Use of Perpendicular Plate of Ethmoid Split Technique in Rhinoplasty and Septoplasty

Overview

The perpendicular plate of the ethmoid is the bone forming the upper rear part of the septum, and it has become a favored source of bone graft. The authors describe a splitting technique for removing the bony septum efficiently or harvesting part of the plate for septal batten grafts, particularly suited to cases where the plate is thick. The aim is to minimize septal defects while obtaining grafts of the intended thickness.

Sections of note

• Design: retrospective study, 36 patients: 22 septoplasties and 14 rhinoplasties. Level of evidence therapeutic IV.
• Technique: the ethmoid plate is detached from the septal cartilage, then split along a vertical plane with a number 10 scalpel blade, to remove bony spurs or prepare batten grafts.
• CT imaging showed the average thickness of the front lower ethmoid plate was 3.46 millimetres.
• The technique was used for batten graft harvesting in 26 cases and for spur removal and septum reshaping in 10. Harvesting succeeded in all but 3, where the graft broke.
• Stated applications: reshaping, correcting a deviated septum, harvesting batten grafts and supporting the profile.

What it means for a patient

• The bone comes from inside the nose, so no chest or ear incision is needed.
• Splitting the plate lengthwise yields a thinner graft while leaving bone behind, which reduces the size of the hole created in the septum.
• Three of 36 grafts broke during harvest, so the technique is not always successful.
• Limits: 36 patients, retrospective, single surgeon, no comparison group, no stated follow up, and no functional or satisfaction outcomes.

Why this paper matters

Straightening a deviated septum often requires removing bone, and the resulting defect weakens the nose while the removed bone is often too thick to use as a graft. Splitting it addresses both problems at once. Whether the technique reduces septal complications or improves graft performance is not measured.

Terms

• Perpendicular plate of the ethmoid: the thin bone forming the upper rear part of the septum.
• Septoplasty: surgery to straighten the wall dividing the two sides of the nose.
• Batten graft: a stiff strip placed to reinforce or straighten a structure.
• Bony spur: a projecting ridge of bone on the septum that can block the airway.
• Osteotomy: a planned cut through bone.
• Septal defect: a hole or gap left in the septum after tissue is removed.