Septal Deformity Research Articles

Septal Reconstruction With Folded Porous Polythylene Implants: An Alternative Technique for the Correction of Severe Saddle Nose Deformities in Asian Populations.

Congenital or secondary deficiency in septal cartilage leads to an unpleasant cosmetic appearance and compromised function as well. Rhinoplasty maneuvers such as spreader graft and septal extension graft with autologous tissue have been exhibited to correct the deformities. However, the relatively severe donor site morbidity stands as a main concern for both surgeons and patients. From January of 2014 to April of 2018, 52 patients presenting septal deformities underwent rhinoplasty with our modified technique. A piece of Medpor (8438) was tailored, folded and then placed as a combination of spreader and septal extension graft. The surgical outcomes were evaluated both objectively and subjectively. All the patients were followed up for 12 to 24 months postoperatively. The ratio of tip projection and the nasal length exhibited significant improvement in all our patients. Nasal obstruction subjectively mended among the 24 patients who had airway obstruction complaint preoperatively. Only 2 patients had severe adverse events and the implants were removed instantly. With our modified technique, Medpor proved to be an effective and reliable material for the reconstruction of septal cartilage, which provides us an alternative way to achieve extended spreader and septal extension graft with one single implant in the correction of saddle nose.Level of Evidence: Level IV, therapeutic study.

Septoplasty by disarticulation

The difficulty of correcting nasal septum deformities using the classical Killian or Cottle techniques or derivatives has led in recent years to new suggestions such as extracorporeal septoplasty or various apposition grafts to counteract refractory deformity of the quadrangular cartilage. Naturally occurring septal deformities result from conflicts in growth between the quadrangular cartilage, perpendicular ethmoidal plate and vomer, which each have their own different evo-devo origin. Septoplasty by disarticulation consistently restores a level septum by completely resolving the growth conflicts. Conserving the quadrangular cartilage is essential for the stability of the nasal pyramid on condition that 1) the lateral flare of the superior edge of both the component septolateral cartilages that suspend it at the roof of the piriform orifice and 2) the height of its anterior edge are respected. The anterior edge is always high enough (except in case of fracture or malformation to project the retrolobular nasal dorsum in proportion to the height of the alar cartilage when it is repositioned on its natural premaxillary base.

Endoscopic Verses Conventional Septoplasty in the Treatment of Deviated Nasal Septum

Background: Septum deviation is the major cause of nasal obstruction, which is the most common symptom in ENT practice. Surgical correction of the deviated nasal septum has been advanced over the years, from the radical removal of both mucosa and cartilage to submucous cartilage resection with preservation of the mucosa. Objective: To compare the efficacy of the conventional and the endoscopic septoplasty in the management of patients with symptomatic nasal deviation. Patients and methods: This study included 40 patients presented to the Otorhinolaryngology outpatient clinic at Assiut University Hospitals between May 2018 and December 2019, suffering from nasal obstruction due to a significant septal deviation, randomly divided into two groups: Group A: 20 patients underwent endoscopic septoplasty and Group B: 20 patients underwent conventional septoplasty. Results: In this study, no significant difference was detected in the preoperative results of both groups regarding the age, sex and types of septal deformities. So, the preoperative circumstances were similar between both groups. Hence, results of this study showed that these two procedures were suitable to correct septal deformities but the endoscopic septoplasty was superior to the traditional septoplasty in cases with isolated septal spur. Also, it was associated with the minimal re-occurrence rate. Conclusion: Endoscopic septoplasty is a valuable teaching tool, which is efficient in the management of different types of septal deformities.

40 Years of Total Extracorporeal Septal Reconstruction: The Past, Present, and Future.

Even today, severe septal deformities are a challenging problem for any rhinoplasty surgeon. Standard techniques are often not able to achieve satisfactory long-term results regarding function or aesthetic form. In such severe cases, a partial or total extracorporeal septal reconstruction may be used, as these techniques provide reliable and lasting results. The aim of this work is to present the authors' experience with the technique of total extracorporeal septal reconstruction and its development to today's standard and to prove its effectiveness in the long-term follow-up. This article presents 40 years of clinical experience in this field and describes the technical changes that have evolved. Low complication rates, safe techniques, and favorable long-term outcomes of the total extracorporeal septal reconstruction show the benefits of this technique. The indication for a total extracorporeal septal reconstruction has been limited by the development of less complex surgical procedures, but it still represents the best technique to achieve long-term functional and aesthetic results in patients with very complex septal deformities. Therapeutic, V.

Inferior Meatus Mucosal Flap for Septal Reconstruction and Resurfacing After Nasoseptal Flap Harvest.

