Internal Nasal Valve Modification via Correction of High Dorsal Deviation Using a Modified Mattress Suture Technique

Abstract

High dorsal deviation of the septum can cause nasal obstruction due to internal nasal valve (INV) stenosis. We have developed a new technique using a modified mattress suture on the bony-cartilaginous junction to correct high dorsal septal deviation. This study focused on the effect of this suturing technique on the modification of the INV. We enrolled 40 patients who underwent septoplasty using a modified mattress suture technique. We retrospectively analyzed the data of the preoperative and postoperative INV angles and cross-sectional areas (CSAs), which were measured using computed tomography. In addition, we compared the patients’ subjective nasal symptoms, which were measured with the preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) instrument. Postoperative increases in the narrow side INV angle and CSA were achieved. Additionally, the wide side INV angle and CSA were significantly decreased postoperatively. The INV and CSA ratio (wide/narrow) were also decreased postoperatively and were brought closer to 1. The subjective nasal symptoms also exhibited significantly reduced NOSE values. In this study, we confirmed the effects of septoplasty using a modified mattress suture technique for INV modification through the comparison of the preoperative and postoperative INV angles and CSAs

One-Unit Osteotomy to Correct Deviated Bony Dorsum

“…Through the “modified mattress suture” technique, the deviated PPE can be moved to the midline by a greenstick fracture at the subdorsal area, and the corrected PPE can be fixed and stabilized by suturing it with septal cartilage. This technique enables internal nasal valve modification by correcting high dorsal deviation leads to improved functional outcomes [ 7 ]. In addition, a greenstick fracture was performed at the PPE below the dorsum, thereby enabling a fully mobilized nasal pyramid by dividing the residual bony septum from the nasal bone.…”

“…Before correction of the external nose, endonasal septoplasty was first performed using customized procedures depending on the individual status of the nasal septum. In addition, we performed “modified mattress suture technique” between the bony and cartilaginous dorsal septum in most of the patients, which was invented by the corresponding author of this study because high dorsal septal deviation is usually accompanied by bony vault deviation [ 6 , 7 ]. During this septoplasty technique, a green stick fracture is usually inflicted on the dorsal area of the perpendicular plate of the ethmoid (PPE) after partial thickness osteotomy with a 2-mm osteotome, which facilitates correction of the dorsum through bony septal separation from nasal bone ( Fig.…”

“…1D ). The detailed septoplasty technique was described in previous articles [ 6 , 7 ]. This technique using 4-0 Vicryl suture with double-arm needles can correct the fractured PPE and the septal cartilage including subdorsal area by applying tension on the convex side by suture tightening.…”