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Original Investigation |

Treatment Outcomes of Extracorporeal Septoplasty Compared With In Situ Septal Correction in Rhinoplasty

Sung Bu Lee, MD1; Yong Ju Jang, MD, PhD1
[+] Author Affiliations
1Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
JAMA Facial Plast Surg. 2014;16(5):328-334. doi:10.1001/jamafacial.2014.387.
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Importance  Extracorporeal septoplasty (ECS) in rhinoplasty is a useful surgical procedure that can achieve considerable functional and aesthetic improvements in the treatment of a deviated nose. However, to our knowledge, no study has compared the treatment outcomes of ECS with those of in situ septal correction (ISSC) in rhinoplasty.

Objective  To compare the surgical outcomes of ECS with those of conventional ISSC in the treatment of a deviated nose.

Design, Setting, and Participants  We retrospectively reviewed the medical records of 169 patients who underwent rhinoplasty from July 1, 2006, through December 31, 2012. For ECS, we used a modified technique. For ISSC, several techniques, including batten and spreader grafting and caudal cutting and suture, were used alone or in combination. Eighty-four patients underwent ECS. The remaining 85 patients, who were age- and sex-matched controls who were operated on at a similar time point, were treated by ISSC for the correction of a deviated nose.

Main Outcomes and Measures  Surgical outcomes were assessed and compared using the anthropometric measurement of photographs and by reviewing medical records to evaluate functional outcomes and complications after surgery.

Results  There were 52 I-shape (61.9%) and 32 C-shape (38.1%) types of external nose deviations in the ECS group. There were 59 I-shape (69.4%) and 26 C-shape (30.6%) types of external nose deviations in the ISSC group. Postoperative deviation angle (P < .001), nasofrontal (P < .05) and nasolabial (P < .001) angles, and nasal tip projection (P < .001) values were significantly improved from the preoperative values in both groups. The mean operating times of ECS and ISSC were 135 and 128 minutes, respectively. The rates of complications, such as an irregular contour of the dorsum, saddling, and postoperative infection, were similar between the 2 groups. However, no patients in the ECS group experienced postoperative nasal obstruction, whereas 5 of 78 patients (6.4%) in the ISSC group experienced persistent or unresolved nasal obstruction that required revision septoplasty.

Conclusions and Relevance  We found that ECS is a useful technique for markedly deviated noses that can achieve a comparable aesthetic success but better functional outcome than ISSC in rhinoplasty.

Level of Evidence  3.

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Figure 1.
Measurements of Deviation Angle According to Deviation Type

A, I-shape deviation angles were measured between the vertical line between the midpoint of the glabella and the midpoint of the upper lip and another line that represented the nasal dorsal axis, consisting of the osseous and cartilaginous parts from the nasion to the tip. B, C-shape deviation angles were measured between an oblique line between the nasion and the most prominent point of convexity and another line between the most prominent point of convexity and the nasal tip.

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Figure 2.
A 16-Year-Old Boy With a Deviated Nose Who Underwent Extracorporeal Septoplasty (ECS)

Preoperative (A and C) and 5-month postoperative (B and D) photographs show a straight nasal dorsum and projected tip. Cartilaginous deviation was corrected by ECS without osteotomy, and the nasal tip was projected by a shield graft.

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Figure 3.
A 20-Year-Old Man With a Deviated Nose Who Underwent Extracorporeal Septoplasty (ECS) With Osteotomy

Preoperative (A and C) and 6-month postoperative (B and D) photographs show a straight nasal dorsum and projected tip. The deviated nose was corrected by osteotomy and ECS. The nasal dorsum and tip were projected by a fascia and shield graft.

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Figure 4.
Degree of Improvement in Anthropometric Measurements Between the Extracorporeal Septoplasty (ECS) and In Situ Septal Correction (ISSC) Groups

No significant differences were found in the degree of improvement between the 2 groups.

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