Extracorporeal Septoplasty Research Articles

Extracorporal Septoplasty

При реконструкция на тежки септални деформитети за възстановяване на носното дишане се предпочита отстраняването на хрущяла на носната преграда, моделирането му извън носната кухина и връщането му обратно. Екстракорпоралната септопластика представлява радикално решение за „трудните” изкривявания на носната преграда. Целта на настоящата статия е да представи нашия опит при 73 случая с тази техника посредством отворен достъп при 50 пациенти и при 23 чрез ендоназален достъп. -------------------------------------------- To reconstruct the airways in the case of serious nasoseptal deviation it is preferable to remove the cartilaginous septum, reshape it, , and replacement of the quadrangular cartilage (put it back). Extracorporeal septoplasty is a radical solution for the “difficult” (severely) deviated nosal septum. The aim of this paper is to present our experience of 73 cases of correction of nasoseptal deviation of 50 patients with open approach, and 23 patients by endonasal approach.

Modified Extracorporeal Septoplasty Technique in Rhinoplasty for Severely Deviated Noses

Secure fixation of the reimplanted septum is critical for successful long-term aesthetic and functional outcomes following extracorporeal septoplasty (ECS). We describe the results of our modified ECS technique. This retrospective study involved 27 patients with a deviated nose who underwent our modified ECS method in rhinoplasty between June 2006 and January 2009. Anthropometric changes were assessed from preoperative and postoperative facial photographs. Patient satisfaction was evaluated, and nasal obstruction improvement was assessed on a visual analog scale. Postoperative correction of the external nose deviation angle was statistically significant. Twenty-four patients (89%) were satisfied with the cosmetic outcome, and all 23 patients with moderate to severe preoperative nasal obstruction were satisfied with the postoperative improved nasal breathing. Our modified ECS fixation technique was easy to perform and effective in septorhinoplasty for severe septal deviation.

Aesthetic Reconstruction of a Crooked Nose via Extracorporeal Septoplasty

Aesthetic Reconstruction of a Crooked Nose via Extracorporeal Septoplasty

Highlights of Archives of Facial Plastic Surgery

Archives of Facial Plastic SurgeryVol. 12, No. 1 Free AccessHighlights of Archives of Facial Plastic SurgeryPublished Online:1 Jan 2010AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Nimodipine and Acceleration of Functional Recovery of the Facial Nerve After Crush InjuryFacial nerve injury often results in devastating emotional and functional impairment. Commonly, a patient must endure a challenging and protracted recovery period in which further ocular, nutritional, and expressive complications may develop. Robin W. Lindsay, MD, and colleagues present their findings of accelerated facial nerve recovery in the rat animal model with nimodipine administration. Statistically significant improvements in whisking amplitude, velocity, and acceleration were observed in comparison with control animals. These findings demonstrate the first pharmacologic therapy to improve facial nerve recovery in an animal model that is safe for routine clinical use.See page 49Reconstruction of the Nasal Septum Using Polydioxanone PlateAs the central divide of the nasal cavity, the nasal septum is an integral component in air passage and structural support. Abnormalities in nasal airflow and external nasal appearance are often intimately related to architectural deviations or disruption of this important structure. Miriam Boenisch, MD, PhD, and Gilbert J. Nolst Trenité, MD, PhD, review their 10-year experience using the polydioxanone plate as a scaffold for septal reconstruction in 396 patients with severe nasal deformities. In their modification of the extracorporeal septoplasty, the authors remodeled and secured the quadrangular cartilage to the resorbable matrix prior to reimplantation. They present their notable functional and cosmetic outcomes as well as variations in their novel operative technique.See page 4Mandibular Distraction Osteogenesis Used to Treat Upper Airway ObstructionThe facial skeleton is an integral element in the establishment and maintenance of a patent airway. To this end, congenital and syndromic causes of mandibular deficiency often result in oropharyngeal narrowing and a variable degree of upper airway obstruction. Tracheostomy is required in nearly 25% of these patients but not without associated risks. Craig W. Senders, MD, and colleagues investigate mandibular distraction osteogenesis (MDO) as an alternative to tracheostomy tube placement in micrognathic patients with tongue-based obstruction. Multiplanar advancement was performed with the application of an external distractor in newborn patients and those with long-standing tracheostomies. The findings observed reveal the significant impact of MDO in the treatment of upper airway obstruction in select pediatric patients.See page 11Orbicularis Suspension Flap and Its Effect on Lower Eyelid Position: A Digital Image AnalysisAge-related changes of the lower eyelid tissues often produce redundancy in eyelid skin, pseudoherniation of orbital fat, and a ptotic laxity of the orbicularis oculi muscle. Some individuals also display a hollowing along the inferior orbital rim. It is this subset of patients that represent a complex challenge in periorbital rejuvenation. Christopher I. Zoumalan, MD, and colleagues discuss changes in lower eyelid position as related to performing an orbicularis suspension flap in combination with an inside-out blepharoplasty in this patient population. Digital analysis of 68 patients revealed a statistically significant decrease in postoperative margin reflex distance in addition to a more natural anatomic position of the lower eyelid.See page 24Hope by Sir Edward Coley Burne-Jones (1833-1898).See page 76This issue's Highlights were written by James Ridgway, MD.FiguresReferencesRelatedDetails Volume 12Issue 1Jan 2010 InformationCopyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Highlights of Archives of Facial Plastic Surgery.Archives of Facial Plastic Surgery.Jan 2010.3-3.http://doi.org/10.1001/archfaci.2009.112Published in Volume: 12 Issue 1: January 1, 2010PDF download

