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The nasal septum is comprised of three parts: membranous septum, cartilaginous septum, and bony septum.
Source publication
Correction of a severely deviated nasal septum remains one of the most challenging operations for the facial plastic surgeon. As understanding of nasal anatomy and physiology advanced over time, so have septoplasty techniques, which have evolved in sophistication and capability to correct increasingly complex nasoseptal deformities. Consequentially...
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Citations
... Delaney et al. in 2018 also found that an open approach provides the exposure and access necessary to release extrinsic distorting forces on the septum to fully appreciate intrinsic septal deformities. Weaknesses or insufficiencies identified through this approach can be precisely corrected with grafts and sutures to maintain the septum in a midline position and support the external nose [14]. The current study revealed that open approach provided the exposure and access necessary to correct the caudal septal deviations. ...
Background
Performing nasal surgery on children has been the subject of controversy among surgeons. Specifically, the indications for and timing of septoplasty in children have been debated for the last several decades.
In this study, we access the efficacy of the modified Goldman’s technique in dealing with caudal septal deviation in pediatric population suffering from severe nasal obstruction and its effect on nasal functions postoperatively.
In this study, 30 pediatric patients suffering from deviated nasal septum who are candidate for septoplasty were included and underwent open septoplasty using modified Goldman’s technique.
They were subjected to detailed assessment protocol preoperatively including NOSE scale, anterior rhinomanometry, and CT scans. Follow-up assessment was done at second week postoperative including anterior rhinoscopy and nasal endoscopy and 3 months postoperative including NOSE scale and anterior rhinomanometry.
Results
There was a statistically significant decrease of the NOSE scale severity to none in 90% of cases. Three months postoperative, all of the patients performed postoperative anterior active rhinomanometry with statistically significant decrease in the postoperative total nasal resistance values with inspiratory values ranging from 0.1 to 0.5 Pa/cm ³ /s with mean of 0.26 Pa/cm ³ /s and expiratory nasal resistance values ranging from 0.1 to 0.6 Pa/cm ³ /s with mean of 0.31 Pa/cm ³ /s.
Conclusions
Open septoplasty in children using the modified Goldman’s technique has enabled accurate and conservative approach for correction of nasal septal deviation especially those located in the caudal septal region. The technique also offers a significant reduction of the nasal symptoms postoperatively with marked improvement of the nasal resistance and quality of life in severe cases of deviated nasal septum.
... 10 Nasal septum is defined as a midline structure of the nasal cavity which divides the nasal cavity into halves and supports the external nose structurally. 11 Nasal septum consists of cartilaginous (anteriorly, quadrangular cartilage), bony (posteriorly, vomer and perpendicular plate of the ethmoid bone) and membranous components. 11 NSD is an anatomic variation that affect approximately 80% of adults. ...
... 11 Nasal septum consists of cartilaginous (anteriorly, quadrangular cartilage), bony (posteriorly, vomer and perpendicular plate of the ethmoid bone) and membranous components. 11 NSD is an anatomic variation that affect approximately 80% of adults. 12,13 In the literature, there are various classification of NSDs. ...
Background:
To determine whether degree of the nasal septum deviation (NSD) can affect the frequency of antral pseudocyst (AP) formation by cone beam computed tomography (CBCT).
Materials and methods:
This retrospective study was included 466 CBCT images. The NSD were categorized into four groups according to the degree: Control group (no NSD, 0°-2°), Group A (2°-9°), Group B (9°-15°), and Group C (≥15°). The predictor variables were demographic factors (patient's age and gender) and anatomic factors (different degrees of nasal septum angulation). The outcome variable was presence of AP.
Results:
Of the 466 cases, 242 (51.9%) had no NSD, 66 (14.2%) had an angle of 2°-9°, 111 (23.8%) had an angle of 9°-15°, and 47 (10.1%) had an angle of over 15°. The prevalence of AP was 2.04 (95% CI, 1.37 to 3.03; p=0.001) times higher in the presence of NSD. Significant increases in presence of AP occurred with NSD in Group A (2.37 times higher; P=.003) and Group B (2.07 times higher; P=.003) compared to control by univariate analysis.
Conclusions:
Although there is no sufficient evidence to suggest that NSD is a definitive etiological factor for AP development, our findings indicated that NSD increased the risk of AP formation.
... Носовые клапаны образованы за счет ригидности тканей носа. При ослаблении носовых структур после ринопластики происходит коллапс тканей носа, сужение и обструкция носовых ходов, с нарушением дыхания [3,15]. ...
Aim . To study results of unsuccessful primary rhinoplasty that require repeated interventions. Material and methods . The work summarizes the analysis of the causes of unsuccessful rhinoplasty in 106 patients who had previously suffered a primary septorhinoplasty in various health facilities in Tajikistan in the period from 1 to 7 years. The main reason for the visit was dissatisfaction with the previous rhinoplasty. Results and discussion. After primary rhinoplasty, patients most often had the following deformities: deformity of the tip of the nose (72 patients); deformity of the “parrot beak” type (14 patients); deformation similar to the inverted “V” (12 patients); deformation of the contours of the nasal dorsum (13 patients); defects of the nasal septum in the lower caudal region (21 patients). All patients underwent secondary rhinoplasty. Conclusion . Unsuccessfully executed as a primary rhinoplasty leads to respiratory dysfunction and aesthetic defects that require more complex secondary surgical operations.
