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For citation purposes: Persichetti P, Toto V, Signoretti M, Del Buono R, Brunetti B, Segreto F, et al. The correction of nasal septal deviations in rhinoplasty. Annals of Oral & Maxillofacial Surgery 2013 Mar 01;1(2):13.

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The correction of nasal septal deviations in rhinoplastyP Persichetti1*, V Toto1, M Signoretti1, R Del Buono1, B Brunetti1, F Segreto1,

D Lazzeri2, GF Marangi1

AbstractIntroductionSeptoplasty is a commonly per-formed procedure that provides an effective treatment of nasal septum deformities. It has become an essen-tial issue in nasal surgery for both functional and aesthetic reasons. The traditional septoplasty approach is often unsuitable for severe septal deviations. In such cases, extracor-poreal septoplasty has been credited to obtain more reliable outcomes. However, this technique has received some criticisms because of the desta-bilization of the keystone area. Due to the increasing number of tech-niques available, an overview of the cosmetic and functional results of such methods is reasonable. In addi-tion, a comparison of the outcomes of the different techniques may shed further light on which is the best method to correct severe septal devi-ations. This critical review discusses the correction of nasal septal devia-tions in rhinoplasty.A review of the literature on the evaluation of the main septoplasty techniques has been conducted. The procedures were evaluated and com-pared for indications, contraindica-tions, advantages and disadvantages. ConclusionThe classic septoplasty approach often appears inadequate in cases of marked septal deformations due

to the increased risk of recurrence. From the critical review, the extra-corporeal septoplasty technique seems more reliable in such cases. In particular, the modified conserva-tive approach has demonstrated to achieve an adequate septum remod-elling with cartilage spare and to avoid post-operative dorsum irregu-larities compared with the more tra-ditional techniques.

IntroductionNasal septum deviation is a common cause of respiratory obstruction, and is due to three main aetiologies: congenital, traumatic and iatrogenic. Septoplasty is currently considered among the most challenging proce-dures for the plastic surgeon1. In a high percentage of rhinological pa-tients, septal deviations represent a major cause of functional and aes-thetic disorders. Furthermore, many authors emphasize the importance of the nasal septum in creating a harmonious relationship between the components of the nasal arch-way and ensuring the proper func-tion of respiratory mechanics2–4.Consequently, the correction of sep-tal deviations plays a crucial role in rhinoplasty5,6,14. Patient’s history and expectations, correct pre-operative analysis and surgeon’s experience determine the surgical approach7. Septal surgery has benefited greatly from the improvements in the avail-able surgical techniques that have allowed to achieve better aesthetic and functional outcomes while mini-mizing the complication rates. A critical review of the main existing techniques involved in the correction of nasal septal deviations has been conducted to evaluate the best surgi-cal treatment.

Historical backgroundThe historical evolution of septoplasty dates back to early last century. The standard approach to correct carti-laginous septal deviations was firstly popularized by Killian and Freer8,9. It involved a submucous dissection of the quadrangular cartilage and the re-moval of the deviation with the pres-ervation of mucoperichondrial flaps. Subsequently, a variety of techniques were introduced to straighten the na-sal septum after its exposure. Using a more conservative approach, the deviated cartilage may be weakened on its concave side by cross-hatching with partial thickness incisions to relieve intra-cartilaginous tension10. Alternatively, the deviation may be submucosally resected leaving a cau-dal–dorsal ‘L-strut’ for support. Even if the described surgical approach has been the gold standard for the treatment of obstructive septal de-formities, it has suffered from serious deficiencies in many common clinical situations11. As a consequence, the traditional septoplasty approach was gradually modified during the last cen-tury to overcome its major drawbacks.

Intracorporeal septoplastyThe standard septoplasty procedure involves six steps: approach, mo-bilization, resection, repositioning, reconstruction and stabilization12. Usually, the operation starts with a right caudal incision that assures the access to the anterior nasal spine, maxillary crest, nasal floor, nasal dorsum and tip (Figure 1, left). A submucoperichondrial dissection is performed starting on the concave side of the septum followed by a subperiosteal dissection of the na-sal dorsum to provide exposure of

* Corresponding author Email: p.persichetti@unicampus.it1 Department of Plastic and Reconstructive

Surgery, Campus Bio-Medico University of Rome, School of Medicine, Rome, Italy

2 Operative Unit of Plastic and Reconstructive Surgery, Hospital of Pisa, Italy

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For citation purposes: Persichetti P, Toto V, Signoretti M, Del Buono R, Brunetti B, Segreto F, et al. The correction of nasal septal deviations in rhinoplasty. Annals of Oral & Maxillofacial Surgery 2013 Mar 01;1(2):13.

