 years]; 23 [71.9%] female and 9 [28.1%] male) had photographs available for analysis. In the frontal view, nasal deviation improved from a mean (SD) of 2.9 (2.0) degrees before surgery to a mean (SD) of 1.4 (1.7) degrees after surgery (P = .004). In the base view, the deviation was corrected from a mean (SD) of 4.9 (2.8) degrees to a mean (SD) of 1.7 (1.2) degrees (P < .001). Tip rotation and projection were unchanged after surgery. Four patients had mild dorsal irregularities after surgery. Anterior septal transplant by the described technique is a safe and effective treatment option for severe anterior septal deviation. 4.

Septoplastia extracorpórea para la correción nasal en casos complejos. Resultados en 16 pacientes

ObjectiveSeptal deviation is one of the main causes of respiratory nasal insufficiency and external asymmetry. Septorhinoplasty, either open or closed, is sometimes unable to achieve good results, mostly due to a severe deviation of the anterior part of the septum. The results of extracorporeal septoplasty in the management of difficult cases of septonasal deviations are presented. Material and methodsAn analysis was performed on 16 consecutive extracorporeal septoplasties. The technique consisted of a complete dissection of bony and cartilaginous septum, followed by complete septal resection and reconstruction «on the table» of a new anterior «L strut». This strut was then sutured to the K area, superior nasal cartilages, and anterior nasal spine. Other rhinoplasty steps were done as necessary. A review is presented of the clinical charts and pre- and post-surgical photographs. ResultsMain indications for surgery have been a severely crooked nose (9 cases), followed by nasal sequelae of cleft lip and palate (2 cases). Three patients had a previous septorhinoplasty performed (one of them plus orthognathic surgery). Comminute cartilage fracture was the most common intra-operative finding.All patients have reported a significant relief of their nasal obstruction, and a clear improvement of their aesthetics. The photographs showed a significant improvement in nasal symmetry and enhancement of dorsal, tip, and columellar projection when indicated. ConclusionsExtracorporeal septoplasty is very useful in difficult cases of septorhinoplasty and has few complications. Technical details are described.

Correcting Deviations of the Lower Third of the Nose.

By convention, a "deviated nose" is one in which the lower third is asymmetric with regard to the midline. The lower third of the nose is composed of the lower cartilages, as well as the dorsal and caudal nasal septum. Not only does the deviated nose cause a cosmetic deformity that is often disconcerting for patients, but it may also be associated with functional problems. Airway obstruction may result from a narrowed internal nasal valve in the middle third or from a deviated caudal septum in the lower third. The most common deviation involves both the middle and lower thirds and often requires addressing the underlying dorsal and caudal septum. The most effective technique to correct this type of deviation is the principle of extracorporeal septoplasty, either the traditional or modified, such as the anterior septal reconstruction (ASR) technique combined with the clocking suture. An isolated middle third deviation may be treated with a camouflage graft or a unilateral spreader graft. An isolated lower third deviation involving the septum should be treated with ASR. When an isolated lower third deviation only involves the lower cartilages, it may be corrected using suture techniques, cartilage division techniques, or grafting.

Extracorporeal septoplasty: Role in correction of unilateral cleft nose

Purpose: To evaluate the functional , aesthetic outcomes, and complications associated with extracorporeal septoplasty (ECS) while correcting moderate to severely deviated nasal septum in unilateral cleft lip and palate (CLP) patients. Materials and Method: Fifteen healthy adolescent and adult unilateral cleft lip and palate patients reporting for cleft rhinoplasty procedure to our department and consenting for the research protocol were taken up for study. Result: Mean duration of ECS was 40 minutes. Adequate cartilage graft from excess septum was available for aesthetic and functional requirements in 100% cases. Post-operatively, overall pain scale scores ranged from moderate to no pain. Nasal Obstruction Symptom Evaluation (NOSE) scale scores were significantly low post-operatively in comparison to baseline values (pre – 46.67; 1st Post-operative month – 21.33, 3rdPost-operative month – 16, 6th Post-operative month - 15). The only Intra-operative complicationsnoted were mucosal tear (40%), haemorrhage (6.7%)with absolutely no early or delayed post-operative complications. According to modified-Asher – Mcdade index, nasal form, nasal profile and deviation of nose hadfair to good appearance throughout the case series. Conclusion: ECS is safe and versatile procedure to amply address the septal deformity in all dimensions and offers adequate septal cartilage from the excess septum in cleft nose that can be used as sole graft for all reconstructive requirements in rhinoplasty with improved aesthetics and no additional intra-operative time, cost and complications

Outcomes of Open-Approach Extracorporeal Septoplasty Without Simultaneous Rhinoplasty: Effects on Nasal Tip Projection and Rotation.

