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Stephen E. Metzinger, MD, MSPH; R. Graham Boyce, MD; Peter L. Rigby, MD; Jeffrey J. Joseph, MD; Jack R. Anderson, MD

Arch Otolaryngol Head Neck Surg. 1994;120(10):1121-1125.

Abstract
Objective
To evaluate a new technique for correction of severe caudal septal defects.

Design
For all patients, preoperative photographs were graded with regard to the severity of caudal septal defects. Preoperatively, nasal airway breathing surveys were conducted and nasal tip projection (NTP) measurements were recorded. The caudal septal defects were then repaired with use of the ethmoid bone sandwich grafting technique. Photographs, NTP measurements, and an airway survey were then repeated 6 and 12 months postoperatively. Preoperative and postoperative assessments were compared and analyzed. Lateral nasal roentgenograms were obtained in five of 10 patients to assess resorption of the bone grafts. Complications were noted if present.

Setting
Urban medical center.

Patients
Ten volunteers with severe caudal septal defects causing both cosmetic and functional problems. All patients had undergone at least one previous submucous resection.

Outcome Measures
Durability and degree of correction, maintenance of NTP, airway improvement, and morbidity.

Results
After 1 year, all patients maintained satisfactory correction of their caudal septal defect based on postoperative photographic grading and physical examination findings. The NTP was maintained in eight of 10 patients. Two patients experienced loss of NTP after 1 year that was not present 6 months postoperatively. Average airway improvement was 126.7% after 1 year. Postoperative roentgenograms showed only minor (<10%) bone graft resorption. The only complication was a granuloma.

Conclusions
The ethmoid bone sandwich grafting technique corrected severe caudal septal deviations while maintaining or strengthening structural support of the caudal septal strut without loss of NTP, airway compromise, or morbidity.

(Arch Otolaryngol Head Neck Surg. 1994;120:1121-1125)

Author Affiliations
From the Department of Otolaryngology/Head and Neck Surgery, Section of Facial Plastic and Reconstructive Surgery, Louisiana State University Medical Center, New Orleans.

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