Surgical Correction of Deviated Septum: A Complex Challenge

Understanding Deviated Septum

Surgical correction of a deviated septum poses significant challenges, but advancements in surgical techniques can lead to improved cosmetic and functional results. Patients with a deviated septum often experience both aesthetic and functional issues. Beyond cosmetic concerns, breathing difficulties arise due to obstructions caused by the deviation.

The anterior section of the septum is made up of cartilage, which serves as a divider between the nasal passages and contributes to the vertical projection of the nose. Due to its flexible nature, this cartilage can buckle easily, leading to an uneven nasal profile or blockage in one nostril. Commonly, individuals with nasal bone fractures or congenital conditions such as cleft lips experience this skewing and associated breathing difficulties.

Challenges in Surgical Correction

Correcting a deviated septum is inherently challenging as it requires addressing the deviation without compromising the nose’s structural integrity. Traditionally, surgical procedures involved removing or resecting the deviated cartilage. However, this method has limitations; insufficient resection may fail to relieve the obstruction, while excessive removal risks compromising the nose’s support structure.

An alternative approach involves the complete reconstruction of the septal cartilage system. In this technique, surgeons remove the cartilage, create a straight and stable framework, and then re-implant it within the nasal structure. Although this method is technically more complex, supporters argue that it offers better long-term outcomes without sacrificing cosmetic or functional quality.

Innovations from Oregon Health and Science University

Surgeons at Oregon Health and Science University in Portland have shared their experiences with this innovative technique, referred to as Anterior Septal Transplant. Between 2008 and 2015, they treated 71 patients with severe anterior septal deviations using this method. The cartilage was remodeled and augmented with grafts before being reintegrated into the nasal architecture.

Post-operative follow-ups assessed the alleviation of obstructive symptoms using the Nasal Obstruction Symptom Evaluation scale. Additionally, a cohort of 32 patients underwent pre- and post-operative assessments using anatomical landmarks and photography.

Results and Implications

One year after the procedure, all 71 patients reported subjective improvements in their obstructive symptoms. Similarly, the 32 patients exhibited stable post-operative measurements after one year. This study, published in JAMA Facial Plastic Surgery, demonstrates that reconstructing a deviated septum can be achieved without rigid fixation to the nasal spine. This approach may reduce postoperative stiffness and the volume of cartilage required.

The researchers advocate for their “Modified Anterior Septal Transplant Technique” as a safe and effective option for specific patients with septal deviations, aiming to enhance both appearance and breathing functionality.

Conclusion

Written by Jay Martin, M.D.

Reference

Loyo, et al. “Technical Refinements and Outcomes of the Modified Anterior Septal Transplant.” JAMA Facial Plastic Surgery. 2017. Doi: 10.1001/jamafacial.2017.1040.