Quadrangular Cartilage Disarticulation Septoplasty: A Biomechanical Approach to Nasal Septal Deviation.

This technical note presents quadrangular cartilage disarticulation septoplasty, a novel method for complex septal deviations by resolving growth conflicts between the quadrangular cartilage, vomer, and perpendicular plate. The technique systematically releases cartilage insertions while preserving superior piriform attachments, avoiding resection-related complications. In 7 patients with "watch-glass" deformities, outcomes improved significantly: Nasal Obstruction Symptom Evaluation scores dropped from 15.4 ± 2.4 to 6.0 ± 5.9 (P = .022); Nasal Appearance and Function Evaluation Questionnaire scores rose from 38.8 ± 8.1 to 58.1 ± 8.1 (P = .014). All cases were outpatient with 24-hour splint removal, showing 0% revisions vs. 3.8% with Cottle technique. The biomechanical rationale aligns with septal development anatomy, preserving native structure. Though technically demanding, its efficiency and safety (no perforations/saddle deformities) make it promising for complex deviations. Multicenter studies are needed to compare efficacy to traditional techniques.