Persichetti Paolo, Toto Vito, Segreto Francesco, Signoretti Matteo, Marangi Giovanni Francesco
From the Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy.
Ann Plast Surg. 2016 May;76(5):504-8. doi: 10.1097/SAP.0000000000000377.
Septal deviations represent a major cause of aesthetic disorders and respiratory obstruction. The traditional septoplasty techniques may often be inadequate to treat severe deviations. Recently, we described a modified extracorporeal septoplasty approach based on partial resection of the cartilaginous septum, with preservation of a superocaudal L-strut measuring approximately 0.5 cm in height. At 6-month follow-up, we demonstrated this technique to be functionally and aesthetically effective in addressing mild to severe septal deviation. The aim of the present study was to evaluate the long-term outcomes of this technique in the patients included in the initial prospective study, followed up during a period of 4 to 6 years.
One hundred fifty-three patients underwent modified extracorporeal septoplasty from January 2006 to June 2009. One hundred twenty of these patients were included in the present study. Patients were grouped according to the preoperative septal deviation as follows: mild (one-third reduction of the nasal cavity), moderate (half reduction), and severe (two-thirds reduction). Follow-up ranged from 4 to 6 years. Respiratory flow improvement was assessed with active anterior rhinomanometry; subjective evaluation of the respiratory function was obtained by mean of Nasal Obstruction Symptom Evaluation (NOSE) scale. Active anterior rhinomanometry values and NOSE scores were compared with the results obtained preoperatively and at 6-month postintervention.
In the whole cohort, rhinomanometric analyses and NOSE scores at long-term follow-up demonstrated a statistically significant improvement in inspiratory flow and obstructive symptoms (P = 0.0122 and P < 0.0001, respectively) compared to preoperative values. In group analysis, a significant improvement in NOSE scores was found in patients with severe (P < 0.0001) and moderate (P < 0.0001) deviations. A significant improvement in inspiratory flow was reported in the severe (P < 0.0001) and moderate (P = 0.0212) deviation groups.
The modified extracorporeal septoplasty technique proved to be functionally effective at long-term follow-up in cases of moderate or severe septal deviation: the improvements in respiratory function and obstructive symptoms found 6 months postoperatively were maintained at 4 to 6 years postintervention. With this technique, structural support is achieved without destabilizing the keystone area; moreover, conservative remodeling of the quadrangular cartilage allows the use of septal cartilage grafts in secondary or revision rhinoplasty.
鼻中隔偏曲是导致美学缺陷和呼吸阻塞的主要原因。传统的鼻中隔成形术技术往往不足以治疗严重的鼻中隔偏曲。最近，我们描述了一种改良的体外鼻中隔成形术方法，该方法基于部分切除鼻中隔软骨，保留一块高度约为0.5厘米的鼻尾L形支柱。在6个月的随访中，我们证明了该技术在治疗轻至重度鼻中隔偏曲方面在功能和美学上均有效。本研究的目的是评估该技术在最初前瞻性研究纳入的患者中的长期疗效，随访时间为4至6年。
2006年1月至2009年6月，153例患者接受了改良的体外鼻中隔成形术。其中120例患者纳入本研究。根据术前鼻中隔偏曲情况将患者分组如下：轻度（鼻腔缩小三分之一）、中度（鼻腔缩小一半）和重度（鼻腔缩小三分之二）。随访时间为4至6年。通过主动前鼻测压法评估呼吸流量改善情况；通过鼻阻塞症状评估（NOSE）量表对呼吸功能进行主观评估。将主动前鼻测压值和NOSE评分与术前及干预后6个月的结果进行比较。
在整个队列中，长期随访的鼻测压分析和NOSE评分显示，与术前值相比，吸气流量和阻塞症状有统计学意义的改善（分别为P = 0.0122和P < 0.0001）。在分组分析中，重度（P < 0.0001）和中度（P < 0.0001）偏曲患者的NOSE评分有显著改善。重度（P < 0.0001）和中度（P = 0.0212）偏曲组的吸气流量有显著改善。
改良的体外鼻中隔成形术技术在中度或重度鼻中隔偏曲病例的长期随访中被证明在功能上是有效的：术后6个月发现的呼吸功能和阻塞症状的改善在干预后4至6年得以维持。采用该技术，在不破坏关键区域稳定性的情况下实现了结构支撑；此外，对四边形软骨的保守重塑允许在二期或修复性鼻整形术中使用鼻中隔软骨移植。
