Comparison of Primary and Secondary Anterior Septal Reconstruction: A Cohort Study

Spataro, Emily A.; Olds, Cristen; Nuyen, Brian; Kandathil, Cherian K.; Most, Sam P.

doi:10.1055/s-0038-1667154

Cited by 7 publications

(7 citation statements)

References 6 publications

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“…7 A modification of this method, the ASR technique, has been shown to significantly reduce nasal obstruction symptoms after both primary and revision septorhinoplasty. 12,13 This modification preserves a segment of the dorsal septum and thereby maintains integrity of the keystone area unlike in traditional extracorporeal septoplasty. 10 Notably, the dorsal surface of the quadrangular cartilage is without bony fixation and therefore relies on the osseocartilaginous interactions at the keystone for structural stability.…”

Section: Discussionmentioning

confidence: 99%

“…The extracorporeal septoplasty technique has been advocated for deviations of the antero‐caudal septum as they are less amenable to standard septoplasty techniques 7 . A modification of this method, the ASR technique, has been shown to significantly reduce nasal obstruction symptoms after both primary and revision septorhinoplasty 12–13 . This modification preserves a segment of the dorsal septum and thereby maintains integrity of the keystone area unlike in traditional extracorporeal septoplasty 10 .…”

Section: Discussionmentioning

confidence: 99%

“…This technique significantly reduces short-and long-term nasal obstruction symptoms after both primary and revision septorhinoplasty and is the senior author's preferred method of treatment for most caudal septal deviations that impinge on the nasal airway. 12,13 Dorsal hump reduction can include removal of either bone, cartilage, or both, with or without osteotomies. In the setting of a simultaneous ASR, there may be an increased risk of destabilizing the keystone area, and this could theoretically attenuate the benefit of this septoplasty technique.…”

Section: Introductionmentioning

confidence: 99%

“…It allows for complete removal of the affected severe antero‐caudal septal deviation and reconstruction of the caudal strut using a neostrut created from either rib or septal cartilage. This technique significantly reduces short‐ and long‐term nasal obstruction symptoms after both primary and revision septorhinoplasty and is the senior author's preferred method of treatment for most caudal septal deviations that impinge on the nasal airway 12–13 …”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Combined Anterior Septal Reconstruction and Dorsal Hump Reduction

2020

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Objectives/Hypothesis: Deviations of the caudal nasal septum can impact airflow and aesthetics. The anterior septal reconstruction (ASR) technique, a modification of extracorporeal septoplasty, addresses this issue while preserving a segment of the dorsal septum. When ASR is combined with dorsal hump reductions and osteotomies, the keystone may be destabilized. This study evaluates the outcomes of this intervention. Study Design: Retrospective chart review. Methods: This is a retrospective study evaluating the functional and aesthetic outcomes of 58 patients who underwent ASR combined with dorsal hump reductions (with or without osteotomies). The Nasal Obstruction Symptom Evaluation (NOSE) and Standardized Cosmesis and Health Nasal Outcomes Survey Obstructive/Cosmetic (SCHNOS-O, SCHNOS-C) scores were measured and compared pre-and postoperatively. Linear regression analysis was performed to determine the impact of sex, gender, osteotomies, and trauma on outcomes. Results: Mean improvement in NOSE, SCHNOS-O, and SCHNOS-C scores within the first 3 months after surgery were −41.8, −32.6, and −51.5 respectively (P < .05). At follow-up >9 months, these improvements were also significant for NOSE and SCHNOS-O scores and approached significance (P = .06) for SCHNOS-C scores. A subanalysis of patients who underwent osteotomies yielded functional and aesthetic improvements across all follow-up periods, all of which were significant with the exception of SCHNOS-O scores at >9 months (P = .1). In a multiple linear regression analysis, osteotomies contributed significantly to change in SCHNOS-C scores (β = −64.09, P = .001) at 3-to 9-month follow-up. Conclusions: The combination of ASR, hump take down, and osteotomies is safe and efficacious with implications for patients who seek correction of caudal septal deviations in conjunction with changes in external contour deformities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of Combined Anterior Septal Reconstruction and Dorsal Hump Reduction

2020

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“…Finally, in the event that the caudal strut has to be removed (e.g., anterior septal reconstruction), keeping a subdorsal strut of cartilage allows the new caudal strut to be stabilized to the dorsum. 26,27 Indications Interestingly, Saban notes that 41% of his patients still undergo conventional Joseph hump resections. 18 In general, DP is limited to primary cases and in patients with a moderately kyphotic hump.…”

Section: Dorsal Preservation Rhinoplasty Techniquesmentioning

confidence: 99%

A Review and Modification of Dorsal Preservation Rhinoplasty Techniques

Patel

Abdelwahab

Most

2020

Facial Plastic Surgery & Aesthetic Medicine

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Importance: Although conventional hump resections are a hallmark of rhinoplasty, there has been a rekindled interest in dorsal preservation (DP) techniques as a means for addressing the dorsal hump, with claims of superior functional and aesthetic results. As such, an understanding of DP, including technical considerations and outcomes, is imperative. Observations: DP allows for mobilization of the osseocartilaginous nasal vault as a single unit and thereby prevents disruption of the natural keystone area. The osseous nasal vault is managed with a transverse osteotomy and either a bilateral single lateral osteotomy (pushdown procedure) or bilateral bony wedge resections (letdown procedure) to allow for descent of the nasal dorsum. A variety of approaches to the septum exist, each differentiated by the location of cartilage resection: subdorsal, high-septal, midseptal, or inferior septum. These techniques result in pleasing dorsal aesthetic lines but may be limited by a higher rate of dorsal hump recurrence. Patency of the internal nasal valve (INV) is theoretically improved with DP. Robust series with patientreported outcomes are lacking, although several reports and early experience at our center with a newly described high-septal resection technique do suggest positive functional and cosmetic outcomes with DP. Conclusions and Relevance: With the recent revitalized interest in DP, an understanding of the potential benefits, techniques, and challenges associated with this surgery is helpful. Maintenance of the dorsum as a single unit has implications for maintaining structural integrity at the nasal keystone, pleasing dorsal aesthetic lines, and the patency of the INV. As surgeons continue to develop and employ these techniques, critical assessment of patient-reported outcomes and objective nasal measurements, with an emphasis on comparison with standard hump takedown techniques, will be valuable.

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