Counter Autografting of Dorsal Septum in Crooked Nose.

INTRODUCTION: The nasal septum plays an important role in nasal form and function. In this study, we describe a novel, alternative septoplasty approach that results in an aesthetically acceptable dorsal profile and improves airway function in patients with a crooked nose. PATIENTS AND METHODS: This study enrolled 26 patients who presented with crooked noses between 2012 and 2017. All patients underwent open rhinoplasty under general anesthesia. During correction of the cartilaginous part, a dorsal strip from the deviated septum was prepared and inverted in a 180° fashion to exert a counter-force to correct the remaining septum and fixed by suturation. This maneuver allowed application of the maximum possible force in the opposite direction to reset the deviation by its own force. RESULTS: The approach was used successfully in 26 patients with severe nasal septal deviations in the caudal septum and dorsal angulation of the nasal shape. There was no case of hematoma, synechia, septal perforation, dorsal irregularity, or saddle deformity. Temporary nasal obstruction occurred in 4 patients but improved in all of them by the third postoperative month. One patient had a recurrence of the septal deviation, dorsal angulation, and persistent nasal obstruction, which were treated by revision nasal valve surgery 14 months postoperatively. There was no subsequent recurrence during the long-term follow-up. The improvement between the preoperative and postoperative 12-month deviation angle measurements, Nasal Obstruction and Septoplasty Effectiveness (NOSE) scores were significant (P < 0.05), Improvement in the NOSE score correlated strongly and significantly with deviation angle changes and patient satisfaction. CONCLUSION: Our counter-autografting technique in septoplasty is safe and effective in the correction of severe dorsal and/or caudal deviations, as long as the severely angulated cartilage septum remains in one piece after careful dissection. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reconstruction of Extensive Orbital Exenteration Defects Using an Anterolateral Thigh/Vastus Lateralis Chimeric Flap.

Neglected malignant tumors within the orbital region can invade the eyeball, extraocular muscles, and bone substance surrounding the eye. Such patients require orbital exenteration, which may involve extraocular skeletal structures (even exposing paranasal sinuses), resulting in 3-dimensional defects requiring reconstruction. This study presents our experience with anterolateral thigh vastus lateralis (ALT/VL) chimeric free flaps for the reconstruction of extensive orbital exenteration defects involving various paranasal sinuses.Between 2012 and 2016, 4 patients with extensive 3-dimensional orbital defects with sinus involvement were treated using the ALT/VL chimeric flap. The ALT component (117-170 cm) was used to resurface the cutaneous defect while the VL component (105-243 cm) was used to obliterate the cavitary defect. The flaps were all based on the common descending pedicle, and branches to separate components were individually dissected. Recipient vessels were in the neck region, to which the donor pedicles were passed through a tunnel for anastomosis.All cavitary and surface defects were simultaneously reconstructed via the ALT/VL chimeric flap. Within an average of 17 months, no complications associated with flap surgery were observed. One patient received postoperative adjuvant radiotherapy with no complications. With its separate components supplied by a common vascular pedicle, the ALT/VL chimeric free flap allows the surgeon to conveniently reconstruct separate spatial and volumetric defects resulting from extensive orbital exenteration.