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Extracorporeal septorhinoplasty: Technical note

Severe nasal septal deformities can be responsible for functional and aesthetic impairments. Correction of these deformities can be difficult and restoring perfect nasal shape and function is still challenging. Classical techniques can, sometimes, lead to disappointing results or relapse. In this article, the aim was to describe the different techniques of extracorporeal septorhinoplasty and fixation of the neoseptum. Three techniques are mainly used: “crisscross” suture, “U-shaped” suture and anterior septal reconstruction to fix the neoseptum after extracorporeal remodeling. All these techniques are technically demanding, especially concerning keystone area management; but, if well performed, could give satisfactory functional and aesthetic outcomes. We therefore think that extracorporeal septorhinoplasty should really improve our results concerning functional and aesthetic aspects in case of severe anterior or caudal septum deviation.

Morphological, anatomical, radiological and clinical features of Mladina type 6 nasal septum deformations in humans.

The objective of this study was to prove the higher frequency of the type 6 deformations overall compared to the results obtained by conventional diagnostic methods, such as computed tomography images and clinical examination. The study was performed at the Institute of Anatomy, where a total of 114 randomly selected skulls were examined. The skulls were then scanned in a fixed position using the cone-beam technique (CBCT). The literature epidemiological data of the clinical incidence of type 6 in studies that also used Mladina classification were obtained. There was a statistically significant difference (p < 0.0001) in the frequency of type 6 deformation as diagnosed by visual inspection (22.8%) and computed tomography (7.9%). The frequency obtained by CT imaging amounted 7.9% and was almost the same as the results obtained by a clinical examination which varied between 9 and 11%. The frequency of type 6 nasal septal deformation is higher by visual inspection of the skulls than by computed tomography imaging at a level of significance of 0.05. The incidence of type 6 findings on coronal CT images of paranasal sinuses is approximately the same as that found with anterior rhinoscopy. Type 6, visible or concealed; probably have one-fourth to one-fifth people in population, so the number of clinically overlooked and/or unrecognized types 6 is much greater than we thought it to be.

Septorhinoplasty by disarticulation

Septorhinoplasty by disarticulation is an esthetic and functional solution for naturally occuring nasal pyramid dysmorphia, releasing the anatomic traces of growth-related stresses. Disarticulating the septolateral cartilage from its bony framework via a closed approach to the septal pocket is associated to Rethi's external approach in order to disarticulate the fibrocartilaginous nasal dorsum, while conserving its integrity, under the bony dorsum. The bony pyramid is then disarticulated down to the nasion, after resecting any bone hump, by 2 paramedian and 2 low lateral osteotomies in the basal groove. The lateral sides of the bony pyramid are then fractured at their posterior edges by percutaneous pinching to close the open roof and realign them along the midline. The septolateral cartilage, reduced as necessary at the inferior and anterior edges, is thereafter repositioned on the premaxillary bone. Traction on its anterior edge restores rectilinear frontal and lateral tension in the fibrocartilaginous dorsum, fully conserved from its attachment to the nasion. This technique corrects any septal deformity and restores frontal and lateral dorsum straightness.

Competitive study of conventional septoplasty versus endoscopic septoplasty

Objective: Traditional surgeries of the nasal septum improve the nasal airway but recent developments of endoscopic techniques have brought focus over several aspects of possible advantages over traditional techniques. These are due to better visualization and illumination, better accessibility and evaluation of exact pathology, the lesser need for unnecessary manipulation, resection and overexposure of the septal framework, and improving the scope for revision surgery if required later. Materials and methods:A hundred cases of the deviated nasal septum (DNS) refractory to conservative medical treatment were divided into two groups and underwent corrective surgery for nasal septal deformity using both endoscopic and conventional techniques. These patients were divided into two groups who underwent septal surgery with two different techniques and the results were compared. All patients were followed up in the outpatient and were assessed for subjective improvement.Time taken for the study was four months. Results:A hundred patients with deviated nasal septum were recruited into a study where the patients were divided into two groups, 50 cases in each group. Group I underwent conventional septoplasty while group II underwent an endoscopic septoplasty. The most prevalent complaint in the patients was nasal obstruction (88%), headache (60%), nasal discharge (54%) and sneezing (44%). The postoperative follow-up of the frequency of symptoms after surgery showed relive of nasal obstruction in 70% of cases of group I and in 92% of group II. However, the headache was relieved in 73% of cases of conventional septoplasty and 90% of cases of endoscopic septoplasty. Conclusion: The clinical results of endoscopic septoplasty were found better as compared to conventional techniques with lesser complications and lesser periods of hospitalization.The use of endoscopic techniques offers lesser complications and lesser periods of hospitalization.

