Abstract: Objective To investigate the surgical efficacy and surgical technique of submucosal correction of the nasal septum in the treatment of rhinorrhea due to nasal septal deviation. Methods Two hundred and sixty patients hospitalized from April 2000 to June 2008 with rhinorrhea caused by deviated septum were treated with submucosal correction of nasal septum. The results showed that 258 cases did not bleed again after surgery, and there was no recurrence in the follow-up period of 6 months to 3 years, with a cure rate of 99.2%. Conclusion: Submucosal correction of nasal septum for rhinorrhea caused by deviated nasal septum has high cure rate and long-lasting efficacy. Rhinorrhea is one of the common emergencies in otorhinolaryngology [1], and rhinorrhea caused by deviated septum accounts for a significant proportion in clinical practice. In our hospital, 260 cases of rhinorrhea caused by deviated septum were treated by submucosal correction of nasal septum from January 2000 to June 2008, with good results, as reported below. 1. Data and methods 1.1 Clinical data Of the 260 cases, 163 were male and 97 were female; the ages ranged from 15 to 71 years, with a median of 49.6 years. All patients were admitted to the hospital for recurrent nasal bleeding, and the duration of the disease ranged from 10 days to 2 years. Before admission, 148 cases had undergone anterior nostril filling and 32 cases had undergone posterior nostril filling; 91 cases had undergone microwave or plasma treatment. Types of nasal septal deviation: 112 cases of “C” deviation, 82 cases of “S” deviation, 46 cases of crestal prominence, 14 cases of spinous prominence, and 6 cases of irregular deviation. Degree of deviation [2]: 61 cases of mild deviation, 94 cases of moderate deviation, and 105 cases of severe deviation. Site of deviation: 122 cases at the anterior end, 98 cases at the middle, 25 cases at the posterior end, and 15 cases with deviation at both anterior and posterior ends. There were 168 cases of left-sided rhinorrhea, 89 cases of right-sided rhinorrhea, and 13 cases of bilateral rhinorrhea. The bleeding site was located in and around the nasal septal crest (spine), and the concave surface bleeding was only in 28 cases. The mucosa of the nasal septum was dry and eroded to varying degrees. 78 cases were associated with hypertension and 11 cases with diabetes. Routine blood examination: 106 cases had different degrees of anemia. Among them, 71 cases had mild anemia (Hb90~110g), 27 cases had moderate anemia (Hb60~90g), and 8 cases had severe anemia (Hb60g). All cases were excluded from bleeding caused by nasal cavity, sinus and nasopharynx tumors, hematological system diseases and post-nasal surgery by relevant examinations (nasal endoscopy, CT, etc.). 1.2 Treatment 1.2.1 Preoperative treatment After admission, those with bleeding were immediately subjected to nasal caulking or removal of caulking and refilling, all with skillful caulking [3]. If it is a sphenoid, the filling should be filled with Vaseline oil gauze from above and below and in an arc around its posterior side, with the sphenoid as the center of the upper and lower back and forth compression to stop bleeding; if it is a crest, it can be changed to a double layer filling from the top to the crest and from the bottom to the crest. If the effect of filling the anterior nostril is not good, it can be changed to filling the posterior nostril. If the nasal cavity has been filled, remove the petroleum jelly gauze for 48-72h and apply antibiotics and hemostatic agents routinely. For severe anemia, blood transfusion should be given. For those with hypertension and diabetes mellitus, appropriate medical treatment was given. After the patient’s condition was stabilized and the Vaseline oil gauze was withdrawn, nasal septal correction was performed. 1.2.2 Surgical method The surgery was performed under local anesthesia or intensive local anesthesia. In elderly patients and patients with combined hypertension and/or heart disease, cardiac monitoring is routinely performed. Patients were placed in a semi-recumbent position, routinely disinfected, head wrapped and toweled. Mucosal surface anesthesia was performed with a cotton pad containing 1% cocaine and 1% ephedrine placed bilaterally in the nasal cavity. Local infiltration anesthesia was performed with 1% lidocaine containing 1‰ epinephrine under the septal mucosa. An “L” shaped incision was made about 0.5 cm posterior to the junction of skin and mucosa on the left anterior part of the septum, from the top of the nasal cavity upward and downward to the bottom of the nasal cavity, and the mucosa and cartilage on the left side of the septum were cut through to the submucosa of the contralateral mucous cartilage at one time, separating the mucous cartilage and mucous periosteum bilaterally, the extent of which was slightly more