Dorsal approach to septum in external septorhinoplasty

During external septorhinoplasty, access from the caudal septum into subperichondrial space often poses difficulties and challenges for proper elevation of the mucoperichondrial flap. The dorsal and caudal approaches were compared with respect to duration and mucosal integrity.

The caudal approach was applied in 52 patients and the dorsal approach in 50 patients. The duration was recorded starting with septal incision, until the end of the completion of the bilateral subperichondrial and subperiosteal elevation. The mucosal integrity was inspected for any mucosal damage.

The elevation durations for the caudal approach and the dorsal approach were 450.3 seconds and 232 seconds, respectively. The impairment in mucosal integrity was observed in 33 cases (63%) with the caudal approach and in 16 cases (32%) with the dorsal approach. Statistically significant differences were found between the 2 groups in terms of duration and mucosal integrity.

The dorsal approach is a more advantageous choice that provides easier, safer, and faster access, ensures a comfortable and effective subperichondrial elevation, and is more advantageous for the protection of mucosal integrity as compared to the caudal approach from the anterior septal angle, since the perichondrium in the caudal septum is more attached to the underlying cartilage.