Twenty-Five Years Experience with Extracorporeal Septoplasty

Abstract

Even today, the difficult septum presents a surgical problem. A severe septum deformity is caused mostly by an accident or is seen in patients with malformations such as cleft lip and palate deformity. It is characterized by a massive malformation in all levels with consecutive blocking of one or both airways. Such marked septal deformities cannot be corrected properly by standard septoplasty techniques. Therefore, in such cases we suggest an extracorporeal septoplasty, where we take out the whole septum and reconstruct a new septal plate by different techniques followed by replantation and reconstruction of the cartilaginous dorsum. From January 1, 1981 to December 31, 2005, we operated on 2301 patients and improved this method constantly, especially the safe septal fixation and rebuilding of the cartilaginous dorsum. Follow-ups showed that even in severe deformities a revision rate of only 5% respectively 7% was found. Therefore, we conclude that the extracorporeal septoplasty with its refinements and the way we are doing it today can also be recommended to less experienced rhinosurgeons.

Revision Rates and Risk Factors of 175 842 Patients Undergoing Septorhinoplasty

“…The largest published retrospective study 9 to date of revision septoplasty cases (2168 patients in Scotland) found a similar revision rate between 3.2% and 4.4%. Other studies 10,11 show a slightly higher revision rate between 5% and 8% but again are limited in sample size and follow-up and were conducted at single institutions. Patients undergoing more complex surgical procedures such as cleft septorhinoplasty had a significantly higher revision rate of 16.9%.…”

“…In the literature focusing on specific rhinoplasty techniques, the revision rate varied from 4% to 15.5%. 3,4,7,8 In the septoplasty literature, a large study 9 of 2168 septoplasties by any technique showed a revision rate of 3.2% among experienced surgeons, while studies 10,11 focusing on specific septoplasty techniques showed higher revision rates of 7% to 8%. 9–11 In addition, there may be an underestimation of the revision rates reported in the literature because the authors of single-surgeon or single-institution studies 1–11 review their own respective data and do not include patients who seek revision surgery at another institution, thereby lowering the reported revision rates.…”

Evidence-Based Medicine

“…These can be generally categorized into 2 types: in situ septoplasty techniques (including septal repositioning, 27 scoring and morselization, 28 suture techniques, 29 and septal batten graft) 30,31 and extracorporeal septoplasty techniques. 32,33 Generally, in situ septoplasty is reserved for less severe caudal deviations, whereas extracorporeal septoplasty is used in severe deviations or in deviations that persist after in situ techniques. Supporting this notion, Lee and Jang 34 performed a retrospective review comparing these 2 techniques in 169 subjects with caudal septal deviation and found that, although both could be performed with similar aesthetic outcomes, subjects who underwent extracorporeal septoplasty achieved superior functional results and were less likely to suffer from persistent or unresolved nasal obstruction (level 3 evidence).…”

Augmenting the Nasal Airway: Beyond Septoplasty

“…Alternatively, a polydioxanone, PDS Flexible Plate (Ethicon, Inc., Somerville, NJ) may be used to augment reconstructed septum 18,20 (Fig. 3).…”