Septoplasty Technique Research Articles

Comparison of Surgical Outcomes and Intraopertive Complications between Endoscopic and Conventional Septoplasty

Abstract Background The nasal septum is essential for nasal stability because it supports the nasal tip, dorsum, and middle nasal third. When the nose is significantly deformed or deviated, it can cause nasal obstruction, a proclivity for chronic or recurring sinusitis, and, less commonly, contact point headaches. Aim of the Work The aim of this study was to compare between endoscopic and conventional septoplasty through a meta-analysis study. Patients and Methods In this meta-analysis we enrolled 22 articles fulfilled inclusion criteria as having symptomatic deviated nasal septum (headache, nasal obstruction, hyposmia and epistaxis) and refractory to medical treatment that diagnosed clinically, radiological and endoscopically having deviated nasal septum or spur. Results Our main finding was that the endoscopic septoplasty technique seemed to offer certain advantages, with fewer overall complications compared with the traditional open technique; According to the study population patients reported better improvement after endoscopic septoplasty over conventional septoplasty regarding: headache (RR = 0.12, 95% CI = 0.05 to 0.18, I2 =0. 01%, P value = 0. 948), nasal obstruction (RR = 0.14, 95% CI = -0.08 to 0.20, I2 = 43.14%, P value = 0. 003),and posterior nasal drip (RR = 0.22, 95% CI = 0.05 to 0.39, I2 = 0%, P value = 0. 921). Endoscopic septoplasty performed much better according to many objective parameters; reduction of turbinates hypertrophy (RR = -0.95, 95% CI = -1.87 to -0.04, I2 = 9.28%, P value = 0. 340), persistent posterior deviation (RR = -1.18, 95% CI = -1.72 to -0.63, I2 = 0%, P value = 0. 920), residual septal deviation (RR =-0.89, 95% CI = -1.31 to -0.48, I2 = 0%, P value = 0. 995), and residual spur (RR = -1.58, 95% CI = -2.39 to -0.76, I2 = 0%, P value = 0. 967). Endoscopic septoplasty was safer than conventional approach in the occurrence of facial swelling (RR = -1.20, 95% CI = -2.00 to -0.40, I2 = 0%, P value = 0. 985), postoperative hemorrhage (RR = -1.18, 95% CI = -1.69 to -0.66, I2 = 0%, P value = 0. 960), mucosal tear (RR = -0.73, 95% CI = -1.08 to -0.37, I2 = 0%, P value = 0. 692), length of postoperative stay (RR = -1.50, 95% CI = -2.07 to -0.93, I2 = 0%, P value = 0. 956), septal hematoma (RR = -1.45, 95% CI = -2.82 to -0.09, I2 = 0%, P value = 1.000), septal perforation (RR = -1.46, 95% CI = -2.61 to -0.31, I2 = 0%, P value = 1.000), nasal pain (RR = -1.02, 95% CI = -1.99 to -0.05, I2 = 0%, P value = 0.984), and synechiae (RR = -1.25, 95% CI = -1.67 to -0.83, I2 = 0%, P value = 0. 761). Conclusion Patients treated with endoscopic septoplasty had better outcome regarding nasal blockage, postnasal drip, headache and septal deviation. Furthermore, Endoscopic septoplasty reported safer result than conventional approach as it reduces residual pain, facial swelling, postoperative hemorrhage, mucosal tear, and length of postoperative stay, septal hematoma, septal perforation, nasal pain, and synechiae.

Achieving a Strong and Straight Septal Extension Graft: A Novel Four-step Surgical Approach in Rhinoplasty.