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septum to the midline. The midline position may be secured with an ab-sorbable suture attached to the peri-osteum adjacent to the opposite side of the nasal spine (Figure 4). This approach has been modified by Pas-torek, who introduced the ‘doorstop’ technique15. It involves the transposi-tion of the deviated caudal septum over the anterior nasal spine to the opposite nasal cavity without fur-ther cartilage resection (Figure 5). Some vertical wedge resections may be performed with the care to pre-serve more of the vertical height than would typically be saved in the swinging door manoeuver. The de-viated portion may be also scored on the concave side to weaken the cartilage. Alternatively, batten grafts applied to the weakened caudal sep-tum may be effective in straightening moderate to severe septal cartilage deformities that are otherwise not correctable via conventional septo-plasty techniques16. These grafts are typically taken from the posterior area of the quadrangular cartilage or from the perpendicular plate of the ethmoid bone. The batten grafts are then tied along the weakened car-tilage to stabilize it in the corrected position. The placement of spreader grafts between the upper lateral car-tilage and the caudal septum may also effectively stabilize the cartilage (Figures 6 and 7, right)17.

The approach introduced by Kridel (Figure 8) for the management of caudal septal deviation involves the cephaloposterior advancement of the medial crura of the lower lateral cartilages onto the caudal septum18. The medial crura are then fixed to the caudal septum ensuring stability and correction of the deviation.

Extracorporeal septoplastyThe extracorporeal septoplasty was first proposed by King and Ashley in the 1950s to cure more severe de-viations or restore the loss of septal portions19. It consists of the total re-moval of the quadrangular cartilage

septum from the anterior septal an-gle to the anterior nasal spine (Figure 3)13. A sharp incision may be neces-sary to maintain a continuous flap through the decussating fibers. A resection of the redundant cartilage is commonly performed, leaving a su-perior attachment for caudal septum. The freed inferior caudal septum is then anchored to the anterior nasal spine with sutures.

An alternative manoeuver to treat caudal septal deviations, named the ‘swinging door’ technique, has been described by Wright14. It consists of a wedge resection of the vertical cartilage excess along the maxillary crest with the release of the cau-dal septal attachments to swing the

the bony and cartilaginous septum ( Figure 1, right). The tunnel combi-nation performed to access the me-dial nasal structures varies from case to case depending upon the observed deformities and the surgical goals (Figure 2). The caudal septum repre-sents a crucial structure in the nasal anatomy and, when an appropriate caudal strut of almost 2 cm in length is not preserved, significant deformi-ties such as saddle nose and tip pto-sis may occur.

Following the experiences of Kil-lian and Freer, Metzenbaum intro-duced a modified technique. The procedure entails a transfixed inci-sion to raise bilateral mucoperichon-drial flaps and expose the caudal

Figure 1: Left: Right caudal incision performed to access the anterior nasal spine, maxillary crest, nasal floor, nasal dorsum and tip. Right: the marked area shows the submucoperichondrial and subperiosteal dissection using a Cottle elevator, starting on the concave side of the septum.

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For citation purposes: Persichetti P, Toto V, Signoretti M, Del Buono R, Brunetti B, Segreto F, et al. The correction of nasal septal deviations in rhinoplasty. Annals of Oral & Maxillofacial Surgery 2013 Mar 01;1(2):13.

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Figure 2: Tunnel approaches: (above, left) the ‘one tunnel’ approach is currently used to treat isolated septal bone disorders; (above, right) the ‘two tunnel’ approach is performed in case of bone or cartilage deviations, fractures, ridges and spurs; (below, left) the ‘three tunnel’ approach is indicated in patients with severe septal base and maxillary crest deformities, pronounced basal ridge or scar tissue; (below, right) the ‘four tunnel’ is still the best approach to manage severe anterior septum disorders due to previous trauma, infection, septal cartilage lack or anterior septal perforation.

followed by the extracorporeal re-construction of a new septal plate that is subsequently re-implanted between the two mucoperichondrial flaps.

Vilar-Sancho has used an L-shaped cartilage graft to support both the back and tip of the nose, while Rees used to relocate the entire quadran-gular cartilage20,21.