... Over the years techniques for correction of a deviated septum have undergone huge transformation in technique and sophistication from digital fracture in ancient times to the currently used endoscopic techniques of septoplasty that can address increasingly complex nasoseptal deformities. Hence the term septoplasty broadly encompasses a number of different techniques that 2,3 aim to correct septal deviations. Techniques used for correction of septal deviations were initially geared towards septal resections, but more recent techniques lay more emphasis on preservation, realignment, or a combination of the two. ...
... Late complications included persistence of symptoms and dissatisfaction in 14 patients(15.55%), of which nasal synechia in 5 patients (5.55%) and septal perforation and vestibular stenosis in one patient respectively(1.11%) . Other reported complications such as CSF leak, tooth anesthesia, structural deformities such as saddle nose and nasal tip ptosis or any ocular3 complication were not seen in our study. ...
Introduction: Septoplasty for nasal septal deviation is one of the most commonly performed surgeries by the otolaryngologist. Though various surgical techniques have evolved for correction of a deviated septum, complications are still common. Method: A prospective study of 90 patients of symptomatic nasal septal deviation was done to investigate for development of complications after endoscopic septoplasty. Complications were catagorised into early, occurring within 7 days and late, usually detected within three months after surgery. Results; Most common early complication was haemorrhage seen in overall 16.66% of patients. 6.66% had primary hemorrhage during surgery and 8.88% had reactionary hemorrhage within 24 hours of surgery. Secondary hemorrhage and septal hematoma was rare(1.1%) . Most common late complication was persistence of subjective symptom of nasal blockage(15.55%) followed by nasal synache(5.55%). Septal perforation and vestibular stenosis are less common(1.1%). CSF leak, saddle nose, nasal tip ptosis or any ocular complications were not seen in any patient. Conclusion:. Meticulous preoperative planning with precise surgical techniques during endoscopic septoplasty can reduce the risk of complications that may have a profound effect on the functional and aesthetic aspects of a person’s life.
... Septoplasty is a commonly performed surgery for patients presenting with nasal obstruction due to deviated nasal septum and has reported success rate of around 70%. [1][2][3] Intermittently it is noted that in spite of a good septal surgery, patients complain of persisting nasal obstruction which could be due to unaddressed nasal valve problems or turbinate issues including concha bullosa, presence of polyps or concomitant allergic rhinitis. 1 Middle turbinate concha bullosa is a term used for pneumatised middle turbinate. ...
p class="abstract"> Background: Concha bullosa is the pneumatisation of middle turbinate which causes crowding and obstruction of the middle meatus. This is associated with contralateral septal deviation. The objective of this study is to evaluate, if a concha bullosa turbinoplasty has any added value in improving nasal symptoms when performed as adjunct with septoplasty.
Methods: Retrospective analysis of the hospital database was done and details of patients who underwent septoplasty along with concha bullosa turbinoplasty was collected and the patients were telephonically contacted to record their symptom improvement.
Results: Details of nineteen patients who underwent concha bullosa turbinoplasty with septoplasty were studied, mean age of the patients was 31.26 years and the mean follow up period was 22 months. All patients had improvement in symptoms with most completely asymptomatic, the others had mild to moderate symptoms.
Conclusions: Concha bullosa turbinoplasty as an adjunct to septoplasty does alleviate the symptom of nasal obstruction.</p
... [5] Virtually 33% patients who go to otolaryngologist have nasal obstruction and among these patients twenty five percent looking for surgical intervention. [6] In medical literature, nasal deviation is described as "deviated nose" a difficult deformity involving about complete structure inside the nose. Crooked or deviated nose, can be identified through drawing a line almost drawn from the mid-glabella to the pogonion, goes through nasal tip, cupids' bow, nasal bridge and lastly incisive teeth, nasal divergence from this line to the other side, could be described like deviated nose. ...
Background: Open septorhinoplasty is most common procedure carried out in the ENT basic setup. It is performed to relieve the nasal obstruction and to get better aesthetic appearance. Objective: The objective of the study was to assess the nasal patency and cosmetic improvement among patients. Method: It was cross-sectional descriptive study in which 100 patients with nasal obstruction and external nasal deformity visiting ENT Department of Lahore General Hospital Lahore were included. Data was collected through questionnaire, which was entered into computer using SPSS software version 20.0. Results: Among 100 patients, 57.0% were males and 48.0% were 21-25 years old. Among these patients, 100.0% had nasal blockage and external deformity. After septorhinoplasty, 94.0% patients had complete improvement in nasal blockage and 95.0% patients had improved external deformity. Conclusion: Study concluded that 94.0% patients had complete improvement in nasal blockage and 95.0% patients in external deformity. Septorhinoplasty is a useful surgical procedure and should be used in health care facilities
Deviated nasal septum is a challenging issue in rhinoplasty surgery. In this chapter, we aimed to discuss considerations, management, and modifications of septoplasty techniques in deviated nasal septum cases.
