Advanced and Comprehensive Management of the Nasal Septum

I feel honored to be invited to act as editor for this issue on septoplasty and I thank all the coauthors for their profound contributions. Some years ago, a German health insurance company surveyed the results of the most common ear, nose, and throat (ENT) procedure, the septoplasty, and the follow-up showed that after surgery at least 50% of patients faced the same problems as before, and sometimes they had even worsened. So there is a big discrepancy between the opinion that septoplasty is an easy operation and the dissatisfying results with a relatively high failure and complication rate. Furthermore, the influence of the septum on the outer shape of the nose is often neglected.

To obtain good functional results without complications such as residual deviation, saddle nose, or pseudohump nose, an exact analysis is necessary with an appropriate operation plan, which is performed in a subtile technique with careful postoperative treatment. The subtile technique seems an important part and often needs magnification-some authors recommend a binocular operating microscope-and in a very severely deformed septum an open approach gives a much better view of the deformity; in cases where the whole septum has to be taken out (extracorporeal septal reconstruction), the refixation of the septum is much safer and more precise. Even in septal surgery the preserving techniques have overcome the resecting methods of submucosal resection which are unfortunately still performed even today. I hope that this issue will be able to show the history and the development, the physiological bases, the different categories of septal deviations, and the way to handle the different deformities. To be informed of these issues seems to me to be a prerequisite not only for the ENT colleague but for every colleague dealing with rhinosurgery. In other words, understanding the principles of septoplasty is a must for every surgeon who performs aesthetic rhinoplasty.