Effects of various submucous resection techniques of septal cartilage on nasal tip projection

There is little research which determines whether septoplasty affects nasal projection.

To assess the effect of various septoplasty (submucous resection, SMR) techniques on nasal tip projection in a fresh cadaver model.

The nasal tip projection was measured on 6 fresh cadaver heads and compared postoperatively after a sequence of submucous septoplasty maneuvers. Five different septoplasty techniques were performed in the same sequence on each cadaver. After each technique, measurements were performed.

Removal of a central square piece of quadrangular cartilage resulted in a loss of projection in 3 in 6 (50%) heads, with average loss of 7.76%. Removal of additional cartilage along the bony cartilaginous junction resulted in no loss of projection. Removing more septum along the floor resulted caused a change loss in nasal projection in 1 in 6 (17%) cadavers. Removing the remaining septum, except for the L-strut resulted in a loss of projection in 2 in 6 (33%) heads with an average percent change in tip projection of 9.08%. Swinging door technique resulted in a loss of projection in 1 cadaver (17%), with loss of 6.25%. All 6 cadavers experienced loss of nasal projection. When all maneuvers were taken in total, there was a statically significant average decrease in projection of 8.93% (range, 5.00-13.04%, p = 0.008).

Primary septoplasty carries a risk of nasal tip projection, with certain maneuvers carrying higher risk.