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Article Type

Article

Abstract

Background: Dorsal deviations of the nasal cartilaginous septum are difficult to correct without exposing and correcting the deviated cartilaginous nasal pyramid. Also, spreader grafts application needs exposure of the nasal dorsum. There are two known approaches to the nasal dorsum: the external open approach and the closed endonasal approach through inter-cartilaginous incision. Both need dissection of the skin with consequent edema and fibrosis which may affect the result.

Objective: a transeptal endonasal approach to the nasal dorsum is described aiming to have a simple correction of the previous problems.

Study design: retrospective study. Setting: tertiary academic medical center.

Patients: the study included 20 adult patients, 14 had deviated nasal septum with cartilaginous deviations of the nasal dorsum, 2 patients had combined internal and external nasal valve collapse during inspiration and 4 patients had internal nasal valve obstruction after previous rhinoplasty.

Methods: Incision on the anterior border of the cartilaginous septum is done followed by elevation of the mucosa on the concave side. The usual septoplasty is performed to correct other associated deviations. A high incision on the septal cartilage parallel to the cartilaginous nasal pyramid is done 4-5 mm parallel to it. The strip of cartilage dorsal to the incision is dissected and separated from the upper lateral cartilages on both sides. A spreader graft may be inserted at this area if needed (done in all cases of combined external and internal nasal valve collapse and internal nasal valve obstruction and 4 cases with septal deviation) then fixed by sutures and silastic splints.

Results: from the 14 patients of cartilaginous dorsal deviation, 11 patients (78.6%) had correction of the cartilaginous septum & cartilaginous nasal pyramid deviation, while, 3 (21.4%) had mild residual deviation. Twelve patients (85.7%) had their nasal obstruction completely improved, and 2(14.3%) had partially improved. All patients with spreader grafts application improved functionally and esthetically.

Conclusion: the transseptal endonasal approach to the nasal dorsum is effective for correction of cartilaginous dorsal nasal deviations and application of spreader grafts without postoperative edema and fibrosis that may change the result.

Keywords: Endonasal transseptal, dorsal nasal deviation, deviated septum, spreader grafts, nasal valve obstruction

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