Performing an open-approach extracorporeal septoplasty (OAES) without simultaneous rhinoplasty could have adverse effects. We sought to understand the effects of OAES without simultaneous rhinoplasty on nasal tip projection and rotation in patients with severe septal deviation. To evaluate the outcomes of OAES without simultaneous rhinoplasty in terms of nasal tip projection and rotation using objective measurements. This retrospective study was conducted at a training and research hospital using medical records of 32 adult patients who underwent OAES without simultaneous rhinoplasty between April 10, 2012 and June 12, 2015. Patients who underwent endonasal septoplasty, revision septal surgery, septorhinoplasty, open-approach septoplasty with nasal tip plasty, or open-approach septoplasty without removal of the entire septal cartilage were excluded from the study. Postoperative photographs of the patients were taken at a mean (range) time of 16.4 (6-36) months after surgery. Nasolabial angle (NLA), nasofacial angle (NFA), and projection index (PI) were measured by the same surgeon on preoperative and postoperative lateral images. Projection index was measured using the Goode method; NLA and NFA were measured drawing lines between specific facial points according to the literature. All measurements were compared statistically. Thirty-two adult patients (26 men and 6 women between ages 20 and 57 years) with severe septal deviation and underwent OAES without simultaneous rhinoplasty were included in the study. The postoperative values of NLA and NFA were observed to be decreased in all patients (100%). The PI was also determined to be decreased in 27 patients (84.6%) whereas it remained unchanged in 5 patients (15.4%). The overall postoperative mean values of NLA, NFA, and PI were found to be lower compared with preoperative mean values and the difference between them were determined to be statistically significant (NLA: 95% CI, 0.40-2.55, P = .005; NFA: 95% CI, 0.48-2.06, P = .003; and PI: 95% CI, 0.004-0.015, P = .002). This study reveals that the nasal tip lost height from facial plane and rotated caudally in most patients who underwent OAES without simultaneous rhinoplasty. Patients demanding only relief of nasal obstruction and scheduled for OAES have to be informed about the potential cosmetic alterations when a simultaneous rhinoplasty is not requested.

Nasal Valve Stabilization in Extracorporeal Septoplasty

Background: Among the different operations for septoplasty, the extracorporeal septoplasty technique basically consists in the removal of all the nasal septum, the correction of bone and cartilage deformities, and their replacement with a particular suture technique to correct the markedly deviated nasal septum especially in the internal nasal valve area. The drawbacks of this surgery technique are as follows: swelling of the mucosa in the valve area and restenosis, the development of saddle nose and septal hematoma. The aim of this study is to describe our results with a modified suture technique of the extracorporeal septoplasty (ECS), taking into account the operative time and functional results.

A New Perspective for Spreader Graft Use in Severely Deviated Septum: Is Septal Continuity an Obligation for a Stable and Straight Nasal Septum?

Severe septal deviation is a challenging deformity usually treated using aggressive surgical methods, and extracorporeal septoplasty (ECS) is a commonly used method for this issue. However, this method has severe risks and complications such as the recurrent deformity or nasal saddling. In this article, we present an alternative solution to ECS procedure for the correction of severe septal deviation. Sixteen patients with severe c- or s-shaped septal deviation with a mean age of 26.5 years were included in the study. The entire deviated part of the septal cartilage was resected as a vertical block creating a full-thickness defect between the most cranial and caudal parts of the septal cartilage. After that, two spreader grafts were placed bilaterally facilitating the septal integrity and leaving the full-thickness septal defect unchanged. The surgical results were evaluated using the preoperative and postoperative facial photographs and patient satisfaction was determined using nine relevant questions of DAS-59 scale. The only complication observed in the follow-up period of 19 months was hanging columella deformity which was corrected at the postoperative first year. The mean length of the resected septal segment was 12.4 mm. The mean length of the resultant septal cartilage defect after the vertical resection was 5.9 mm. The mean length of the placed spreader grafts was 25.6 mm. The comparison of the preoperative and postoperative photographs showed significant improvement of the nasal contour and considerable correction of the septal deviation. The statistical evaluation of the answers given to the questions of the DAS-59 scale clearly demonstrates that a significant degree of patient satisfaction was achieved. Severe septal deviation may be successfully corrected by full-thickness resection of the deviated part and reconstruction with bilateral spreader grafts with a low risk of postoperative complications.

New Suturing Techniques to Reconstruct the Keystone Area in Extracorporeal Septoplasty.

