Excision and replacement of nasal septum in aesthetic and functional nose surgery: setting criteria and establishing indications.

Despite the technical details of the excision and replacement of the nasal septum both in aesthetic and functional nasal surgery have been extensively reviewed, in the opinion of the authors a clear and precise definition of the indications of this technique is still lacking. A simplified classification of the nasal septum deformities, based on the site and the direction of the fracture or bending axis, is proposed to establish reproducible guidelines to nasal septum surgery. On the basis of this classification the post-operative results of 227 patients affected by obstructive nasal septum deviation were evaluated. The surgical treatment consisted of conservative septoplasty in 173 cases, while in 54 cases excision and replacement of the nasal septum were performed. A conservative tension release septoplasty was performed for horizontal fracture or angulation of the septum. The more radical excision/replacement surgical approach was preferred when a vertical angulation or bending axis was observed (vertical = normal to the maxillary ridge). Twenty persisting septal deviations were found at the one year post-operative follow-up. Nineteen of these were the outcome of 173 conservative septoplasty, while only one case with unsatisfactory results was the outcome of 54 excision/replacement procedures. Seventeen out of 19 cases originally classified as horizontal deformity who presented at follow up with persisting septum deviation were reclassified as vertical. The reason for surgical failure must be probably identified in a preoperatory classification mistake where vertical deformities were erroneously evaluated horizontal and operated accordingly. The authors suggest excision/replacement of the nasal septum whenever its fracture or major bending axis is vertical.