Columella stabilising suture

Fashioned Mucoperichondrial Flap Technique Versus Fishing Line Technique in the Repair of Septal Dislocation: A Prospective Comparative Study

BACKGROUND

A nasal septal dislocation is a common form of septal deviation with many challenges and different surgical techniques for correction.

OBJECTIVE

To assess the efficacy of fashioned mucoperichondrial flap technique versus fishing line technique in the repair of septal dislocation.

METHODS

The study was a prospective comparative cohort study conducted on 88 patients aged above 18 years who have symptomatic mild to moderate caudal septal dislocation spanning the period from June 2021 to June 2022. Preoperatively, all patients were evaluated by the Nasal Obstruction and Septoplasty Effectiveness (NOSE) scale to assess the degree of nasal obstruction. Anterior rhinoscopy and endoscopic examination of the nose were done for every patient to assess the degree of obstruction, whether mild, moderate, or severe. Outcomes included an assessment of both techniques' efficacy in managing nasal obstruction as expressed by the NOSE scale and comparing both techniques regarding the operative and postoperative details.

RESULTS

The current study showed a highly significant improvement in the NOSE scale postoperatively in both groups (P < .00001 for both groups). The mean operative duration for group I was significantly less than that for group II (P < .00001). There was a nonsignificant difference between both groups regarding the postoperative NOSE scale, and postoperative degree of obstruction (P = .066 and .56, respectively). Regarding postoperative complications, there was a nonsignificant difference between both groups except for patient discomfort as assessed 1 week postoperatively. Group II showed significantly more patient discomfort (P = .02), which improved 4 weeks postoperatively.

CONCLUSION

Both techniques presented in this study effectively corrected mild and moderate caudal septal dislocation with significant improvement of nasal obstruction postoperatively. Both techniques produced good esthetic outcomes and were associated with few comparable complications in both groups.

Fashioned Mucoperichondrium Flap Technique in Caudal Septal Deviation

Caudal septal dislocation is a common finding, and it could lead to functional as well as aesthetic morbidity. There are different techniques to support the anterior end of the nasal septum and stabilize it in midline position. There are technical and practical difficulties in those techniques. This study describes a newly fashioned mucoperichondrium flap technique in caudal septal dislocation. This study was done in 40 patients (29 male and 11 female) with a mean (SD) age of 25 (3.2) years who had symptomatic septal deviation with minor and moderate caudal septal dislocation. The mucoperichondium flap on the side of the columellar dislocation was fashioned to be straight and stretched by excision of the extra length. It acted as a supporting scaffold for the straightened septum to be secured and fixed in the midline without need of any stabilizing sutures. All the patients had satisfactory functional and cosmetic results with correction of the columellar dislocation.

A new technique during septoplasty to prevent saddle nose

During septoplasty, especially in patients with severe deviation of the nasal septum, there is the risk of septal instability, which may result in a saddle nose deformity. Therefore, prevention of this unwanted outcome is very important and removes surgeon's anxieties. This article describes a simple technique during septoplasty to prevent the development of this serious complication. In this surgical technique, the dislocated nasal septum is lifted and stabilised with a temporary traction suture. This traction suture holds the mobile septal cartilage in the proper position to restore and support the nasal dorsum and provides it with a normal contour. The advantages of this technique are that it is (i) easy to perform, (ii) not time-consuming, (iii) is less traumatic compared to other methods, (iv) is comfortable for the patient and (v) provides long-term stability.