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Dorsum Surgery
Published in Suleyman Tas, Rhinoplasty in Practice, 2022
If there is a deviation on the spine, the deviated part can be reshaped, or the septum can be stitched side by side on the opposite side of the deviation. For more challenging spine deviations, stabilization is ensured through bone grafts which can be obtained from the vomer or maxillary crest during septoplasty (Figure 3.51).
Rhinolaryngoscopy for the Allergist
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Jerald W Koepke, William K Dolen
The nasal septum, rarely straight in normal adults, consists of both cartilaginous and bony components (Fig. 11.4), with mucous membrane overlying perichondrium or periosteum of the underlying cartilage or bone. The mobile, anterior portion of the septum is composed of a quadrangular septal cartilage resting in a groove on the maxillary bone and articulating posteriorly with the thin, delicate bone of the perpendicular plate of the ethmoid and inferiorly with the thicker, more rigid bone of the vomer. The vomer forms the medial border of the choanae and rests on the crest of the maxillary bone anteriorly and the crest of the palatine bone posteriorly. The perpendicular plate of the ethmoid extends superiorly, attaching to the cribriform plate (lamina cribosa). A superior projection of the hard palate, the maxillary ridge (crista nasalis maxillae; nasal crest of maxilla) often forms a ‘T’ anteriorly at the base of the septum. The lateral wings of the ‘T’ may project into the nasal cavity.
A Study of Facial Growth in Patients with Unilateral Cleft Lip and Palate Treated by the Oslo CLP Team
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
The paper suggests that the vomer flap independently may not be detrimental to facial growth. This is based on the observation that the outcomes for maxillary prominence (S-N-SS) and upper face angulation (NSL-NL) in this and other centres who carried out the same protocol1–3, did not differ from other centres who performed delayed hard palate closure between 4 and 8 years of age.4–6 It is also postulated that hard palate repair at 4–8 years of age could still have an adverse effect on maxillary development and that it is only when hard palate repair is exceptionally delayed, as in the Marburg sample when the mean age at repair was 13.2 years, that a beneficial effect on maxillary growth is apparent. This benefit is arguably outweighed by the impaired speech outcome associated with the delay in palate repair.7
From above or from below? That is the question. Comparison of the supraorbital approach with the endonasal approach. A cadaveric study
Published in British Journal of Neurosurgery, 2018
Simone Peraio, Paul Chumas, Paul Nix, Nick Phillips, Atul Tyagi
We started our dissection from the right nostril. After introducing the rigid endoscope through the nostril, the inferior turbinate was identified and followed until the choana. The middle turbinate was removed using endoscopic scissors and the sphenoid ostium was identified. In the contralateral nostril, the middle turbinate was displaced laterally to make more room to allow access with instruments. A portion of the nasal septum anteriorly to the vomer was resected allowing bilateral access. The sphenoid sinus ostiums were opened using Kerrison rongeurs and anterior sphenoidotomy was performed. The mucosa of the sphenoid sinus was removed. The sphenoid septum was removed, using a drill to make the internal surface of the sphenoid sinus smooth. The floor of the sella, the two carotid protuberances, the medial aspect of the optic canals, and the upper clivus were identified (Figure 1(A)). We drilled the anterior aspect of the sella and then enlarged the bone opening with the Kerrison rongeurs (Figure 1(B)). We drilled the medial aspect of the optic canal in order to decompress the nerve (Figure 1(C)). We then removed the planum ethmoidalis starting from the tuberculum sellae, using Kerrison rongeurs and high speed drill. We measured the planum opening, which was 2 cm wide and 3 cm long. Using a high speed drill we removed the dorsum sellae and the superior two thirds of the clivus. We opened the dura of the sellar floor and then we proceeded anteriorly (Figure 1(D)). This gave us a wide exposure of the pituitary gland, the optic chiasm, the infrachiasmatic cistern and the pituitary stalk, the oculomotor nerves, the basal pons, the upper trunk of the basilar artery, the superior cerebellar arteries, the posterior cerebral arteries, the posterior communicating arteries and the basilar bifurcation.
Olfactory outcomes after transsphenoidal endonasal surgery
Published in British Journal of Neurosurgery, 2020
Irene Baudracco, Jinendra Ekanayake, Elinor Warner, Joan P. Grieve, Neil L. Dorward
A direct endonasal approach is used, on the right unless septal deviation causes marked narrowing. A mucosal incision is made anteriorly on the nasal cartilage and the mucosa elevated off the nasal cartilage. The nasal posterior septum is displaced to the contralateral side. The keel of the vomer is removed at the level of the sphenoid ostia and widened with punches. A Hardy retractor is placed. At completion, the nasal septum is restored to the midline and mucosa reapproximated.
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.