Hydrodissection for subperichondrial septoplasty - an experimental anatomical study

Area of Science:

• Otolaryngology
• Surgical Anatomy
• Histology

Background:

• The efficacy of hydrostatic infiltrations for subperichondrial dissection is debated, with some sources citing it as crucial and others deeming it impractical.
• Case reports have documented severe adverse events associated with this technique, yet experimental data is lacking.

Purpose of the Study:

• To experimentally evaluate the reliability and accuracy of hydrostatic infiltrations for achieving subperichondrial dissection.
• To analyze the histological outcomes of simulated hydrodissection, including dissection plane accuracy, and potential complications.

Main Methods:

• An experimental study involving three surgeons performing simulated subperichondrial hydrodissection on 20 human cadaver heads.
• Infiltration of 1 ml of lidocaine 5% with adrenaline and India ink, followed by histological examination of serial sections to analyze dissection planes, ink deposition, and intravasal spread.

Main Results:

• All injections resulted in physical dissection, but the planes were predominantly supra-perichondrial (n=8) or within the perichondrium (n=4), with only five achieving the desired subperichondrial plane.
• Infiltrated material spread beyond the dissection site, accumulating in surrounding vessels (n=8).
• Three anomalous septa were excluded from quantitative analysis.

Conclusions:

• Hydrostatic infiltrations are an unreliable method for accurate subperichondrial dissection.
• The technique may offer benefits for anesthesia and hemostasis, but high-pressure, high-volume injections carry risks of significant complications.