Evaluation of nasal tip shape in patients with severe caudal septal deviation after modified extracorporeal endonasal septoplasty

Abstract

The aim of this prospective study was to evaluate the effect of modified extracorporeal endonasal septoplasty on nasal tip shape and function in patients with severe caudal septal deviation. Methods: The study population comprised of 55 patients undergoing modified extracorporeal endonasal septoplasty, which called marionette septoplasty. To analyse the aesthetic objective outcomes, postoperative photographs were measured for projection index (PI), tip projection (TP), nasolabial angle (NLA), tip deviation angle (TDA), nasofrontal angle (NFA), supratip height (STH), columellar height (CH), at three times (2 weeks, 3, and 6 months after surgery) and were compared with preoperative photographs. Functional and aesthetic outcomes were also evaluated using nasal obstruction symptom evaluation (NOSE) scale and standardized cosmesis and health nasal outcomes survey (SCHNOS). Results: Between the pre-and post-operative 6th-month examinations, a significant increase in PI and TP were 7%, and 5% respectively. There was a significant alteration in the NLA and TDA values following the last examination (mean difference ± standard error of mean 9.68 ± 0.9 °and 1.5 ± 0.8 °, respectively). Moreover, the technique did not make a significant change in the final NFA, STH, and CH, measurements. Following surgery, the NOSE and SCHNOS scores were decreased significantly and the improvement continued over time until the last examination. Conclusion: The present study findings suggest that the marionette septoplasty technique is an effective to correct and stabilize severe caudal septal deviations. This technique also can provide tip support and protection with a low incidence of dorsal irregularity.

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

“…Previous studies have identified various caudal septal deviations, including deviations and displacements such as anterior subluxation, S or C-shaped deviations, and combinations of vertical and/or horizontal deviations. [8][9][10][11] Modification of caudal septal deviation is considered one of the greatest challenging health issues in septal surgery. While scoring, excision, swingdoor techniques and extracorporeal endonasal septoplasty have been described for correcting deviations of caudal septum, these techniques may not suffice for high-level caudal septal deviations.…”

“…While scoring, excision, swingdoor techniques and extracorporeal endonasal septoplasty have been described for correcting deviations of caudal septum, these techniques may not suffice for high-level caudal septal deviations. 8,12,13 In our study, we performed unilateral batten graft application for high-level deviations of the caudal septum, where the caudal septum was dissected at the base, excess portions were excised, and the batten graft was applied. Our study's findings indicate that dissection of the caudal septum at its base, followed by strip excision and unilateral batten graft placement, can effectively alleviate nasal obstruction symptoms.…”

Long‐Term Outcomes of Septoplasty With or Without Turbinoplasty: A Systematic Review

“…These successful surgical techniques yielded very high long‐term satisfaction rates of 92.3% 42 and 91.1%, 45 meriting further investigation and direct comparison to other techniques. Modified extracorporeal septoplasty and marionette septoplasty are two similar methods that have shown great effectiveness in treating severe septal deformities, 52,59,60 with some studies reporting better outcomes using these techniques than in situ or open septoplasty 60–62 . However, due to the very extensive nature of these techniques in restructuring the entire support system of the nose and surrounding cartilages, both surgical techniques were excluded from the analysis.…”

“…Modified extracorporeal septoplasty and marionette septoplasty are two similar methods that have shown great effectiveness in treating severe septal deformities, 52,59,60 with some studies reporting better outcomes using these techniques than in situ or open septoplasty. [60][61][62] However, due to the very extensive nature of these techniques in restructuring the entire support system of the nose and surrounding cartilages, both surgical techniques were excluded from the analysis. Overall, it appears that these alternative septoplasty techniques generally have higher success rates than standard endonasal septoplasty, but this may be because they are often tailored to treat more severe septal deformities resulting in more noticeable improvement in nasal obstruction.…”