Facial Plast Surg 2006; 22(4): 223-229
DOI: 10.1055/s-2006-954840
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Surgery of the Nasal Septum

Gunter Mlynski1
  • 1Department of Otorhinolaryngology, Head and Neck Surgery, The Ernst-Moritz-Arndt-University, Greifswald, Germany
Further Information

Publication History

Publication Date:
28 November 2006 (online)

ABSTRACT

Long-term results after septoplasty are not satisfactory. Apart from a recurrence of deviation, there are various reasons for this: false preoperative analysis, complete straightening of the septum, and a disturbed nasal cycle. Preoperative functional diagnostics with a combination of rhinoresistometry, acoustic rhinometry, and long-term rhinoflowmetry are necessary for differentiating between “physiological” and “pathological” septal deviations and recognizing other causes for obstruction. The surgical procedure of septoplasty includes approach, mobilization, resection, reposition, and finally reconstruction of all three layers. The goal of the operation should not be complete straightening of the nasal septum. The space between the septum and turbinates is of utmost importance. It should not be enlarged as much as possible; rather, it must be shaped in such a way as to allow freely congestion and decongestion reciprocal on the two sides during the nasal cycle.

REFERENCES

  • 1 Mlynski G. Wiederherstellende Verfahren bei gestörter Funktion der oberen Atemwege. Nasale Atmung.  Laryngorhinootologie. 2005;  84 S101-S117
  • 2 Kayser R. Die exacte Messung der Luftdurchgängigkeit der Nase.  Arch Laryngol Rhinol. 1894;  3 101-120
  • 3 Lang C, Grutzenmacher S, Mlynski B, Plontke S, Mlynski G. Investigating the nasal cycle using endoscopy, rhinoresistometry, and acoustic rhinometry.  Laryngoscope. 2003;  113 284-289
  • 4 Stoksted P. Measurements of resistance in the nose during respiration at rest.  Acta Otolaryngol Suppl. 1953;  109 143-158
  • 5 Eccles R B. The nasal cycle in respiratory defence.  Acta Otorhinolaryngol Belg. 2000;  54 281-286
  • 6 Eccles R. A role for the nasal cycle in respiratory defence.  Eur Respir J. 1996;  9 371-376
  • 7 Mlynski G. Physiology and pathophysiology of nasal breathing. In: Behrbohm H, Tardy ME Essentials of Septorhinoplasty. New York, NY; Thieme 2004
  • 8 Mlynski G, Grutzenmacher S, Plontke S, Mlynski B, Lang C. Correlation of nasal morphology and respiratory function.  Rhinology. 2001;  39 197-201
  • 9 Zuckerkandl E. Normale und pathologische Anatomie der Nasenhöhle und ihrer pneumatischen Anhänge. 1. Vienna; Wilhelm Braumüller 1882
  • 10 Kastenbauer E. Äußere Nase und Nasenscheidewand.  Laryng Rhinol. 1973;  52 597
  • 11 Masing H. Functional aspects in septal plasty.  Rhinology. 1977;  15 167-172
  • 12 Huizing E, de Groot J. Functional Reconstructive Nasal Surgery. New York; Thieme 2003
  • 13 Jessen M, Malm L. The importance of nasal airway resistance and nasal symptoms in the selection of patients for septoplasty.  Rhinology. 1984;  22 157-164
  • 14 Schwab J A, Pirsig W. Complications of septal surgery.  Facial Plast Surg. 1997;  13 3-14
  • 15 Cottle M, Loring R, Fischer G, Gaynon J. The maxilla-premaxilla, approach to extensive nasal septum surgery.  Arch Otolaryngol. 1958;  68 301-313
  • 16 Paulsen K. Wie wichtig ist die Anlage unterer Tunnel für die Septumplastik nach Cottle?.  HNO. 1976;  24 106-107
  • 17 Eitschberger E, Merklein C, Masing H, Pesch H J. Tierexperimentelle Untersuchungen zur Verformung des Septumknorpels nach einseitiger Schleimhautablösung.  Arch Otorhinolaryngol. 1980;  228 135-148
  • 18 Eitschberger E, Merklein C, Masing H, Pesch H J. Das histologische Verhalten plangeschlagenen Septumknorpels nach Retransplantation zur Versteifung der hinteren Septumregion.  HNO. 1980;  28 158-160
  • 19 Gibson T, Davis W. Distortion of autogenous grafts: its cause and prevention.  Br J Plast Surg. 1957;  10 257-274
