OBJECTIVE:  To describe a surgical technique using bony septum, specifically vomer or perpendicular plate of the ethmoid (PPE), as an extended spreader graft (ESG) for securing septal extension graft (SEG) and for correcting internal nasal valve dysfunction.

METHODS:

            Design:            Descriptive Case Series

            Setting:           Tertiary Private Hospital

            Participants: Thirty-two (32) patients who underwent aesthetic rhinoplasty from May 2016 to October 2017 were evaluated, and ten (10) patients presenting with symptomatic obstruction were considered for inclusion. The surgical technique was applied in patients with weak SEG for control of nasal length and tip projection who had inadequate septal cartilage for SEG and ESG intraoperatively. Results were evaluated grossly under direct vision intra-operatively and post-operatively to check the patency of the internal valve.

RESULTS:  Bony septum was used as an ESG in five (5) patients (1 male, 4 females, ages 35 to 50-years-old) with inadequate septal cartilage. Intraoperative evaluation under direct vision showed anterior caudal septal deviation in all 5 patients in whom correction was confirmed after placement of SEG and ESG. Immediate post-operative evaluation confirmed bilaterally patent nasal valve in all 5, who reported subjectively improved breathing at 2 and 4 weeks post-operatively.  Post-operative photographs showed improvement of nasal length and tip.

CONCLUSION: The use of the bony septum (vomer and PPE) as an ESG for primary or secondary rhinoplasty is a potentially effective means of supporting and securing the SEG for control of nasal length, preventing tip deviation or rotation and for improving internal valve function. Further trials are needed to establish its reliability and long-term effectivity.

BACKGROUND AND OBJECTIVES: The nasal septum, centrally located in the nasal cavity, has dynamic relations with other craniofacial structures and is also influenced by them during development. Moreover, the mosaic structure of the septum is constituted through ossification. The purpose of this study was to evaluate the anatomical characteristics of the deviated nasal septum with preoperative computed tomography (CT) and calculations during surgery. SUBJECTS AND METHOD: We studied 62 patients with nasal septal deviation on one side, who underwent septoplasty between July 2008 and February 2009. The area of the septal cartilage, vomer, and perpendicular plate of the ethmoid bone was calculated with sagittal imaging using preoperative CT. The angle of deviation was also measured with coronal imaging. The length between the anterior nasal spine and sphenoidal sinus and that of the sphenoidal process was measured during surgery. RESULTS: The deviation angle increased significantly with the length of the sphenoidal process (p<0.01). The area of the septal cartilage decreased with age due to the progression of ossification. CONCLUSION: Nasal septal deviation without a history of trauma is influenced by the progression of nasal septal ossification.
Bone Development ; Cartilage ; Ethmoid Bone ; Humans ; Nasal Cartilages ; Nasal Cavity ; Nasal Septum ; Spine ; Vomer

Defect or perforation of the nasal septum may arise from diverse causes such as trauma, infection, drug abuse, inhalant irritants and neoplasia. The septal defect or perforation is usually located at the anterior half of the nasal septum regardless of etiologic factors. However, posterior nasal septal defect is infrequent. Moreover, congenital vomer defect is very rare. Recently, we have experienced three cases of congenital vomer defect of the nasal septum detected during nasal endoscopy. We report these cases with review of literature.
Congenital Abnormalities ; Endoscopy ; Irritants ; Nasal Septum ; Substance-Related Disorders ; Vomer

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.
Cartilage ; Nasal Obstruction ; Nasal Septum ; Nose ; Symptom Assessment ; Vomer

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.
Cartilage ; Nasal Obstruction ; Nasal Septum ; Nose ; Symptom Assessment ; Vomer

Among the variety of local and systemic causative factors of nasal septal defects, the most frequent cause is the iatrogenic perforation found during septal surgery. We report a 10-year-old boy who showed a defect at the posteroinferior portion of the septum that appeared to coincide with the location of the vomer. He didn't have nasal surgery, any trauma, infectious disease or drug Abuse. These findings suggests that a developmental abnormality of the vomer taken place during the prenatal period may have resulted in a congenital defect of the vomer. To the best of our knowledge, this report is the first case of a congenital defect of the vomer reported in Korea.
Child ; Communicable Diseases ; Congenital Abnormalities* ; Humans ; Korea ; Male ; Nasal Septum ; Nasal Surgical Procedures ; Substance-Related Disorders ; Vomer*

