Clin Exp Otorhinolaryngol.  2008 Mar;1(1):20-23. 10.3342/ceo.2008.1.1.20.

Are Cross-hatching Incisions Mandatory for Correction of Cartilaginous Septal Deviation?

• Yang JW
• Kim SI
• Kwon JW
• Park DJ

• KMID: 1486031
• DOI: http://doi.org/10.3342/ceo.2008.1.1.20

Abstract

OBJECTIVES
Cross-hatching incisions have been considered mandatory for correcting cartilaginous septal deviation. We evaluated the clinical outcome of septoplasty without cross-hatching incisions to determine the necessity for making septal cartilage incisions. METHODS: The reconstructed septal components during septoplasty were categorized into four anatomical areas: vomer, maxillary crest, perpendicular plate of ethmoid (PPE) and septal cartilage (the area for cross-hatching incisions). During septoplasty, we attempted to complete the surgery only by removing or fracturing the bony part of the septum without cross-hatching incisions on the cartilage. Only in the cases that the deviation was not immediately corrected, the cross-hatching incisions were made onto the cartilage at the end of the procedure. We analyzed the frequency of manipulating the septal components. The changes of symptoms were evaluated using a modified nasal obstruction symptom evaluation (NOSE) scale and a visual analog scale (VAS) preoperatively, 1 and 3 months after the surgery. RESULTS: Seventy five percents of the deviated septums were immediately corrected only by removing or fracturing of the bony septal components. In decreasing order of frequency, the sepal components for correcting septal deviation were the vomer (59%), maxillary crest (49%), septal cartilage (cross-hatching only: 25%) and PPE (15%). The modified NOSE scale and the VAS demonstrated significant improvement of the nasal symptoms postoperatively (P<0.05). CONCLUSION: Most of septal deviations could be corrected by manipulating only the bony septum. The results of this procedure were not different from conventional septoplasty with cross-hatching incisions. Our data suggest cross-hatching incisions during septoplasty might have been overemphasized and that the main cause for cartilaginous deviation may be the extrinsic forces that are generated by the neighboring bony structures.

Keyword

Nasal septum; Cartilage; Surgery

MeSH Terms

Cartilage
Nasal Obstruction
Nasal Septum
Nose
Symptom Assessment
Vomer

Figure

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  Fig. 1 Items on the modified NOSE scale and VAS.NOSE: modified nasal obstruction symptom evaluation, VAS: visual analog scale.

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  Fig. 2 Frequency of manipulation of the septal framework for the patients without a definite trauma history (N=56).MC: maxillary crest; PPE: perpendicular plate of the ethmoid; CH: cross-hatching.

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  Fig. 3 Frequency of manipulation of the septal framework for the patients with a history of trauma (n=15).MC: maxillary crest; PPE: perpendicular plate of the ethmoid; CH: cross-hatching.

Reference

1. Cottle MH, Loring RM, Fischer GG, Gaynon IE. The maxilla-premaxilla approach to extensive nasal septum surgery. AMA Arch Otolaryngol. 1958; 9. 68(3):301–313. PMID: 13570788.

2. Murakami WT, Wong LW, Davidson TM. Applications of the biomechanical behavior of cartilage to nasal septoplastic surgery. Laryngoscope. 1982; 3. 92(3):300–309. PMID: 7040866.

3. Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004; 2. 130(2):157–163. PMID: 14990910.

4. Freer OT. The correction of deflections of the nasal septum with a minimum of traumatism. JAMA. 1902; 38:636–642.

5. Gibson T, Davis WB. The distortion of autogenous cartilage grafts: its causes and prevention. Br J Plast Surg. 1957; 10:257–274.

6. Fry HJ. Interlocked stresses in human nasal septal cartilage. Br J Plast Surg. 1966; 7. 19(3):276–278. PMID: 4952287.

7. Fry H, Robertson WV. Interlocked stresses in cartilage. Nature. 1967; 7. 215(5096):53–54. PMID: 4293257.

8. Min YG, Chung JW. Cartilaginous incisions in septoplasty. ORL J Otorhinolaryngol Relat Spec. 1996; Jan–Feb. 58(1):51–54. PMID: 8718540.

9. Lee BJ, Chung YS, Jang YJ. Overcorrected septum as a complication of septoplasty. Am J Rhinol. 2004; Nov–Dec. 18(6):393–396. PMID: 15706988.

10. Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, Johnson JT. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004; 3. 130(3):283–290. PMID: 15054368.

11. Samad I, Stevens HE, Maloney A. The efficacy of nasal septal surgery. J Otolaryngol. 1992; 4. 21(2):88–91. PMID: 1583714.

12. Arunachalam PS, Kitcher E, Gray J, Wilson JA. Nasal septal surgery: evaluation of symptomatic and general health outcomes. Clin Otolaryngol Allied Sci. 2001; 10. 26(5):367–370. PMID: 11678943.

13. Dinis PB, Haider H. Septoplasty: long-term evaluation of results. Am J Otolaryngol. 2002; Mar–Apr. 23(2):85–90. PMID: 11893975.

14. Foda HM. The role of septal surgery in management of the deviated nose. Plast Reconstr Surg. 2005; 2. 115(2):406–415. PMID: 15692343.

15. Dhong HJ, Kim HY, Chung MK. [Septoplasty with Conservative Resection and Figure of 8 Anchoring Suture for the Caudal Septal Deviation]. Korean J Otolaryngol-Head Neck Surg. 2005; 1. 48(1):51–55. Korean.

16. Uppal S, Mistry H, Nadig S, Back G, Coatesworth A. Evaluation of patient benefit from nasal septal surgery for nasal obstruction. Auris Nasus Larynx. 2005; 6. 32(2):129–137. PMID: 15917169.

17. Fry H. Nasal skeletal trauma and the interlocked stresses of the nasal septal cartilage. Br J Plast Surg. 1967; 4. 20(2):146–158. PMID: 6025581.