The Role of Extracorporeal Septoplasty in Severely Deviated Nasal Septum

Abstract

Extracorporeal septoplasty is a valuable tool in the armamentarium of the nasal surgeon for the reconstruction of the severely deviated septum. Extracorporeal septoplasty offers the surgeon the opportunity to correct the septum under direct visualization, shape the nasal vault and address the nasal dorsum with the ultimate goal of providing both form and function for the patient with a complex septal deviation. The study was conducted with the aim to measure the outcomes of extracorporeal septoplasty in severely deviated nasal septum, relief of symptoms (nasal obstruction), surgical complications, if any, revision, if any with objective to evaluate the functional outcome and aesthetic aspects of extracorporeal septoplasty. This was a prospective observational study of 35 patients with severe deviated nasal septum with or without external deformity of nose attending the ENT OPD between Jan 2015 and Jan 2016 at Sri Aurobindo Medical College and Post Graduate Institute, Indore (M.P.). In this study, 17 patients (48.57%) shows excellent improvement on VAS scale, out of which 13 patients shows excellent improvement and 4 patients shows good improvement on photographic assessment. 11 patients (31.43%) show good improvement on VAS as well as photographic assessment and 7 patients (20%) show moderate improvement on VAS scale and fair improvement on photographic assessment. Extracorporeal septal reconstruction is an important surgical option for the correction of the markedly deviated nasal septum. Fixation of the straightened and replanted septum at the nasal spine and dorsal septum border with the upper lateral cartilages is essential. Spreader grafts for stabilization of the internal nasal valve and dorsal onlay grafts to prevent dorsal irregularity are strongly encouraged.

Outcomes of Endonasal Septoplasty and Extracorporeal Septal Reconstruction in Anterocaudal Septal Deviation

“…This study demonstrated that ESR could significantly improve postoperative nasal patency. About the evaluation of the aesthetic outcomes in ESR technique, Baser et al 20 described the postoperative aesthetic outcomes in ESR technique with 35 patients. This study reported that 32 (91.43%) patients showed significant improvement of aesthetic satisfaction and only 3 (8.5%) patients showed there is no improvement.…”

“…This study demonstrated that ESR could significantly improve postoperative nasal patency. About the evaluation of the aesthetic outcomes in ESR technique, Baser et al 20 Because of the limitation of ES technique, the outcomes of the nasal obstruction were significantly less improved and it was not effective in improving the nasal aesthetic satisfaction. About the surgical complications, Dąbrowska-Bien ét al 24 conducted a study about the complications of nasal septoplasty in a large group of 5639 patients.…”

“…Higher scores meant serious nasal obstruction. According to the NOSE Scale results, the patients were categorized as mild (1-5), moderate (6)(7)(8)(9)(10), severe (11)(12)(13)(14)(15), or extreme (16)(17)(18)(19)(20).…”

Management of the Middle Vault

“…Although many of these changes occur gradually over a period of years, middle vault anatomy has been increasingly emphasized in an effort to reduce these factors that lead to nasal valve compli-cations. 3,4 While dorsal preservation rhinoplasty is not the focus of this article, recent increased interest in these techniques is, in part, due to the avoidance of a need for middle vault reconstruction. By preserving the dorsal anatomy in lieu of traditional dorsal hump excisional techniques, dorsal preservation rhinoplasty avoids many of the functional and cosmetic middle vault issues seen with other approaches.…”

“…13 Suture techniques to fix the caudal portion of the neoseptum to avoid narrowing of the internal nasal valve is vital. 3 Classic extracorporeal septoplasty has a significant rate of postoperative dorsal irregularity and, occasionally, saddle-nose deformity. A modification of the extracorporeal septoplasty technique to minimize these complications is anterior septal reconstruction or transplantation, where the majority of the dorsal strut is left intact and the caudal strut is replaced.…”