Modified Mattress Suturing Technique for Correcting the Septal High Dorsal Deviation around the Keystone Area

Abstract

Background

High dorsal deflection of the nasal septum around the bony–cartilaginous junction (“keystone area”) is often missed and difficult to treat because of the importance of septal support. This study introduces a new technique of septoplasty to correct this dorsal deviation.

Methods

Forty-two patients with severe dorsal septal deviation around the bony–cartilaginous junction were included in the study. The surgical process was as follows: after elevation of mucoperichondrial flap, deflected bony septum and surplus cartilage were removed. Then, partial thickness scorings were performed on the concave side of the deviated cartilaginous septum. For correcting the dorsal deviation around bony–cartilaginous junction, greenstick fracture and two suture holes were made at higher bony septum. Modified mattress suture was performed across the deflected bony–cartilaginous junction while pushing the deviated septum to the midline gently. Subjective and objective improvements were evaluated with questionnaires and acoustic rhinometry at least 3 months after the surgery.

Results

Significant improvements in nasal obstruction (4.61-2.42) and discomfort (1.82-1.39) were achieved. On acoustic rhinometry, cross-sectional area (CSA₁; 0.41 ± 0.18 to 0.64 ± 0.22 cm²) and CSA₂ (0.83 ± 0.37 to 1.39 ± 0.36 cm²) at the narrower sides showed significant improvements and the ratio of the wider to narrower sides in CSA₁ (2.61 ± 1.91 to 1.47 ± 0.61) and CSA₂ (2.07 ± 1.51 to 1.33 ± 0.40) showed significant improvements.

Conclusion

The proposed “modified mattress suture technique” provides positive initial results for correction of the high dorsal deviation of septum around the bony–cartilaginous junction.