Triangular excision and submucosal rejoining to correct horizontally folded caudal nasal septum

Abstract

Background: Surgical correction of severe caudal deviation of nasal septum using an endonasal approach is challenging for surgeons. Among cases of severe caudal septal deflection, fracture lines along the horizontal direction are occasionally encountered during the surgery. We devised a simple and efficient technique called "triangular excision and submucosal rejoining" to address this kind of deformity.Methods: A total of 9 patients with severe caudal septal deflection underwent "triangular excision and submucosal rejoining." A er the removal of the deformed posteroinferior portion of the quadrangular cartilage, 2 incision lines were made on the remaining caudal septum, starting from a point at the most anterior portion of the fracture line and diverging posteriorly above and below the fracture line. After removing a triangular cartilaginous piece, the upper and lower remaining cartilage segments were approximated using a single or 2 simple interrupted sutures. Sutures exiting the mucosa were re-entered from the exit point so that all the sutures were buried underneath the mucosa while the mucosal flap was elevated only unilaterally. Results:This technique was effective in all cases. Septal ba en gra s were applied in 3 patients, in whom the remaining quadrangular cartilage was weak and thin. One patient showed a mildly recurred septal deviation, but the nasal cavities remained patent with no symptoms. Serious complications such as dorsal saddling or tip ptosis did not occur in any cases.Conclusion: "Triangular excision and submucosal rejoining" may be a safe and efficient septoplasty technique to correct a horizontally folded caudal septum. C 2019 ARS-AAOA, LLC.

Wedge resection combined with 3D-printed polycaprolactone mesh for caudal septal deviation

“…Hosokawa et al introduced modified technique that connects the cartilage bank to the anterior nasal spine to avoid adding batten grafts, but the risk of pollybeak deformity persists if the cartilage is cut excessively [ 17 ]. Jeon et al devised a triangular excision and submucosal rejoining technique using the natural fracture line formed on the quadrangular cartilage, but it is of limited use when the fracture line does not involve the most-bent portion of the caudal septum [ 18 ]. The wedge resection technique used in this study is not only useful for reducing the cartilage length, but also effective in eliminating septal curvature and internal cartilage memory by removing most of the deviated portion of the cartilage.…”

Correcting Caudal Septal Deviation with a Modified Horizontal Mattress Suture

“…4 Multiple techniques have been described for caudal septal deviation correction using grafting techniques; however, correction with isolated suture technique as described in our paper is limited. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] One of these articles had some similarities to the technique we described. However, in comparison with our technique, the previous author separated cartilage from the maxillary crest by excising a thin strip of cartilage.…”

Evolving management of upper airway diseases: focus on Asia

“…Surgical correction of severe caudal deviation of the nasal septum using an endonasal approach is always challenging for surgeons. From this viewpoint, Jeon et al . developed the “triangular excision and submucosal rejoining” technique, which is a simple, safe, and effective septoplasty technique for addressing and correcting a horizontally folded caudal septum.…”