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Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Received: February 19, Published: March 27, Endonasal endoscopic assisted extracorporeal septoplasty in aesthetic reconstruction of crooked nose. DOI: Download PDF. Methods: This is a prospective comparative study was conducted on 60 patients suffering from crooked nose and septal deviation of different etiologies between November and January Patients were randomly equally divided in 2 groups A and B.
Anthropometric changes were assessed from preoperative and postoperative facial photographs. Results: The ECS through endonasal endoscopic assisted approach and in open septorhinoplasty techniques proved to be functionally effective and obtained reasonable straight nasal septum and aesthetic outcome at follow-up in all cases included in the current study. Conclusion: The technique of ECS through endonasal endoscopic assisted approach provided the structural support without destabilizing the keystone area.
Sutures the replanted quadrangular cartilage to the fibrous tissue in the area of the nasal spine under direct endoscopic visualization was easy to perform and effective fixation technique. The present study had some limitations. The study involved a relatively small number of patients, a relatively short follow-up period and an ambiguous indication for ECS.
In these cases, it can appear vaguely C-shaped or S-shaped or wholly displaced to one side or the other. The consequences for the patient are severe in both functional and aesthetic terms, as great difficulty in nasal respiration is always combined with unsightliness that cannot be hidden.
Septal surgery plays a central role in the successful management of the externally deviated nose. Septal surgery procedures are among the most frequently performed otorhinolaryngological procedures which might be very challenging for the surgeon. Classic septal surgery procedures and septorhinoplasty techniques are not usually capable of reliably correcting severe nasal septal deformities.
Quite often the deviation of the external nose persists even after performing septal surgery. Each surgical procedure has its limitations and cannot deal with all the variants of the deformities of the nasal septum. Extracorporeal septoplasty is a newer, rapidly evolving technique for correction of the severely deviated caudal septum. It is the process where in the entire cartilaginous septum is removed, straightened, reinserted, and secured in the nose.
It was first reported by Gubisch. The first area of fixation is the caudal end of the nasal bones, where the cephalic dorsal septum is reattached. He accomplished this by suturing the reconstructed septum to the upper lateral cartilage or by placing a transcutaneous U-suture.
The second point of fixation is the maxillary crest, where the posterior septal angle is reattached. He accomplished this by drilling a hole through the nasal spine and suturing the newly reconstructed neocaudal septum down to the maxillary crest.
This is a prospective comparative study that was conducted on sixty patients suffering from crooked nose and septal deviation of different etiologies attending the outpatient clinic, ENT department, Menufia university hospitals and in our private centres in Egypt, in the period between November and January Patients with age more than 18 and less than 50 years of both sexes with crooked nose and septal deviation were included in the study.
Informed consent was taken from all patients, explaining the procedure, benefits, possible complications and importance of regular follow up postoperatively.
A detailed and comprehensive otorhinolaryngological evaluation of each patient was performed as described in the the study design using subjective evaluation of the nasal patency by mean of Nasal Obstruction Symptom Evaluation NOSE scale. Septal deviation was grouped according to the preoperative evaluation to septal dislocation and deviation.
Types of septal deviations were mild one-third reduction of the nasal cavity , moderate half reduction , and severe two-thirds reduction. To document the state of the nose and septum for the current study we used the examination sheet prescribed by Tebbetts, Position of the patient : The procedure was performed under general anesthesia in supine position with head elevated about 15 degrees and face towards the surgeon.
All instruments used were non-powered instrumentation e. An incision was made at the caudal end of the nasal septum hemitransfixation. The incision was made on the concave side of the septum to expose the abnormality at the bony cartilaginous junction. Flap elevation in the correct cleavage plane to minimize the bleeding.
Exposure was limited to the target area. The flap elevated was limited as it was raised from over the most deviated portion of the nasal septum, without disturbing the rest of nasal septum. Septal cartilage was incised parallel but posterior to the flap incision and caudal to the deviation. Deviated portions of bone from the vomer or perpendicular plate of the ethmoid were removed as necessary. This step was followed by bilateral extramucosal dissection of the junction of the border between the caudal septum and upper lateral cartilage to preserve an intact mucosal cover.
The upper lateral cartilages were incised bilaterally at their junction with the septum after extramucosal dissection. This maneuver made the nasal septum more flexible and made mucosal dissection easier and more accurate. The entire septal cartilage was dislocated from its suture line with maxillary and or palatine crests. If there was a bony septal spur at this area a paramedian osteotomies were used to free the nasal septum along its inferior border.
The complete cartilaginous and bony septum was then excised along its superior border except for the remaining few millimeters of the dorsal strip at the keystone area and removed in 1 piece if possible. Several technical options were used to create a straight septal plate which needs usually the dimensions of 30 mm. The ideal reconstructed plate would be as large as possible, with stable upper and anterior borders.
Redundant cartilage and fracture lines can be excised and sutured together to provide a stable reconstructed nasal septum. Partial-thickness releasing incisions on the concave side of the cartilage with a knife may straighten the bent cartilage Figure 1.
Smoothing the cartilage and bone with a sharp drill may be necessary. If the cartilage was straight but soft and unstable, 2 options exist to stabilize it. Smoothly filed pieces of the lamina perpendicularis of the ethmoid bone could be sutured to the cartilaginous septum Figure 2. Figure 1 Twenty-year-old man with a deviated nose after trauma. A, Removed nasal septum demonstrating deviated cartilage. B, Straight septum after excision of some cartilage and partial thickness releasing incisions on the concave side of the cartilage.
