Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Am J Rhinol Allergy. 2012 May-Jun;26(3):227-32. doi: 10.2500/ajra.2012.26.3734. Epub 2012 Mar 26.
High dorsal deflection of the nasal septum around the bony-cartilaginous junction ("keystone area") is often missed and difficult to treat because of the importance of septal support. This study introduces a new technique of septoplasty to correct this dorsal deviation.
Forty-two patients with severe dorsal septal deviation around the bony-cartilaginous junction were included in the study. The surgical process was as follows: after elevation of mucoperichondrial flap, deflected bony septum and surplus cartilage were removed. Then, partial thickness scorings were performed on the concave side of the deviated cartilaginous septum. For correcting the dorsal deviation around bony-cartilaginous junction, greenstick fracture and two suture holes were made at higher bony septum. Modified mattress suture was performed across the deflected bony-cartilaginous junction while pushing the deviated septum to the midline gently. Subjective and objective improvements were evaluated with questionnaires and acoustic rhinometry at least 3 months after the surgery.
Significant improvements in nasal obstruction (4.61-2.42) and discomfort (1.82-1.39) were achieved. On acoustic rhinometry, cross-sectional area (CSA(1); 0.41 ± 0.18 to 0.64 ± 0.22 cm(2)) and CSA(2) (0.83 ± 0.37 to 1.39 ± 0.36 cm(2)) at the narrower sides showed significant improvements and the ratio of the wider to narrower sides in CSA(1) (2.61 ± 1.91 to 1.47 ± 0.61) and CSA(2) (2.07 ± 1.51 to 1.33 ± 0.40) showed significant improvements.
The proposed "modified mattress suture technique" provides positive initial results for correction of the high dorsal deviation of septum around the bony-cartilaginous junction.
由于鼻中隔支撑的重要性，高背鼻中隔偏曲（“关键区”）在骨-软骨交界处周围经常被忽视且难以治疗。本研究介绍了一种新的鼻中隔成形术技术来纠正这种背侧偏曲。
本研究纳入了 42 例严重背侧鼻中隔偏曲（骨-软骨交界处）患者。手术过程如下：在掀起黏骨膜瓣后，切除偏曲的骨性鼻中隔和多余的软骨。然后，在偏曲的软骨鼻中隔的凹侧进行部分厚度划痕。为了纠正骨-软骨交界处的背侧偏曲，在较高的骨性鼻中隔上制作绿棒骨折和两个缝线孔。通过轻轻推动偏曲的鼻中隔，在偏曲的骨-软骨交界处进行改良褥式缝合。术后至少 3 个月，通过问卷调查和鼻声反射测量评估主观和客观改善情况。
患者的鼻塞（4.61-2.42）和不适（1.82-1.39）均显著改善。鼻声反射测量显示，狭窄侧的横截面积（CSA(1)；0.41 ± 0.18 至 0.64 ± 0.22 cm(2))和 CSA(2)（0.83 ± 0.37 至 1.39 ± 0.36 cm(2)）均显著改善，CSA(1)的较宽侧与较窄侧的比值（2.61 ± 1.91 至 1.47 ± 0.61）和 CSA(2)的较宽侧与较窄侧的比值（2.07 ± 1.51 至 1.33 ± 0.40）均显著改善。
提出的“改良褥式缝合技术”为纠正骨-软骨交界处的高背鼻中隔偏曲提供了积极的初步结果。
