Septal Surgery
Septoplasty A number of studies have shown septoplasty to have a good effect on nasal blockage and to be costeffective compared with non-surgical management.
Surgical Approach
In most cases of septal deviation, the septal L-strut is involved and the approach should allow adequate exposure.
Hemitransfixion incision is placed at the caudal edge of the septum.
Mucosal flap is raised on the concave side.
In certain deformities (e.g. S-shaped deformity), both mucosal flaps are raised.
When the osseocartilaginous junction is reached, depending on type of deformity, this junction can be disarticulated, and a segment of bone or cartilage removed.
Disarticulation of the septal cartilage from the maxillary crest allows the septum to move to midline (the 1 cm of bony-cartilaginous junction at the L-strut is left undisturbed if possible).
The surgical approach is often through an endonasal route; however, other approaches are available.
Submucosal Resection (SMR)
This technique addresses deviation at the body of the septum (not the L-strut). A Killian incision is placed about 1 cm from the caudal septal edge and the flap is raised. The deviated part of the septum is excised after being freed from its peripheral attachments. The harvested bony or cartilaginous septum can then be used as a graft or it can be straightened and reinserted in its place.
Endoscopic septoplasty
Used for limited septal excision
Good visualisation
Requires minimal access
Can be performed at the same time of sinus surgery to improve access
External (open) septoplasty (septorhinoplasty approach)
Mostly used when the dorsal L-strut deformity requires correction
It can improve surgical access
It is favourable in complex septal reconstructive cases such as extracorporeal septoplasty
Cartilage Manipulation
The deviated septum can be addressed by a variety of techniques. Here, the most commonly employed techniques are described:
Scoring of the septal cartilage on the concave side allows the septum to become straight. This technique is not reliable as under-scoring or over-scoring can occur; splinting the septum against a batten graft adds security.
Septal batten grafts (harvested from the septal cartilage or bone) can be used to keep the deviated septum in a straight line.
Spreader grafts can be used as batten grafts to straighten the deviation of the dorsal L-strut.