Extracorporeal Septoplasty: A Boon for Correction of Crooked Nose

A crooked nose is one of the most challenging deformities for a plastic surgeon. Severe nasal septal deformities are responsible for functional and aesthetic impairments. Classical techniques can, sometimes, lead to disappointing results or relapse. We recount our experience of extracorporeal septoplasty (ECS) for correcting a post-traumatic case of severely deviated nose. A 32-year-old male presented to our outpatient department with complaints of trauma one year back, with gradually increasing nasal obstruction (right>left) and gross deviation of nasal dorsum and tip. Computed tomography revealed S-shaped deviation of nasal septum in both cephalo-caudal and antero-posterior axis, synechiae between right lateral wall and septum, hypertrophy of left inferior turbinate and deviation of bony septum. We performed ECS, used rib cartilage for septal extension graft, columellar strut graft and spreader graft and diced cartilage for minor dorsal irregularity. There was improvement in both obstruction symptoms and aesthetic outcomes. The most critical point in ECS is the re-implantation of the neoseptum. This requires stable and strong reattachment of both the cephalic dorsal neoseptum and the caudal part of the anterior nasal spine. ECS has been shown to provide long-lasting results with minimal revision rates.