  • 20 Fry H. The distorted residual cartilage strut after submucous resection of the nasal septum.  Br J Plast Surg. 1968;  21 170-172
  • 21 Hellmich S. Das Problem der Knorpelverbiegung in der Nasenchirurgie (Experimentelle und praktische Aspekte).  HNO. 1973;  21 223-226
  • 22 Metzenbaum M. Replacement of the lower and of the dislocated septal cartilage.  Arch Otolaryngol. 1929;  9 282-296
  • 23 Fritz K. Funktionelle Nasenscheidewandoperationen.  Arch Ohren Nasen Kehlkopfheilkd. 1958;  173 452
  • 24 Huffmann W, Lierle D. Progress in septal surgery.  Plast Reconstr Surg. 1957;  20 185
  • 25 Kastenbauer E. Zur Operation der knorpeligen Schiefnase.  HNO. 1968;  16 341
  • 26 Patterson C. Reconstructive septonasoplasty.  Arch Otolaryngol. 1966;  84 457
  • 27 Seltzer A. The nasal septum: plastic repair of the deviated septum associated with a deflected tip.  Arch Otolaryngol. 1944;  40 433-444
  • 28 Lawson W, Kessler S, Biller H F. Unusual and fatal complications of rhinoplasty.  Arch Otolaryngol. 1983;  109 164-169
  • 29 Converse J. Deformities of the nose. In: Converse J Reconstructive Plastic Surgery. Philadelphia, PA; Saunders 1970: 736
  • 30 Fomon S, Gilbert J, Syracuse V. Plastic repair of obstruction septum.  Arch Otolaryngol. 1948;  47 7
  • 31 Hoffmann K. Über Fehler und Gefahren bei rhinoplastischen Operationen.  HNO. 1964;  12 58
  • 32 Lefkon J. Rhinoplasty in children.  Arch Otolaryngol. 1948;  48 73
  • 33 Sputh C. New thoughts on the repair of the caudal and anterior parts of the septum.  Int Rhinol. 1970;  8 68
  • 34 Joseph G. Septum variations, strips and grids.  Int Rhinol. 1972;  10 29
  • 35 Richter H. Über die Wiedereinpflanzung des Septumknorpels.  Laryng Rhinol. 1957;  36 679
  • 36 Fries R, Platz H, Haidenthaler A. Surgical correction of cartilaginous nasal septumdeformities.  J Maxillofac Surg. 1978;  6 163-173
  • 37 Fry H J. Interlocked stresses in human nasal septal cartilage.  Br J Plast Surg. 1966;  19 276-278
  • 38 Huizing E. Implantation and transplantation in reconstructive nasal surgery.  Rhinology. 1974;  12 93-106
  • 39 Pirsig W. Growth of the deviated septum and its influence on midfacial development.  Facial Plast Surg. 1992;  8 224-232
  • 40 Rettinger G. Autogene und allogene Knorpeltransplantate in der Kopf- und Halschirurgie (ohne Mittelohr und Trachea).  Eur Arch Otorhinolaryngol Suppl. 1992;  127-162
  • 41 Beekhuis G J. Saddle nose deformity: etiology, prevention, and treatment; augmentation rhinoplasty with polyamide.  Laryngoscope. 1974;  84 2-42
  • 42 Rettinger G. Aktuelle Aspekte der Septorhinoplastik.  Otorhinolaryngol Nova. 1992;  2 70-79
  • 43 Briant T D, Middleton W G. The management of severe nasal septal deformities.  J Otolaryngol. 1985;  14 120-124
  • 44 Peer L. An operation to repair lateral displacement of the lower border of the septal cartilage.  Arch Otolaryngol. 1937;  25 475
  • 45 Rees T D. Surgical correction of the severely deviated nose by extramucosal excision of the osseocartilaginous septum and replacement as a free graft.  Plast Reconstr Surg. 1986;  78 320-330
  • 46 Bessede J P, Huth J, Orsel S, Sauvage J P. La dépose septale dans les rhinoseptoplasties difficiles. Techniques chirurgicales-expérience-résultats.  Ann Chir Plast Esthet. 1991;  36 436-441
  • 47 Galloway T. Plastic repair of the deflected nasal septum.  Arch Laryngol. 1946;  44 141
  • 48 Masing H, Hellmich S. Erfahrungen mit konserviertem Knorpel im Wiederaufbau der Nase.  Z Laryngol Rhinol. 1968;  47 904-914
  • 49 Hellmich S. Die Verträglichkeit konservierter homoplastischer Knorpelimplantate in der Nase.  Z Laryngol Rhinol Otol. 1970;  49 742-749
  • 50 Hellmich S. Cartilage implants in rhinoplasty-problems and prospects.  Rhinology. 1972;  10 1-8
  • 51 Hellmich S. Die Verwendung von Kunststoff bei Nasenplastiken.  Z Laryngol Rhinol Otol. 1983;  62 321