Septal extension grafts allow the precise elongation of the nasal septum to attain facial harmony and optimize aesthetic outcomes. In this context, septal surgery requires meticulous design to address both functional and aesthetic goals. Traditional septoplasty techniques often overlook aesthetic considerations and postoperative nasal structural stability, resulting in unresolved or recurrent deviations, nose tip drooping, and obstruction recurrences. Despite advancements in surgical techniques, achieving simultaneous septal alignment and long-term stability remains a significant challenge. This study introduces a systematic 4-step technique. The procedure encompasses caudal septum liberation, placement of the septum extension cartilage graft, positioning of an ethmoidal bone graft, and redefinition through an intermediate cartilage. A retrospective analysis of outcomes involving 753 patients was conducted with a minimum follow-up of 6 months. During follow-up visits, 1.73% of cases exhibited residual columellar asymmetry, and 0.66% showed tip asymmetries. The infection rate was 0.40%, with no cases of tip drop identified. The overall satisfaction rating on the Rhinoplasty Outcomes Evaluation questionnaire at 12 months postoperative was 9.3. The technique provides a systematic approach to integrate functional and aesthetic objectives, emphasizing septal stability and alignment while concurrently addressing tip projection and stability. The study provides comprehensive insights into the principles, methodology, and advantages of this rhinoplasty technique. The outcomes underscore the efficacy of the technique, presenting a reliable and long-term stable solution.

Modification of Low Septal Strip Septoplasty to Reduce Hump Recurrence in Dorsal Preservation Rhinoplasty.

Among the problems encountered in the dorsal preservation rhinoplasty technique are residual hump and hump recurrence. In our study we performed a modification to lower strip resection and the fixation of the septum. The clinical results of these modifications on hump recurrence were investigated. 231 patients who underwent dorsal preservation rhinoplasty with low septal strip septoplasty between November 2021 and February 2023 were included in the study. Closed dorsal preservation rhinoplasty was performed with low septal strip septoplasty in 31.2% (n=72) and modified low septal strip septoplasty technique in 68.8% (n=159) patients. All cases were primary rhinoplasty. Demographic data, complications, revision surgeries and follow-up periods of the patients were analyzed retrospectively. The mean follow-up period of the cases was 9.68±4.02 (3-16) months. Gender and age of the cases did not differ statistically significantly between the groups (p>0.05). Complications were observed in 3.5% of the patients (n=8/231). The complications in the low septal strip septoplasty group were statistically significantly higher than in the modified low septal strip septoplasty group (p=0.012; p<0.05). The incidence of recurrent hump complications in the low septal strip septoplasty group was statistically significantly higher than in the modified low septal strip septoplasty group (p=0.029; p<0.05). Septum fixation is one of the most important parts of the surgery in dorsal preservation rhinoplasty and must be done properly. In this modification that we described, the risk of recurrent hump is reduced, as sufficient septum fixation is achieved.

Tip Surgery in Dorsal Preservation Rhinoplasty: The Effect of Modified Low Septal Strip Septoplasty on Tip Plasty.

The aim in tip surgery is to provide rotation, derotation, projection and deprojection. In this study, we aimed to show the effects of modified low septal strip septoplasty, septal extension graft, TIG technique and additional maneuvers on tip shape in dorsal preservation rhinoplasty (DPR) and to discuss our clinical results. One hundred eighty-nine patients who underwent DPR with modified low septal strip septoplasty between November 2021 and August 2023 were included in the study. Demographic data, complications, revision surgeries and follow-up periods of the patients were analyzed retrospectively. The mean age of the patients is 29.58±9.04 (17-65). The mean follow-up period was 14, 50±2,98 months. Complications were observed in 1.1% of the patients (n=2/189). Revision surgery was performed in all these patients. Residual hump in 2 were observed and dorsum rasping was performed under local anesthesia. No tip revision was performed on any patient. A strong tip fixation is achieved with the modified low septal septoplasty technique described in this publication, and when combined with septal extension graft, tongue in groove technique and other suture techniques, an effective and permanent tip plasty can be performed in DPR. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Septoplasty During Primary Cleft Lip Reconstruction: A Historical Perspective and Scoping Review.