Side asymmetry in nasal resistance correlate with nasal obstruction severity in patients with septal deformities: Computational fluid dynamics study.

The objective of this study was to investigate the relationship between side asymmetry in nasal resistance (NR) and severity of the nasal airway obstruction (NAO) in patients with different types of nasal septal deformity (NSD). Computational fluid dynamics (CFD) study. The study was conducted in a tertiary medical centre. The study included 232 patients, who were referred to the CT examination of the paranasal sinuses. Exclusion criteria were sinonasal and respiratory diseases that may interfere with the nasal obstruction. The presence and the type of NSD were recorded according to the Mladina's classification. The presence and severity of NAO in each patient were assessed by NOSE questionnaire. Eight computational models of the nasal cavity were created from CT scans. Models represented seven Mladina's NSD types and a straight septum of a symptomless patient. CFD calculated airflow partitioning and NR for each nasal passage. Side differences in NR were calculated by the equation ∆NR=NRleft -NRright . The relationship between NOSE scores, airflow partitioning and side differences in NR was explored using Spearman's correlation analysis. Mladina's types of NSD showed differences in airflow partitioning and the degree of side asymmetry in NR. A significant positive correlation was detected between side differences in NR and NOSE scores (R=.762, P=.028). A significant negative correlation was found between the per cent of unilateral airflow and NR (R=-.524, P=.037). Our results demonstrated that side asymmetry in NR could explain differences in NAO severity related to the NSD type.

Anévrysme isolé du septum interauriculaire : cause exceptionnelle d’ischémie digitale

An atrial septal aneurysm (ASA) is a rare but well recognized entity characterized by saccular deformity of the atrial septum that bulges into the right or left atrium. Diagnosis can be established using transthoracic and transesophageal echocardiography. Although this abnormality is considered clinically benign, it has been independently associated with systemic or cerebral embolism. We present a unique case of isolated atrial septal aneurysm complicated by digital ischemia in a 51 years old woman.

Changes in the Interventricular Septal Curvature in Healthy Full-term Neonates During the First 14 Days of Life.

Interventricular septal geometry and motion reflect the interaction between the ventricles, and an abnormal shape and abnormal motion are always regarded as signs of increased right ventricular or pulmonary artery pressure. During the neonatal period, there are profound changes in the cardiac circulation. The aims of this study were to quantitatively analyze neonatal septal deformations under normal physiologic conditions and evaluate the changes in association with the hemodynamic changes occurring during the transitional period. This was a retrospective study of 114 healthy full-term neonates from birth to 14 days of age. Normalized septal curvatures were measured on left ventricular parasternal short-axis views during end diastole and end systole. The interventricular pressure gradient, ratio of ventricular volumes, septal strain, thickness, and some clinical characteristics were assessed, along with the association of these parameters with septal curvature. All 4 normalized septal curvatures were found to have a significant correlation with the trans-septal pressure gradient (TSPG) and the end-diastolic volume ratio of the left and right ventricles (P < .0001). The TSPG had the highest impact on septal curvature, and among the 4 curvatures, the middle end-systolic normalized septal curvature had the highest correlation with the TSPG (r2 = 0.948; P < .0001). There were significant correlations between septal curvature and the interventricular pressure gradient and ventricular volume ratio in healthy full-term neonates. The normalized septal curvatures gradually increased with increasing age and could be good indicators of the hemodynamic changes occurring during the transitional period.

Влияние нарушения архитектоники полости носа и носоглотки на развитие околоносовых пазух и формирование в них воспалительных процессов

The structure of the paranasal sinuses (PNS) is characterized by pronounced variability and largely depends on the state of the intranasal architectonics, the violation of which may be a predisposing factor for the development of sinusitis. Leading among the disturbances in the architectonics of the nasal cavity and nasopharynx are the nasal septum deviation (NSD), concha bullosa (CB), hypertrophy of the inferior turbinates and pharyngeal tonsil. This review presents an analysis of modern data on the influence of the architectonics of the nasal cavity and nasopharynx on the development of PNS and the formation of inflammatory processes in them. Sources of information - databases Medline, Pubmed, Cochrane, E-library from 2004 to 2019. The search was carried out by keywords. Criteria for inclusion of articles in the review: assessment of multispiral computed tomography of SNP of patients in axial and coronary projections, presence of a control group, sample size of more than 50 people. In the presented review, it is noted that types 3 and 5 of DNP according to the classification of R. Mladina, along with contralateral CB and adenoids, can be predictors of the development of sinusitis. Information about the side of sinusitis formation in relation to the direction of the deformity of the nasal septum, about the effect of other violations of the architectonics of the nasal cavity on sinusitis and the size of the SNP remains controversial. The reasons for the contradictions are the use of different classifications of DNP, the underestimation of the complexes of anatomical anomalies and the mechanisms of aerodynamics of the sinuses, which determine the greater dependence of the volume and ventilation of the sinuses on expiration than on inspiration. Taking these positions into account, the question of the influence of the architectonics of the nasal cavity on the development of the paranasal sinuses and the formation of the inflammatory process in them requires further study.