Diagnosis and management of nasal fractures

The nasal bony–cartilaginous framework provides support to the nose and maintains airway patency. The cartilaginous and bony components are both susceptible to fracture. Nasal fractures are one of the most common facial injuries, occurring across a broad spectrum of age groups. Inadequate acute injury treatment can lead to persistent airway obstruction and nasal deformities that are subsequently more difficult to correct. Herein we discuss common presentations of nasal fractures, classifications, and options for treatment.

Trends in Functional Rhinoplasty

The evolution of the rhinoplastic surgery has spanned several centuries, with the last few decades focused on the development and refinement of techniques that address the nasal airway specifically. This increased focus on functional rhinoplasty has led to significant improvements in our ability to preserve and augment the nasal airway. Techniques are generally categorized by their effects on the external and/or internal nasal valves. Limitations exist, however, in our ability to critically interpret and apply these techniques due to a dearth of validated and reliable outcomes measures as well as confusion regarding the nomenclature of the nasal valves. This chapter will present a brief introduction to the history of functional rhinoplasty, means of evaluating the nose, outcomes, and surgical treatment of the nasal airway during functional rhinoplasty.

Extracorporeal septoplasty-how we do it at marienhospital stuttgart germany

Septoplasty is one of the most common surgery of ENT but even today the difficult septum still presents a great surgical problem. A severe septum deformity is usually due to an accident quite often in childhood. It is also seen in patients with malformation such as cleft lip and cleft palate deformity. It affects not only the nasal function, but also the aesthetic part of the nose. Severe septal deformities can not be corrected properly by the standard septoplasty techniques. Therefore in such cases an extracorporeal septoplasty is recommended. In this technique the whole septum is taken out, the bony and cartilaginous septum in one piece if possible, a new septal plate is reconstructed by different surgical techniques, followed by replantation and reconstruction of the cartilagenous dorsum. The first author kept on improving the safe septal fixation, rebuilding of cartilagenous dorsum and overall the extracorporeal septoplasty technique over the period of time and this technique with all its refinement can be recommended to all the surgeons dealing with this challenging noses.

