ETHMOID BONE SANDWICH GRAFTING FOR CAUDAL SEPTAL-DEFECTS

Objective: To evaluate a new technique for correction of severe caudal septal defects. Design: For all patients, preoperative photographs we re graded with regard to the severity of caudal septal defects. Preope ratively, nasal airway breathing surveys were conducted and nasal tip projection (NTP) measurements were recorded. The caudal septal defects were then repaired with use of the ethmoid bone sandwich grafting tec hnique. Photographs, NTP measurements, and an airway survey were then repeated 6 and 12 months postoperatively. Preoperative and postoperati ve assessments were compared and analyzed. Lateral nasal roentgenogram s were obtained in five of 10 patients to assess resorption of the bon e grafts. Complications were noted if present. Setting: Urban medical center. Patients: Ten volunteers with severe caudal septal defects cau sing both cosmetic and functional problems. All patients had undergone at least one previous submucous resection. Outcome Measures: Durabili ty and degree of correction, maintenance of NTP, airway improvement, a nd morbidity. Results: After 1 year, all patients maintained satisfact ory correction of their caudal septal defect based on postoperative ph otographic grading and physical examination findings. The NTP was main tained in eight of 10 patients. Two patients experienced loss of NTP a fter 1 year that was not present 6 months postoperatively. Average air way improvement was 126.7% after 1 year. Postoperative roentgenograms showed only minor (<10%) bone graft resorption. The only complication was a granuloma. Conclusions: The ethmoid bone sandwich grafting techn ique corrected severe caudal septal deviations while maintaining or st rengthening structural support of the caudal septal strut without loss of NTP, airway compromise, or morbidity.