Transoral Septoplasty before Le Fort I Downfracture: A Novel Functional Rhinoplasty Technique

Overview

People having upper jaw surgery for dentofacial deformity commonly also have a blocked nasal airway with a deviated septum. Combined jaw and septum procedures are already established, with the septoplasty performed after the jaw is down fractured. The authors state that sequence gives poor visibility of the upper septum and makes the work harder because the septum has become mobile. Their proposal is to reverse the order.

Sections of note

• Article type: technique description. No patient numbers, outcomes or complication data are reported.
• Population addressed: individuals with maxillary dentofacial deformities and preexisting nasal obstruction with septal deviation.
• Current practice: intraoral septoplasty performed after maxillary down fracture, described as effective.
• Two stated limitations of the current sequence: limited visualization of the superior septum, and septal mobility after down fracture.
• The proposed change: perform the transoral septoplasty before completing the Le Fort I down fracture.
• Stated advantages: improved septal stability during dissection and better visualization of the septal L strut.
• Stated purpose of that visualization: precise cartilage removal without compromising support.

What it means for a patient

• Both approaches treat the blocked nose during jaw surgery without a separate nasal operation.
• The proposed change is one of sequence, not of what is removed, so the operation itself is not lengthened by a new step.
• The L strut is the support the nose depends on after septal cartilage is removed, and cutting it accurately matters for keeping the nose from collapsing later.
• The abstract reports no outcomes. There are no breathing scores, patient counts, follow up or complication rates.

Why this paper matters

Jaw repositioning surgery affects the nasal airway directly, and combining it with septal correction spares a second anesthetic. Sequencing details determine how safely the cartilage can be trimmed. Whether operating before the down fracture actually improves breathing results or lowers complications has not been tested here.

Terms

• Septoplasty: surgery to straighten the wall dividing the two sides of the nose.
• Transoral: performed through the mouth.
• Le Fort I downfracture: deliberate separation of the upper jaw so it can be repositioned.
• Dentofacial deformity: a mismatch in the position of the jaws and teeth.
• L-strut: the L shaped strip of septal cartilage left to support the nose after septoplasty.