Literature DB >> 32036638

Crosshatching Incision in Septoplasty: Abandoning an Old Myth.

Hong Ryul Jin1, Jong-Sook Yi1.   

Abstract

Entities:  

Year:  2020        PMID: 32036638      PMCID: PMC7010488          DOI: 10.21053/ceo.2019.01767

Source DB:  PubMed          Journal:  Clin Exp Otorhinolaryngol        ISSN: 1976-8710            Impact factor:   3.372


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Septoplasty is the most commonly performed surgical procedure in rhinology [1]. Since the introduction of submucosal resection [2], diverse surgical techniques to correct the deviated septum have been developed. In septoplasty, one technique hardly corrects all the diverse deformities of the septum. In 1982, Murakami et al. [3] advocated the crosshatching incisional technique as one maneuver to correct the deviated cartilaginous septum, and it continued to gain popularity until recently. This technique is based on the theory of an internal interlocked stress system of septal cartilage. In their experimental study, Murakami et al. [3] concluded that a full-thickness crosshatching incision on the concave side is the most effective incisional method for straightening the bent cartilage. Yet recently, many surgeons who used this technique have raised questions about the efficacy and safety of this technique due to unintended consequences. The primary drawbacks of the crosshatching incision are the unpredictability of straightening the curved cartilage and the potential for a weakening of the septum over time. In an issue of Clinical and Experimental Otorhinolaryngology, Kim and Heo [4] compared their experience of crosshatching incision septoplasty with non-incision septoplasty. They reviewed 151 patients who underwent septoplasty using crosshatching incision and 202 patients who did not. All patients were followed up for more than 1 year (mean, 15.9 months). The correction degree of septal deviation and improvement of nasal obstruction were no different between the two groups. Notable complications such as saddle nose deformity and overcorrection after septoplasty were seen in nine patients in the incision group, while the non-incision group lacked any such cases. In the discussion, the authors noted that the biomechanical properties of septal cartilage, scarring during the wound-healing process, and the thickness of septal cartilage may differ widely across individuals, resulting in such outcomes. In their previous research, the authors performed an experiment with pig ear cartilage to reproduce the original experiment done by Murakami et al. [3] in an actual surgical setting [5]. Unlike Murakami et al.’s study method, the authors fixed two contiguous borders of cartilage with the preservation of a 1 cm margin like an L-strut, considering the effects of fixation and gravity; they did full-thickness crosshatching incision on the concave side. In this condition, the curvature improvement was found to be only 15.5%. Moreover, newly developed reverse curvatures or splitting of the cartilage occurred. This result is in line with those of Gruber et al. [6] and Min and Chung [7], who warned that the incisional technique could cause instability of the cartilage and scored cartilage could collapse entirely. In practice, executing the full-thickness crosshatching incision in a regular pattern and at a uniform depth is almost impossible in relatively thin septal cartilage, which most Asians have. From our experience with revision septoplasty, the authors found that a crosshatching incision without proper splinting often fails to correct the curvature of the septum and leads to another deformity [8]. We firmly believe that the curvature of the cartilaginous septum will not be adequately corrected with crosshatching incisions alone, and the additional splinting or battening the weakened cartilage would be an effective way to correct the curvatures. There is always a rise and fall in the popularity of surgical concepts and techniques. Any new fascinating technique can be discarded if it fails the test of time. The authors think the crosshatching incision technique failed to accumulate relevant evidence of success. Thus, it seems apparent that we are at a point when we should abandon our old myth about the role of this technique in septoplasty.
  7 in total

1.  Cartilaginous incisions in septoplasty.

Authors:  Y G Min; J W Chung
Journal:  ORL J Otorhinolaryngol Relat Spec       Date:  1996 Jan-Feb       Impact factor: 1.538

2.  Evaluation of patient benefit from nasal septal surgery for nasal obstruction.

Authors:  Sandeep Uppal; Hiran Mistry; Shri Nadig; Gary Back; Andrew Coatesworth
Journal:  Auris Nasus Larynx       Date:  2005-03-23       Impact factor: 1.863

3.  Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: part II. Clinical results.

Authors:  Ronald P Gruber; Farzad Nahai; Michael A Bogdan; Gary D Friedman
Journal:  Plast Reconstr Surg       Date:  2005-02       Impact factor: 4.730

4.  Applications of the biomechanical behavior of cartilage to nasal septoplastic surgery.

Authors:  W T Murakami; L W Wong; T M Davidson
Journal:  Laryngoscope       Date:  1982-03       Impact factor: 3.325

5.  Crosshatching incision technique in septoplasty: Experimental outcomes under actual surgical settings.

Authors:  Sung Jae Heo; Jung Soo Kim
Journal:  Auris Nasus Larynx       Date:  2016-01-14       Impact factor: 1.863

6.  Common Sites, Etiology, and Solutions of Persistent Septal Deviation in Revision Septoplasty.

Authors:  Hong Ryul Jin; Dae Woo Kim; Hahn Jin Jung
Journal:  Clin Exp Otorhinolaryngol       Date:  2018-07-20       Impact factor: 3.372

7.  Questionable Effect of Crosshatching Incision in Septoplasty.

Authors:  Jung-Soo Kim; Sung Jae Heo
Journal:  Clin Exp Otorhinolaryngol       Date:  2019-08-17       Impact factor: 3.372

  7 in total

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