Ultrasonic septocorrection of traumatic deformities of the nasal septum in the acute period

Traumatic Nasal Septum Deformities and Impaired Breathing

Impact of Nasal Trauma

Traumatic deformity of the nasal dorsum (external nose) and the internal nasal septum is a common consequence of domestic injuries, sports-related accidents, and road traffic incidents. Such injuries can significantly alter nasal anatomy, leading to both aesthetic concerns and, more importantly, functional impairments.

 

Consequences of Septal Deformation

Deformation of the nasal septum frequently results in impaired nasal breathing. The nose is a critical anatomical structure of the face, and the correct alignment and relationship of its internal structures, particularly the septum, are fundamental for ensuring free and unobstructed nasal airflow. Normal nasal function is a basic prerequisite for optimal physical and mental development, especially in children and adolescents. Dysfunction of the nose due to traumatic deformity can negatively affect the activity of vital organs and overall systemic functions, including pulmonary ventilation and cardiovascular health. Despite its prevalence, the optimal management tactics for patients with acute trauma to the nose and nasal septum remain a subject of ongoing discussion and refinement in the medical community.

In patients with injuries to the nasal dorsum, careful attention must be paid to the condition of the nasal septum. Rhinoscopic and endoscopic examinations following trauma often reveal signs of septal fracture and deformation, such as:

• Ruptures or lacerations of the septal mucous membrane.
• Submucosal hemorrhages (septal hematoma).
• Pathological mobility or instability of septal segments.
• Pronounced curvature, deviation, or angulation of the cartilaginous and/or bony portions of the nasal septum.

It is often the acute fracture and subsequent deformation of the nasal septum that is the leading cause for the development of persistent and significant difficulty in nasal breathing following trauma.

 

Rationale for Early Surgical Intervention: Ultrasonic Septocorrection

Limitations of Traditional Reduction Methods

Elimination of traumatic deformities of the nasal septum is often challenging and almost impossible to achieve adequately with routine finger-instrumental closed reduction of the nasal bones alone. While closed reduction can realign fractured nasal bones, it may not sufficiently address complex septal fractures or dislocations.

 

Advantages of Early Septocorrection

Performing surgical intervention, specifically **ultrasonic septocorrection**, in the acute period (shortly after trauma) is advocated for several reasons. This approach aims to:

• Promptly restore impaired respiratory function.
• Prevent the development of long-term post-traumatic complications such as septal scarring, synechiae (adhesions within the nasal cavity), and persistent deformities that may require more complex secondary surgery later.

A sparing surgical treatment methodology has been developed for deformities of the nasal septum that cause obstruction of nasal breathing, emphasizing early intervention.

 

Ultrasonic Septocorrection: Operative Technique

Ultrasonic septocorrection is presented as a method to align the nasal septum using a specialized device that employs low-frequency ultrasonic vibrations. The procedure aims to achieve physiological straightening of the septum with minimal tissue trauma.

 

Preoperative Assessment and Anesthesia

The diagnostic algorithm prior to surgery includes:

• Clinical examination.
• Endoscopic examination of the nasal cavity.
• Radiography of the paranasal sinuses (CT scans are often preferred for detailed assessment of fractures).
• Clinical and laboratory examinations as needed.

The procedure is typically performed under endotracheal anesthesia (general anesthesia). This is supplemented with infiltration anesthesia of the nasal mucosa using, for example, a 1% lidocaine solution (approximately 5 ml) injected in the premaxillary area and along the nasal septum on both sides.

 

