A novel surgical technique to correct caudal and high dorsal septal deviations: L-shape cutting and suturing on the septal L-strut (L-septoplasty).

OBJECTIVES: In general, deviation of the L-strut of the nasal septum is more challenging to correct than the middle and has less favorable results. This study aimed to develop a technique to correct the L-strut while preserving nasal support effectively and introduce the L-septoplasty technique and its effects. METHODS: Patients with caudal and high dorsal septal deviations who underwent the L-septoplasty technique were retrospectively analyzed. Preoperative and three-month postoperative comparative assessments included the Nasal Obstruction Symptom Evaluation (NOSE) scale and minimal cross-sectional area (MCA). RESULTS: Thirty patients seen at a tertiary care center were included. NOSE scale scores improved from 47.2 to 13.6, which was statistically significant (P < .001). MCA increased from 0.43 cm2 to 0.74 cm2 (P < .001). During the 3-month follow-up period, deviation correction was well maintained in all patients, and no surgical complications, such as saddle nose deformity, occurred. CONCLUSION: The L-septoplasty technique is effective in simultaneously correcting caudal and high dorsal septal deviations without any complications. LEVEL OF EVIDENCE: 4.

Thermal-Induced Osteonecrosis of Adjacent Vertebra after Intradiscal Electrothermal Therapy.

A 42-year-old man was admitted to our hospital with complaints of low back pain and intermittent right thigh pain. Twelve weeks before admission, the patient received intradiscal electrothermal therapy (IDET) at a local hospital. The patient still reported low back pain after the procedure that was managed with narcotic analgesics. Follow-up magnetic resonance imaging (MRI) was performed, and his referring physician thought the likely diagnosis was spondylodiscitis at the L4-5 spinal segment with a small epidural abscess. At admission to our department, the patient reported aggravated low back pain. Blood test results, including the erythrocyte sedimentation rate and C-reactive protein levels, were slightly elevated. Biopsy samples of the L4, L5 vertebral bodies and disk were obtained. The material underwent aerobic, anaerobic, fungal, mycobacterial cultures and histologic examination. Results of all cultures were negative. Histologically, necrosis of the bone was evident from the number of empty osteocyte lacunae. In addition, there was no evidence of infection based on biopsy results. No antibiotic treatment was administered on discharge. Repeat computed tomography and MRI performed 12 months after IDET showed a bony defect in the L4 and L5 vertebral bodies, and a decrease in the size of the L4-5 intervertebral disc lesion. We report a case of lumbar vertebral osteonecrosis induced by IDET and discuss etiology and radiologic features.