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

Abstract

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.

Outcomes of Extracorporeal Septoplasty and Its Modifications in Treatment of Severe L-Strut Septal Deviation

“…Of 31 studies, 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%), while the other 15 (48.4%) were modifications of this technique, although heterogeneity of each technique used for every study was present. Sample size varied from 10 to 567, and the mean age varied from 22.5 to 46 years (Table 1).…”

“…Of the included 31 studies, methodologically, 14 (45.2%) were considered to be good, 11 (35.5%) were considered poor, and 6 (19.3%) were considered fair (eTable 2 in the Supplement).…”

“…Rates of complications and/or revision surgery were reported in 24 studies (77.4%) (eTable 1 in the Supplement): infection rates ranged from 0% to 8.9%; bleeding from 0% to 6.25%; dorsal irregularities from 0% to 12.5%; and revision surgery from 0% to 14%. Of the 11 studies (35.5%) on modified ECS (pooled n = 695, only including groups of interest), there were 6 infections (0.80%), no bleeding events, 12 nasal dorsal irregularities (1.7%), 6 other cosmetic complications (0.86%), and 7 other functional complications (1.0%). Of 3 studies reporting revision rates (n = 230), there were 19 revision operations (8.3%).…”

“…Complication and/or revision surgery rates were reported in 24 studies, 11 using the modified ECS, and 13 using conventional ECS (eTable 1 in the Supplement). Pooled data analysis comparing modified vs conventional ECS resulted in statistically significant difference in the relative risk of nasal dorsal irregularities 0.29 (95% CI, 0.16-0.53).…”

Triangular Resection of the Upper Lateral Cartilage for Middle Vault Deviation

“…Another disadvantage of a spreader graft is that it requires septal cartilage harvest; sometimes conchal or costal cartilage is required in cases of revision septoplasty or with a severely deviated septum [ 19 ]. If the harvesting of ear or rib cartilages is necessary, surgeons often worry about donor site morbidities; the associated procedures are also time-consuming and laborious.…”