PURPOSE: To know the normal CT appearance of the anterior skull base and nasal septum after birth. MATERIALS AND METHODS: Coronal CT scans with a helical mode were performed from the nasal bone to the sphenoid sinus in 99 children whose ages ranged from 27 days to 14 years. We investigated the CT appearance of the developing anterior skull base and nasal septum with particular attention to the anteroposterior length of the anterior skull base and the ossification patterns of the cribriform plate, perpendicular plate, crista galli, and vomer. RESULTS: The anteroposterior length of the anterior skull base statistically significantly increased with age. The cribriform plate showed partial or complete ossification in at least one segment at more than 3 months of age and in all three segments at more than 6 months of age. Ossification of the cribriform plate occurred earlier in the middle segment than in the anterior and posterior segments. It began exclusively in the region of the lateral mass of the ethmoid and proceeded medially toward the crista galli. Partial ossification of the perpendicular plate was noted as early as 9 months of age, and complete ossification as early as 13 months of age. All children at 18 months and older showed at least partial ossification of the perpendicular plate. Partial ossification of the crista galli was noted as early as 27 days of age, and complete ossification as early as 3 months of age. CT showed complete ossification of the crista galli in all but two children at 6 months and older. The superior aspect of the vomer exhibited a V- or Y-shape on all CT scans in 66%(65/99) of children at any age. It appeared as an undivided single lump anteriorly and a V or Y posteriorly in 34%(34/99). CONCLUSION: Knowledge of the normal developing patterns of ossification of the anterior skull base and nasal septum could help prevent errors in interpreting CT scans in this region, especially in infants and young children.
Child ; Ethmoid Bone ; Humans ; Infant ; Nasal Bone ; Nasal Septum* ; Parturition ; Skull Base* ; Skull* ; Sphenoid Sinus ; Tomography, X-Ray Computed ; Vomer

The traffic accident was one of most common cause for the facial bone fracture. When it involved the midfacial structures, the nasal bone fracture was usually shown. If the reduction was not done in time, it would result in facial deformity. Simple case could be corrected by simple rhinoplasty. However, severe cases would require more invasive technique. We used triangular osteotomy included the nasal bones, the vomer, and the medial wall of maxilla for the correction of post-traumatic nasal deformity and reported the result with the review of literatures.
Accidents, Traffic ; Congenital Abnormalities* ; Facial Bones ; Maxilla ; Nasal Bone ; Osteotomy* ; Rhinoplasty ; Vomer

Even though many surgical techniques have been reported to correct the unilateral cleft lip nose deformity, it is very difficult to achieve optimal results. The authors used the porous high-density polyethylene(Medpor(R)) sheet as a columellar strut for alar cartilage repositioning and the triangular transposition flap based on the superior columella for correction of excess skin of alar web. A silicone implant was used for nasal dorsal augmentation. Additional techniques including segmental resection of the excessive alar cartilage on the normal side, freeing of the septal cartilage from the vomer, the nasal osteotomies, a Z-plasty on the afftected plica vestibularis, alar advancement of denuded alar base flap or an interalar cinch, and subcutaneous reduction of the external lateral triangle were also used to repair individual differences of the nasal deformities. Twenty-four patients (11 females and 13 males; mean age, 24 years) were included in this study. From six to thirty-four months(mean fifteen months) postoperatively, the patients were evaluated by the ordinary scale method and the anthropometric analysis using preoperative and postoperative nasal cast models. The analysis of the result was conducted by Paired samples T test. All the patients showed uneventful healing except three cases of columellar strut protrusion. By the ordinary scale method, "good" aesthetic results were noted. By the postoperative anthropometric analysis, the alar length of the normal side, the columellar length and the tip projection of both normal and affected sides were significantly increased. The nostril floor width of the affected side and the nose width were significantly decreased. In conclusion, this technique is valuable in the correction of unilateral cleft lip nasal deformity. But in cases of severe deformity, residual septal deviation, those who have received the operation several times, the porous high-density polyethylene sheet must be used carefully because of the protrusion.
Cartilage ; Cleft Lip* ; Congenital Abnormalities* ; Female ; Humans ; Individuality ; Male ; Nose* ; Osteotomy ; Polyethylene* ; Silicones ; Skin ; Vomer

One of the problems in the correction of the cleft lip nose deformity is the hypoplastic alar nasi on the affected side, even after secondary rhinoplasty. This deformity was managed with various cartilage grafts for augmentation of the cleft side, but that procedures have been complicated by inadequate cartilage augmentation, complex procedure, unpredictable results. To overcome the problem of the hypoplastic alar nasi, the authors used subcutaneous reduction of the upper part of the ala and external lateral triangle on the non-cleft side through the intranasal approach. Additional techniques including partial-thickness incisions of the septal cartilage, freeing of the septal cartilage from the vomer, the nasal osteotomy, a z-plasty on the affected plica vestibularis and cinching of denuded alar base of the affected side or an interalar cinch were also used to repair individual differences of the nasal deformities. The authors performed 20 cases (11 women and 9 men) of the correction of the unilateral cleft lip nose deformity between 1997 and 1999. The patient, ranged in age from 19 years to 51 years at the time of surgery, with a mean age of 24 years. Eight to twenty (mean twelve) months postoperatively, the patients were evaluated by the ordinary scale method and the photogrammetric measurements using preoperative and postoperative photos. All the patients showed uneventful healing except two cases of superficial skin necrosis. By the ordinary scale method, "good" aesthetic results were noted. By the photogrammetric measurement, the alar height of non-cleft were significantly decreased. The results showed a relatively symmetrical alar height index of both cleft and non-cleft sides. In conclusion, the procedure is very simple and fast to perform, and it is easy to achive nasal symmetry. It is possible to use the procedure with additional techniques in the various deformities for the better results.
Cartilage ; Cleft Lip* ; Congenital Abnormalities* ; Female ; Humans ; Individuality ; Necrosis ; Nose* ; Osteotomy ; Rhinoplasty ; Skin ; Transplants ; Vomer