Gubisch described a surgical ap-proach usually carried out in com-bination with a closed rhinoplasty22. This technique consists of the ex-cision of the entire quadrangular

cartilage and, subsequently, pieces of the septal bone. The septal plate is straightened through the division of the septum into small, straight cartilage pieces connected by sin-gle sutures or by tension-reducing incisions. The new septum is then re-implanted and the cartilaginous dor-sum and the nasal tip reconstructed. Anyway, this procedure may produce complications, among which the most important is the tendency to de-velop dorsum notching or saddling. Specifically, dorsum irregularity was described to be the most common

post-operative complication with an 8% recurrence rate23.

Senyuva described the extra-corporeal septoplasty performed through an open approach that was considered more reliable because of the easier visualization for dissec-tion and re-implantation24. Subperi-chondrial dissection is performed, as described by Jost, to expose septal cartilage and bone25. An extramucous incision is then performed from the dorsal septum junction to allow an accurate lateral dissection of the up-per lateral cartilage. The dorsal sep-tum is freed from the ‘keystone’ area, where the dorsal septal cartilage con-nects to the nasal bones and to the perpendicular plate of the ethmoid. An inferiorly based osteotomy may be necessary to separate the caudal septum from the anterior nasal spine and maxillary crest. Once the septum has been freed from its bony attach-ments, it is removed and its structure examined. The reconstructed septum must contain straight sections cau-dally and through the dorsum in or-der to recreate the L-strut. Recently, Most has described a modification

Figure 3: Metzenbaum access: complete transfixion incision is performed to raise bilateral muco- perichondrial flaps and expose the caudal septum from the anterior septal angle to anterior nasal spine.

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For citation purposes: Persichetti P, Toto V, Signoretti M, Del Buono R, Brunetti B, Segreto F, et al. The correction of nasal septal deviations in rhinoplasty. Annals of Oral & Maxillofacial Surgery 2013 Mar 01;1(2):13.

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Figure 4: Swinging door manoeuvre: left, the caudal septum excess is removed allowing the septum to swing to the midline; right, the position may be secured with an absorbable suture anchoring the caudal septum to the periosteum on the opposite side.

Figure 5: Modified swinging door technique: left, the caudal septum is detached from the maxillary crest and nasal spine but is not excised; right, rather, the septum is flipped over the nasal spine, which acts as a doorstop and secures the caudal septum in a straighter position.

Figure 6: Internal nasal valve narrowing and collapse: this may be prevented by positioning a spreader graft.

Figure 7: Left: the typical orientation of the narrow stripes that will be excised and used as spreader grafts is shown; Right: spreader grafts in place.

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For citation purposes: Persichetti P, Toto V, Signoretti M, Del Buono R, Brunetti B, Segreto F, et al. The correction of nasal septal deviations in rhinoplasty. Annals of Oral & Maxillofacial Surgery 2013 Mar 01;1(2):13.

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The ‘L’ strut is also rectified if necessary. The correction technique depends on the degree of the deviation. Partial thickness tension-reducing incisions (as described by Cottle) are performed in cases of mild deviations (Figure 11). Cartilage crushing and mattress sutures are performed for moderate deviations28.

Discussion

The importance of septoplasty wa-s, when Killian and Freer laid the basis for the intracorporeal

Figure 8: Kridel’s technique: this approach consists the cephaloposterior advancement of the medial crura of the lower lateral cartilages onto the caudal septum. The medial crura are then fixed to the caudal septum ensuring stability and correction of the deviation.

Figure 9: A transfixion incision, 2 mm above the inferior border of the caudal septum, is joined with an intercartilaginous incision in the vestibule skin to obtain exposure of the nasal septum and dorsum.

of this technique that preserves the dorsal septum at the keystone area, minimizing the nose destabiliza-tion and dorsum irregularities. This technique, known as anterior septal reconstruction, is achieved via open rhinoplasty and mainly addresses anterior septal deviations26.

