尾侧鼻中隔分离及插入条片移植：鼻中隔成形术中纠正尾侧鼻中隔偏曲的新技术。
Caudal Septal Division and Interposition Batten Graft: A Novel Technique to Correct Caudal Septal Deviation in Septoplasty.
作者信息
Kim Shin Ae, Jang Yong Ju
机构信息
Department of Otorhinolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea.
Department of Otorhinolaryngology - Head and Neck Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
出版信息
Ann Otol Rhinol Laryngol. 2019 Dec;128(12):1158-1164. doi: 10.1177/0003489419866214. Epub 2019 Aug 6.
BACKGROUND
Correction of caudal septal deviation is a challenging task that may require multiple surgical approaches.
OBJECTIVE
To introduce a novel technique - caudal septal division and interposition batten graft - and evaluate its surgical outcomes in patients undergoing correction of caudal septal deviation.
METHOD
The surgical procedure includes a division of the deviated caudal L-strut preserved after resection of the deviated quadrangular septal cartilage at the central portion. A batten graft made of septal cartilage or bone is interposed between the cut ends of the caudal L-strut, the upper part of which mobilized toward the more concave side of the nasal cavity, and then sutured. The medical records of 29 patients with caudal septal deviation who underwent septoplasty using caudal L-strut division and interposition batten graft technique between January 2016 and March 2018 were retrospectively reviewed. Patient satisfaction and symptom improvement were evaluated by using the Nasal Obstruction Symptoms Evaluation scores. Endoscopic assessment of deviation correction was performed and postoperative complications were analyzed.
RESULTS
Of the 29 patients, 19 (65.5%) answered the telephonic interview. Mean Nasal Obstruction Symptoms Evaluation scores were 62.1 preoperatively and 9.2 postoperatively, exhibiting significant improvement ( < .001). Satisfaction was rated as much improved in 9 (32.0%) patients, improved in 16 (57.0%), unchanged in 2 (7%), and worse in 1 (4%). Records of endoscopic examinations showed that 26 (82.9%) patients had a straight septum, 4 (11.4%) had improved but persisting caudal deviation, and 2 (5.7%) had no available data. Four patients had postoperative complications: 2 had septal abscesses, 1 had wound dehiscence, and 1 had synechia. All of these complications were managed without persistent problems.
CONCLUSIONS
Caudal septal division and interposition batten graft can serve as an alternative surgical approach with acceptable surgical outcomes for managing severely deviated caudal septum.
LEVEL OF EVIDENCE
背景
鼻中隔尾端偏曲的矫正手术具有挑战性，可能需要多种手术方法。
目的
介绍一种新技术——鼻中隔尾端切开并植入支撑条移植物，并评估其在鼻中隔尾端偏曲矫正患者中的手术效果。
方法
手术步骤包括在中央部分切除偏曲的四边形鼻中隔软骨后，对保留的偏曲鼻中隔尾端L形支柱进行切开。将由鼻中隔软骨或骨制成的支撑条移植物置于鼻中隔尾端L形支柱的切断端之间，其上部向鼻腔更凹陷侧移动，然后缝合。回顾性分析2016年1月至2018年3月期间29例采用鼻中隔尾端L形支柱切开并植入支撑条移植物技术行鼻中隔成形术的鼻中隔尾端偏曲患者的病历。采用鼻塞症状评估评分评估患者满意度和症状改善情况。进行内镜下偏曲矫正评估并分析术后并发症。
结果
29例患者中，19例（65.5%）接受了电话随访。术前平均鼻塞症状评估评分为62.1，术后为9.2，改善显著（P<0.001）。9例（32.0%）患者满意度评为明显改善，16例（57.0%）改善，2例（7%）无变化，1例（4%）恶化。内镜检查记录显示，26例（82.9%）患者鼻中隔变直，4例（11.4%）改善但仍有尾端偏曲，2例（5.7%）无可用数据。4例患者出现术后并发症：2例发生鼻中隔脓肿，1例伤口裂开，1例粘连。所有这些并发症均得到处理，未遗留持续性问题。
结论
鼻中隔尾端切开并植入支撑条移植物可作为一种替代手术方法，用于治疗严重偏曲的鼻中隔，手术效果可接受。
证据级别
4级。
Zotero 插件