Septal Surgery in Rhinoplasty

ABSTRACT

In general, septoplasty precedes all other procedures in rhinoplasty because a straight, stable septum dictates profoundly the aesthetic and functional outcome. The patient's history and expectations, proper preoperative analysis, and the surgeon's skills determine the way to proceed in septum correction. As a rule of thumb, slight deviations (e.g., single vomer spurs, maxillary crests, the septal tilt, and simple C-shaped deformities) may be managed endonasally using the hemitransfixion incision and procedures such as the swinging door technique, scoring incisions, batten grafts, or caudal septal replacement grafts. By contrast, for S-shaped and severe wavelike deviations, the cleft nose, the multiple fractured septum, and for most revisional cases, the open approach with extracorporeal septum reconstruction has been found to be the method of choice. After initial general remarks on the basic procedures, this article focuses on current concepts of septum correction that have to be adapted to the individual pathologic condition.

KEYWORDS

Septum - septal deviation - septoplasty - septum reconstruction - rhinoplasty

REFERENCES

• 1 Killian G. Die submuköse Fensterresektion der Nasenscheidewand.  Arch Laryng Rhin (Berlin). 1904;  16 326
• 2 Freer O. The correction of deflections of the nasal septum with minimum of traumatism.  JAMA. 1902;  38 636-692
• 3 Metzenbaum M. Replacement of the lower end of the dislocated septal cartilage vs. submucous resection of the dislocated end of the septal cartilage.  Arch Otolaryngol. 1929;  9 282-292
• 4 Peer L. An operation to repair lateral displacement of the lower border of septal cartilage.  Arch Otolaryngol. 1937;  25 475-477
• 5 Peer L. An operation to repair lateral displacement of the lower border of septal cartilage.  Arch Otolaryngol. 1937;  25 185-198
• 6 Cottle M H, Loring R M, Fischer G G, Gaynon I E. The maxilla-premaxilla approach to extensive nasal septum surgery.  AMA Arch Otolaryngol. 1958;  68 301-313
• 7 King E D, Ashley F L. The correction of the internally and externally deviated nose.  Plast Reconstr Surg (1946). 1952;  10 116-120
• 8 Perret P. [Surgical correction of nasal deviation].  Pract Otorhinolaryngol (Basel). 1958;  20 115-124
• 9 Gubisch W. [Cleft nose correction in unilateral cleft formation].  HNO. 1989;  37 415-422
• 10 Gubisch W. The extracorporeal septum plasty: a technique to correct difficult nasal deformities.  Plast Reconstr Surg. 1995;  95 672-682
• 11 Zachow S, Steinmann A, Hildebrandt T, Weber R, Heppt W. CFD simulation of nasal airflow: towards treatment planning for functional rhinosurgery.  International Journal of Computer Assisted Radiology and Surgery, I. Springer. 2006;  165-167
• 12 Pirsig W. Growth of the deviated septum and its influence on midfacial development.  Facial Plast Surg. 1992;  8 224-232
• 13 Kamer F M, Churukian M M. High septal hemitransfixion for the correction of caudal septal deformities.  Laryngoscope. 1984;  94 391-394
• 14 May H. The Réthi incision in rhinoplasty.  Plast Reconstr Surg (1946). 1951;  8 123-131
• 15 Hwang P H, McLaughlin R B, Lanza D C, Kennedy D W. Endoscopic septoplasty: indications, technique, and results.  Otolaryngol Head Neck Surg. 1999;  120 678-682
• 16 Giles W C, Gross C W, Abram A C, Greene W M, Avner T G. Endoscopic septoplasty.  Laryngoscope. 1994;  104 1507-1509
• 17 Getz A E, Hwang P H. Endoscopic septoplasty.  Curr Opin Otolaryngol Head Neck Surg. 2008;  16 26-31
• 18 Kamami Y V. Laser-assisted outpatient septoplasty results on 120 patients.  J Clin Laser Med Surg. 1997;  15 123-129
• 19 Protsenko D E, Wong B J. Laser-assisted straightening of deformed cartilage: numerical model.  Lasers Surg Med. 2007;  39 245-255
• 20 Zuckerkandl E. Normale und pathologische Anatomie der Nasenhöhle und ihrer pneumatischen Anhänge. Bd. I. Wien, Germany: Wilhelm Braumueller; 1882
• 21 Mlynski G. Restorative procedures in disturbed function of the upper airways – nasal breathing.  GMS Curr Top Otorhinolarnygol Head Neck Surg. 2005;  4 07
• 22 Rettinger G. [Autogenous and allogeneic cartilage transplants in head and neck surgery (excluding middle ear and trachea)].  Eur Arch Otorhinolaryngol Suppl. 1992;  1 127-162
• 23 Byrd H S, Andochick S, Copit S, Walton K G. Septal extension grafts: a method of controlling tip projection shape.  Plast Reconstr Surg. 1997;  100 999-1010
• 24 Pirsig W, Kern E B, Verse T. Reconstruction of anterior nasal septum: back-to-back autogenous ear cartilage graft.  Laryngoscope. 2004;  114 627-638
• 25 Pham A M, Tollefson T T. Correction of caudal septal deviation: use of a caudal septal extension graft.  Ear Nose Throat J. 2007;  86 142 144
• 26 Foda H M. The caudal septum replacement graft.  Arch Facial Plast Surg. 2008;  10 152-157
• 27 Gubisch W. Twenty-five years experience with extracorporeal septoplasty.  Facial Plast Surg. 2006;  22 230-239
• 28 Daniel R. Mastering Rhinoplasty: A Comprehensive Atlas of Surgical Techniques. 2nd ed. New York, NY: Springer; 2010
• 29 Bönisch M, Mink A. [Healing process of cartilage attached to a polydioxanone implant].  HNO. 2000;  48 743-746
• 30 Fuchshuber G. Komplikationen bei der Nasenseptum-Rekonstruktion mit Polydioxanonfolie. [thesis] Heidelberg, Germany: Medical Department of Ruprecht-Karls-University; 2003
• 31 Becker H. Paraffinoma as a complication of nasal packing.  Plast Reconstr Surg. 1983;  72 735-736