Mattress Suture Technique for Caudal Septum Dislocations in Open and Endonasal Septoplasty: Which Approach is Better?

Abstract

Objectives: Various techniques have been described to correct caudal septum dislocations but the issue has not been resolved conclusively. This study aimed to describe a suture technique that can be used to correct and stabilize the caudal septum on the maxillary spine and also to evaluate the effects on patientsymptoms. Methods: Fifty-two patients with caudal septal dislocation were included in this study. Nineteen of the patients underwent open septoplasty and 33 patients underwent endonasal septoplasty. The caudal cartilage septums were fixed to the maxillary spine with horizontal mattress suturing in all patients. The patient followed up between 3 and 24th month. The modified "NOSE" survey was used to assess surgical outcome in all patients. The degree of septal correction was also classified. Results: Complete correction was achieved in the postoperative period in 96% of the patients. The status was near complete correction in 2 (3.8%) of the patients. But in these 2 patients, degree of caudal septal dislocation was corrected from severe to moderate after surgery and the fixation suture side is correct and stable. Postoperative modified NOSE survey scores were lower than the preoperative scores in all open and endonasal septoplasty groups (P <0.05). NOSE 2 (nasal blockage or obstruction) and NOSE 4 (trouble sleeping) scores were higher in patients with higher followup duration in open septoplasty group. Conclusion: Suturing technique is quite suitable for caudal septum dislocations and can easily be used in open and endonasal septoplasty. This suture reduces postoperative NOSE scores and the patients are satisfied with the results of the surgery. The septal stability may decrease in open septoplasty group with the longer post-operative duration. However, wide exposure can be ensured with an open septorhinoplasty approach. We concluded that it will be better to use endonasal septoplasty in appropriate cases and suture with nonabsorbable sutures.