What are the comparative outcomes of Modified (Preservation) versus Classical (Resection) Extracorporeal Septoplasty?

Modified (Preservation) versus Classical (Resection) Extracorporeal Septoplasty: Comparative Outcomes

Modified extracorporeal septoplasty with cartilage preservation is superior to classical resection techniques, providing comparable aesthetic outcomes with better functional results and fewer complications. 1, 2

Understanding Extracorporeal Septoplasty Approaches

Modified (Preservation) Technique

• Involves partial resection of the cartilaginous septum while preserving a superocaudal L-strut measuring approximately 0.5 cm in height 2
• Maintains structural support without destabilizing the keystone area, preserving the dorsal strut of septal cartilage and its attachment to the nasal bones 2, 3
• Allows for conservative remodeling of the quadrangular cartilage, enabling the use of septal cartilage grafts in secondary or revision procedures 2

Classical (Resection) Technique

• Involves more extensive resection of cartilage and bone, with complete removal of the septal cartilage 1
• Less tissue-sparing approach with higher risk of complications including septal perforation 1
• May require more extensive reconstruction after cartilage removal 1

Functional Outcomes

Respiratory Function

• Modified extracorporeal septoplasty demonstrates statistically significant improvement in inspiratory flow, particularly in patients with moderate to severe septal deviations 2
• Long-term follow-up studies (4-6 years) show sustained improvement in respiratory function with the modified technique 2
• Classical resection techniques are associated with a higher risk of persistent or unresolved nasal obstruction requiring revision surgery 4

Symptom Improvement

• Modified techniques show significant improvement in Nasal Obstruction Symptom Evaluation (NOSE) scores, with benefits maintained at long-term follow-up 2, 3
• Patients with severe and moderate deviations experience the most significant improvement in obstructive symptoms with the modified approach 2
• Preservation techniques focus on realignment through suture fixation, which helps maintain the structural integrity of the septum 1

Complications and Aesthetic Outcomes

Structural Complications

• Modified extracorporeal septoplasty avoids the most important complication of classical techniques by preserving structured support of the nasal archway 5
• Classical techniques have higher rates of complications including saddle nose deformity due to destabilization of the keystone area 1, 5
• No patients in modified technique groups experienced postoperative nasal obstruction in comparative studies, while approximately 6.4% of classical technique patients required revision septoplasty 4

Aesthetic Results

• Both techniques can achieve significant improvements in external nasal appearance 4
• Postoperative deviation angle, nasofrontal and nasolabial angles, and nasal tip projection values are significantly improved with both approaches 4
• Modified techniques may provide better aesthetic outcomes by preserving natural contours and avoiding over-resection 3

Surgical Considerations

Patient Selection

• Modified extracorporeal septoplasty is particularly effective for moderate to severe septal deviations that cannot be adequately addressed with traditional septoplasty techniques 2, 5
• Classical resection techniques may be considered in cases of extremely severe deviations, though they carry higher risks 1

Technical Aspects

• Cartilage preservation techniques focus on realignment through suture fixation and conservative thinning rather than extensive removal 1
• After realignment and weakening procedures, reconstruction is often necessary using "Figure 8" sutures to stabilize adjacent cartilage segments and prevent overlap 1
• Morselization (crushing) of cartilage is generally not favored as it increases surface area with risk of absorption and makes secondary revision extremely difficult 1

Clinical Recommendations

• For most patients with septal deviation, a cartilage preservation approach should be preferred over extensive resection to maintain structural support and reduce complications 1, 2
• Modified extracorporeal septoplasty provides better long-term functional outcomes compared to classical resection techniques, particularly for moderate to severe deviations 2, 4
• Surgical intervention should only be considered after failure of comprehensive medical management, including intranasal corticosteroids and saline irrigations 6, 7
• Anterior septal deviation is more clinically significant than posterior deviation as it affects the nasal valve area responsible for more than 2/3 of airflow resistance 6

Important Caveats

• While 80% of the general population has an off-center nasal septum, only about 26% have clinically significant deviation causing symptoms that warrant surgical intervention 6, 7
• The extent of surgical intervention should be tailored to the type and severity of septal deviation, with more conservative approaches for milder deviations 1
• Preservation of as much turbinate tissue as possible is now considered an important part of surgical management to avoid complications like nasal dryness 6
• Endoscopic approaches may offer advantages for visualization and precision in certain cases, with lower rates of complications compared to conventional techniques 8