One of the unfavorable outcomes of septoplasty is secondary deviation of the nasal septum (NS), which develops in the late period after surgery and may be associated with post-traumatic inflammation of the quadrangular cartilage of the NS. At the same time, the involvement of mucoperichondria (MPC) in the formation of postoperative deviation of the septal framework has not yet been studied.

PURPOSE OF THE STUDY

Improving the effectiveness of treatment of patients with PN deformity by improving the technique of septoplasty, which prevents the development of secondary curvature of its cartilaginous section.

PATIENTS AND METHODS

The study included 105 patients with NS deformity and chronic hypertrophic rhinitis (42 women and 63 men aged 18—53 years). Inclusion criteria: pronounced curvature of the nasal cavity (II and III degree), unilateral lateral displacement of the cartilaginous region of the nasal cavity with contralateral retraction in the other half of the nasal cavity (C-shaped curvature of the NS). Subjective (visual analog scales) and objective (endoscopy, anterior active rhinomanometry with resistometry) research methods were used to assess the presence of secondary NS deformity and the state of nasal breathing.

RESULTS

In all patients after septoplasty, the MPC in the area of the C-shaped curvature repeated the original form of the NS, shifted during instrumental palpation and restored its configuration. Measurements showed that the excess MPC of NS in both halves of the nose was 23.4 mm2. Three methods of MPC plastic surgery have been proposed. Patients were divided into 5 groups depending on the method of MPC plastic surgery (21 patients in each group). In the 2nd, 3rd and 4th groups, one of the methods of MPC plasty was used. In patients of the 5th group, a combined MPC plasty was performed. Patients of the 1st group (control group) did not undergo MPC plastic surgery. The analysis of the results of surgical treatment showed that in all patients of the 1st—4th clinical groups, secondary deformities of the NS developed in the long-term follow-up period, while the side of the curvature of the NS, narrowing the common nasal passage, remained the same, and in all patients of the 5th clinical group, the NS was in the median plane, the airflow indicators were 74.4% higher than in the control (1st) group (p<0.01).

CONCLUSION

In patients with severe septal curvature, the area of the mucosa of the NS significantly exceeds the area of the septal skeleton, which was set in the middle position during the operation. The MPC-flap in the area of the greatest curvature of the NS retains the initial deformation, which in the long term leads to secondary deformation of the NS. The developed technique of «contour plastics of the mucosa of the NS», which must be carried out after septoplasty, makes it possible to prevent the development of secondary deformation of the NS in this group of patients.