title: As the Nasal Spine Goes, So Goes the Septum.
abstract: BACKGROUND
  "As the septum goes, so goes the nose". A well-known phrase by Maurice Cottle forms the pillar of septoplasty. Since the inception of septal surgeries, numerous methods of septoplasty have been described. But, if not performed meticulously, may lead to deformity. For a successful surgery, understanding the anatomy and addressing the anterior nasal spine and maintaining the tip integrity is vital.
  
  
  OBJECTIVE
  To study the outcomes of "ROUND ABOUT technique" to correct deviated nasal septum which focuses on the importance of anterior spine and hence maintain the tip integrity.
  
  
  METHODS
  This was a prospective, single-centre outcome study of 35 patients with symptomatic nasal obstruction. Here, we describe a method of elevating the mucoperichondrial and mucoperiosteal flaps bilaterally, without transecting the quadrilateral cartilage of the septum. The Sino Nasal Outcome Test-22 (SNOT-22) Questionnaire was administered pre-operatively and after 3 months following surgery. The post-operative follow-up period ranged from 3 to 6 months (mean= 4.5 months) to evaluate the functional and aesthetic outcomes of the performed procedure.
  
  
  RESULTS
  A total of 35 patients underwent surgery by this technique who presented with deviated nasal septum and variable degrees of nasal obstruction. To assess the statistical outcome, Paired t-test was applied. Mean SNOT-22 scores decreased significantly from 40.02 pre-operatively to 18.65 three months after surgery. The results sustained after 6 months (p-value <0.0001), 85% of these patients had improved breathing post-operatively and none of the patients complained any aesthetic criticisms. The patients were content and the requirement of medications post-operatively were minimal.
  
  
  CONCLUSIONS
  The ROUND ABOUT technique is a very effective and safe method in correcting the septal deviations especially the ones with caudal or dorsal deflections. It also helps in maintaining the tip integrity and addressing the anterior nasal spine. It avoids the complications of conventional septoplasty.
authors.affiliation: Resident, Department of ENT and Neck Surgery, Grant Medical College & Sir JJ Group of Hospitals , Mumbai, Maharashtra, India .
authors.forename: Devkumar
authors.initials: D
authors.lastname: Rengaraja
authors.affiliation: Head of Department, Department of ENT and Neck Surgery, Grant Medical College & Sir JJ Group of Hospitals , Mumbai, Maharashtra, India .
authors.forename: Mohan
authors.initials: M
authors.lastname: Jagade
authors.affiliation: Lecturer, Department of ENT and Neck Surgery, Grant Medical College & Sir JJ Group of Hospitals , Mumbai, Maharashtra, India .
authors.forename: Vitthal
authors.initials: V
authors.lastname: Kale
authors.affiliation: Resident, Department of ENT and Neck Surgery, Grant Medical College & Sir JJ Group of Hospitals , Mumbai, Maharashtra, India .
authors.forename: Anoop
authors.initials: A
authors.lastname: Attakil
authors.affiliation: Resident, Department of ENT and Neck Surgery, Grant Medical College & Sir JJ Group of Hospitals , Mumbai, Maharashtra, India .
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kar
authors.affiliation: Resident, Department of ENT and Neck Surgery, Grant Medical College & Sir JJ Group of Hospitals , Mumbai, Maharashtra, India .
authors.forename: Arpita
authors.initials: A
authors.lastname: Singhal
authors.affiliation: Resident, Department of ENT and Neck Surgery, Grant Medical College & Sir JJ Group of Hospitals , Mumbai, Maharashtra, India .
authors.forename: Karthik
authors.initials: K
authors.lastname: Rao
authors.affiliation: Resident, Department of ENT and Neck Surgery, Grant Medical College & Sir JJ Group of Hospitals , Mumbai, Maharashtra, India .
authors.forename: Pallavi
authors.initials: P
authors.lastname: Gupta
keywords: Round-about; Septoplasty; Septorhinoplasty