The effect of deviated nasal septum on aesthetic appearance of the nose

Background The deviated nasal septum affects the aesthetic appearance of the nose, as a well-known phrase projects ‘As the septum goes, so goes the nose.’ The nasal septum is the central structure supporting the framework of the nose. Aim To evaluate the relationship between nasal septum deformities and its effects on aesthetic appearance of the nose, and the management of each effect. Patients and methods A total of 30 patients who underwent septorhinoplasty between April 2016 and December 2019 were evaluated prospectively. This was done in Al-Zahraa University Hospital. Patients who had nasal deformities owing to septal deformities were included. Results Regarding interference with nasal septum in rhinoplasty operation, only two (6.7%) cases were done without septoplasty, whereas 28 (93.3%) cases were done with septoplasty. In 93.33% of the cases, nasal septum affected the shape of the nose, and in only 6.67% of the cases, the nasal septum did not affect the shape of the nose. Conclusion The deviated nasal septum affects the aesthetic appearance of the nose, but not all parts of septum affect it. Bony part does not affect the shape of the nose and not all types of deviations of the septum. However, deviations that reach the dorsum of the nose or columella surely affect the shape of the nose.

Функциональное состояние полости носа после эндоскопической септопластики

Septoplasty is one of the three most frequently performed operations in otorhinolaryngology. The history of the development has more than 200 years. The research and analysis of the features of different methods of this surgical treatment does not lose interest to this day. The article presents an analysis of the restoration of the functions of the nasal cavity after septoplasty. The research included 96 patients with various types of nasal septum deformities. The age range of patients ranged from 19 to 54 years. All patients had nasal septum correction under general anesthesia. Patients were divided into 2 groups. The 1st group included 64 patients who had endoscopic septoplasty. The 2nd control group consisted of 43 patients with the same pathology who underwent classical septoplasty without optical control. Dynamic observation was carried out before surgical treatment, on the 7th day, 1, 3, 6, 12 months after surgery. The aim of the research was to estimate the functional status of the mucous membrane of the nasal cavity after surgery, the time of the operation, as well as long-term postoperative complications if any. The following diagnostic measures there were: complaints, otorhinolaryngological examination by using endoscopic techniques, anterior active rhinomanometry on the Rinolan device (manufactured by Lana-Medica), measurement of mucociliary transport time using the saccharin test. Comparative analysis of groups of patients showed no significant difference in the restoration of nasal cavity functions. However, performing septoplasty using endoscopic technique reduces the time of surgery and the percentage of complications in contrast to the classical septum surgery

Quick and easy septoplasty: our technique

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Septoplasty is among the most common procedure in nasal surgery, and it has some difficulties, especially at the beginning of the surgical training.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study including 154 patients underwent septoplasty surgery in Zahrawi Private Hospital using our surgical technique from October 2015 to June 2017, preoperative examination using zero degrees 3 mm sinuscope, anterior active rhinometry (AAR), and computed tomography of paranasal sinuses was done. Operative time and postoperative AAR was calculated. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A significant reduction in nasal breathing resistance was found in 146 patients (95%), there are two patients with postoperative bleeding, and one patient develops synechiae. No septal perforation or other major deformities. The mean septoplasty operation time was 15.34±3.66 min (range 10-35 min).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our surgical technique is an effective and rapid procedure for the correction of septal deformities. It is reproducible and easily learned.&lt;/p&gt;

An algorithm for management of nasal caudal septal deformities

IntroductionCaudal end septal deformities are common deformities. Trauma is a main cause of these deformities. there is lack of an algorithm for choosing the suitable technique for the type of deformity. The aim of this retrospective study was to put an algorithm for approaching different caudal end deformities.Patients and methodsRetrospective review of 136 patients underwent surgical correction for caudal end deformities. Data collection included functional breathing outcomes and drawbacks of different techniques as postop caudal end sublaxation and firm nasal tip sensation.ResultsPatients were divided into 4 groups (according to the technique by which the caudal end of nasal septum was managed) as following: Group A: 90 patients who had undergone surgeries with swinging door or modified swinging door techniques with fixation to anterior nasal spine technique, Group B: 26 patients who had undergone surgery with tongue in groove technique, Group C: 10 patients who had undergone surgery with caudal end splinting using septal bone, Group D: 10 patients who had undergone surgery with septal extension graft with tongue in groove technique.ConclusionAn algorithm was obtained to help in deciding a methodology for correcting the caudal end deformities according to preoperative patient data.