Severe septal deformations require adequate treatment to restore shape and function using extracorporeal septoplasty. Because it has been criticized for being technically demanding to execute and has increased risk for aesthetic complications, the authors have developed two new suture techniques for refixation of the neoseptum. A retrospective analysis of multisurgeon consecutive extracorporeal septoplasties performed from January of 2014 to December of 2014 was conducted at a single institution using the criss-cross or transcutaneous transosseous cerclage suture (group 1) compared with fixation at the upper lateral cartilages only (group 2). One hundred ten extracorporeal septoplasties were performed in 110 patients over 12 months. Group 1 consisted of 58 patients (53 percent), whether receiving the criss-cross [12 patients (21 percent)] or the transcutaneous transosseous cerclage suture [46 patients (79 percent)], and group 2 consisted of 52 patients (47 percent). The median follow-up was 11 months (range, 6 to 16 months). Operative revision because of complications at the dorsum or the keystone area had to be performed in no case in group 1 and in five cases (9.6 percent) in group 2, resulting in a statistically significant difference between the two groups (p = 0.0212). There were no complications such as bleeding or infection observed in any of the 110 cases. To facilitate and to reduce the complication rate after extracorporeal septoplasty, the authors have developed the criss-cross and transcutaneous transosseous cerclage suture to overcome the important and technically demanding reimplantation of the neoseptum. Thus, the authors believe that these new operative techniques are safe and reproducible procedures that may take a permanent place among extracorporeal septoplasty procedures. Therapeutic, III.

Extracorporeal Septoplasty: External and Endonasal Techniques.

Severe septal deformities are among the most challenging problems faced by rhinoplasty surgeons. Extracorporeal septoplasty (ES)--also known as subtotal septal reconstruction--involves removal of the native deformed septum and replacement with a reconstructed neoseptum. Several techniques and multiple variations have been described in the literature. We present an overview of ES, pertinent anatomical structures and deformities, and the external versus endonasal approach, and describe some of our techniques.

Extracorporeal Septoplasty: Assessing Functional Outcomes Using the Validated Nasal Obstruction Symptom Evaluation Score over a 3-Year Period.

It is well recognized that the standard septoplasty approach, in patients with severe septal deformities, may be less than adequate to address all portions of the deviated septum. The extracorporeal septoplasty technique is an alternative to the other common approaches in these more severe cases. In this study, the authors investigate functional outcomes of the standard approach. The authors use the validated Nasal Obstruction Symptom Evaluation score, before and after surgery, to quantify symptom improvement and confirm the validity and usefulness of this method in treating severe septal deviation. A retrospective collection of clinical data was performed on all patients undergoing extracorporeal septoplasty in a 28-month period from January of 2010 through May of 2013. Fifty-five patients were identified. Demographic information, previous surgical history, and complication status were collected. The main outcome measured was functional outcome identified from preoperative and postoperative Nasal Obstruction Symptom Evaluation scores. Collaboration occurred with the study design and biostatistics center for statistical analysis. The median preoperative and postoperative Nasal Obstruction Symptom Evaluation scores were 14.5 (interquartile range, 11.0 to 16.0) and 3.0 (interquartile range, 1.0 to 5.0), respectively. The median change between preoperative and postoperative scores was a decrease of 9.0 (interquartile range, 25.0 to 47.5). It was a statistically significant difference with (p < 0.0001 (Wilcoxon signed rank test). Extracorporeal septoplasty is an important surgical option for repair of the severely deviated nasal septum. This study shows significant improvements in functional outcomes following this procedure, as shown by notable improvements in the validated Nasal Obstruction Symptom Evaluation score after extracorporeal septoplasty surgery. Therapeutic, IV.

Extracorporeal Septoplasty Combined With Valve Surgery in Rhinoplasty Patients.

External nasal deviation is caused primarily by severely a deformed septum. The nose functions as a whole composed of the septum, valve systems, and mucosal structures. Patients with severely deviated septums also have deformed nasal valve systems. Extracorporeal septoplasty is advocated for an extremely deviated nasal septum. Nasal valve dysfunctions can be resolved successfully with spreader grafts. Application of extracorporeal septoplasty in combination with spreader grafts in patients with nasal valve dysfunction not only enables nasal respiration but also supports aesthetic appearance. The 19 patients in our study had undergone aesthetic rhinoplasty and presented with breathing problems and septal deviations. The patients were treated with extracorporeal septoplasty and spreader grafts. The patients were followed with clinical measures and computed tomographic scanning. No complications such as relapse, perforation, or saddling were encountered during follow-up. Aesthetically and functionally satisfactory results were obtained.