Reconstructive Septal Surgery

ABSTRACT

To attain without compromise the surgical goal, a straight and concurrently solid septum, especially in cases of marked deviations or severe post-traumatic deformities (sometimes combined with external deformities), an excellent proven and well-known technique is extracorporal or external septoplasty. Surgery consists of excision of the quadrilateral cartilage and its division into straight fragments. To avoid postoperative sequelae such as saddling, the pieces of cartilage must be reconnected meticulously to form a straight and at the same time solid plate. This difficult and time-consuming procedure can be assisted by the use of a connecting material. Since 1996 we have been using a polydioxanone foil (PDS, Ethicon Norderstedt Germany) as the supporting material for this purpose. The PDS as well as the suture material is completely resorbed within 5 months, excluding long-term complications of other artificial implants.

KEYWORDS

Septoplasty - septal reconstruction - extracorporal septoplasty - iatrogenic saddle nose - PDS foil

REFERENCES

• 1 Rees T D. Surgical correction of the severely deviated nose by extramucosal excision and replacement as a free graft.  Plast Reconst Surg. 1986;  78 320-330
• 2 Toriumi D M, Mueller R A, Grosch T et al.. Vascular anatomy of the nose and the external rhinoplasty approach.  Arch Otolaryngol Head Neck Surg. 1996;  122 22-34
• 3 Boenisch M, Nolst Trenité G J. In: Nolst Trenité GJ Rhinoplasty: A Practical Guide to Functional and Aesthetic Surgery of the Nose. The Hague; Kugler Publications 2005: 285-295
• 4 Gubisch W. The extracorporal septum plasty: a technique to correct difficult nasal deformities.  Plast Reconst Surg. 1995;  95 672-682
• 5 Gubisch W. Zwanzig Jahre Erfahrung mit der extrakkorporalen Septumkorrektur.  Laryngorhinootologie. 2001;  81 22-30
• 6 Tardy Jr M E. Sculpturing of the nasal tip. In: Tardy ME Jr Rhinoplasty: The Art and the Science. Philadelphia, PA; WB Saunders 1997: 374-571
• 7 Jizuka T, Mikkonen P, Paukku P, Lindqvist C. Reconstruction of orbital floor with polydioxanone plate.  Int J Oral Maxillofac Surg. 1991;  20 83-88
• 8 Hollinger J O, Battistone G. Biodegradable bone repair materials.  Clin Orthop Relat Res. 1986;  207 290-305
• 9 Boenisch M, Mink A. Heilungsprozess des Knorpels in Verbindung mit PDS-Folie.  HNO. 2000;  48 743-746
• 10 Boenisch M, Hajas T, Nolst Trenité G J. Influence of polydioxanone foil on growing septal cartilage after surgery in an animal model.  Arch Facial Plast Surg. 2003;  5 316-319
• 11 Vuyk H D. Grafts in nasal surgery. In: Fourth International Course in Modern Rhinoplasty Techniques. Amsterdam; 1997
• 12 Tardy Jr M E, Denneny III J, Fritsch M H. The versatile cartilage autograft in reconstruction of the nose and face.  Laryngoscope. 1985;  95 523-533
• 13 Nolst Trenité G J, Verwoerd C D, Verwoerd-Verhoef H L. Reimplantation of autologous septal cartilage in the growing nasal septum I.  Rhinology. 1987;  25 225-236
• 14 Nolst Trenité G J, Verwoerd C D, Verwoerd-Verhoef H L. Reimplantation of autologous septal cartilage in the growing nasal septum II.  Rhinology. 1988;  26 25-32