In an effort to further reduce desta-bilization risk and to preserve the na-sal dorsum contour, Persichetti et al. have modified the classic technique with a more conservative approach that spares the dorsal cartilage and a portion of the caudal septum, thus maintaining a support for the nasal archway27. This approach, that can be combined with an open or closed rhinoplasty, has already demonstrat-ed to be effective from a functional point of view through a prospective observational study. An intercarti-laginous incision is performed in the vestibule skin between the cau-dal border of the upper lateral car-tilages and the cranial border of the lower lateral cartilages. Subsequently,

further transfixion incision is per-formed 2 mm above the inferior bor-der of the caudal septum to expose the nasal dorsum (Figure 9). Start-ing on the concave side of the nasal septum, submucoperichondrial and subperiosteal dissections of the na-sal dorsum are performed. The carti-laginous septum is resected partially, thus preserving an ‘L’ strut, meas-uring at least 0.5 cm in height (Fig-ure 10). The resected septal cartilage is then rectified on the surgical work-bench by means of partial thickness tension-reducing incisions (as de-scribed by Cottle), cartilage crushing (Figure 11) or other means. Redundant or dislocated osteocartil-aginous spur may be easily carried out during this procedure. The strai-ghtened and/or reconstruct-ed cartilage is then re-implanted between the two submucoperichon-drial flaps ( Figure 12). The securing of the re-implanted septum is obtain-ed through mucoperichondrial trans-fixed 4-0 absorbable sutures.

The authors have referenced some of their own studies in this review. These referenced studies have been conducted in accordance with the Declaration of Helsinki (1964) and the protocols of these studies have been approved by the relevant ethi-cs committees related to the institut-ion in which they were performed. All human subjects, in these referen-ced studies, gave informed consent to participate in these studies.

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For citation purposes: Persichetti P, Toto V, Signoretti M, Del Buono R, Brunetti B, Segreto F, et al. The correction of nasal septal deviations in rhinoplasty. Annals of Oral & Maxillofacial Surgery 2013 Mar 01;1(2):13.

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technique8,9. Several modifications have innovated their approach dur-ing the following decades. The surgi-cal technique described by Pastorek has been demonstrated to be effec-tive in reducing nasal obstructive symptoms and in treating mild to moderate deviations15. However, it is criticized for the recurrence of sub-sequent deviations. Functional im-provements have been achieved with the cephaloposterior advancement of the medial crura of the lower lateral cartilages onto the caudal septum, as described by Kridel18. However, this technique is also associated with a widening of the columella. Generally, intracorporeal septoplasty is often inadequate to address severe septal deformities; in these cases cartilage grafts16,17 may be effective in straight-ening the septum. The main point of criticism of the grafting techniques is the tendency for the overlapping grafts to widen the caudal septum and narrow the internal and the

external nasal valve. Thus, these grafts must be adequately thinned before fixation to the septum.

Extracorporeal septoplasty was first proposed by King and Ashley to adequately resect the anterior tip of the septal cartilage and to calibrate the resection of the dorsum. Initial experiences showed a residual dor-sum irregularity as the most com-mon postoperative complication (8% of cases)19. This was mainly due to the lack of stability of the recon-structed cartilaginous framework. Since then, plastic surgeons’ efforts have shifted towards a more con-servative approach. The technique described by Most preserves the dorsal septum at the keystone area, thus minimizing nose destabilization and dorsum irregularities26. How-ever, it requires an open rhinoplasty and mainly addresses anterior septal deviations. The ideal approach for extracorporeal septoplasty should be adequate to address the entire

Figure 10: Intra-operative (left) or a sagittal plane (right) view of the portion of cartilaginous septum that is resected (dashed line). The resection is performed preserving an ‘L’ strut, measuring at least 0.5 cm in height.

Figure 11: Left: the resected portion is then removed and rectified on the surgical workbench; Right: to straighten the septal plate, partial thickness reducing tension incisions, as described by Cottle, cartilage crushing, or other means are achieved.

and severely deformed septal carti-lagineous plate and to build a solid framework. The technique for ex-tracorporeal septoplasty described by Persichetti et al. shows different advantages compared with other ap-proaches (Table 1). Foremost, it is versatile, allowing the correction of mild to most severe septal deformi-ties, cartilage spurs and fractures. It is conservative, because only the cen-tral and dorsal portions of the sep-tum are excised: as a consequence, complications such as nasal dorsum irregularity and saddle nose are avoided. Moreover, compared with the classical surgical technique, it spares as much quadrangular carti-lage as possible, thus not hampering the use of septal cartilage graft for an eventual secondary rhinoplasty. In addition, the re-implantation of sep-tal cartilage reduces the incidence of septum perforation, that is possible when the remaining tissue consists only of the mucoperichondrium.

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For citation purposes: Persichetti P, Toto V, Signoretti M, Del Buono R, Brunetti B, Segreto F, et al. The correction of nasal septal deviations in rhinoplasty. Annals of Oral & Maxillofacial Surgery 2013 Mar 01;1(2):13.