Surgical Steps

1. Incision and Exposure: A hemitransfixion incision (or similar limited septal incision) is made with a scalpel, typically on the left side (or the side of convexity/access).
2. Mucoperichondrial Dissection: The mucoperichondrium and mucoperiosteum are carefully elevated from the quadrangular cartilage and bony septum on both sides, creating submucosal tunnels. This exposes the zones of pronounced cartilaginous and bony deformation of the nasal septum.
3. Application of Ultrasonic Device: The branches of the ultrasonic septocorrection device are inserted into the mucoperichondrial tunnels, directly contacting the deformed cartilaginous and bony sections.
4. Ultrasonic Correction: Low-frequency ultrasonic vibrations are transmitted through a choke to the working branches of the device and onto the deformed septal segments. It is proposed that under the influence of these vibrations, the tissue undergoes a form of "dispersion" or softening, which then allows it to be gently and physiologically straightened.
5. Assessment and Closure: After the ultrasonic application and realignment, the mucosal flaps are brought together (reapproximated). The surgeon then monitors the corrected location of the septum and assesses the degree of restoration of the lumen of the common nasal passage.
6. Suturing and Splinting: The initial incision is closed with sutures. Thin silicone splints are typically installed on both sides of the septum and sutured in place to prevent synechiae formation and displacement of the corrected septum.
7. Airway Restoration: The overall goal is to restore the lumen of the common nasal passage to normal dimensions, eliminating obstacles to airflow and thereby improving nasal aerodynamics.
8. Nasal Packing: Anterior nasal packing with an oil-based ointment (e.g., Levomekol) is usually applied for approximately one day.

 

Outcomes and Benefits of Ultrasonic Septocorrection

Correction of the nasal septum using this ultrasonic device is described as convenient for the patient (likely referring to reduced postoperative discomfort compared to traditional methods), relatively painless, and as not causing significant atrophic or cicatricial (scarring) changes in the mucous membrane. The low-frequency ultrasonic vibrations are purported to flatten the nasal septum effectively without major complications. Nasal breathing is reportedly restored completely, often immediately after the intervention, once packing is removed.

Experience with this technique (e.g., 517 patients aged 10 to 15 years operated on between 2009 and 2020) reportedly showed no significant complications during surgery or subsequent treatment. None of the patients in this cohort were said to have developed synechiae, and nasal breathing was fully restored. Patients were typically discharged on average 5-7 days after the operation.

This technology of minimally invasive compression ultrasonic septocorrection is presented as a key to achieving a stable and positive clinical effect in the acute period following nasal septal trauma.

 

Comparison with Traditional Destructive Techniques

There is considerable disagreement and ongoing debate regarding the merit of many commonly performed traditional surgical techniques for septal correction, some of which can be considered more "destructive" as they involve significant resection of cartilage and bone. Proponents of ultrasonic septocorrection and similar minimally invasive, structure-preserving approaches argue that these functionally justified technologies should be the methods of choice, particularly in the acute setting, to minimize tissue trauma and optimize long-term physiological outcomes.

 

Differential Diagnosis of Acute Nasal Obstruction Post-Trauma

Following nasal trauma, acute nasal obstruction can be due to several factors that need differentiation:

Condition	Key Differentiating Features
Traumatic Deviated/Fractured Nasal Septum	Visible septal deformity on rhinoscopy/endoscopy; impaired airflow; history of trauma. CT confirms fracture/deviation.
Nasal Septal Hematoma	Bilateral, smooth, fluctuant, reddish/bluish swelling of septum; severe obstruction; history of trauma. Aspiration yields blood.
Nasal Septal Abscess	Similar to hematoma but with signs of infection (fever, intense pain, erythema). Aspiration yields pus.
Severe Mucosal Edema	Diffuse swelling of nasal lining due to inflammatory response to trauma; no discrete septal collection or gross deviation.
Displaced Nasal Bone Fractures	External nasal deformity, crepitus, mobility of nasal bones. Can contribute to internal obstruction.
Internal Nasal Packing (if placed for epistaxis)	Known history of packing placement.

 

When to Consider Ultrasonic Septocorrection

Ultrasonic septocorrection in the acute period is considered for patients with:

• Recent nasal trauma resulting in a demonstrable fracture and/or deformation of the nasal septum.
• Associated significant difficulty in nasal breathing directly attributable to the acute septal deformity.
• Desire to restore normal nasal function promptly and potentially prevent long-term complications of untreated septal trauma (e.g., persistent obstruction, chronic scarring).

The decision is made after a thorough clinical and endoscopic examination, and often imaging (like CT scan), to accurately assess the extent and nature of the septal injury. The suitability of this specific technique versus other septoplasty approaches or conservative management would be determined by the treating ENT surgeon based on the individual case.