Back-and-forth endoscopic septoplasty: analysis of the technique and outcomes.

Background: To describe our clinical experience in 218 consecutive
patients undergoing endoscopic back-and-forth
septoplasty (EBFS), examining surgical indications, technique,
and follow-up.
Methods: From January 2005 to November 2008, 218
patients underwent EBFS at the Department of Otorhinolaryngology,
San Raffaele Hospital, Milan, Italy. The
indication for EBFS in this series was nasal airway obstruction
(NAO). Patients were studied with nasal rigid endoscopy
and in some cases computed tomography (CT)was
used to exclude rhinosinusitis. The most common concomitant
diagnoses included allergic rhinitis and turbinate hypertrophy.
EBFS facilitates the interruption of perichondrial
and periosteal bridges, which are more represented
in the anterior portion of the septum between the caudal
quadrangular cartilage and the vomeropremaxillary
crest. Septal splints were positioned. No nasal packing was
required.
Results:No cases required conversion to a traditional headlight
approach, and no intraoperative complications were
encountered. Intraoperative mucosal microlacerations occurred
in 77.98% of cases; suturing was required in only
8.25%of cases.Of 218 patients, 74.77% experienced resolution
of NAO, while 16.06% experienced only improvement;
9.17% noted the persistence of symptoms. Complications
included transient dental pain/hypesthesia (6.88%), septal
hematoma (5.04%), synechiae formation (2.29%), epistaxis
(1.83%), septal perforation (1.83%), cheek swelling (0.45%),
and septal abscess (0.45%).
Conclusion: EBFS as a variation of endoscopic septoplasty
(ES) represents a viable procedure with good outcomes
and a low rate of complications. The technique allows lysis
of tissue fibers while preserving the integrity of mucosa
at the critical area using less force and reduces the probability
of mucosal tears, based on embryologic knowledge of
anatomical dissection.