Traditional surgical approaches excluded septoplasty at primary cleft lip reconstruction due to concerns about restricted nasal and midfacial growth. Modern opinion in the treatment of cleft lip has increasingly employed primary septoplasty; this scoping review and historical perspective aims to chronicle the evolution of septoplasty in patients born with cleft lip and palate and discuss current evidence. The historical perspective explicitly contrasts American and European perceptions of septoplasty in cleft lip deformity and the competing anatomical theories of the role of the septum on midfacial and nasal growth. For the scoping review, articles were extracted from Embase, PubMed, and Medline, as well as manual searches of reference lists. Results were compiled, grouped, and appraised by date, outcomes, and historical significance. Inclusion criteria consisted of children who underwent primary septoplasty for any indication and were followed up on outcomes of facial growth and nasal function. Literature reviews, opinion articles, case reports, guidelines, or studies not available in English or online were excluded. Evolving anatomical theories relating to midfacial growth in the mid-late 20th century underpinned a progressive ideological shift on the safety and efficacy of septoplasty in children. This is supported by our scoping review, which included 23 articles mutually selected for inclusion by 2 blinded assessors. Several competing methods have been employed to measure endpoints on facial growth and nasal function, but generally indicate primary septoplasty is successful in improving nasal function and preserving midfacial growth. Perceptions towards septoplasty on facial growth in the pediatric population have transformed significantly and suggest a growing acceptance of primary septoplasty techniques in patients born with a cleft lip.

Mini Endoscopic Septoplasty for High Localized Nasal Septum Deviation: Surgical Technique, Outcomes, and Comparison With Regular Septoplasty.

This prospective cohort study aimed to describe the technique of mini endoscopic septoplasty for patients with a high localized nasal septum deviation in front of the middle turbinate and chronic sinusitis or nasal sinus fungus ball. Our primary objective was to investigate the indications and outcomes of this procedure, and the secondary objective was to compare it with regular endoscopic septoplasty. Patients with chronic sinusitis or nasal sinus fungus ball and high localized nasal septum deviation underwent mini endoscopic septoplasty, while those with a broad deviation of the nasal septum underwent regular endoscopic septoplasty. The study evaluated the procedure duration, blood loss, and complications associated with both methods. All patients were followed up for 3 months. Thirty patients underwent mini endoscopic septoplasty; another 30 underwent regular endoscopic septoplasty. Mini endoscopic septoplasty demonstrated a significantly shorter procedure duration and lower blood loss than regular endoscopic septoplasty. Neither group experienced operative complications, such as nasal septum perforation or hematoma. Mini endoscopic septoplasty is a safe, time-efficient, and effective technique indicated for highly localized nasal septum deviations in patients with chronic sinusitis or nasal sinus fungus ball. This procedure offers advantages in terms of the surgical approach and postoperative debridement. Future research could explore the broader clinical implications of these findings.

Investigation of the Short-Term Functional Outcomes and the Impact on Nasal Tip Shape of the Caudal Septal Batten Grafting Technique

Objective: Septoplasty is a common rhinological intervention. We aimed to evaluate the effectiveness of septoplasty techniques applied to patients with septal deviation. Materials and Methods: 300 patients admitted to our clinic in 2022 and 2023 and underwent septoplasty were involved and divided into two groups: The "Caudal", which used a caudal septal batten graft, and the "Classic", which involved the 2-5 region, where the caudal septum was not touched. The patients' conditions were evaluated by applying the NOSE scale preoperatively and postoperatively in the 1st and 3rd months. Results: Our study included 223 patients who came for all follow-up visits and consented to participate. The preoperative, postoperative 1st and 3rd month NOSE scale average scores of the "Caudal" group were 12.3±3.7, 5.4±2 and 2.8±1.2, respectively. In the "Classic" group, the values were 9.3±2.1, 5±1.4 and 3.3±1 and significantly different (p

