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Subtotal septal reconstruction may have utility in severe septal deviation

Subtotal septal reconstruction was associated with improved Nasal Obstruction Symptom Evaluation scores in a cohort of patients undergoing septorhinoplasty for severe septal deviation.

The study included 144 patients (72.2% female) undergoing this procedure between Sept. 1, 2008, and Sept. 1, 2013. In addition to Nasal Obstruction Symptom Evaluation (NOSE) scores, the investigators used three-dimensional (3-D) stereophotogrammetry to evaluate aesthetic outcomes at three time points: preoperative, early postoperative and final postoperative.

Overall, 60.5% of the cohort underwent revision septorhinoplasty and the remainder underwent primary septorhinoplasty.

Improvements were observed in all five categories of nasal obstruction as assessed by the NOSE survey.

Between the early postoperative period and the final postoperative period, mean nasal length failed to significantly decrease (0.16 mm; 95% CI, 0.54 to 0.22 mm). Also between these two time points, no significant loss of projection was observed (0.19 mm; 95% CI, 0.45 to 0.07 mm).

Results also showed a postoperative increase in nasolabial angle, significantly increasing by 4.24 degrees (95% CI, 1.14-7.34). There was also a significant decrease in rotation of 2.63 degrees (95% CI, 4.63 to 0.63).

Between the preoperative and early postoperative measurements, a nonsignificant improvement was seen in measurement of symmetry (0.16 mm; 95% CI, 0.52 to 0.20 mm). This improvement reached statistical significance by the final postoperative assessment: 0.43 mm (95% CI, 0.73 to 0.13) from preoperative to final postoperative; and 0.28 mm (95% CI, 0.53 to 0.03 mm) from early postoperative to final evaluation.

The procedure also yielded a decrease in columellar show (0.66 mm; 95% CI, 1.05 to 0.27 mm). The alar-columellar association, however, failed to change significantly between the two postoperative time points. The researchers suggested that this confirmed there was no unwanted alar or columellar retraction over time (0.10 mm; 95% CI, 0.07 to 0.27 mm), according to the findings.

Costal cartilage harvest was necessary for adequate reconstruction in 79.2% of the cohort. – by Rob Volansky

Disclosures: The authors report no relevant financial disclosures.