Fibroperichondrectomy for the treatment of inveterate nasal septum deviation

Conventional surgical techniques used for the treatment of nasal deviations do not avoid recurrences, especially in inveterate forms. The primary alteration of the nasal osteocartilaginous framework would progressively increase and, therefore, could cause changes of structures initially not involved by the trauma, such as alar or upper lateral cartilage. According to our analysis, it is supposed that the septal perichondrium is capable of restoring its previous position. This happens especially in the inveterate forms of deviation and even when the septal straightening has already been done. The anatomopathological study points out the constant presence of the fibrous thickening of the perichondrium at the same level as the concave portion of septum, and this finding represents the anatomical expression of the scarring reaction after the traumatic event. The fibroperichondrium is excised as radically as possible for the entire bilateral surface of the chondral septum. Good results by extramucosal perichondrectomy, associated with more conventional procedures of septum correction, in a series of 20 selected patients has encouraged reporting of the technique.