than the deviated bone crest (or spine), excising the deviated The cartilage was removed and the crest (or spine) was occluded. After hemostasis, the septum was repositioned bilaterally in a neutral position, the mucosal incision was sutured, and the bilateral nasal cavity was filled with Vaseline oil gauze. Postoperatively, antibiotics and hemostatic agents were given, and the nasal stuffing was removed 48-72 h after surgery, and the sutures were removed in 5-7 d. The mucosa on the convex side of the septal crest (spine) is thin and even eroded, so it is easy to break when separating, so it is appropriate to separate the concave side first and try to maintain the integrity of the mucosa on that side to prevent the septum from being perforated. For highly deviated or large bone crest, it is advisable to separate the mucoperiosteum on one side after it is completely separated and the tension is reduced, which can reduce the chance of mucosal breakage. If the posterior septum is mainly deviated, the septum can be corrected endoscopically by cutting the mucosa near the crest (spine), separating it and then biting off the crest (or spine), which results in less tissue removal, less injury, faster recovery, and lower incidence of septal perforation. In case of combined inferior turbinate hypertrophy and nasal polyps, partial excision of inferior turbinate and/or removal of nasal polyps were performed at the same time to facilitate filling. 2. Results 258 cases did not bleed again after surgery. The other 2 cases still had violent bleeding after surgery and were cured by ligating the ipsilateral external carotid artery. 249 cases healed in one stage. Among the remaining 11 cases, nasal septal perforation occurred in 6 cases, all of them were elderly with high degree of deviation, and 4 of them were suffering from diabetes mellitus. The other 5 cases had nasal septal hematoma, 2 of which were cured after opening the incision to remove the blood clot in the septum and refilling it; the other 3 cases with septal hematoma did not want to receive the above treatment and had to be closely observed while using antibiotics, as a result, the hematoma was absorbed only after 1 month, after poor nasal ventilation and adhesion of the septal mucosa to the inferior turbinate. All cases were followed up for 6 months to 3 years without recurrence of nasal bleeding. 3. Discussion Nasal septal deviation is a common local factor of nasal bleeding, and although nasal filling can temporarily stop the bleeding, it cannot solve the problem at root. Many patients still bleed repeatedly after the nasal stuffing is withdrawn, and even cause anemia. Submucosal correction of the nasal septum relieves the structural abnormality of the patient’s nose and therefore has a long-lasting effect. Among 260 patients with nasal bleeding treated by the author, 258 cases did not bleed again after surgery, with a cure rate of more than 99.2%. Complications occurred in 11 cases, accounting for only 4.2%. The six patients with nasal septal perforation were all elderly patients with high degree of deviation, and some of them even had diabetes mellitus. The author’s experience is that the tissues of elderly patients are not easily repaired, and if they have diabetes mellitus again, the breakage is not easily repaired, which is very likely to cause septal perforation. Therefore, good perioperative treatment, control of blood pressure, prevention of infection, improvement of surgical skills for septal correction, and avoidance of septal mucosal pair perforation can greatly reduce the incidence of nasal septal perforation. For those with severe deviation, the mucosa at the crest (spine) is thin and even eroded, and intraoperative mucosal rupture is sometimes difficult to avoid. In order to prevent the occurrence of septal perforation, a thin strip of Vaseline gauze can be applied to the broken side during filling to avoid the displacement of the mucosa at the broken area during filling. Large mucosal breaches should be carefully closed with small circular sutures in alignment. Bony deviations located at the posterior end of the septum can be corrected endoscopically in the nose. Since the incision is made only in the deviation, large pieces of septal cartilage are avoided and the scope of injury is small; in addition, the nasal endoscope has good illumination and clear vision, which can improve the safety of the operation. If septal hematoma occurs after surgery, the septal mucosa incision should be opened to clear the septal blood clot, which can shorten the healing time and avoid the occurrence of nasal adhesions. Submucosal correction of the nasal septum for rhinorrhea is not only suitable for young and middle-aged people, but also safe and effective for the elderly [4]. The procedure is worth mentioning because of its high cure rate and long-lasting efficacy.