Atespare Altay, Boyaci Zerrin
Department of Otorhinolaryngology, Maltepe University Medical Faculty, Istanbul, Turkey.
J Craniofac Surg. 2016 Oct;27(7):1656-1660. doi: 10.1097/SCS.0000000000002898.
Persistent nasal obstruction at internal nasal valve was a common problem seen after septoplasty and submucous resection, the 2 methods used for surgical treatment for deviation of nasal septum during the first half of twentieth century. The authors performed cartilage-grafting technique and retrospectively analyzed the patients after 12 months with Nasal Obstruction and Septoplasty Effectiveness scale to emphasize persistent nasal obstruction.
In this study, 115 (65 male, 50 female) patients operated between 2008 and 2013 who underwent revision septoplasty and complaints were evaluated with Nasal Obstruction and Septoplasty Effectiveness scale. The surgical technique was used in 32 (27.8%) of the patients "open" and in 83 (72.2%) "closed" approach. Wilcoxon sign test is used for the statistical analysis. Postoperative values were statistically significant compared with preoperative ones (P <0.05).
Septoplasty and submucous resection described by Cottle and Killian are similar techniques, but a septoplasty often includes less cartilage resection and septal cartilage modification or placement of a cartilage graft instead of resection. Most important disadvantage of these techniques is to be deficient in the correction of the caudal and/or dorsal deviations. In authors' experience these classical septoplasty techniques are not suitable for columellar and dorsal deviations and especially in revision surgery an internal nasal valve correction with cartilage grafts is a necessary alternative technique.
鼻内瓣膜处持续性鼻塞是鼻中隔成形术和黏膜下切除术之后常见的问题，这两种方法是20世纪上半叶用于鼻中隔偏曲手术治疗的方法。作者实施了软骨移植技术，并在12个月后使用鼻塞与鼻中隔成形术疗效量表对患者进行回顾性分析，以强调持续性鼻塞问题。
在本研究中，对2008年至2013年间接受翻修鼻中隔成形术且有相关主诉的115例患者（65例男性，50例女性），使用鼻塞与鼻中隔成形术疗效量表进行评估。32例（27.8%）患者采用“开放式”手术技术，83例（72.2%）采用“封闭式”手术技术。采用Wilcoxon符号秩和检验进行统计分析。术后值与术前值相比具有统计学意义（P<0.05）。
科特尔（Cottle）和基利安（Killian）描述的鼻中隔成形术和黏膜下切除术是相似的技术，但鼻中隔成形术通常包括较少的软骨切除以及鼻中隔软骨的修整或放置软骨移植物而非切除。这些技术最重要的缺点是在纠正尾侧和/或背侧偏曲方面存在不足。根据作者的经验，这些经典的鼻中隔成形术技术不适用于鼻小柱和背侧偏曲，尤其是在翻修手术中，采用软骨移植物矫正鼻内瓣膜是一种必要的替代技术。