Figure 2 A, The removed nasal septum demonstrates cartilage that is thin, weak, and without support. A thin piece of the perpendicular plate of the ethmoid was harvested for stabilization of the cartilage. B and C, Reconstructed septum as cartilage-bone sandwich in dorsal L-strut cutting and suture technique, with the dimension of 30 mm. Multiple small holes have been drilled in the lamina perpendicularis to allow suture placement and tissue in growth.
In post-traumatic cases with multiple fractures sites and cartilaginous fragments healed in the wrong position, it was often possible to dissect and preserve many pieces of straightened cartilage.
These could be used to construct a neoseptum Figure 3. Figure 3 Nineteen-year-old woman with a crooked nose and deviated nasal septum secondary to trauma. A, Removed of nasal septum. Fracture lines at sites of cartilage dislocation B, Straight, reconstructed septum after excision of redundant dislocated cartilage. C, The reconstructed straight septal plate before reinsertion. The neoseptum was then replanted between the two perichondrial and subperiosteal layers.
Stable fixation of the replanted septum was essential for permanent aesthetic and functional success. The new upper septum border was positioned at the height of the lateral cartilage, temporarily fixed with needles if necessary, and reconnected to the lateral cartilages using 2 sutures Figure 4 use of a U-shaped suture pattern is recommended to secure the cartilage and allow final modifications of the dorsum without cutting the suture if indicated.
The replanted nasal septum was sutured to the fibrous tissue in the area of the nasal spine under direct endoscopic visualization. Figure 4 Possible ways of securing the replanted nasal septum, Fixation on the lateral cartilage with polydioxanone suture. The hemitransfixion incision was closed. A quilting suture was placed in the anterior septum, leading from caudal to cranial and back, to approximate the nasal mucosa, prevent dead space and hematoma formation, and further stabilize the replanted septum.
Silicone nasal septum splints were inserted and Meroce nasal packs were applied. Group B: Thirty patients with crooked nose and septal deviation that caused nasal deformity and air way obstruction were treated with extracorporeal septo-rhinoplasty through open approach.
All the cases were done under general anesthesia. The procedure was carried out as described by Gubisch A. Post-operatively patients were put on antibiotics at least for a week, along with analgesics and decongestants. Nasal packs were removed 48 hours after the surgery. Saline nasal douching was advised for a week. Patients were followed up on seventh day and then monthly up to six months. At each follow up visit, subjective and objective assessment was done.
Subjective assessment was done by asking about nasal obstruction, headache, nasal discharge, hyposmia, post nasal discharge. Objective assessment was done clinical and with diagnostic nasal endoscopy.
Photography: Postoperative regular follow up photography was conducted for at least two month. Preoperative and postoperative photographs were studied to evaluate surgical outcome Figure 5.
Figure 5 Male patient 28 years old with history of trauma. Assessment of deviation improvement was based on comparisons between the preoperative photograph and the postoperative photograph at the final follow-up. Postoperative history was reviewed to assess complications, including postoperative infection, postoperative deformity e.
The outcomes of surgery were measured. Unpaired t test was used to measure the outcome with respect to nasal patency. Chi square test was used to measure the outcome with respect to other signs, symptoms and complications. This study was conducted on sixty patients suffering from crooked nose and septal deviation of different etiologies attending the outpatient clinics of ENT department, Menufia university hospitals and Prof. Patients of this study are randomly divided in 2 groups A and B:.
Those patients had different complaints. After history taking and examination, 22 patients
Extracorporeal Septoplasty for the Markedly Deviated Septum
Background: Among the different operations for septoplasty, the extracorporeal septoplasty technique basically consists in the removal of all the nasal septum, the correction of bone and cartilage deformities, and their replacement with a particular suture technique to correct the markedly deviated nasal septum especially in the internal nasal valve area. The drawbacks of this surgery technique are as follows: swelling of the mucosa in the valve area and restenosis, the development of saddle nose and septal hematoma. The aim of this study is to describe our results with a modified suture technique of the extracorporeal septoplasty ECS , taking into account the operative time and functional results. Patients and Methods: A retrospective chart review of adult patients treated with extracorporeal septoplasty from January to December was performed in a primary care centre in Imola city, Italy. Preoperative and postoperative evaluations were done using rhinomanometry and acoustic rhinometry. Results: We followed up a total of cases in our centre. Three patients 2.
The Role of Extracorporeal Septoplasty in Severely Deviated Nasal Septum
We'd like to understand how you use our websites in order to improve them. Register your interest. 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.
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If the address matches an existing account you will receive an email with instructions to reset your password. If the address matches an existing account you will receive an email with instructions to retrieve your username. To describe a technique of extracorporeal septal reconstruction to correct the markedly deviated nasal septum. Retrospective medical chart review of patients undergoing extracorporeal septoplasty from January 1, , through July 31, , by the author in a tertiary care facial plastic surgery center. Of the patients, 2 cohorts were available for review. From January 1, , to July 31, , the author performed the operation on patients. From January 1, , to December 31, , the author supervised residents performing extracorporeal septoplasty in patients.