[Quadrangular cartilage disarticulation septoplasty - Technical note about 7 cases]

The earliest descriptions of septoplasty date back to the 18th century. Modern techniques, including disarticulation septoplasty, aim to correct complex septal deformities while preserving nasal function and aesthetics. Our study evaluates the functional and aesthetic outcomes of this innovative approach.

We conducted a single-center retrospective study including 7 patients who underwent surgery between 2024 and 2025 for unilateral nasal obstruction with characteristic "watch glass" septal deviation. The surgical technique was based on three fundamental principles: meticulous bilateral dissection of the fibromucosal flap using ethmoid-vomer landmarks, complete disarticulation of the quadrangular cartilage including its caudal, vomerine and ethmoidal release, followed by anatomical repositioning stabilized with silicone splints. Outcomes were assessed by comparing preoperative and 3-month postoperative NOSE and NAFEQ scores using Wilcoxon tests (R software v4.1.3).

Analysis revealed significant functional improvement, with mean NOSE scores decreasing from 15.4±2.4 preoperatively to 6.0±5.9 postoperatively (P=0.022). Aesthetically, NAFEQ scores showed global improvement from 38.75±8.1 to 58.1±8.1 (P=0.014), with significant enhancements in both functional (P=0.025) and aesthetic (P=0.03) subscores. No major complications such as septal perforation or saddle nose deformity were observed in our series.

Quadrangular cartilage disarticulation septoplasty represents a significant advancement in managing complex septal deviations. It effectively combines resolution of nasal obstruction (61% NOSE score reduction), satisfactory correction of columellar deviations (50% NAFEQ score improvement), and demonstrated short-term safety. These promising results warrant confirmation through randomized comparative studies with longer-term follow-up.