Procedure of

Septoplasty
N. Pavan Reddy
Group - 5
Table of contents
Types of Septal surgeries and their
01 differences

02 Septoplasty and its types

03 Steps of septoplasty

Advantages and complications of

04 septoplasty
 Septal surgery
● It is of two types
1. SMR (Sub-mucosal resection of septum)
2.Septoplasty

Septoplasty Sub mucosal resection

Deviated bone and cartilage is removed Bone and cartilage are removed
Frees's incision is given Killian's incision is given
Flap is raised on one side Flaps raised on both sides
Less chance of saddle nose deformity More chances os saddle nose deformity
 Septoplasty
It is a tissue-sparing procedure, where septal deviation is corrected by minimal resection of cartilage
and bone, strategic criss-cross incision and repositioning .
2 Types

Conventional septoplasty Endoscopic septoplasty

Conventional septoplasty Endoscopic septoplasty

Exposure Wide Limited
Illumination Relatively poor Excellent
Posterior bony spur Can't be seen can be seen clearly
Septal Perforation More Less
Chance of excessive tissue injury More Less
Septal Perforation More Less
Synechiae More Less
 Steps of surgery
Positioning of the patient : Reclining position with head end of the table raised

Step 1 : Nasal packing : By 4% Xylocaine nasal packing.

Step 2 : Infiltration :by 2% Xylocaine and 1 in 100,000 adrenaline on either side of the septum from anterior to
posterior or posterior to anterior direction.
C/I: In cases of atrophic rhinitis
● Step 3: Freer's hemitransfixation :incision is given at the caudal end of the septum upto mucoperichondrium,
usually on the concave side of the cartilage.

● Step 4: Flap elevation :The mucoperichondrial elevation is done on the side of incision and three tunnels are created.

Freer's elevator

Anterior tunnel
Exposure of the quadrangular
septal cartilage is done on the
concave side
Flap elevation
Inferior tunnel
Periosteum is elevated and the
anterior nasal spine and maxillary
crest on both the sides are
exposed
Posterior tunnel
With sharp dissection the bony septum
comprising of the perpendicular plate
of ethmoid and vomer is exposed. A
small incision is given at the bony
cartilaginous junction to elevate the
mucoperiosteum of the opposite side
Step 5: Cartilage and bone resection : Inferior strip of excess cartilage is resected. The part of the
perpendicular plate and the vomerine angulation is removed using bone cutting forceps

Step 6:Columellar tunneling : done if caudal dislocation is present. Excess caudal end is trimmed and is
inserted into the tunnel, which is fixed by figure of 8 sutures through the anterior nasal spine.
Step 7 Nasal packing : Both the septal flaps are apposed and anterior nasal packing/ splinting is done in
both the sides of nasal septum after the incision site is sutured. The splints may be sutured in place by
through and through sutures
 Advantages of septoplasty
● Mucoperichondrial flap in elevated on one side.
● Whole cartilage need not be removed & only deviated portion can be addressed.
● Can be used for correction of caudal deviation also.
● Can be performed in both children & adults.
● Flappy septum usually doesn't occur .
 Complications
● 1. Bleeding.
● 2. Septal haematoma.
● 3. Septal abscess.
● 4. Depression of bridge. Usually occurs in supratip area due to too much removal of cartilage
along the dorsal border.
 Resources
● Hazarika
● Logan turner
Thank you