This patient had broken his nose and had had a repair of his septum (i.e. a septoplasty). However a septal perforation had resulted and the patient had a persisting deviation of his septum behind the perforation, which as you all know can be a very difficult problem. We were able to undertake this septorhinoplasty using an endoscopic septoplasty technique. We have described an endoscopic technique in this situation in the literature (Operative Techniques in Otolaryngology vol 12 no 2, 2001). Using an endoscope the surgeon can look directly at the part of the septum where there is deviation and just correct that, leaving everything else undisturbed. This is in contrast to a more traditional septoplasty in which the entire septum is exposed. The endoscopic septoplasty is particularly useful when there is persistent obstruction further in the back of the nose after previous septoplasty, and in these revision cases the lining of the septum is very densely adherent and more difficult to elevate. Therefore, rather than undertake this very trying and challenging dissection that risks septal perforation, it is much more appropriate – and easier – to undertake an endoscopic septoplasty to bypass the hazardous area and go directly to the deviated site.
I have had numerous patients present to me for revision septoplasty who were worried about a septal perforation because they have been to other doctors who have recommended revision septoplasty and told them that they would most certainly have a septal perforation. However, using the endoscopic technique in these cases, we have never had this problem.