Clin Exp Otorhinolaryngol.  2021 Feb;14(1):100-107. 10.21053/ceo.2019.01704.

Evaluation of the Esthetic and Functional Outcomes of Extracorporeal Septoplasty for Rhinoplasty in Asian Patients

• Mun SJ
• Choi YS
• Kim JH
• Shim WS
• Jung HJ

• KMID: 2512888
• DOI: http://doi.org/10.21053/ceo.2019.01704

Abstract

Objectives
. In extracorporeal septoplasty (ECS), the entire septal cartilage is harvested, and a neo-L strut is built extracorporeally. Thus, ECS can simultaneously achieve septum straightening and tip projection. This study evaluated the functional and esthetic outcomes of the ECS technique for rhinoplasty in Asian patients.
Methods
. We conducted a retrospective review of 64 patients who underwent rhinoplasty using ECS between January 2016 and March 2018. Subjective patient satisfaction was assessed and objective surgical outcomes were evaluated. Improvement in nasal obstruction was rated using a visual analog scale (VAS). Anthropometric changes were compared between preoperative and postoperative facial photographs. Complications and revisions were also analyzed.
Results
. The participants comprised 64 patients (48 males and 16 females, with a mean age of 29.3 years). The mean operative time was 89.3 minutes. In total, 61 patients were satisfied with the esthetic outcome, and the overall objective rhinoplasty outcome score was 3.45. Preoperative nasal obstruction symptoms (7.9±1.2 on VAS) improved postoperatively (3.1±1.3, P<0.001), and significant improvements were also observed in the nasofrontal angle (152.3° to 148.1°, P<0.001), nasolabial angle (88.8° to 92.0°, P<0.001), and nasal tip projection (0.62 to 0.66, P<0.033). Recurrent deviation of the nasal septum and external nose or tip deprojection did not occur in any patients, and there were no cases of revision during the mean follow-up period of 13.3 months.
Conclusion
. ECS might be an esthetically and functionally satisfactory alternative rhinoplasty technique for Asian patients with a shortage of septal cartilage.

Keyword

Extracorporeal Septoplasty; Rhinoplasty; Asian; Septal Extension Graft

Figure

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  Fig. 1. Schematic drawing of the surgical procedure of rhinoplasty using the extracorporeal septoplasty technique. (A) Preoperative photograph of a patient illustrating tip drooping and a pseudohump. (B) Harvestable septal cartilage in situ. (C) Septal cartilage harvest with the exception of a few millimeters of the dorsal stump to avoid injury to the keystone area. (D) Extracorporeal design of the neo-L strut and spreader graft on the harvested septum. (E) Neo-L strut construction with an optimum tip projection and dorsal profile. (F) Additional spreader grafts for further stabilization of the dorsal support, if needed. (G) Additional onlay graft as necessary to improve tip definition. (H) Postoperative photograph of the patient with an improved dorsolateral profile.

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  Fig. 2. Representative case. Preoperative (A-C) and 6-month postoperative (D-F) views of a 19-year-old woman with a deviated nose and underprojected tip treated with extracorporeal septoplasty for rhinoplasty (extracorporeal septoplasty technique with bilateral spreader grafts, two tip onlay grafts, and a dorsal onlay graft with crushed septal cartilage).

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  Fig. 3. Representative case. Preoperative (A-C) and 5-month postoperative (D-F) views of a 23-year-old man with an underprojected and derotated nasal tip treated with extracorporeal septoplasty for rhinoplasty (extracorporeal septoplasty technique with a unilateral spreader graft and a tip onlay graft).

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  Fig. 4. Anthropometric measurements. (A) Nasofrontal angle: angle of the nasal tip, radix, and forward-most projecting point of the forehead. (B) Nasolabial angle: angle between the line from the anterior columella to the subnasale and the line from the subnasale to the labrale superius. (C) Tip projection index: the length of the line drawn from the nasal tip to the alar crease divided by the length of the nasion-to-nasal tip line. (D) Deviation angle: angle between the vertical line between the midpoint of the glabella and the midpoint of the upper lip and another line representing the nasal dorsal axis.

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  Fig. 5. Preoperative and postoperative visual analog scale (VAS) scores for nasal obstruction. The VAS scores for nasal obstruction significantly decreased from 7.9 to 3.1 (P<0.001).

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  Fig. 6. Objective esthetic surgical outcomes using the objective rhinoplasty outcome score. The objective rhinoplasty outcome scores were >3 for all components, and the overall result was 3.45.

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