A Comparative Study of Conventional vs. Endoscopic Septoplasty

Background: Septoplasty is the treatment for the symptomatic Deviated Nasal Septum. There has been a drift from septal resection to mucosal preservation to conservation of possible septal framework in the septoplasty surgeries. The endoscopic technique is modern evolution of the septoplasty surgery. This study has been undertaken to evaluate the conventional and endoscopic approaches of the septoplasty surgeries and aid in statistical informative data to ongoing researches for better outcome comparison. Aims and Objectives: To compare conventional and endoscopic techniques of Septoplasty and to find out which technique is better on the basis of various intraoperative and postoperative objectives. Material and Methods: A prospective randomized comparative study was conducted with a sample size of total 60 patients; 30 in each group. Both the groups were statistically compared for various predefined intraoperative and postoperative objective to determine the better technique of septoplasty. Results: Endoscopic technique was better than conventional in terms of ease for surgical process, time taken for the surgery, intra operative blood loss, visualization of the pathology and postoperative residual deviation. Conclusions: Endoscopic technique was found better in terms of less intra operative complication like bleeding, better visualization, better illumination, magnification, more conservative approach, ease of surgery, less time duration of surgery and less postoperative residual deviation with limitation of binocular vision and bimanual work. Endoscopic septoplasty is modern alternative technique to conventional septoplasty and is a good teaching tool also.

Nasal septum deviation with severe obstruction

The nasal septum is a nasal structure that is anatomically and physiologically has a very important role. Various degrees of nasal septal deformity are present at birth and are thought to increase with age. The diagnosis of septal deviation is established based on clinical symptoms, physical examination and supporting examinations. Investigations such as nasoendoscopy, paranasal sinus X-ray, computer tomography, Peak Nasal Inspiratory Flow (PNIF), Rhinomanometry and Acoustic Rhinometry can be performed to assess the anatomical structure of the nose, nasal obstruction caused, as well as complications from septal deviation. An 18-year-old man came to the ENT clinic at Sanglah Hospital Denpasar with complaints of an aquiline nose since two years ago. Complaints are accompanied by complaints of nasal congestion and headaches. Two years ago, the patient was hit on the nose by his friend. Assess complaints of nasal obstruction using the Nasal Obstruction Symptom Evaluation (NOSE) score to get a score of 60. In this case, the open septoplasty technique was chosen because the patient had a severe degree of nasal obstruction, often had headaches, and the patient also complained of cosmetic problems because the deviation to the contralateral side was evident on the outside of the nose.

Transoral Septoplasty before Le Fort I Downfracture: A Novel Functional Rhinoplasty Technique.

Individuals with maxillary dentofacial deformities commonly have preexisting nasal airway obstruction with associated nasal septal deviation. Combination bimaxillary procedures with intraoral septoplasty after maxillary downfracture have been demonstrated to address dentofacial deformities and nasal obstruction simultaneously. Although effective, current transoral septoplasty techniques offer limited visualization of the superior septum and are challenging to perform due to septal mobility after Le Fort I downfracture. Here, we describe a novel approach in which a transoral septoplasty is performed before completion of the Le Fort I maxillary downfracture, improving septal stability during the dissection and affording better visualization of the septal L-strut for precise cartilage resection.

Septal Reconstruction: Simple to Complex.

Nasal septal deviation is a frequent problem treated by otolaryngologists and facial plastic surgeons. Complete correction of the septal deformity is often essential both for straightening a crooked nose and for restoration of the nasal airway. While standard septoplasty techniques provide excellent outcomes in most patients, severe septal deformities may require treatment with more advanced maneuvers including adjacent grafting, caudal septal replacement, and even extracorporeal septoplasty. This article reviews a range of septoplasty techniques, with an emphasis on complex septal reconstruction and approaches that can be utilized to maintain keystone stability and establish a robust midline L-strut even in cases with challenging anatomy.