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9. Freer O. The correction of deflections of the nasal septum with minimum of traumatism. JAMA. 1902;38:636–92.10. Cottle MH, Loring RM, Fischer GC,Gaynon IE. The maxilla-premaxilla ap-proach to extensive nasal septum surgery. Arch Otolaryngol. 1958 Sep;68(3):301–13.11. Edwards N. Septoplasty. Rational sur-gery of the nasal septum. J Laryngol Otol. 1975 Sep;89(9):875–97.12. Mlynski G. Surgery of the nasal septum. Facial Plast Surg. 2006 Nov;22(4):223–9.13. Metzenbaum M. Replacement of thelower end of the dislocated septal carti-lage vs. submucous resection of the dis-located end of the septal cartilage. Arch Otolaryngol. 1929:282–92.14. Wright WK. Principles of nasal septum reconstruction. Trans Am Acad Opthalmol Otolaryngol. 1969 Mar–Apr;73(2):252–5.15. Pastorek NJ, Becker DG. Treating thecaudal septal deflection. Arch Facial Plast Surg. 2000 Jul–Sep;2(3):217–20.16. Wee JH, Lee JE, Cho SW, Jin HR. Septal bat-ten graft to correct cartilaginous deformities in endonasal septoplasty. Arch Otolaryngol Head Neck Surg. 2012 May;138(5):457–6.17. Wagner W, Schraven SP. Spreadergrafts in septorhinoplasty. Laryngorhi-nootologie. 2011 May;90(5):264–74.18. Kridel RW, Scott BA, Foda HM.The tongue-in-groove technique in septorhinoplasty. A 10-year experience. Arch Facial Plast Surg. 1999 Oct–Dec; 1(4):246–56; discussion 257–8.19. King ED, Ashley FL. The correctionof the internally and externally devi-ated nose. Plast Reconstr Surg. 1952 Aug;10(2):116–20.20. Vilar-Sancho B. Rhinoseptoplasty.Aesthetic Plast Surg 1984;8(2):61–5.21. Rees T. Surgical correction of the se-verely deviated nose by extramucosal ex-cision of the osseocartilagineous septum and replacement as a free graft. Plast Re-constr Surg. 1986 Sep;78(3):320–30.22. Gubisch W. Refinements in extracor-poral septoplasty. Plast Reconstr Surg 1999;104(4):1131–9.23. Gubisch W. Twenty-five years experi-ence with extracorporeal septoplasty. Fa-cial Plast Surg. 2006;22(4):230–9.24. Senyuva C, Yücel A, Aydin Y, OkurI, Güzel Z. Extacorporeal septoplasty combined with open rhinoplasty. Aesthet-ic Plast Surg. 1997 Jul–Aug;21(4):233–9.25. Jost G, Legent F, Meresse B. Atlas derasthetischen-plastiken Chirurgie. Stutt-gart/New York: Schattauer-Verlag; 1977.

Figure 12: The straightened new septum is then replanted in between the two submucoperichondrial flaps.

ConclusionThe intracorporeal septoplasty ap-proach may be inadequate in cases of marked septal deformations. In these cases, extracorporeal septoplasty is more reliable. However, its main limi-tation is the risk of destabilizing the cartilaginous septum and its junctions, thus resulting in post-operative dor-sum irregularities. Recent more con-servative extracorporeal septoplasties may allow the correction of severe septal deformities with a very low risk for post-operative dorsum irregulari-ties, as well as the achievement of ade-quate functional and aesthetic results with minimum morbidity.

References1. Baumann I. Septoplasty update. Laryn-gorhinootologie. 2010 Jun;89(6):373–84. German.

2. Sykes JM, Kim JE, Shaye D, Boccieri A.The importance of the nasal septum in the deviated nose. Facial Plast Surg. 2011 Oct;27(5):413–21.3. Heppt W, Gubisch W. Septal surgeryin rhinoplasty. Facial Plast Surg. 2011 Apr;27(2):167–78.4. Foda HMT. The role of septal surgery in management of the deviated nose. Plast Reconstr Surg. 2005 Feb;115(2):406–15.5. Dingman RO. Correction of nasal de-formities due to defects of the septum. Plast Reconstr Surg. 1956 Oct;18(4): 291–304.6. King ED, Ashley FL. The correctionof the internally and externally devi-ated nose. Plast Reconstr Surg. 1952 Aug;10(2):116–20.7. Heppt W, Hildenbrand T. Septal sur-gery in septorhinoplasty. HNO. 2011 Aug;59(8):831–43.8. Killian G. Die submukose Fensterresek-tion der Nasenscheiderwand. Arch Laryn-gol Rhinol (Berl). 1904;16:326. German.