Every year, there has been a steady increase in the number of rhinoplasty. At the same time, the patient’s demands for these surgery are also increasing. Therefore, unsatisfactory functional and aesthetic results after rhinoplasty require repeated (revision) operations. The secondary rhinoplasty itself is more complex than the primary operation. Incorrectly performed rhinoplasty and iatrogenic tissue damage lead to deformities that require repeated reconstructive interventions. The reasons for the unsatisfactory results of rhinoplasty can be different. In assessing the results of rhinoplasty, the surgeon’s opinion may not be ambiguous with the patient. Often, when the surgeon considers the rhinoplasty result to be acceptable, the patient may be unhappy. In the postoperative period, deformities of the tissues of the nose may be due to the rough scars, and an infectious process. Еxcessive cartilage resection, insufficient or excessive osteotomy lead to deformities that require repeated reconstructive interventions. For secondary rhinoplasty, it is necessary to take into account all tissue deformations to eliminate them in one stage. Sometimes after the second, third or more operations performed, the result of revision rhinoplasty is difficult to predict, so the surgeon must predict the expected outcome result. Keywords: Secondary rhinoplasty, nasal meatus, nasal septum deviation, septoplasty.
Objective:
To compare endonasal and external septoplasty for type 2 caudal septal deviations in terms of operative time, aesthetic and functional outcome.
Study design:
Descriptive Analysis.
Place and duration of study:
ENT Department, Mayo Hospital/ K.E.M.U, Lahore, from October 2019 to October 2020.
Methodology:
Record of patients operated for septal deviations in 2019 were retrospectively reviewed. All patients, diagnosed with type 2 caudal septal deviations, were included; while those with marked inferior turbinate hypertrophy, deviated nasal septum after trauma, and those who could not be followed-up, were excluded. Twenty-eight patients, operated by external approach, were placed in group A; and 32 patients, who had endonasal surgery, were placed in group B. Functional outcome was assessed by nasal obstruction symptom evaluation (NOSE) scale; and cosmetic deformity was assessed by visual analog scale (VAS) pre- and postoperatively at six months. Operative time was measured for both the groups.
Results:
Sixty patients were included. Mean preoperative NOSE scale score for group A was 67.36 ± 8.07 and postoperative was 15.82 ± 3.62 (p<0.001). Mean preoperative NOSE score for group B was 69.40 ± 5.80 and postoperative it was 18.00 ± 3.75 (p<0.001). Mean VAS score for group A preoperative and postoperative was 18.93 ± 7.86 and 76.07 ± 6.85 (p<0.001), respectively. Mean VAS score for group B preoperative and postoperative was 19.69 ± 7.82 and 71.56 ± 8.84, respectively (p<0.001). Mean operative time for group B was 52.25 ± 3.37 minutes, and for group A 115.00 ± 9.91 minutes (p<0.001). The difference in preoperative and postoperative NOSE and VAS scores compared for both groups revealed p-value of 0.952 and 0.044, respectively.
Conclusion:
Extracorporeal septoplasty resulted in better aesthetic outcome; though endonasal septoplasty had shorter operative time. Both surgical techniques resulted in good functional outcome. Key Words: Nasal septum, Nasal surgical procedures, Deviated nasal septum, Caudal deviation septum, Septoplasty, Septorhinoplasty, Nasal obstruction symptoms evaluation (NOSE) score, Visual analogue scale (VAS).
Background:
Septoplasties and septorhinoplasties are very commonly performed surgical procedures in modern aesthetic and functional medicine. Throughout the surgery, close manipulation to the incisive nerves' course is being executed. This retrospective analysis followed up on potential sensitivity disorders of the anterior palate due to nerve damage.
Methods:
This retrospective review of 2000 patients' charts, who had undergone the procedure of a septoplasty or septorhinoplasty between June 2013 and January 2019 was conducted at the Department of General Otorhinolaryngology, Medical University of Graz. Medical records of all included patients were reviewed with special attention to postoperative numbness of the anterior palate.
Results:
Among the 2000 included patients, a septoplasty was performed in 48% (n = 955), a septorhinoplasty in 35% (n = 703) and a septoplasty in combination with a functional endoscopic sinus surgery in 17% (n = 342). In total, 86% (n = 1721) showed no complications at all during the follow-up period. In 0.25% (n = 5) a sensitivity disorder of the anterior palate occurred. Of the five cases with a postoperative numbness of the anterior palate four occurred after a septoplasty and the fifth occurred following a septorhinoplasty.
Conclusion:
At this current time, this is the largest study investigating postoperative numbness of the anterior palate retracing septoplasty or septorhinoplasty. As a result, the currently used techniques for the operations do not pose a risk for the incisive nerve despite close surgical manipulation to the nerves' course. Nevertheless, patients should be informed and educated about the possibility of an occurring sensitivity disorder regarding the anterior palate during informed consent.