Fertility, pregnancy and perioperative outcomes after operative hysteroscopy for uterine septum: a network meta-analysis.

Septate uterus is a congenital malformation associated with adverse reproductive and pregnancy outcomes. It remains controversial whether hysteroscopic septoplasty should be recommended for the treatment of septate uterus, and it is also unclear if different hysteroscopic methods have more favorable outcomes. This study aims to compare the available hysteroscopic techniques of septoplasty for fertility, reproductive, and perioperative outcomes. This systematic review and meta-analysis was conducted following PRISMA guidelines. We searched Medline, Scopus, and Cochrane databases up to April 2023 without language restrictions. Eligible studies had to compare two or more different methods of hysteroscopic septoplasty in women with septate uterus and report on fertility and pregnancy outcomes after a follow-up. Perioperative outcomes were also examined. Data extraction was performed by two independent reviewers using a standardized form. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Form and Revised Cochrane risk-of-bias tool (RoB 2). Out of 561 studies identified, 9 were included in the systematic review and meta-analysis. The comparison of different hysteroscopic septoplasty techniques based on the energy used showed higher pregnancy rates after mechanical septoplasty in comparison to electrosurgery, while miscarriage and live birth rates were comparable. Laser vs. electrosurgery and mechanical techniques of septoplasty had comparable pregnancy, miscarriage, and live birth rates. The network meta-analysis after comparing every different method used showed significantly higher clinical pregnancy rate in scissor group in comparison to resectoscope. No significant differences were found among the techniques regarding miscarriage rate and live birth rate. In summary, this systematic review and network meta-analysis suggests that hysteroscopic septoplasty with scissors is associated with higher pregnancy rates compared to resectoscope. However, the limited evidence available and small sample sizes in the included studies indicate that these findings should be interpreted with caution. Further studies are required to determine the effectiveness of various hysteroscopic techniques and guide clinical decision-making in the management of this condition.

Sliding Spine Relocation Surgery with Anterior Septal Reconstruction.

Study Design: Technical note. Objective: The lower nasal architecture is dependent on caudal septal integrity. Deviations of the caudal septum can compromise nasal airflow. The presence of anterior nasal spine deviations contributes to septal and medial crural shifting with ipsilateral encroachment. It is essential to identify nasal spine deviation during surgery in order to reconstruct the septum in a midline position at its base. This allows an appropriate management plan that creates a better functional and aesthetically pleasing outcome. A stable midline anterior nasal spine is warranted to support the newly reconstructed straight caudal strut, which can be effectively corrected by anterior septal reconstruction. Methods: The proposed method intends to combine anterior nasal spine centralization with correcting caudal septal deviation and nasal obstruction through a modified extracorporeal septoplasty technique. We describe a novel technique to centralize the deviated anterior nasal spine using the piezoelectric device by performing a contralateral adjacent ostectomy and en-bloc relocation and fixation of the anterior nasal spine with microplates and screws. Results: This surgical approach creates a stable caudal septum and a centrally positioned anterior nasal spine, which improves nasal airflow and ensures a stable repair. Conclusion: Sliding spine relocation surgery with anterior septal reconstruction repositions a deviated anterior nasal spine and corrects caudal septum deviation, that can impair the nasal airway.

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.

Toward automatic atlas-based surgical planning for septoplasty.

