Twenty-Five Years Experience with Extracorporeal Septoplasty

ABSTRACT

Even today, the difficult septum presents a surgical problem. A severe septum deformity is caused mostly by an accident or is seen in patients with malformations such as cleft lip and palate deformity. It is characterized by a massive malformation in all levels with consecutive blocking of one or both airways. Such marked septal deformities cannot be corrected properly by standard septoplasty techniques. Therefore, in such cases we suggest an extracorporeal septoplasty, where we take out the whole septum and reconstruct a new septal plate by different techniques followed by replantation and reconstruction of the cartilaginous dorsum. From January 1, 1981 to December 31, 2005, we operated on 2301 patients and improved this method constantly, especially the safe septal fixation and rebuilding of the cartilaginous dorsum. Follow-ups showed that even in severe deformities a revision rate of only 5% respectively 7% was found. Therefore, we conclude that the extracorporeal septoplasty with its refinements and the way we are doing it today can also be recommended to less experienced rhinosurgeons.

Septum deformity - extracorporeal septoplasty - spreader graft - polydioxanone (PDS) foil - fascia transplant - perpendicular plate

REFERENCES

• 1 King E D, Ashley F L. The correction of the internally and externally deviated nose.  Plast Reconstr Surg. 1952;  10 116-120
• 2 Perret P. Correction chirurgicale des nez déviés.  Pract Otorhinolaryngol (Basel). 1958;  20 115-124
• 3 Gubisch W. Zum Problem der Spaltnasenkorrektur bei einseitigen Spaltbildungen.  HNO. 1989;  37 415-422
• 4 Gubisch W. The extracorporeal septum plasty: a technique to correct difficult nasal deformities.  Plast Reconstr Surg. 1995;  95 672-682
• 5 Gubisch W, Constantinescu M A. Refinements in extracorporeal septoplasty.  Plast Reconstr Surg. 1999;  104 1131-1140
• 6 Gubisch W. Das schwierige Septum.  HNO. 1988;  36 286-289
• 7 Gubisch W, Reichtert H, Schuffenecker J, Widmaier W. Aesthetische und funktionelle wiederherstellung nach nasentraumen durch septumreplantation. In: Jungbluth KH, Mommsen U Plast und wiederherstellende Massnahmen bie Unfallverletzungen. New York; Springer Verlag 1984: 314
• 8 Hellmich S. Das Problem der Knorpelverbiegung in der Nasenchirurgie (Experimentelle und praktische Aspekte).  HNO. 1973;  21 223-226
• 9 Cottle M H, Loring R, Fischer G, Gaynon I E. The “maxilla-premaxilla” approach to extensive nasal septum surgery.  Arch Otolaryngol. 1958;  68 301-313
• 10 Rohrich R J, Adams Jr W P. Nasal fracture management: minimizing secondary nasal deformities.  Plast Reconstr Surg. 2000;  106 266-273
• 11 Thatte R L, Deshpande S N, Thatte M R. A radical approach in the treatment of the deviated nose.  Br J Plast Surg. 1990;  43 596-602
• 12 Godfrey N V. Sagittal section septoplasty: an intrinsically stabilized septoplasty.  Plast Reconstr Surg. 1994;  93 188-196
• 13 Mantovani M, Mazzola R F, Cioccarelli M G. The back-and-forth septoplasty.  Plast Reconstr Surg. 1996;  97 40-44
• 14 Koeppe T, Constantinescu M A, Schneider J, Gubisch W. Current trends in local anaesthesia in cosmetic plastic surgery of the head and neck: results of a German national survey and observations on the use of ropivacaine.  Plast Reconstr Surg. 2005;  115 1723-1730
• 15 Bönisch M, Mink A. Heilungsprozess des Knorpels in Verbindung mit PDS-Folie.  HNO. 2000;  48 743-746
• 16 Fuchshuber G F. Komplikationen bei der Nasenseptum-Rekonstruktion mit Polydioxanfolie, Thesis of Medical Department of Ruprecht-Karls-University Heidelberg 2003
• 17 Lipski K. Personal communication 2006
• 18 Numanoglu A. External cantilever sling in septorhinoplasty: a new technique.  Plast Reconstr Surg. 1997;  100 250-256
• 19 McKinney P. An aesthetic dorsum: the CATS graft: cartilaginous autogenous thin septal.  Clin Plast Surg. 1996;  23 233-244