Effectiveness of caudal septal extension graft application in endonasal septoplasty

Failure to control the projection, shape, and rotation of the nasal tip is a common occurrence among patients with weak lower lateral cartilages. These patients' noses are characterized by a weak midvault, a plunging tip with "Polly beak," and drawn-up alae. The purpose of our study was to identify methods for controlling the position and shape of the nasal tip in these high-risk patients. Twenty patients at risk of losing nasal tip projection were retrospectively identified, and measurements made from their preoperative and postoperative photographs were compared. Loss of tip projection occurred in all but one patient whose columella strut was fixed to the caudal septum. Prompted by these failures, we studied the relationship between the dorsum and tip in cadaveric specimens with and without a supratip break. From our observations, a structural extension of the septum-an anterior septal extension graft-was developed to predictably control this relationship. The clinical application of septal extension grafts in open rhinoplasty was subsequently evaluated in 20 patients who were deemed to be at risk of losing tip projection. Postoperative photographic analysis showed nasal tip projection to be maintained or increased in all but one patient with the use of septal extension grafts. A stable caudal septum is essential to the success of the technique.

To evaluate the usefulness of septal batten grafts to correct cartilaginous septal deformities in endonasal septoplasty.

To evaluate a new technique for correction of severe caudal septal defects. For all patients, preoperative photographs were graded with regard to the severity of caudal septal defects. Preoperatively, nasal airway breathing surveys were conducted and nasal tip projection (NTP) measurements were recorded. The caudal septal defects were then repaired with use of the ethmoid bone sandwich grafting technique. Photographs, NTP measurements, and an airway survey were then repeated 6 and 12 months postoperatively. Preoperative and postoperative assessments were compared and analyzed. Lateral nasal roentgenograms were obtained in five of 10 patients to assess resorption of the bone grafts. Complications were noted if present. Urban medical center. Ten volunteers with severe caudal septal defects causing both cosmetic and functional problems. All patients had undergone at least one previous submucous resection. Durability and degree of correction, maintenance of NTP, airway improvement, and morbidity. After 1 year, all patients maintained satisfactory correction of their caudal septal defect based on postoperative photographic grading and physical examination findings. The NTP was maintained in eight of 10 patients. Two patients experienced loss of NTP after 1 year that was not present 6 months postoperatively. Average airway improvement was 126.7% after 1 year. Postoperative roentgenograms showed only minor (< 10%) bone graft resorption. The only complication was a granuloma. The ethmoid bone sandwich grafting technique corrected severe caudal septal deviations while maintaining or strengthening structural support of the caudal septal strut without loss of NTP, airway compromise, or morbidity.