Surgery for nasal airway obstruction (NAO) has a high failure rate, with up to 50% of patients reporting persistent symptoms postoperatively. Virtual surgery planning has the potential to improve surgical outcomes, but current manual methods are too labor-intensive to be adopted on a large scale. This manuscript introduces an automatic atlas-based approach for performing virtual septoplasties. A cohort of 47 healthy subjects and 26 NAO patients was investigated. An atlas of healthy nasal geometry was constructed. The automatic virtual septoplasty method consists of a multi-stage registration approach to fit the atlas to a target NAO patient, automatically segment the patient's septum and airway, and deform the patient image to have a non-deviated septum. Our automatic virtual septoplasty method straightened the septum successfully in 18 out of 26 NAO patients (69% of cases). In these cases, the ratio of the higher to the lower airspace cross-sectional areas in the left and right nasal cavities improved from 1.47 ± 0.45 to 1.16 ± 0.33 in the region surrounding the septal deviation, showing that the nasal airway became more symmetric after virtual septoplasty. This automated virtual septoplasty technique has the potential to greatly reduce the effort required to perform computational fluid dynamics (CFD) analysis of nasal airflow for NAO surgical planning. Future studies are needed to investigate if virtual surgery planning using this method is predictive of subjective symptoms in NAO patients after septoplasty.

Comparison of Outcomes of Conventional Septoplasty Versus Endoscopic Septoplasty using Freer’s Incision in Symptomatic Deviated Nasal Septum

Background Septoplasty techniques have evolved over the years with endoscopic septoplasty gaining popularity in the recent times.&#x0D; Objective To compare the outcomes of conventional septoplasty with endoscopic septoplasty using Freer’s incision in symptomatic deviated nasal septum.&#x0D; Method It was a prospective, randomized and comparative study done at Department of ENT Head and Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from July 2018 to August 2019. A total of 70 patients with symptomatic deviated nasal septum were allocated randomly into two groups. Group A underwent conventional septoplasty whilst Group B underwent endoscopic septoplasty using Freer’s incision. Sino-nasal outcome test (SNOT-10) score was recorded pre-operatively and post -operatively between four to six weeks of surgery. Paired and independent ‘t’ test for mean was used as a statistical tool.&#x0D; Result Out of 70 patients, 57(81.43%) were males and 13(18.57%) females. The age group mostly affected was in the third and fourth decades with total 47 patients (67.14%). In the conventional group, the pre-op mean SNOT-10 score was 11.46 (SD±3.6) while post-op mean SNOT-10 score was 2.60 (SD±1.9), the difference being statistically significant (p value 0.00001). Similarly, in the endoscopic group, pre-op mean SNOT-10 score was 12.06 (SD±4.88) and post-op mean SNOT-10 score was 3.37 (SD±2.71) with the difference being statistically significant (p value 0.00001). Comparison of post-operative mean SNOT-10 score between two techniques was not statistically significant (p value 0.17).&#x0D; Conclusion Both conventional and endoscopic septoplasty techniques using Freer’s incision were equally effective in improving symptoms due to deviated nasal septum.

Endoscopic septoplasty without nasal packing: our technique and outcomes

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Septoplasty is one of the common procedures performed in otorhinolaryngology practice for treatment of nasal obstruction caused by deviated nasal septum. Septoplasty is traditionally performed using a headlight and nasal speculum. However Endoscopic technique using rigid endoscopes has gained widespread popularity in recent years. Traditionally after correction of septal deviation the mucosal flaps are opposed and held together by some kind of nasal packing to prevent bleeding and septal hematoma. But the nasal pack causes significant morbidity in the post-operative period and also bleeding and pain while pack removal. In the present study we describe our technique of endoscopic septoplasty without nasal packing, in terms of patient comfort and complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;It was a descriptive study, conducted at Subbaiah institute of medical sciences, Shimoga from January 2017 to December 2020 on 50 subjects and the results were analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All 50 patients included in the study had reduced NOSE scores on the 2&lt;sup&gt;nd&lt;/sup&gt; post-operative day itself. None of the patients had septal hematoma, reduced oxygen saturation or post-op sinusitis. 3 out of 50 patients had minimal bleeding in the post-operative period. 12 out of 50 patients had crusting post operatively on 2&lt;sup&gt;nd&lt;/sup&gt; day but none had at 2 weeks. One patient had synechiae and one patient had residual septal deviation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Endoscopic septoplasty is preferred over conventional septoplasty. Trans septal quilting sutures has less complication rate, good quality of life and can be practiced easily and hence a valid alternative to intranasal packing following septal surgery.&lt;/p&gt;

A Novel Septoplasty Technique for Patients With Nasal Fractures.

