Reconstructive technique provides option for difficult nasal plastic surgery

July 18, 2005

CHICAGO - A surgical technique that requires the removal, restructure and re-implantation of the nasal septum (the partition of the nose between the nostrils) appears to be a useful option for repairing the hard-to-treat severely deviated septum, according to an article in the July/August issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.

Severe nasal septal deviations, usually the result of trauma, previous surgery or congenital malformations such as cleft palate, pose a particular challenge to plastic surgeons, according to background information in the article. The nasal septum affects both the appearance and the airway passages of the nose. Usual plastic surgical techniques often prove insufficient for reliably correcting severe septal deformities, the author suggests, necessitating the complete removal and correction of the septum to achieve good functional and aesthetic results.

Wolfgang Gubisch, M.D., of Marienhospital, Stuttgart, Germany, reviewed the medical charts of patients undergoing septoplasty (surgery of the nasal septum), either performed by him or under his supervision, at a facial plastic surgery center. Of the 2,119 patients from 1981 to 2004 with severe nasal septal deviations undergoing the surgery developed and refined by Dr. Gubisch, the charts of two groups were reviewed: 459 procedures performed by Dr. Gubisch from January 1, 1981 through July 31, 1987 and 108 patients whose procedures were supervised by Dr. Gubisch in 1996.

In the first group of patients, "Based on the subjective opinion of the surgeon and patients and the findings of the clinical examinations, a good to excellent functional result was obtained in 96 percent," the author writes. "Despite the complex deformity and complicated operative procedure, postoperative complications were rare and only 20 patients (four percent) elected to have revision septoplasty. Fifty-seven complications (12 percent) occurred, with the most common complaint being irregular contour of the dorsum [the bridge of the nose] (32 patients, seven percent)." In the supervised procedures, there were 14 postoperative complications (13 percent) and 12 dorsal (bridge of the nose) irregularities (11 percent). Eight patients (7 percent) chose to redo surgery.

"This vast experience of extracorporeal septoplasty [removal of the septum from the nose for repair] in 2,119 patients spanning 20 years demonstrates that it is an important technique in the armamentariam (armory of techniques) of surgeons for correcting of extensive nasal septal deviations that result from trauma, previous surgery, or congenital anomalies," the author concludes. "During the study period, the technique was improved to make it safe and practical for all surgeons dealing with this difficult problem."
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(Arch Facial Plast Surg. 2005; 7:218-226. Available pre-embargo to the media at www.jamamedia.org.)

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email mediarelations@jama-archives.org.

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