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Septoplasty, Septal Reconstruction, Surgery of the Septum and Turbinates
K. J. Lee
The goal of correcting a deviated septum is to eliminate the obstructing components of the cartilaginous and bony septum while preserving support of the nasal architecture and avoiding a septal perforation.
- In general, two types of incisions can be utilized:
- Killian incision Used for patients whose cartilaginous septal deviation does not involve the caudal aspect of the septum. The advantage of using this incision is that no septal-columellar sutures are needed, thus avoiding possible postoperative suture irritation at the columellar site.
- Hemi-transfixion incision or Cottle incision Used for patients whose cartilaginous septal deviation includes the caudal aspect. The caudal septum deviates into one nostril or the other. This incision allows the surgeon to correct the deviated “caudal strut” and anchor it in the midline with two or three 3–0 chromic mattress sutures. The caudal strut cannot be sacrificed; the lack of a caudal strut will lead to columellar retraction and lack of tip support.
- In developing the mucoperichondrial and mucoperiosteal tunnels bilaterally, great care should be exercised to avoid through-and-through septal mucosal perforation. The use of the Freer septum knife (Storz N-2252, nicknamed “D knife” because it is shaped like the letter D
