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Nasal Airway Surgery: Management of Septal Deformities
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Shahram Anari, Ravinder Singh Natt
The nasal septum is divided into bony, cartilaginous and membranous parts. The bony septum is mainly formed by the perpendicular plate of ethmoid and vomer. The palatine bones and maxillary crest form the most posterior parts of the bony septum. The cartilaginous septum (i.e. quadrilateral cartilage) is not an isolated cartilage and is in unison with the upper lateral cartilages (ULCs). An L-shaped strut of septum (forming the dorsal and caudal segments) measuring approximately 1 cm in width is required to support the external nasal skeleton (Figure 38.1).
Nose
Published in Ali Pirayesh, Dario Bertossi, Izolda Heydenrych, Aesthetic Facial Anatomy Essentials for Injections, 2020
Dario Bertossi, Fazıl Apaydın, Paul van der Eerden, Enrico Robotti, Riccardo Nocini, Paul S. Nassif
The skeletal component of the nose consists of bone and cartilage. The paired nasal bones and the frontal process of the maxilla form the lateral aspect whilst the lateral surfaces of the upper two-thirds join in the midline at the nasal dorsum. Supero-laterally the paired nasal bones connect to the lacrimal bones, and infero-laterally they attach to the ascending processes of the maxilla. Postero-superiorly, the bony nasal septum is composed of the perpendicular plate of the ethmoidal bone. The vomer lies postero-inferiorly and partially forms the choanal opening into the nasopharynx.
Rhinoplasty Following Nasal Trauma
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The key structure to repair is the septum, especially when there are high septal deviations such as occur in Chevallet fractures, loss of the septal angles or where there has been septal cartilage necrosis due to haematoma. The important principle is to create a stable dorsal line connected to the nasal bones and then correct the position of the anterior and posterior angles as these two important points determine the support of the tip cartilages, nostril shape and the columella–labial profile. Being the least supported part of the nose, the caudal/dorsal free septum is the most frequently damaged. Simple oblique fractures can be released and the fragments secured by batons or pieces of perforated perpendicular plate sutured usually on the more concave side. Curvature of the leading edge of the dorsum will usually require reinforcement: bilateral spreader grafts (often asymmetric) provide a secure compression that is not always possible with a unilateral graft.3
Incidence of re-deviated nasal septum after septoplasty in adolescent and adult patients
Published in Acta Oto-Laryngologica, 2018
Eunsang Lee, Seung Jae Lee, Hyo Jun Kim, Jae Min Shin, Ji Ho Choi, Jae Yong Lee
The main components of the nasal septum are the nasal septal cartilage, perpendicular plate, and vomer. In humans, the nose and nasal septum, including the septal cartilage, are known to grow until young adulthood (16–17 years of age) [8], such that septoplasty is usually recommended thereafter. However, septoplasty may already be necessary during adolescence in patients with severe nasal obstruction caused by a deviated nasal septum.
Underwater posterior nasal neurectomy compared to resection of peripheral branches of posterior nerve in severe allergic rhinitis
Published in Acta Oto-Laryngologica, 2021
Seiichiro Makihara, Mitsuhiro Okano, Syotaro Miyamoto, Kensuke Uraguchi, Munechika Tsumura, Shin Kariya, Mizuo Ando
Each operation was performed under general anesthesia. All surgical procedures were performed with a 0-degree nasal endoscope with a diameter of 4 mm. 1:100,000 epinephrine was injected into the inferior turbinate. A vertical incision was made at the anterior inferior turbinate. After the anterior part of the inferior turbinate bone was located, the mucoperiosteum was carefully elevated, and the turbinate bone was removed to reduce the volume of the inferior turbinate (submucous inferior turbinectomy). Then, we could see peripheral branches of the posterior nasal nerve beneath the periosteum usually running along vessels (Figure 1). In the Control group only, peripheral branches of the posterior nasal nerve were coagulated by bipolar cautery and resected. An additional procedure was performed in the Underwater group as a substitute for resection of Peripheral branches of the posterior nasal nerve; a vertical incision was made on the membranous portion of the maxillary sinus. The mucoperiosteal flap was elevated from the anterior part of the perpendicular plate of the palatine bone to the posterior end of the middle meatus (Figure 2). The neurovascular bundle including the posterior nasal nerve trunk was visualized at the sphenopalatine foramen. Saline solution was subsequently infused around the sphenopalatine foramen through the Endo-Scrub Lens Cleaning Sheath (Medtronic ENT, Jacksonville, Florida, USA) mounted on the 0-degree nasal endoscope. Saline was supplied via the Integrated Power Console (IPC System; Medtronic ENT). The tip of the inserted endoscope was filled completely with saline water to make a clear surgical field. To prevent saline solution from draining into the laryngopharynx, the surgeon placed a pharyngeal pack in advance, and the assistant surgeon suctioned the overflowing water in front of anterior nares. The mucoperiosteum around the SPA was separated with malleable bipolar forceps for endoscopes (Fujita Medical Instruments Co., Ltd., Tokyo, Japan). The posterior nasal nerves, SPA, and veins were divided. The posterior nasal nerves and veins were coagulated with bipolar coagulation forceps and resected. The SPA was preserved (Figure 3). A hemostatic agent (oxidized cellulose polymer) was placed around the SPA, and the mucoperiosteal flap was put back to its initial position. A concomitant septoplasty was performed in 16 patients in the Control group (100%) and 26 in the Underwater group (96.3%). Finally, the incision was closed using a 5-0 absorbable suture, and postoperative packing (chitin-coated gauze) was then placed in the common nasal meatus.