Technical Considerations in Septoplasty

The anatomy of the septum is well recognized by nasal surgeons (Figure 1).8-11 In this section, we will consider traditional septoplasty, endoscopic septoplasty, and sep­toplasty techniques to address the caudal septum. I prefer the traditional septoplasty approach (as opposed to endo­scopic septoplasty) for broad deviations and for primary septoplasty. Endoscopic approaches are less invasive and advantageous for focal deflections and spurs, as well as for revision septoplasty. Caudal septal deflections require special attention.

To perform a traditional septoplasty, I retract the col­umella with a small nasal speculum, but a columellar retractor, large 2-prong hook, or other suitable instru­ment may also be used. The purpose is to expose the cau­dal margin of the septum and to protect the columella from injury. Next I make a hemitransfixion incision extending from the anterior septal angle to the posterior septal angle along the caudal border of the cartilaginous septum with a 15 blade or 15-C blade. I use a modified Killian incision if less exposure is necessary. However, if I need access to the caudal septum or need to separate the upper lateral cartilages from the dorsal septum to place spreader grafts, or if I simply feel that I require the widest possible exposure, I will use a hemitransfixion incision.

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