Treatment outcomes of extracorporeal septoplasty compared with in situ septal correction in rhinoplasty

Overview

A markedly crooked nose can be corrected by removing the septum, reshaping it outside the body and replacing it, or by working on it in place. The authors state that no study had compared the two. They reviewed records of 169 patients operated between July 2006 and December 2012 at their centre.

Sections of note

• Retrospective review of 169 patients; 84 had extracorporeal septoplasty and 85 age and sex matched controls had in situ correction at a similar time.
• In situ techniques included batten and spreader grafting and caudal cutting with suture, alone or combined.
• Outcomes came from anthropometric measurement of photographs plus chart review of function and complications.
• Deviation types in the extracorporeal group were 52 I-shape (61.9 percent) and 32 C-shape (38.1 percent); in the in situ group 59 I-shape (69.4 percent) and 26 C-shape (30.6 percent).
• Deviation angle, nasofrontal and nasolabial angles and tip projection all improved significantly in both groups.
• Mean operating time was 135 minutes for extracorporeal and 128 minutes for in situ.
• Complication rates for dorsal irregularity, saddling and infection were similar; no extracorporeal patient had postoperative obstruction against 5 of 78 (6.4 percent) in situ patients needing revision septoplasty. Level of evidence 3.

What it means for a patient

• For a markedly crooked nose, both methods straightened the appearance to a similar degree.
• The difference was in breathing: persistent blockage requiring another operation occurred only in the in situ group.
• Retrospective with matched rather than randomised groups, so unmeasured differences between patients could affect the result.
• The extra operating time for the more extensive method was about seven minutes on average.

Why this paper matters

Extracorporeal septoplasty is more invasive, and this is the first reported comparison testing whether that buys anything. Unanswered is how the two compare over years, particularly for late collapse of a reconstructed septum.

Terms

• Extracorporeal septoplasty: removing the septum, reshaping it outside the body, and replacing it.
• In situ correction: straightening the septum while it stays in place.
• Batten graft: a strip of cartilage placed to brace a weak or bent area.
• Spreader graft: a strip of cartilage placed alongside the septum to widen the airway.
• Saddling: collapse of the bridge leaving a dip in the profile.
• Anthropometric measurement: measuring set distances and angles on photographs.