  • 52 Hellmich S. Operativ wesentliche Gesichtspunkte bei Spanimplantationen der Nase.  Z Laryngol Rhinol Otol. 1972;  51 298-305
  • 53 Huizing E. Experience on the use of homologous cartilage in nasal surgery.  Acta Otorhinolaryngol Belg. 1970;  24 194-197
  • 54 Huizing E H, Mackay I S, Rettinger G. Reconstruction of the nasal septum and dorsum by cartilage transplants-autogeneic or allogeneic?.  Rhinology. 1989;  27 5-10
  • 55 Tardy Jr M E, Denneny III J, Fritsch M H. The versatile cartilage autograft in reconstruction of the nose and face.  Laryngoscope. 1985;  95 523-533
  • 56 Vuyk H, Adamson P. Biomaterials in rhinoplasty.  Clin Otolaryngol. 1997;  23 209-217
  • 57 Ortiz-Monasterio F, Olmedo A, Oscoy L. The use of cartilage grafts in primary aesthetic rhinoplasty.  Plast Reconstr Surg. 1981;  67 597-605
  • 58 Sheen J. Secondary rhinoplasty. In: MacCarthy J Philadelphia, PA; Saunders 1990: 1895-1923
  • 59 Stucker F, Gage-White L. Survey of surgical implants.  Fac Plast Surg. 1986;  3 141-144
  • 60 Pirsig W, Kern E B, Verse T. Reconstruction of anterior nasal septum: back-to-back autogenous ear cartilage graft.  Laryngoscope. 2004;  114 627-638
  • 61 Cheney M. Reconstructive grafting by the open nasal approach.  Fac Plast Surg Clin N Am. 1993;  1 99-109
  • 62 Metzinger S E, Boyce R G, Rigby P L, Joseph J J, Anderson J R. Ethmoid bone sandwich grafting for caudal septal defects.  Arch Otolaryngol Head Neck Surg. 1994;  120 1121-1125
  • 63 Romo III T, Jablonski R D. Nasal reconstruction using split calvarial grafts.  Otolaryngol Head Neck Surg. 1992;  107 622-630
  • 64 Tessier P. Autogenous bone graft taken from the calvarium for facial and cranial applications.  Clin Plast Surg. 1982;  9 531-538
  • 65 Gurlek A, Askar I, Bilen B T, Aydogan H, Fariz A, Alaybeyoglu N. The use of lower turbinate bone grafts in the treatment of saddle nose deformities.  Aesthetic Plast Surg. 2002;  26 407-412
  • 66 Reiter D, Alford E, Jabourian Z. Alternatives to packing in septorhinoplasty.  Arch Otolaryngol Head Neck Surg. 1989;  115 1203-1205
  • 67 Stucker F, Ansel D. A case against nasal packing.  Laryngoscope. 1978;  88 1314-1317
  • 68 Weber R, Hay U. Ist die Nasentamponade noch zeitgemäß?.  Laryngorhinootologie. 2003;  82 650-654
  • 69 Baumgartner P. Zur Korrektur der vorderen Septumdeviation.  Pract Otorhinolaryngol. 1959;  21 450
  • 70 Huizing E, Pirsig W, Wentges R et al.. Unanimity and diversity in nasal surgery.  Rhinol Suppl. 1989;  9 15-23
  • 71 Walter C. Die Korrektur der Nasenscheidewand. II. In: Gohrbrandt J, Gabka J, Berndorfer A Handbuch der Plastischen Chirurgie. Berlin; de Gruyter 1965: 89
  • 72 Guyuron B. Is packing after septorhinoplasty necessary? A randomized study.  Plast Reconstr Surg. 1989;  84 41-44 discussion 45-46
  • 73 Becker H. Paraffinoma as a complication of nasal packing.  Plast Reconstr Surg. 1983;  72 735-736
  • 74 Spillmann D. Aspiration von Nasentamponaden mit Todesfolge.  Laryngol Rhinol Otol (Stuttg). 1981;  60 56-59
  • 75 Cassisis N, Biller H, Ogura J. Changes in arterial oxygen tension and pulmonary mechanics in the use of posterior packing in epistaxis. A preliminary report.  Laryngoscope. 1971;  81 1261-1266
  • 76 von Schoenberg M, Robinson P, Ryan R. Nasal packing after routine nasal surgery-is it justified?.  J Laryngol Otol. 1993;  107 902-905
  • 77 Lemmens W, Lemkens P. Septal suturing following nasal septoplasty, a valid alternative for nasal packing?.  Acta Otorhinolaryngol Belg. 2001;  55 215-221
  • 78 Lee I, Vukovic L. Hemostatic suture for septoplasty: how we do it.  J Otolaryngol. 1987;  17 54-56
  • 79 Sessions R. Membrane approximation by continuous mattress sutures following septoplasty.  Laryngoscope. 1984;  94 702-703

 Prof. Dr. med.
Gunter Mlynski

Klinik und Poliklinik für Hals-Nasen-Ohrenkrankheiten, Kopf- und Halschirurgie, der Ernst-Moritz-Arndt-Universität

Walther-Rathenau-Str. 43-45, D-17487 Greifswald, Deutschland