Caudal Septal Deviation: A Computed Tomography-Based Evaluation Method.

OBJECTIVE: Caudal septal deviation (CSD) correction during septorhinoplasty is challenging, and various surgical modifications and evaluations remain controversial. This study aimed to introduce an objective evaluation method based on computed tomography (CT) images to measure the effectiveness of septorhinoplasty for CSD treatment. METHODS: We retrospectively analyzed preoperative and postoperative CT images of patients who had undergone functional open septorhinoplasty by the plastic surgery and otorhinolaryngology teams between January and September 2019. Using OsiriX Lite (Pixmeo, Switzerland), CSD was calculated as the distance between the septum midline and palatal plane. Deformation was categorized as C-shaped unilateral or S-shaped bilateral deviations. The change in the distance between preoperative and postoperative images was considered because of surgical intervention. RESULTS: Twenty patients (mean age, 35 years; 13 males [65%], 7 females [35%]) were included. The median deviation was 3.01 mm (range, 0.45-7.34 mm) preoperatively and 1.6 mm (range, 0.5-2.86 mm) postoperatively, indicating a reduction of 1.26 mm (median, P < 0.05) due to surgical intervention. C- and S-shaped deviations were seen preoperatively in 9 (45%) and 11 (55%) patients and postoperatively in 6 (30%) and 14 (70%) patients, respectively. The mean ± SD time of analysis was 7 ± 2.1 minutes. CONCLUSIONS: Caudal septal deviation showed significant changes from preoperative to postoperative CT images, based on the distance between the actual septum midline and the constructed straight septum. This allowed effective evaluation of surgical efficacy for septum straightening. Although additional studies are needed, this method allows clearer stratification of surgical outcomes.

Effectiveness of modified cutting and suture technique for endonasal caudal septoplasty in correcting nasal obstruction and preventing nasal tip projection loss.

PURPOSE: Caudal septoplasty is a difficult procedure. The cutting and suture technique is suitable for caudal septoplasty, but a batten graft is always necessary and bears the risk of nasal tip projection loss. We established a modified cutting and suture technique (MCAST), without using a batten graft, and investigated its effectiveness in correcting nasal obstruction and preventing nasal tip projection loss. METHODS: We retrospectively reviewed the medical records of 22 patients who underwent caudal septoplasty using MCAST. Subjective assessment by Nasal Obstruction Symptom Evaluation (NOSE) score and objective assessment by computed tomography (CT) were performed before and after the surgery. For evaluating nasal tip projection, we asked patients about their awareness of external nasal deformity. Additionally, the nasal tip projection was measured by CT and compared before and after surgery. RESULTS: The median preoperative NOSE score reduced significantly after MCAST (P < 0.001). On CT, the ratio of the area of the convex side to that of the concave side in the anterior portion of the nasal cavity increased significantly after MCAST (P < 0.001). All patients were unaware of external nasal deformity. There were no significant differences in the mean preoperative and postoperative nasal tip height and nasolabial angle. The mean supra tip height was significantly greater postoperatively than preoperatively (P = 0.02). CONCLUSIONS: The MCAST was useful for correcting nasal obstruction with caudal septal deviation. There was no postoperative loss of nasal tip projection. The MCAST can be suitable for correcting C-shaped caudal deviations without dislocating the caudal septum from the anterior nasal septum.

A new "J septoplasty" technique for correction of mild caudal septal deviation.

OBJECTIVE: A major drawback of the Killian incision is its inability to access the caudal septum and correct caudal septal deviation. Open and hemitransfixion septorhinoplasty are considered necessary in such cases. We developed a new septoplasty method that can be successfully applied in patients with mild caudal septal deviation. In this study, we evaluated the outcome of this technique. METHODS: We prospectively collected data of 16 patients with mild caudal septal deviation who underwent endoscopic septoplasty between November 2015 and October 2017. A modified Killian incision was made on the concave side of the septum. The central part of the cartilage was preserved, and excess cartilage was resected; the central part of the cartilage was sutured to the caudal cartilage. RESULTS: Postoperatively, the ratio of the area of the convex side to that of the concave side in the anterior portion of the nasal cavity was significantly improved, as revealed on CT analysis (p < 0.001). Nasal obstruction was significantly reduced or eliminated in all patients (p < 0.001). CONCLUSION: The J septoplasty method for the correction of mild caudal septal deviation is easy to perform through a modified Killian incision, and seems to be useful in selected cases.

Use of Unsintered Hydroxyapatite and Poly-L-lactic Acid Composite Sheets for Management of Orbital Wall Fracture.

Although unsintered hydroxyapatite and poly-L-lactic acid (u-HA/PLLA) composite sheets have various applications, such as in craniomaxillofacial fractures, orthognathic surgery, and orthopedic surgery, and have been proven to be safe and effective, no studies have reported the use of u-HA/PLLA composite sheets for orbital wall reconstruction with long-term follow-up. This study reports our preliminary results using the u-HA/PLLA composite sheet for orbital wall fractures. The SuperFIXSORB MX sheet (u-HA/PLLA composite sheet; Takiron, Tokyo, Japan), with size of 30 × 50 mm and thickness of 0.5 mm, was used in all cases of hard reconstruction of the orbital bone defect. Seventy-two patients with acute orbital wall fractures (within 2 weeks after sustaining the injury) treated at the Jikei University between January 2014 and August 2016 were included. The authors evaluated the postoperative complications and the operability of the material. The authors did not observe any postoperative complications, such as infection, postoperative diplopia, or enophthalmos, due to the use of the u-HA/PLLA composite sheet. In pure orbital fractures (orbital fractures only), the mean (±standard deviation) operation time was significantly longer with combined inferior and medial wall fractures (201.1 ±â€Š36.6 minutes; n = 11) than with inferior wall or medial wall fractures only (135.0 ±â€Š54.4 minutes; n = 51) (Mann-Whitney U test, P < 0.001). The U-HA/PLLA composite sheet is safe and can be used for orbital wall fracture reconstruction. Further long-term functional and aesthetic assessments for infection, ocular movement disorder, enophthalmos, and any other complication are necessary.