Septoplasty: A Comparison of Septocolumellar and High Septal Hemitransfixion Approaches to the Nasal Septum

Objectives: To compare the classical septocolumellar approach with the high septal hemitransfÍxion incision for deformities of the nasal septum. Patients and Methods: A prospective randomised controlled trial of 56 patients undergoing primary septoplasty over a 6-month period was carried out. Pre-operatively, symptoms and signs were assessed. A high septal approach was used in 32 patients and a septocolumellar approach in 24 patients. Postoperative evaluation at 6 months included alteration of symptoms, clinical appearance of the septum and complications. Results: Overall subjective symptoms improved in 75% of the septocolumellar group and 87.5% of the high septal group (p > 0.2). The septum was noted to be straight postoperatively in 66.6% of the septocolumellar group and 93.8% of the high septal group (p = 0.01). There was no significant difference in the pattern of symptom scores between the two groups (p = 0.6503). There was a statistically significant difference in the alteration of sign scores between the two groups (p = 0.0162). Assessment of complications showed temporary numbness over the columella and tip in 8 cases (33.3%) in the septocolumellar group in contrast with no cases in the high septal group (p < 0.001) and 5 cases of recurrent dislocation of the caudal septum and 2 cases of columellar retraction in the septocolumellar group compared to no similar complications in the high septal group (p < 0.01). Conclusions: The high septal hemitransfixion incisions provides more improved, although non-significant, results for alteration of symptoms but a significant improvement on objective assessment and a lower incidence of complications, particularly postoperative numbness, than the septocolumellar incision.