Long-term Outcomes of Subtotal Septal Reconstruction in Rhinoplasty

Asher SA, Kakodkar AS, Toriumi DM.

PubMed 28910438 Publisher (DOI)Free full text (PMC)

What this paper says

In 144 patients who had the septal support structure largely rebuilt, breathing scores improved in all 5 NOSE categories and 3D imaging showed no significant loss of nasal length or projection over a mean follow-up of 613.5 days.

Overview

Severe septal deviation can require rebuilding the L-shaped support strip rather than simply straightening it. This medical record review reports what happened to breathing and to nose shape afterward, using a validated symptom questionnaire and three-dimensional photographic measurement.

Sections of note

144 patients who underwent subtotal septal reconstruction between September 1, 2008, and September 1, 2013.
104 (72.2%) female; mean age 37.3 years, SD 13.7; 57 primary septorhinoplasties and 87 (60.5%) revisions.
NOSE scores improved in all 5 categories, with mean survey completion at 270 days, SD 260.1.
3D stereophotogrammetry at mean 613.5 days, SD 434.4.
No significant loss of nasal length between early and final postoperative time points, -0.16 mm, P .41, and no significant loss of projection, -0.19 mm, P .17.
Rotation increased at surgery by 4.24 degrees, P .01, then decreased by 2.63 degrees during healing, P .01.
Symmetry improvement reached significance only at final measurement, -0.43 mm from preoperative, P .007; columellar show decreased 0.66 mm, P .001; no significant alar-columellar change late, confirming no retraction over time.
114 patients (79.2%) required rib cartilage harvest. Level of evidence 4.

What it means for a patient

Rebuilding the septum held its length, projection, and nostril rim position over roughly 20 months.
Some of the upward tip rotation gained at surgery was lost during healing, about 2.6 of 4.2 degrees.
Nearly 4 in 5 patients needed cartilage taken from the rib, which adds a chest incision and its own recovery.
Limits: retrospective record review, single practice, no comparison group, and mixed primary and revision cases in one cohort.

Why this paper matters

The concern with major septal reconstruction is that the rebuilt framework will settle, shortening the nose or dropping the tip. This provides measured evidence against that over about 20 months. Longer follow-up would be needed to rule out later collapse.

Terms

L-strut: The L-shaped strip of septal cartilage along the bridge and base that holds the nose up.
Subtotal septal reconstruction: Rebuilding most of that support strip rather than only straightening it.
3D stereophotogrammetry: Building a 3D surface model from multiple simultaneous photographs.
Columellar show: How much of the strip between the nostrils is visible from the side.
Alar-columellar relationship: How the nostril rim sits relative to that strip.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Importance: Significant nasal septal deviation may require complex reconstruction to achieve complete correction. Subtotal septal reconstruction is a method for addressing deviations in the L-strut.

Objectives: To review the long-term outcomes of subtotal septal reconstruction and provide objective evidence of functional and aesthetic improvement.

Design, Setting, And Participants: This medical record review obtained data on 144 patients who underwent subtotal septal reconstruction from September 1, 2008, to September 1, 2013. Data analysis was performed from September 1, 2013, to September 1, 2014.

Main Outcomes And Measures: Functional outcomes were measured using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and objective aesthetic outcomes were measured using 3-dimensional (3-D) stereophotogrammetry. Follow-up times were classified as time point 1 (TP1; preoperative), time point 2 (TP2; early postoperative), and time point 3 (TP3; final postoperative).

Results: Of the 144 patients who underwent subtotal septal reconstruction, 104 (72.2%) were female; the mean (SD) age was 37.3 (13.7) years; 57 underwent primary septorhinoplasty; and 87 (60.5%) underwent revision septorhinoplasty. The NOSE scores improved in all 5 categories of nasal obstruction, with mean (SD) survey completion at 270 (260.1) days. Aesthetic results were measured with 3-D imaging after a mean (SD) follow-up of 613.5 (434.4) days postoperatively. No statistically significant loss was found in mean (SD) nasal length over time (TP2 to TP 3, -0.16 [1.36] mm; 95% CI, -0.54 to 0.22 mm; P = .41) or between mean (SD) postoperative loss of projection (TP2 and TP3, -0.19 [0.92] mm, 95% CI, -0.45 to 0.07 mm; P = .17). An increase in mean (SD) rotation (nasolabial angle) generated with septorhinoplasty (4.24° [11.08°]; 95% CI, 1.14°-7.34°; P = .01) and a mean (SD) decrease in rotation detected during postoperative healing (-2.63° [6.96°]; 95% CI, -4.63° to -0.63°; P = .01) were found. Although measurement of symmetry was improved in the early postoperative period (TP1 to TP2, -0.16 [1.26] mm; 95% CI, -0.52 to 0.20 mm; P = .40), this finding did not become statistically significant until the final measurement (TP1 to TP3, -0.43 [1.07] mm; 95% CI, -0.73 to -0.13 mm; P = .007; TP2 to TP3, -0.28 [0.87] mm; 95% CI, -0.53 to -0.03 mm; P = .03). A mean (SD) decrease in columellar show was achieved with surgery (-0.66 [1.37] mm; 95% CI, -1.05 to -0.27 mm; P = .001). No statistically significant change was found in the alar-columellar association from TP2 to TP3 in this patient population, confirming no unwanted alar or columellar retraction over time (0.10 [0.61] mm; 95% CI, -0.07 to 0.27 mm; P = .25). A total of 114 patients (79.2%) required costal cartilage harvest for adequate reconstruction.

Conclusions And Relevance: Subtotal septal reconstruction yields improved functional and aesthetic outcomes and has the potential to be a useful tool for the rhinoplasty surgeon in the treatment of severe septal deviation.

Level Of Evidence: 4.

Abstract as indexed by PubMed; the article is open access (PubMed Central).