2. Definition
Extracorporeal :- outside the body corporeal :- within the body
Septoplasty :- the correction of deformity of the septum.
So we could define it as “ The correction of septal deformity following extraction of the septum en bloc outside then
reshaping, strengthening and repositioning the neo-septum back into the submuco-perichondrial covering to acquire
adequate patency and aesthetic outcome.”
It was first discussed in the 1950s by King and Ashley .
Gubisch, was the first to publish a large and highest series on this topic in 1995.
He defined the Areas of fixation were the caudal end of the nasal bones, upper lateral cartilage and maxillary crest. He
accomplished this by drilling a hole through nasal bones and the nasal spine and suturing the newly reconstructed neo
septum.
It is indicated for
1. severely fractured and
2. deformed septum
3. difficult septum
We refer to a difficult septum if there has been a preoperation and big parts of the septum have been resected, but the
remaining framework is still bent and causes a deviated external nose.
The main indication for extracorporeal septoplasty is severely deviated crooked septum causing both functional as well as
cosmetic deformity
3. Technique
1. All patients are treated with perioperative intravenous antibiotics.
2. Ropivacaine is the only local anesthetic with vasoconstrictive properties and effects last longer than
those of epinephrine. Its use can be beneficial instead of epinephrine.
3. It starts off with exposure of the septum an external Rhinoplasty approach in all cases. The domes
are divided in the midline, and the upper lateral cartilages are released laterally, creating excellent
exposure of the septum. Bilateral submucoperichondrial flaps are elevated, exposing the entire
cartilaginous and anterior bony septum.
8. In our experience, conchal cartilage has not been a reliable material for structural grafting. Deformation
and resorption in the long term have been observed when used in rhinoplasty to give support to the
nasal dorsum or to the tip. This finding has been previously reported in the literature.
9.
10.
11. We do not think that bone alone is an optimal graft for the septal L-strut due to its tendency to reabsorb and we find
it unnecessary to use artificial material, such as PDS foil, which substantially increases the operative cost and the risk
of foreign body reaction to an already traumatized nose
12. Cartilage has been harvested from the fifth right rib through a 4-cm submammary incision others have also
harvested 7th costal cartilage .
13. When a polydioxanone plate is used, it basically is used as stable “platform” on which to sew smaller
pieces of cartilage.
14. The key point to avoid warping of rib cartilage is by sectioning the rib at the beginning of the operation,
hydrating the sectioned cartilage, and using only its core sections for straight grafts.
18. Follow up
It is customary all our patients have a postoperative evaluation the following day.
Antibiotic therapy is continued postoperatively in prophylatic doses for 5 days.
Columellar sutures are removed 1 week postoperatively.
The splints are usually removed at the 2-week postoperative visit. However, in a few cases of very high
complexity, in which multiple grafts are sutured to one another, the splints are left in place for 3 weeks in an
effort to fabricate the neoseptum.
Complications
Major complications were classified as those necessitating additional surgical procedure and affecting nasal
function.
1. septal deviations
2. septal perforations
3. nasal deviations
4. dorsal deviations
Minor complications required no further surgical intervention
The patients undergoing rib graft placement noted prolonged stiffness of the nasal tip, but none of them
considered it a significant drawback to the operation.
granulation over suture at rim graft, and thus treated by 7-day course of oral antibiotic therapy with local
steroid ointment.
19. advantages
• Anterior and/or superior complex septal deviations are not adequately addressed through standard
septoplasty techniques. Extracorporeal septoplasty is a complex but effective operation that can
correct a severely twisted nasal septum.
• Although possible, securefixation of the neoseptum, especially on the keystone area, and internal
nasal valve grafting are significantly more difficult with a closed approach. Because of the complexity
of this operation, we believe that an open approach is more adequate and surgeon friendly.
• Secure fixation of the neoseptum to the keystone area and to the anterior nasal spine is the key
maneuver to obtain a long-lasting stabilization of the nasal dorsum.
• The complications are similar to that of conventional endonasal surgeries.
• It can be done in cases of difficult septum.
It gives dual outcome with both patency and aesthetic improvement. Extracorporeal septoplasty is a
newer, rapidly evolvingtechnique.
20. Scope
This technique is difficult to perform and learning phase is slow.
We believe that the technique of extracorporeal septal reconstruction using an open approach can be
recommended even to less experienced rhinosurgeons. ( 25 yrs experience article states that)
We these In view and for the better outcome for patients, extracorporeal septoplasty will very soon be
routinely practiced in cases where it is indicated.
Even with the advent of endoscope this procedure holds it position as the only preferred treatment
options where indicated.
Minor modification that have been made to it over the years further confirms its wide spread use in the
coming future.