Twenty-Five Years Experience with Extracorporeal Septoplasty

Even today, the difficult septum presents a surgical problem. A severe septum deformity is caused mostly by an accident or is seen in patients with malformations such as cleft lip and palate deformity. It is characterized by a massive malformation in all levels with consecutive blocking of one or both airways. Such marked septal deformities cannot be corrected properly by standard septoplasty techniques. Therefore, in such cases we suggest an extracorporeal septoplasty, where we take out the whole septum and reconstruct a new septal plate by different techniques followed by replantation and reconstruction of the cartilaginous dorsum. From January 1, 1981 to December 31, 2005, we operated on 2301 patients and improved this method constantly, especially the safe septal fixation and rebuilding of the cartilaginous dorsum. Follow-ups showed that even in severe deformities a revision rate of only 5% respectively 7% was found. Therefore, we conclude that the extracorporeal septoplasty with its refinements and the way we are doing it today can also be recommended to less experienced rhinosurgeons.

Anterior Septal Reconstruction

To describe a modified extracorporeal septoplasty technique and measure its efficacy with a validated quality-of-life instrument. A prospective observational outcomes study of patients with severe septal deviation who subsequently underwent anterior septal reconstruction. Preoperative and postoperative evaluation was performed using photographs and the Nasal Obstruction Symptoms Evaluation scale. Twelve consecutive patients were enrolled. No complications occurred. All patients noted improved airway function postoperatively. There was a significant improvement in mean Nasal Obstruction Symptoms Evaluation score postoperatively (76.6 vs 12.9; P<.01). Examination of postoperative photographs revealed improved midvault and tip anatomy. The anterior septal reconstruction technique is effective in improving both nasal airway function and aesthetics in patients with severe septonasal deviation. The technique avoids the most common complication of standard extracorporeal septoplasty by preserving the dorsal strut of septal cartilage and its attachment to the nasal bones at the keystone area.

Extracorporeal Septoplasty for the Markedly Deviated Septum

To describe a technique of extracorporeal septal reconstruction to correct the markedly deviated nasal septum. Retrospective medical chart review of 2119 patients undergoing extracorporeal septoplasty from January 1, 1981, through July 31, 2004, by the author in a tertiary care facial plastic surgery center. The main outcomes measured included surgical complications, revision rate, and the surgeon's subjective determination of functional and aesthetic outcomes. Of the 2119 patients, 2 cohorts were available for review. From January 1, 1981, to July 31, 1987, the author performed the operation on 459 patients. Fifty-seven complications (12%) occurred, with irregular contour of the dorsum or saddling noted in 38 (8%). Twenty patients (4%) elected to have revision septoplasty. From January 1, 1996, to December 31, 1996, the author supervised residents performing extracorporeal septoplasty in 108 patients. Fourteen postoperative complications (13%) occurred, with dorsal irregularity noted in 12 (11%). Eight patients (7%) elected to have revision septoplasty. 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.

The relevance of extracorporeal septoplasty in cleft nose correction

The aim of this paper is to delineate the importance of the correction of the nasal septum when attempting to improve the nasal shape and function in patients with cleft lip and palate (CLP) deformity. The particular problems of the nasal shape in CLP patients are assessed. Various approaches for adequate correction are reviewed and discussed. The method of extracorporeal septoplasty is presented in detail. This method was used between 1982 and 1997 in 141 out of 332 CLP patients who required septoplasties and appears particularly suited for this purpose since it offers the possibility of reconstructing an almost normal septum. This is necessary in order to achieve both a functionally and an aesthetically good result. Our experience over the past 16 years confirms the advantages of this approach.

Extracorporeal septoplasty combined with open rhinoplasty.

Extracorporeal septoplasty is a radical solution for the severely deviated nose. The major problems associated with this procedure are fixation of the septal cartilage graft and dorsal irregularities. Extracorporeal septoplasty was performed in combination with open rhinoplasty in 17 patients with severe nasal deformities. In this technique septum was totally removed through the columellar incision of open rhinoplasty, corrected outside, and replaced as a free "L" shaped cartilage graft. The cartilage graft was fixated to the upper lateral cartilages to restore the natural relations of the anatomical structures. Additional rhinoplastic manipulations were also performed. The follow-up period was up to 18 months. The overall result was successful in all patients. Nasal deviation did not recur and secondary revisions were not needed for any patient during follow-up.