Advanced Septoplasty: Extracorporeal Septoplasty—Septal Reconstruction

Summary

The severe septal deformity is even today a challenging problem. Standard techniques often do not achieve a good long-term result in function or aesthetics. Therefore, we used the idea of removing a badly deformed septum, building up a straight and strong neo-construct, and replanting it back into the nose. During the last 39 years, we improved this technique continuously and have proven that it is an effective technique for getting good results.

Introduction

Historical Background

In the early 1980s, we began to develop the extracorporeal septal reconstruction as a method for correcting pronounced septal deformities. The idea of completely removing the septum in the case of massive deformations, and then replanting it after straightening was not new at that time. The technique was first recommended by King and Ashley in 1952 but had not gained significant clinical importance. At the end of the 1970s, this idea was revitalized. Since 1980, we have consistently applied this technique to all severe septum deformities, and we have continued to develop it further. A decisive breakthrough came with the change from the closed to the open approach. Although the follow-up results of our patients with the closed approach were very encouraging, the open approach enabled us to create a reliable fixation of the neo-septum to the cartilaginous and bony nasal framework. Subsequently, this technique could also be performed by less experienced rhinoplasty surgeons. In addition to the secure fixation, restoring a smooth nasal dorsum was a problem that we first solved by covering it with allogeneic fascia lata and later by the regular use of free diced cartilage, which we used as a smoothing paste. Our long-term studies proved the effectiveness of this technique. In the discussion, the indications for this technique are described and compared with modifications that have been published recently.

Surgical Problem

The septum is the central part of the nasal skeleton and is thus of fundamental importance for any rhinoplasty. Nevertheless, septal correction is considered an entry-level operation in the surgical training of ENT surgeons. This is by no means justified, as the range of septal deformities is extraordinarily variable and broad, and the degree of difficulty of surgical correction can differ immensely. Not every septal spur or pronounced deviation in the depth inevitably causes obstructed nasal breathing. Therefore, many opportunities for the functional impairment must be considered during the preoperative evaluation. A completely straight septum is not required for a perfect function. According to Mlynski, working nasal airways are far more crucial for nasal breathing. However, a straight septum is essential for the external form: only when the septum is straight can the outer nose be straight. Thus, a straight septum is more desirable in aesthetic nasal surgery than in a nose correction solely aiming for a functional improvement.

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