Septal surgery in rhinoplasty

Overview

A straight, stable septum sets both the look and the breathing result of a rhinoplasty, so the authors argue septal correction should come first. The paper reviews how the patient's history, expectations, the preoperative analysis and the surgeon's skill determine the method, then lays out current concepts matched to each type of septal deformity.

Sections of note

• Review article; the abstract reports no patient counts or outcomes.
• Septoplasty is placed before all other steps in rhinoplasty.
• Slight deviations, such as single vomer spurs, maxillary crests, septal tilt and simple C-shaped bends, are handled endonasally via a hemitransfixion incision.
• Endonasal tools named: the swinging door technique, scoring incisions, batten grafts and caudal septal replacement grafts.
• S-shaped and severe wave-like deviations, cleft noses, multiply fractured septums and most revisions are treated by the open approach with extracorporeal septum reconstruction.
• The method must be adapted to each patient's specific pathology.

What it means for a patient

• A crooked septum is usually fixed at the same time as cosmetic rhinoplasty, and the fix is planned first.
• The severity and shape of the bend decide whether the work is done through the nostrils or through an open approach with the septum rebuilt on the table.
• This is expert guidance from two surgeons; the abstract gives no success or complication figures.

Why this paper matters

The paper packages the Stuttgart school's extracorporeal septoplasty into a decision scheme by deformity type. It is widely used as a teaching frame. Comparative outcome data between endonasal and extracorporeal methods are not presented in the abstract.

Terms

• Septum: the wall of cartilage and bone dividing the two sides of the nose.
• Septoplasty: surgery to straighten the septum.
• Hemitransfixion incision: a cut at the front edge of the septum inside one nostril, used to reach the septum.
• Swinging door technique: freeing the bent septum along one edge so it swings back to the midline.
• Batten graft: a flat cartilage strip stitched alongside a weak or bent segment to brace it.
• Extracorporeal septum reconstruction: removing the whole septum, straightening and rebuilding it outside the body, then reinserting it.