Effectiveness of Decortication Septorhinoplasty via External Approach

ABSTRACT

The purpose of this article is to describe an alternative approach to the nasal septum and the advantages offered by the decortication septorhinoplasty in correcting difficult nasal deformities. Using the Decortication septorhinoplasty approach, the entire cartilagenous septum can be exposed so that each specific deformity can be visualized and corrected appropriately. Retracting the lateral crura laterally, a midline plane is dissected, and the anterior septal angle and dorsal margin of the septal cartilage is identified. The elevation of the mucoperichondrium is started at the area of the anterior septal angle. After anterior approach, scissors are inserted between the septal cartilage and the upper lateral cartilage and their junction is sharply divided. Elevation of the rest of the mucoperichondrium is completed as a skeletonized single unit. Sculpting the entire cartilagenous and/or bony vault, as well as correcting difficult septal malalignments, can be carried out under better direct vision with great precision, accuracy, and predictability. From January 2000 till March 2001 the decortication approach is used for correcting difficult nasal deformity in 24 patients. Of these, 5 are secondary cleft lip nose, 10 are deviated nose, 5 are traumatic saddle nose, and 4 are hump nose. The mean follow up period is 12 months, ranging from 5 to 20 months. The patients are overall satisfied with the aesthetic and functional results. The disadvantage and complication of the Decortication septorhinoplasty is the same as compared to the conventional open rhinoplasty. The decortication approach is most suited for correction of deformities at the dorsal aspect of the nasal septum that causes a twisted nose deformity, of deformities at the anterior septal angle causing an asymmetric tip, and of deformities along the caudal aspect of the quadrangular cartilage producing columellar distortion, and of relational deformities between anterior nasal spine and septum. The decortication technique has provided a effective avenue for the correction of severe nasal deformities.