From 2004 to 2006, 125 cases of nasal septoplasty were performed under nasal endoscopy in our department, and all of them obtained satisfactory results, which are reported as follows.
I. Data and methods 1.1 General data. 125 patients, 97 males and 28 females, aged 15-81 years old, average 34.6 years old. There were 98 cases of “C” type deviation and 98 cases of “S” type deviation according to the site of deviation.
“According to symptoms, there were 66 cases of nasal congestion, 22 cases of headache, 13 cases of runny nose, 11 cases of trauma, 7 cases of snoring and breath-holding, 3 cases of recurrent rhinorrhea, 1 case of ear stuffiness, 66 cases of combined sinusitis and nasal polyps, and 11 cases of combined allergic rhinitis-like symptoms. All cases underwent detailed nasal endoscopy, sinus CT scan, and preoperative routine anti-inflammatory and hormonal treatment for combined sinusitis and nasal polyps.
1.2 Surgical method. The posterior-superior part of the square cartilage and part of the deviated vertical plate of the sieve bone were removed first: then the deviated plow bone and nasal crest of the superior jaw bone were removed. For the more deviated square cartilage, a strip of cartilage can be removed at the most obvious point of deviation to further reduce the septal tension. For some localized spinous processes, an incision is made in front of the spinous process to remove the spinous process and correct the deviation. After surgery, the nasal cavity was filled with oil gauze for 3 days.
The symptoms of nasal congestion and headache disappeared in 125 patients after surgery. 66 patients with combined sinusitis and nasal polyps were followed up for 1 year after surgery and no recurrence was seen. Recent observation of allergic rhinitis-like symptoms such as nasal itching and sneezing basically disappeared. The longest case with allergic rhinitis-like symptoms was followed up for 3 years after surgery, and no recurrence was observed. No septal perforation was found in all cases, and three cases of nasal septal deviation with nasal bleeding as the main symptom had no further bleeding at postoperative follow-up for more than 1 year. 7 patients with snoring and breath-holding as the main symptom underwent septoplasty and related nasal surgery without treatment other than nasal surgery, and their symptoms were significantly relieved after surgery.
The most common site of deviation was located at the junction of the posterior part of the square cartilage and the vertical plate of the sieve bone and at the junction of the lower end of the square cartilage and the plough bone and the nasal crest of the upper jaw bone. When disconnecting the cartilage and the vertical plate of the sieve bone, we see that the cartilage is interlaced with the vertical plate of the sieve bone, which means that there is tension there, and the tension can be lifted by biting off part of the bone. Mucosal tearing is very likely to occur during separation. During the operation, we will cut from the top of the nasal cavity to the bottom of the nose when making the anterior curved incision.
This can effectively prevent the mucosa from tearing when separating the mucosa at the crest, thus maintaining the integrity of the mucosa on one side. The septum tension could be completely released and the deviated septum was corrected. In two cases of high septal deviation, because of the fear of nasal collapse due to removal of the vertical plate of the high septum, only the posterior upper part of the square cartilage and a small piece of high septum were removed during surgery, which released the tension in this area, and the high septum was still deviated. The septum was reshaped and worth further study.
Our study found that: ① it can make the septal deviation satisfactorily corrected and relieve the patient’s nasal congestion and rhinogenic headache PJI ② it is conducive to the effective treatment of sinusitis nasal polyps; ③ it effectively reduces the patient’s allergy symptoms p1; ④ it effectively treats rhinorrhea. In this group, 11 patients with trauma were examined for external nasal collapse deformity, nasal septum dislocation deviation, cartilage protrusion into the nasal cavity, mucosal laceration, and nasal blockage. The nasal bone was found to be floating up and down during the operation. If septoplasty was not performed to remove the tension of the nasal septum on the nasal bone, the nasal bone was displaced under the tension of the nasal septum after the gauze filled in the nasal cavity was removed, thus deforming the external nose.