Nasal structures have both functional and cosmetic significance. These structures maintain the shape of the nose and regulate the nasal airflow. During trauma, fractures of the nasal bone are frequently associated with nasal septum deviations. This can lead to the nasal bone collapsing and nasal obstruction. The septoplasty technique is a major surgical intervention to improve nasal obstructions, with the submucosal resection of the deviated septum. In the past, septoplasty was deferred until the nasal bone fracture was healed to reduce the postoperative risk of saddle-nose and flat nose deformities. Advances in technology have enabled surgeons to attempt septoplasty together with a closed reduction of the nasal bone fraction. It is most important to preserve the septal support structure during surgery. Hence, we advocate that the nasal septum be reset in the midline rather than removed, by modified endoscopic septoplasty.

Modified technique of extracorporeal septoplasty in severe septal deviation

ObjectivesSeptal deviation represent a major cause of aesthetic disorders and respiratory obstruction. The traditional septoplasty techniques may often be inadequate to treat severe deviations. This study was designed to evaluate the effectiveness of the modified technique of extracorporeal septoplasty in terms of subjective improvement in validated NOSE score post-operatively and complications in short term (3months). MethodsA total of 20 patients with severe septal deviation were evaluated in the Otolaryngology Outpatient Department in Al-Immamain Al-Khadimain Medical City, from March 2017 to February 2018. All were undergoing extracorporeal septoplasty (ECS) and assessed pre and post-operatively clinically and endoscopically and subjective evaluation of the respiratory function was obtained by mean of Nasal Obstruction Symptom Evaluation (NOSE) scale which compared with the results obtained preoperatively and at 1 and 3 months post-intervention. ResultsNOSE scores at 1 and 3 months follow-up demonstrated a statistically significant improvement (P < 0.0001) compared to preoperative values. There were no complications recorded. ConclusionsThe modified extracorporeal septoplasty technique proved to be functionally effective at 3-month follow-up in cases of severe septal deviation.

Objective evaluation of caudal deviation of the nasal septum and selection of the appropriate septoplasty technique

ObjectiveSeveral methods have been reported to correct caudal deviation of the nasal septum, including open septorhinoplasty (OSR) and septoplasty with Killian incision (KI). In general, OSR is applied instead of KI for caudal deviation. However, there is little objective evidence own on the effects of OSR and KI for caudal deviation. In this study, we compared surgical outcomes between OSR and KI by quantifying nasal septum deviation using two simple and objective parameters on routine paranasal sinus CT scans. MethodsWe retrospectively analyzed 18 patients who underwent OSR and 11 patients who underwent septoplasty with KI between April 2006 and October 2019. Caudal deviation was defined on the basis of the “Anterior-posterior Position of the most deviated point of the nasal septum (AP),” which was measured on computerized tomography. The deformation rate (DR) of the nasal septum was also calculated. Nasal airway resistance and visual analogue scale (VAS) score for nasal obstruction were examined. ResultsThe AP was significantly correlated with the VAS score (r=-0.58, p=0.017). The DR in patients with caudal septal deviation was significantly decreased by OSR (0.14±0.06 to 0.03±0.03, p=0.004), but not by KI (0.09±0.08 to 0.04±0.03, p=0.25). OSR also improved nasal airway resistance (1.10±0.44 to 0.42±0.15, p=0.02), and the VAS score (79.11±14.74 to 5.78±7.89, p=0.004). ConclusionNasal obstruction is more severe in patients with the caudal deviation. OSR corrects caudal deviation of the nasal septum more effectively than does KI. The AP could be useful for the evaluation of the deviation of the nasal septum and help in selecting the appropriate septoplastic technique.