Shin Ae Kim1, Yong Ju Jang2. 1. Department of Otorhinolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea. 2. Department of Otorhinolaryngology - Head and Neck Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Abstract
BACKGROUND: Correction of caudal septal deviation is a challenging task that may require multiple surgical approaches. OBJECTIVE: To introduce a novel technique - caudal septal division and interposition batten graft - and evaluate its surgical outcomes in patients undergoing correction of caudal septal deviation. METHOD: The surgical procedure includes a division of the deviated caudal L-strut preserved after resection of the deviated quadrangular septal cartilage at the central portion. A batten graft made of septal cartilage or bone is interposed between the cut ends of the caudal L-strut, the upper part of which mobilized toward the more concave side of the nasal cavity, and then sutured. The medical records of 29 patients with caudal septal deviation who underwent septoplasty using caudal L-strut division and interposition batten graft technique between January 2016 and March 2018 were retrospectively reviewed. Patient satisfaction and symptom improvement were evaluated by using the Nasal Obstruction Symptoms Evaluation scores. Endoscopic assessment of deviation correction was performed and postoperative complications were analyzed. RESULTS: Of the 29 patients, 19 (65.5%) answered the telephonic interview. Mean Nasal Obstruction Symptoms Evaluation scores were 62.1 preoperatively and 9.2 postoperatively, exhibiting significant improvement (P < .001). Satisfaction was rated as much improved in 9 (32.0%) patients, improved in 16 (57.0%), unchanged in 2 (7%), and worse in 1 (4%). Records of endoscopic examinations showed that 26 (82.9%) patients had a straight septum, 4 (11.4%) had improved but persisting caudal deviation, and 2 (5.7%) had no available data. Four patients had postoperative complications: 2 had septal abscesses, 1 had wound dehiscence, and 1 had synechia. All of these complications were managed without persistent problems. CONCLUSIONS: Caudal septal division and interposition batten graft can serve as an alternative surgical approach with acceptable surgical outcomes for managing severely deviated caudal septum. LEVEL OF EVIDENCE: 4.
BACKGROUND: Correction of caudal septal deviation is a challenging task that may require multiple surgical approaches. OBJECTIVE: To introduce a novel technique - caudal septal division and interposition batten graft - and evaluate its surgical outcomes in patients undergoing correction of caudal septal deviation. METHOD: The surgical procedure includes a division of the deviated caudal L-strut preserved after resection of the deviated quadrangular septal cartilage at the central portion. A batten graft made of septal cartilage or bone is interposed between the cut ends of the caudal L-strut, the upper part of which mobilized toward the more concave side of the nasal cavity, and then sutured. The medical records of 29 patients with caudal septal deviation who underwent septoplasty using caudal L-strut division and interposition batten graft technique between January 2016 and March 2018 were retrospectively reviewed. Patient satisfaction and symptom improvement were evaluated by using the Nasal Obstruction Symptoms Evaluation scores. Endoscopic assessment of deviation correction was performed and postoperative complications were analyzed. RESULTS: Of the 29 patients, 19 (65.5%) answered the telephonic interview. Mean Nasal Obstruction Symptoms Evaluation scores were 62.1 preoperatively and 9.2 postoperatively, exhibiting significant improvement (P < .001). Satisfaction was rated as much improved in 9 (32.0%) patients, improved in 16 (57.0%), unchanged in 2 (7%), and worse in 1 (4%). Records of endoscopic examinations showed that 26 (82.9%) patients had a straight septum, 4 (11.4%) had improved but persisting caudal deviation, and 2 (5.7%) had no available data. Four patients had postoperative complications: 2 had septal abscesses, 1 had wound dehiscence, and 1 had synechia. All of these complications were managed without persistent problems. CONCLUSIONS: Caudal septal division and interposition batten graft can serve as an alternative surgical approach with acceptable surgical outcomes for managing severely deviated caudal septum. LEVEL OF EVIDENCE: 4.