Evolution of the Septoplasty: Maximizing Functional and Aesthetic Outcomes in Nasal Surgery

                    http://www.mathewsopenaccess.com/Otolaryngology-articlesinpress.html

Correction of a severely deviated nasal septum remains one of the most challenging operations for the facial plastic surgeon. As understanding of nasal anatomy and physiology advanced over time, so have septoplasty techniques, which have evolved in sophistication and capability to correct increasingly complex nasoseptal deformities. Consequentially, the term “septoplasty” has become fraught with confusion, even among physicians, as it broadly encompasses a number of different surgical techniques that all attempt to correct septal deviations. Accurate pre-operative assessment of septal deformities and selection of the most appropriate surgical procedure can help maximize functional and aesthetic outcomes. In this article, we will review the evolution of septal surgery and the differences between the various surgical septoplasty techniques.

Septal deviation is one of the most common causes of nasal obstruction. In a cadaveric study of 2000 subjects, over 75% were found to have some degree of septal deviation. Approximately 33% of patients who visit an otolaryngologist report nasal obstruction, with up a quarter of these patients seeking surgical intervention. Septoplasty is the third most commonly performed otolaryngologic surgery in the United States, preceded only by ear tube placement and adenotonsillectomy. In the United States, 340,000 septoplasties were performed in 2006 alone. The term “septoplasty” is fraught with confusion, even among physicians, as it broadly describes any technique that attempts to correct a deviated septum, and these techniques may vary considerably in complexity and effectiveness. This confusion may contribute to the selection of inappropriate surgical techniques. Despite being one of the most commonly performed surgeries, septal deviations often persist following primary septoplasty, with persistent anterior septal deviation noted in 51-72% of revision septoplasties and patient dissatisfaction rates upwards of 35%. In this article, we will review the evolution of the nasal septal surgery and the examine the differences between the described septoplasty techniques. 

The nasal septum is a midline structure, composed of membranous, cartilaginous and bony components, which divides the nasal cavity into halves and provides structural support to the external nose. The membranous septum, comprised of fibrofatty tissue, is positioned between the medial crura of the lower lateral cartilages (LLC) anteriorly and the cartilaginous septum posteriorly. The cartilaginous septum articulates with the membranous septum anteriorly, nasal bones superiorly, maxillary crest inferiorly and bony septum posteriorly.