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For citation purposes: Persichetti P, Toto V, Signoretti M, Del Buono R, Brunetti B, Segreto F, et al. The correction of nasal septal deviations in rhinoplasty. Annals of Oral & Maxillofacial Surgery 2013 Mar 01;1(2):13.

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Table 1 Comparison among the techniques (NA = not available).

Technique Indications DisadvantagesComplications

reported

Number of

patientsOutcome assessment

Mean follow-

up time

Swinging door (Wright)14

•  Caudal septum deviation

•  Caudal septum excess

•  Not advisable if there is a weakened septum

NA NA NA NA

Doorstop (Pastorek)15

•  Caudal septum deviation

•  Not advisable if there is a long caudal septum

NA NA NA NA

Tongue in groove (Kridel)18

•  Overly long midline caudal septum

•  Poor tip support•   Nasal tip rotation 

and projection defects

•  Columellar show•  Caudal septum

 deviation

•  Widening of the columella

Nine (3%) cases required revision (8 required revision to further correct columellar show or to increase tip rotation or projection; 1 required revision for overprojection)

287 Clinical inspection

NA

Extramucosal excision of the osseocartilagi-neous septum and replace-ment as a free graft (Rees)21

•  Severe obstruction•  Severely deviated

external nose

•  Inadequate dorsal support

•  dorsum irregularities

•   alar cartilage deformities

•  persistent obstructive symptoms

•  Two dorsum irregularities (8%)

•   One alar cartilage deformity (4%)

•  Five persistent obstructive symptoms (20%)

25 Clinical inspection 36 mo

Anterior septal reconstruction (Most)26

•  Severe septum deviation

•  Dorsal strut of septal cartilage preservation

•  Keystone area attachment preservation

•  Inadequate tip support

No complications reported

12 •  Clinical inspection•   subjective 

questionnaire (NOSE)

5.4 mo

Standard extracorporeal septoplasty (Gubisch)22

•  Severe septum deviation

•  Need to achieve an effective median fixation

•  Dorsal irregularities

•  Recurrent deviation

•  Recurrent obstructive symptoms

•  One epistaxis (1%)•  Twelve dorsum

irregularities (12%)

•  Three recurrent deviations (3%)

•  Two persistent obstructive symptoms (2%)

98 Clinical inspection 8.75 mo

Page 9 of 9

Critical review

Licensee OA Publishing London 2013. Creative Commons Attribution License (CC-BY)

For citation purposes: Persichetti P, Toto V, Signoretti M, Del Buono R, Brunetti B, Segreto F, et al. The correction of nasal septal deviations in rhinoplasty. Annals of Oral & Maxillofacial Surgery 2013 Mar 01;1(2):13.

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petin

g in

tere

sts:

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e de

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ed. C

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ct o

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one

decl

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. A

ll au

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s co

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uted

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ption

and

des

ign,

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ipt p

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ratio

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the

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ure.

27. Persichetti P, Toto V, Marangi GF, Poc-cia I. Extracorporeal septoplasty: func-tional results of a modified technique. Ann Plast Surg. 2012 Sep;69(3):232–9.

28. Boccieri A, Pascali M. Septal cross-bar graft for the correction of the crooked nose. Plast Reconstr Surg. 2003 Feb;111(2):629–38.

26. Most SP. Anterior septal reconstruc-tion. Outcomes after a modified extracor-poreal septoplasty technique. Arch Facial Plast Surg. 2006 May–Jun;8(3):202–7.

Table 1 (continued)

Modified extracorporeal septoplasty (Vilar Sancho)20

•  Severe septum deviation

•  Severely deviated external nose

•  Severe obstruction

•  Not enough dorsal support and cartilage release

NA NA NA NA

Modified extracorporeal septoplasty (Senyuva)24

•  Severe septum deviation

•  Severely deviated external nose

•  Severe obstruction

•  External scar •  One persistence of the septal deviation (3%)

•   One tip dropping (3%)

33 Clinical inspection 12 mo

Modified extracorporeal septoplasty (Persichetti)27

•  Severe septum deviation

•  Severely deviated external nose

•  Severe obstruction

NA

•  One epistaxis (0.6%)

153 •  Clinical inspection•  Rhinomanometrical

assessment•   Subjective 

questionnaire (NOSE)

6 mo