Orientation of the premaxilla in the origin of septal deviation.

While most people believe the nasal septum to have intrinsic deviation and overgrowth in patients seeking rhinoplasty, an alternative concept is that a mal-oriented premaxilla causes extrinsic septal buckling and external extrusion of the septal cartilage. In this sense, the premaxillary bone plays a significant role in the pathogenesis of septal deviation. This study was performed to determine if non-traumatically acquired septal/nasal functional and aesthetic pathology or septal deviation may be related to the orientation of the premaxilla relative to the skullbase. A retrospective, single-center study of patients in the general population who underwent maxillofacial CT scans and presented for the evaluation of nasal obstruction. CT scans were used to measure features of both pathologic and non-pathologic nasal septums. A total of 68 subjects were evaluated. When comparing patients with a premaxillary-skullbase angle of greater than 81° (the mean of the study group) to those of less than 81°, and a more obtuse nasolabial angle was observed (p = 0.0269). When comparing the extremes of premaxillary rotation, specifically, greater than 87° (mean 91.7°, SD 5.1) and less than 77° (mean 70.7°, SD 3.6), the differences were more pronounced with regard to caudal septal excess (p = 0.0451) and septal deviation in the axial plane (p = 0.0150). Septal developmental changes may involve an overly rotated or more vertically oriented premaxillary bone relative to the skull base. An understanding of the cause of septal deformity may provide insight into the design of improved treatments.

Crooked nose correction: an institutional experience

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Crooked noses pose a particular challenge in nasal reconstruction, even for the most experienced of surgeons, as there is inevitably a combination of functional and aesthetic abnormalities which need to be addressed. Crooked nose deformity is a common presentation in the ENT clinic due to raise in the road traffic accidents.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective study conducted in the Department of ENT, GMCH. All the cases of crooked noses presenting to our department was included in the study. The patients were subjected to a proper history and thorough physical examination. Preoperative nasal analysis was done using photography and nasal endoscopy. The type of intervention for each patient and their outcome was analyzed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The majority of the crooked nose was due to blunt force trauma sustained during road traffic accidents (RTA) or during physical violence. In all crooked nose with an external deformity, there is an underlying septal deformity. The aim of the surgery is to achieve an aesthetically pleasing and a physiologically functioning nose.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; From the present study, we can conclude that the majority of the crooked nose was due to blunt force trauma sustained during road traffic accidents or due to physical violence. Besides having a considerable external deformity, majority of the cases also had functional problems too and this two aspects could be addressed properly by doing a septorhinoplasty. &lt;/p&gt;

Mucosal leishmaniasis: A forgotten disease, description and identification of species in 50 Colombian cases

Mucosal leishmaniasis has a progressive course and can cause deformity and even mutilation in the affected areas. It is endemic in the American continent and it is mainly caused by Leishmania (Viannia) braziliensis. To describe a series of mucosal leishmaniasis cases and the infectious Leishmania species. We included 50 patients with a clinical diagnosis of mucosal leishmaniasis and parasitological confirmation, and we described their clinical and laboratory results. We performed species typing by PCR-RFLP using the miniexon sequence and hsp70 genes; confirmation was done by sequencing. The median time of disease evolution was 2.9 years (range: 1 month to 16 years). The relevant clinical findings included mucosal infiltration (94%), cutaneous leishmaniasis scar (74%), total loss of the nasal septum (24%), nasal deformity (22%), and mucosal ulceration (38%). The symptoms reported included nasal obstruction (90%), epistaxis (72%), rhinorrhea (72%), dysphonia (28%), dysphagia (18%), and nasal pruritus (34%). The histopathological study revealed a pattern compatible with leishmaniasis in 86% of the biopsies, and amastigotes were identified in 14% of them. The Montenegro skin test was positive in 86% of patients, immunofluorescence in 84%, and culture in 8%. Leishmania (V.) braziliensis was identified in 88% of the samples, L. (V) panamensis in 8%, and L. (V.) guyanensis and L. (L.) amazonensis in 2% respectively. In this study, we found a severe nasal disease with destruction and deformity of the nasal septum in 25% of the cases, probably associated with late diagnosis. Leishmania (V.) braziliensis was the predominant species. We described a case of mucosal leishmaniasis in Colombia caused by L. (L.) amazonensis for the first time.