Department of Otorhinolaryngology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
Int Forum Allergy Rhinol. 2019 Nov;9(11):1381-1386. doi: 10.1002/alr.22378. Epub 2019 Aug 23.
Surgical correction of severe caudal deviation of nasal septum using an endonasal approach is challenging for surgeons. Among cases of severe caudal septal deflection, fracture lines along the horizontal direction are occasionally encountered during the surgery. We devised a simple and efficient technique called "triangular excision and submucosal rejoining" to address this kind of deformity.
A total of 9 patients with severe caudal septal deflection underwent "triangular excision and submucosal rejoining." After the removal of the deformed posteroinferior portion of the quadrangular cartilage, 2 incision lines were made on the remaining caudal septum, starting from a point at the most anterior portion of the fracture line and diverging posteriorly above and below the fracture line. After removing a triangular cartilaginous piece, the upper and lower remaining cartilage segments were approximated using a single or 2 simple interrupted sutures. Sutures exiting the mucosa were re-entered from the exit point so that all the sutures were buried underneath the mucosa while the mucosal flap was elevated only unilaterally.
This technique was effective in all cases. Septal batten grafts were applied in 3 patients, in whom the remaining quadrangular cartilage was weak and thin. One patient showed a mildly recurred septal deviation, but the nasal cavities remained patent with no symptoms. Serious complications such as dorsal saddling or tip ptosis did not occur in any cases.
"Triangular excision and submucosal rejoining" may be a safe and efficient septoplasty technique to correct a horizontally folded caudal septum.
经鼻内入路矫正严重鼻中隔后段偏曲对术者具有挑战性。在严重鼻中隔后段偏曲的病例中，手术中偶尔会遇到沿水平方向的骨折线。我们设计了一种简单有效的技术，称为“三角切除和黏膜下重新连接”，以解决这种畸形。
共有 9 例严重鼻中隔后段偏曲患者接受了“三角切除和黏膜下重新连接”。在去除四边形软骨变形的后下部分后，在剩余的鼻中隔上制作 2 条切口线，从骨折线最靠前的部位开始，向后上方和下方发散。切除一块三角软骨片后，使用单或 2 个简单间断缝线将上下剩余软骨段靠拢。穿出黏膜的缝线从穿出点重新进入，以便所有缝线都埋在黏膜下，而仅单侧提起黏膜瓣。
该技术在所有病例中均有效。在 3 例患者中应用鼻中隔夹板移植，其中剩余的四边形软骨薄弱且薄。1 例患者出现轻度鼻中隔再偏曲，但鼻腔通畅，无任何症状。在任何情况下都没有出现严重并发症，如背侧鞍形或鼻尖下垂。
“三角切除和黏膜下重新连接”可能是一种安全有效的鼻中隔成形术技术，可矫正水平折叠的鼻中隔后段。
