Total septal reconstruction through decortication (external) approach in children

Severe posttraumatic deformities of the ventrocaudal and ventrocranial septum in children continue to present a serious challenge to the modern rhinosurgeon. Conservative septoplastic techniques through Cottle's approach produce an untolerably high rate of recurrence or insufficient restoration of the function of the nose. The total septal reconstruction through decortication (external) approach is proposed as a solution for this problem. After temporary elevation of the skin, the nasal septum is approached in between the lower lateral cartilages. The mucoperichondrium is elevated, and the entire septal cartilage is removed. The straight part of the cartilage from the central part is used to reconstruct the ventrocaudal and ventrocranial septum, while the deformed cartilage is straightened by crushing and positioned in the posterior septal space. The cartilage graft is precisely sutured to the upper lateral cartilages and to the fibers of the septospinal ligament. In an eight-year period, five girls and 19 boys, aged 5 to 14 years, were operated on using this technique. Satisfactory functional results were obtained without any major complications in all patients. There were neither serious alterations of the growth of the nose, nor the necessity for reoperation. Total septal reconstruction through decortication (external) approach is useful for correction of severe septal deformities in children.