Nasal septum correction surgery is one of the most common rhinological procedures in otorhinolaryngology-head and neck surgery. Its surgical approach has evolved over the past 100 years and is divided into three stages: subtotal nasal septal resection, submucosal resection, septal correction and septoplasty. Submucosal resection can meet the correction of various types of septal deviations and is still widely used today. With the introduction and development of nasal endoscopy in the 1970s, the development of endoscopic septal correction surgery was promoted. The treatment of nasal septal deviation under direct endoscopic vision resulted in a clear operative field and expanded the indications for traditional surgery. However, a concomitant problem is the prevalence of excessive removal of the septal stent. Although these procedures can correct the deviated septum and relieve the symptoms, the large area of nasal septal cartilage and bone is removed, resulting in the absence of the main septal scaffold, making the septal mucosa too loose and swinging, and can lead to slow deformation of the nose, such as saddle nose, overly wide nasal dorsum, collapse of the supra-apical region, and septal perforation.
Biomechanical analysis of septal deviation production: How to correct various forms of septal deviation while preserving the septal cartilage and normal bone structure scaffolding and avoiding complications by relieving the stress relationship that leads to septal deviation is still a topic well worth exploring.
From the perspective of bone growth and development, the cranial bone completes its development earlier, while the nasal septal cartilage completes its development later, i.e., the nasal septal cartilage is still growing when the frontal bone is completed with the maxilla and palate. Therefore, the upper and lower part of the nasal septum is fixed and will form an upper and lower stress relationship because of the inability to lengthen, which is mainly concentrated in the connection area between the weaker nasal septal cartilage and the peripheral bones and is probably the most important factor in the formation of nasal septal deviation. Therefore the tension caused by this developmental imbalance acts mainly on the three lines of the anterior, inferior and posterior septal cartilage, i.e., the interconnection with the ossified part, forming the three core areas of stress, forming a protrusion, and in severe cases, a crest, a momentary protrusion, causing severe deviation.
Three-line subtraction septoplasty is different from septal correction septoplasty septoplasty is a new modified septal correction surgery procedure designed according to the biomechanical law of septal deviation, namely three-line subtraction septoplasty. Its features are as follows: most of the septal cartilage and normal bony scaffold are preserved; only a little cartilage and bone are partially removed from the area of the three tension lines to relieve the stress that causes septal deviation. The vertical plate of the septum with severe high deviation can be fractured by clamping with occlusal forceps without resection, and then the square cartilage is repositioned medially and the bilateral mucous cartilage membranes are aligned. This procedure preserves the deviated cartilage and bone, which is the main difference from the traditional procedure.
This procedure attempts to re-establish the concept of septal correction in accordance with the biomechanics of septal deviation. By releasing the core area where the three tensions are generated, the mutated stress relationship is corrected to normal and the new stress relationship causes the reshaping of the nasal septal stent with the aim of reducing surgical complications while correcting the deviated septum.
Its significance is as follows: 1. Maintain the thickness and hardness of the septum, otherwise the mucosa healing together will lead to mucosal atrophy and deformation, such as septal defect is too large and the septum produces flapping and whistling sound when breathing.
2.It helps to prevent the collapse of nasal cone and nasal tip, and can prevent the contraction of connective tissue of mucous cartilage membrane layer.
3.Reduces the occurrence of nasal septal perforation.
The recovery after trilinear subtraction septum correction is different from previous surgeries. Nasal recovery is faster after traditional complete removal of septum bone surgery, but if cartilage structure is preserved or after intraoperative fracture is performed there will be prolonged swelling and time for bone storage healing, so it is important to maintain patience. Postoperative follow-up quality should be ensured to avoid nasal adhesions and stenosis and to administer reasonable medication.
Selection of surgical age Over the years, due to the limitations of surgical concepts, we often locked septal correction surgery into an age limit, emphasizing that septal surgery should be performed after the age of 18. This old surgical concept has influenced several generations, believing that immature patients who undergo septum correction surgery have a higher possibility of nasal collapse. Nowadays it seems that a number of children and adolescents have a completely deviated and obstructed nasal cavity on one side, and if they wait until the age of 18, he will have a long period of open-mouth breathing causing altered compliance remodeling of the mandible, which in turn will have a negative impact on growth and development and increase the risk of developing obstructive sleep apnea hypoventilation syndrome as an adult. In these children there is no longer any age limit and early restoration of normal nasal function is essential.
Conclusion Nasal endoscopic septoplasty with the trilinear subtraction method is simple, easy to perform, safe and reliable, with adequate correction of the septal deformity, which facilitates the postoperative transformation of the compensatory changes of the nasal cavity toward a physiological state and the eventual restoration of nasal-sinus physiological function. Although the characteristics and forms of nasal septal deviation are diverse, by removing the trilinear tension area and eliminating the tension between the septal cartilage and bone, the anterior, posterior and high deviation of the septum and local deformities such as crest and talus can be solved at the same time, which is in line with the biomechanical law of nasal septal deviation generation and raises the surgery to the level of minimally invasive.