Extracorporeal Septoplasty for the Markedly Deviated Septum

Abstract

To describe a technique of extracorporeal septal reconstruction to correct the markedly deviated nasal septum. Design: Retrospective medical chart review of 2119 patients undergoing extracorporeal septoplasty from January 1, 1981, through July 31, 2004, by the author in a tertiary care facial plastic surgery center. The main outcomes measured included surgical complications, revision rate, and the surgeon's subjective determination of functional and aesthetic outcomes. Results: Of the 2119 patients, 2 cohorts were available for review. From January 1, 1981, to July 31, 1987, the author performed the operation on 459 patients. Fiftyseven complications (12%) occurred, with irregular contour of the dorsum or saddling noted in 38 (8%). Twenty patients (4%) elected to have revision septoplasty. From January 1, 1996, to December 31, 1996, the author supervised residents performing extracorporeal septoplasty in 108 patients. Fourteen postoperative complications (13%) occurred, with dorsal irregularity noted in 12 (11%). Eight patients (7%) elected to have revision septoplasty. Conclusions: 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.

Oblique Septal Crossbar Graft for Anterior Septal Angle Reconstruction

“…With the extracorporeal approach, most of the septum is excised and recontoured ex vivo, followed by reimplantation. 15 This technique is predicated on a relatively straight posterior portion of the septum, which will be midline once the graft is in place. When the septum is removed, a dorsal cartilaginous strut is preserved in the keystone area, which will serve as an anchor point for the reimplanted septum.…”

Biodegradable polymer membrane used as septal splint

“…Several techniques of septal reconstruction have been published. Septoplasty techniques include suture techniques for correct bending, 12 septal crossbar graft 1,2 and extracorporeal remodelling 13 . The use of spreader grafts from autologous cartilage is also well documented, 7,21,25 but this is dependent on the amount of stable and straight graft material.…”

Role of Extracorporeal Septoplasty in Deviated Noses

“…It was first discussed in the 1950s by King and Ashley [3]. Gubisch, [1,4], [5], was the first to publish a large and highest series on this topic in 1995. That series included more than 1000 patients during a 15-year clinical experience.…”