Caudal septoplasty: efficacy of a surgical technique-preliminary report

Leonardo Bomediano Sousa Garcia, Pedro Wey de Oliveira, Tatiana de Aguiar Vidigal, Vinicius de Magalhães Suguri, Rodrigo de Paula Santos, Luis Carlos Gregório, Leonardo Bomediano Sousa Garcia, Pedro Wey de Oliveira, Tatiana de Aguiar Vidigal, Vinicius de Magalhães Suguri, Rodrigo de Paula Santos, Luis Carlos Gregório

Abstract

Although not being the most frequent nasal septal deviations, those of the caudal septum account for many complaints. The correction of such defects has always been the subject of much controversy, and several different operative techniques have been described.

Aim: To assess the efficacy of a surgical technique for correcting caudal septal deviations.

Materials and methods: Prospective study with preliminary reports of 10 patients who answered a standardized, specific questionnaire (the Nasal Obstruction Symptom Evaluation, or NOSE), underwent acoustic rhinometry and had their noses photographed. Caudal deviations were then corrected through a surgical technique whereby the entire deviated portion is removed and a straight cartilage segment is placed between the medial crura of the alar cartilages, through a retrograde approach, to support the nasal tip. Sixty days after all patients were reassessed.

Results: As for the NOSE questionnaire, mean pre-operative and post-operative scores were 82.39 and 7.39 respectively (p<0.001). Pre-operative acoustic rhinometry showed mean minimum cross-sectional area (MCA) values of 0.352 and 0.431 cm2, whereas mean post-operative values were 0.657 and 0.711 cm2(p<0.0001).

Conclusions: The study results prove, both subjectively (patient satisfaction as measured with a standardized questionnaire) and objectively (acoustic rhinometry findings), that the proposed technique for correction of caudal septal deviation is safe and effective.

Figures

Figure 1
Figure 1
Bilateral mucoperichondrium lifting, starting at the caudal nasal septum.
Figure 2
Figure 2
Removed the entire anterior portion with the deviation, with the posterior portion. Notice that the supra tip and nasal dorsum regions were kept intact.
Figure 3
Figure 3
Columella strut graft making.
Figure 4
Figure 4
Making the tunnel between the medial crus of the alar cartilages with the angled converse scissors or curved iris scissors.
Figure 5
Figure 5
Retrograde placement of the strut. Notice the nylon stitches anchored in the graft, which help its positioning.
Figure 6
Figure 6
Transfixion sutures with 5-0 monocryl wire to stabilize the graft.
Graph 1
Graph 1
NOSE Questionnaire Results, before and after surgical treatment
Graph 2
Graph 2
MCA (Minimal Cross Section Area) results, before and after surgical treatment

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