Modification of Low-Septal-Strip Septoplasty to Reduce Hump Recurrence in Dorsal Preservation Rhinoplasty

Overview

Residual hump and hump recurrence are the recognized problems of dorsal preservation. The authors modified how the lower septal strip is removed and how the septum is then fixed in place, and compared results against the standard technique. All patients had closed dorsal preservation rhinoplasty as a first operation, performed between November 2021 and February 2023.

Sections of note

• Design: retrospective comparison of two techniques, 231 patients. Level of evidence therapeutic III.
• 72 patients, 31.2 percent, had standard low septal strip septoplasty; 159 patients, 68.8 percent, had the modified version.
• All cases were primary rhinoplasty performed by a closed approach.
• Mean follow up: 9.68 months, range 3 to 16.
• Sex and age did not differ significantly between the groups.
• Complications occurred in 8 of 231 patients, 3.5 percent overall.
• Complications were significantly more frequent in the standard group, p equal to 0.012.
• Recurrent hump was significantly more frequent in the standard group, p equal to 0.029.

What it means for a patient

• The hump coming back is the main way preservation rhinoplasty fails, and how firmly the septum is fixed appears to determine it.
• Overall complications were low, at about 1 in 29 patients across both techniques combined.
• Follow up averaged under 10 months, and hump recurrence develops over time, so the difference may widen or narrow later.
• Limits: retrospective, groups of unequal size, patients not randomized, and follow up as short as 3 months in some cases.

Why this paper matters

Preservation rhinoplasty has spread widely with hump recurrence as its acknowledged cost, and most proposed solutions are described without comparison. This study compares two versions of the same step in a reasonably sized group and finds a measurable difference. Longer follow up is needed, since recurrence is a late event.

Terms

• Dorsal preservation rhinoplasty: lowering the bridge while keeping its natural surface intact.
• Low septal strip: a band of cartilage removed from the lower part of the septum to let the bridge settle.
• Septum fixation: securing the septum in its new position so it does not spring back.
• Hump recurrence: the bump on the bridge returning after it was lowered.
• Closed approach: surgery through incisions inside the nose only, with no external scar.
• Primary rhinoplasty: a first nose operation, with no previous nasal surgery.