Endoscopic septoplasty using autocartilage prepared by the method of intersecting incisions

Introduction. Septum surgery is one of the most common otolaryngological surgical interventions. Techniques of recent years demonstrate trends towards the use of endoscopic equipment in septum surgery. Also, the use of autocartilage to restore nasal septum skeleton has proven itself to be effective in order to avoid undesirable effects in the future.

Methods and materials. The medical records of 78 consecutive patients who underwent nasal septum surgery for various reasons over a 12-month period (from May 2023 to June 2024) were analyzed. The study group included 68 people who underwent reimplantation of autocartilage prepared by thinning it and making relaxing intersecting incisions on both sides during nasal septum surgery. The average age of the patients was 36.49±10.69 years (min – 18 years, max – 66 years), 23 (33.8 %) surgeries were performed on women (95 % CI: 22.8–46.3), 45 (66.2 %) – on men (95 % CI: 53.7–77.2).

Ten patients were excluded from the study: 7 patients did not undergo cartilage reimplantation for various reasons. Also, 3 patients underwent cartilage crushing in addition to incisions, which subsequently caused its pronounced edema for up to 2–3 weeks. All operations were performed under 0-degree endoscope control. For data comparability, surgical interventions performed by one surgeon were evaluated.

Results. All 68 patients had an uneventful surgery, with a good long-term result without the formation of adhesions and significant residual septal deviations. The tampons were removed the day after the surgery. In the early postoperative period, temporary cartilage edema was observed in 2 patients (2.94 %; 95 % CI: 0.4–10.2). In 1 patient (1.47 %; 95 % CI: 0.1–7.9), a hematoma in the posterior parts of the nasal septum was detected and opened. In the late postoperative period, the thickness of the nasal septum at the site of cartilage reimplantation, according to computed tomography, was 3–3.5 mm.

Conclusions. Preparation of autocartilage using the method of intersecting incisions, as well as its thinning, allows preserving the structure of cartilage tissue and eliminating the deviation of the cartilage plate before reimplantation. With this approach, temporary adverse events such as cartilage edema and septum hematoma occur in less than 3 % of cases. Endoscopic control during operations provides good visualization at all stages of treatment. The use of autocartilage allows preventing thinning of the nasal septum in the postoperative period and reducing the likelihood of adverse events associated with atrophy of the mucous membrane.

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