Clin Exp Otorhinolaryngol.  2020 Feb;13(1):47-51. 10.21053/ceo.2019.00206.

Questionable Effect of Crosshatching Incision in Septoplasty

• Kim JS
• Heo SJ

• KMID: 2501297
• DOI: http://doi.org/10.21053/ceo.2019.00206

Abstract

Objectives
. Crosshatching incision has been considered a useful method for correcting cartilaginous septal deviation. The aim of this study was to determine the utility and limitations of this approach.
Methods
. This retrospective case-control study included 353 patients who underwent septoplasty performed by a senior surgeon between January 2004 and December 2010. Patients were classified into two groups according to whether crosshatching incision was performed (n=151) during septoplasty or not (n=202). All other techniques performed during septoplasty were identical. The parameters of surgical success (improvement of nasal obstruction, correction of deviation, and acoustic rhinometry results) and adverse effects were compared between the groups.
Results
. There were no significant differences in the parameters of surgical success between the groups (improvement of nasal obstruction, P=0.333; correction of deviation, P=0.608; acoustic rhinometry results, P=0.322 for the difference in the minimal cross-sectional area; P=0.919 for difference in volume). Relative to patients who did not undergo the cross-hatching incision, patients with whom the technique was performed showed a significantly higher incidence of saddle nose (0/202 vs. 4/151 cases, P=0.033) and overcorrection (0/202 vs. 5/151 cases, P=0.014).
Conclusion
. Crosshatching incision during septoplasty did not produce better surgical outcomes; however, it caused adverse effects such as saddle nose and overcorrection. Therefore, the use of crosshatching incision should be re-evaluated.

Keyword

Nasal Septum; Cartilage; Nasal Surgical Procedures; Reconstructive Surgical Procedures

Figure

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  Fig. 1. Illustrations of anchoring suture technique. (A) An anchoring suture was started from the concave side of septum to penetrate the septal cartilage and mucosa at the most deviated portion with 4-0 polydioxanone. (B) Knots were made at the periosteum and soft tissues around the anterior nasal spine. Adopted from Song et al. J Rhinol. 2016;13:18-21 [10].

Reference

1. Killlan G, Foster EE. The submucous window resection of the nasal septum. Ann Otol Rhinol Laryngol. 1905; Jun. 14(2):363–93.

2. Murakami WT, Wong LW, Davidson TM. Applications of the biomechanical behavior of cartilage to nasal septoplastic surgery. Laryngoscope. 1982; Mar. 92(3):300–9.

3. Lee JE, Jung HJ, Chang M, Jin HR. A novel wedge technique to correct the curved deviation of the cartilaginous nasal septum. Auris Nasus Larynx. 2014; Apr. 41(2):190–4.

4. Shin JH, Lee MH, Kim YH, Kim SW, Kim SW, Cho JH, et al. Wedge resection and modified mattress suture for correcting anterior septal deviation: how we do it. Clin Otolaryngol. 2011; Oct. 36(5):504–9.

5. Chung YS, Seol JH, Choi JM, Shin DH, Kim YW, Cho JH, et al. How to resolve the caudal septal deviation? Clinical outcomes after septoplasty with bony batten grafting. Laryngoscope. 2014; Aug. 124(8):1771–6.

6. ten Koppel PG, van der Veen JM, Hein D, van Keulen F, van Osch GJ, Verwoerd-Verhoef HL, et al. Controlling incision-induced distortion of nasal septal cartilage: a model to predict the effect of scoring of rabbit septa. Plast Reconstr Surg. 2003; May. 111(6):1948–57.

7. Gruber RP, Nahai F, Bogdan MA, Friedman GD. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures. Part II: clinical results. Plast Reconstr Surg. 2005; Feb. 115(2):595–606.

8. Heo SJ, Kim JS. Crosshatching incision technique in septoplasty: experimental outcomes under actual surgical settings. Auris Nasus Larynx. 2016; Oct. 43(5):518–23.

9. Jin HR, Lee JY, Jung WJ. New description method and classification system for septal deviation. J Rhinol. 2007; May. 14(1):27–31.

10. Song SH, Nam WH, Kim JS. Anchoring suture for correction of septal deviation. J Rhinol. 2006; Apr. 13(1):18–21.

11. Fry H, Robertson WV. Interlocked stresses in cartilage. Nature. 1967; Jul. 215(5096):53–4.

12. Fry HJ. Interlocked stresses in human nasal septal cartilage. Br J Plast Surg. 1966; Jul. 19(3):276–8.

13. Murray JA. The behaviour of nasal septal cartilage in response to trauma. Rhinology. 1987; Mar. 25(1):23–7.

14. Lopatin AS. Do laws of biomechanics work in reconstruction of the cartilaginous nasal septum. Eur Arch Otorhinolaryngol. 1996; 253(4-5):309–12.

15. Min YG, Chung JW. Cartilaginous incisions in septoplasty. ORL J Otorhinolaryngol Relat Spec. 1996; Jan-Feb. 58(1):51–4.

16. Seo MC, Heo SC, Chung YS, Lee BJ. Overcorrected septums as a complication of septoplasty. Korean J Otolaryngol-Head Neck Surg. 2001; Jun. 44(6):628–32.

17. Yang JW, Kim SI, Kwon JW, Park DJ. Are cross-hatching incisions mandatory for correction of cartilaginous septal deviation. Clin Exp Otorhinolaryngol. 2008; Mar. 1(1):20–3.

18. Lee DC, Jin SG, Kim BY, Yoo S, Han S, Lee YJ, et al. Does the effect of inferior turbinate outfracture persist? Plast Reconstr Surg. 2017; Feb. 139(2):386e–391e.

19. Kim DH, Park HY, Kim HS, Kang SO, Park JS, Han NS, et al. Effect of septoplasty on inferior turbinate hypertrophy. Arch Otolaryngol Head Neck Surg. 2008; Apr. 134(4):419–23.