Endoscopic Septoplasty

Pastorek and Becker described a modified swinging-door technique for treatment of the caudal septum.13 The septal cartilage along the maxillary crest is dissected free but not excised. Instead, the caudal septum is flipped over the nasal spine, which acts as a "doorstop" and secures the caudal septum in a straighter position (Figure 5).

Endoscopically guided septoplasty (Figure 6) is useful in difficult revision nasal surgeries in which obstructing septal deviation persists. Indications for endoscopic septoplasty include an isolated septal deformity, or a posterior septal deformity in a patient with densely adherent septal muco­sal flaps, typically found in cases of revision septoplasty.

If septal deviation persists posteriorly after a septo‑plasty, persisting nasal obstruction may require revision septoplasty. Because the mucosal flaps are often densely adherent after a septoplasty, revision septoplasty involv­ing a traditional approach may present technical difficul­ty, including significant risk of septal perforation. Endoscopic septoplasty is a relatively recent and impor­tant technique.

Figure 8. In a patient with a deviated septum, return of the septum to midline by means of septoplasty may actually diminish the airway on the side of a hypertrophied middle turbinate. Partial middle turbinectomy may be indicated in this situation.

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