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Hosokawa Y, Miyawaki T, Akutsu T, Omura K, Tsumiyama S, Iimura J, Otori N, Kojima H. Effectiveness of modified cutting and suture technique for endonasal caudal septoplasty in correcting nasal obstruction and preventing nasal tip projection loss. J Otolaryngol Head Neck Surg 2021; 50:35. [PMID: 34130761 PMCID: PMC8205607 DOI: 10.1186/s40463-021-00516-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Caudal septoplasty is a difficult procedure. The cutting and suture technique is suitable for caudal septoplasty, but a batten graft is always necessary and bears the risk of nasal tip projection loss. We established a modified cutting and suture technique (MCAST), without using a batten graft, and investigated its effectiveness in correcting nasal obstruction and preventing nasal tip projection loss. METHODS We retrospectively reviewed the medical records of 22 patients who underwent caudal septoplasty using MCAST. Subjective assessment by Nasal Obstruction Symptom Evaluation (NOSE) score and objective assessment by computed tomography (CT) were performed before and after the surgery. For evaluating nasal tip projection, we asked patients about their awareness of external nasal deformity. Additionally, the nasal tip projection was measured by CT and compared before and after surgery. RESULTS The median preoperative NOSE score reduced significantly after MCAST (P < 0.001). On CT, the ratio of the area of the convex side to that of the concave side in the anterior portion of the nasal cavity increased significantly after MCAST (P < 0.001). All patients were unaware of external nasal deformity. There were no significant differences in the mean preoperative and postoperative nasal tip height and nasolabial angle. The mean supra tip height was significantly greater postoperatively than preoperatively (P = 0.02). CONCLUSIONS The MCAST was useful for correcting nasal obstruction with caudal septal deviation. There was no postoperative loss of nasal tip projection. The MCAST can be suitable for correcting C-shaped caudal deviations without dislocating the caudal septum from the anterior nasal septum.
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Affiliation(s)
- Yu Hosokawa
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-19-8, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan. .,Septorhinoplasty Clinic, The Jikei University Hospital, Tokyo, Japan.
| | - Takeshi Miyawaki
- Septorhinoplasty Clinic, The Jikei University Hospital, Tokyo, Japan.,Department of Plastic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Taisuke Akutsu
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-19-8, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Kazuhiro Omura
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-19-8, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Shinya Tsumiyama
- Septorhinoplasty Clinic, The Jikei University Hospital, Tokyo, Japan.,Department of Plastic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Jiro Iimura
- Septorhinoplasty Clinic, The Jikei University Hospital, Tokyo, Japan.,Department of Otorhinolaryngology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-19-8, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan.,Septorhinoplasty Clinic, The Jikei University Hospital, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-19-8, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
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Kimura S, Suzuki M, Honma A, Nakazono A, Osawa M, Nakamaru Y, Homma A. Objective evaluation of caudal deviation of the nasal septum and selection of the appropriate septoplasty technique. Auris Nasus Larynx 2021; 49:67-76. [PMID: 33966932 DOI: 10.1016/j.anl.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/16/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Several methods have been reported to correct caudal deviation of the nasal septum, including open septorhinoplasty (OSR) and septoplasty with Killian incision (KI). In general, OSR is applied instead of KI for caudal deviation. However, there is little objective evidence own on the effects of OSR and KI for caudal deviation. In this study, we compared surgical outcomes between OSR and KI by quantifying nasal septum deviation using two simple and objective parameters on routine paranasal sinus CT scans. METHODS We retrospectively analyzed 18 patients who underwent OSR and 11 patients who underwent septoplasty with KI between April 2006 and October 2019. Caudal deviation was defined on the basis of the "Anterior-posterior Position of the most deviated point of the nasal septum (AP)," which was measured on computerized tomography. The deformation rate (DR) of the nasal septum was also calculated. Nasal airway resistance and visual analogue scale (VAS) score for nasal obstruction were examined. RESULTS The AP was significantly correlated with the VAS score (r=-0.58, p=0.017). The DR in patients with caudal septal deviation was significantly decreased by OSR (0.14±0.06 to 0.03±0.03, p=0.004), but not by KI (0.09±0.08 to 0.04±0.03, p=0.25). OSR also improved nasal airway resistance (1.10±0.44 to 0.42±0.15, p=0.02), and the VAS score (79.11±14.74 to 5.78±7.89, p=0.004). CONCLUSION Nasal obstruction is more severe in patients with the caudal deviation. OSR corrects caudal deviation of the nasal septum more effectively than does KI. The AP could be useful for the evaluation of the deviation of the nasal septum and help in selecting the appropriate septoplastic technique.
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Affiliation(s)
- Shogo Kimura
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Masanobu Suzuki
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Aya Honma
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Akira Nakazono
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Masayuki Osawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan.
| | - Akihiro Homma
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
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Han JK. Answers to some common rhinologic questions. Int Forum Allergy Rhinol 2020; 9:829-830. [PMID: 31390490 DOI: 10.1002/alr.22393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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