Endoscopic Septoplasty

SEPTOPLASTY
Perhaps more commonly performed than the classically described SMR is the septoplasty, which is a more conservative procedure. Septoplasty identifies the specific area of septal deviation and targets that area for resection. The techniques are similar to the SMR, but far less cartilage is removed. In addition, a septoplasty often includes septal cartilage modification or placement of a cartilage graft in place of cartilage resection.
Anesthesia
As with the SMR, the nose is decongested with oxymetazoline (0.05%)-soaked pledgets bilaterally. The septum is injected with 1% lidocaine with epinephrine bilaterally.
Incision and Flap Elevation
Either the Killian or hemitransfixion incision can be used. The hemitransfixion is used when …show more content…
Early reports of endoscopic septoplasty describe several advantages associated with the technique. For example, the technique makes it easier for surgeons to see tissue planes. Also, because the technique is minimally invasive, it offers a better way to treat isolated septal spurs. Furthermore, the technique gives surgeons improved access to a deviation that is posterior to a septal perforation. Additionally, the endoscopic approach makes it possible for many people to simultaneously observe the procedure on a monitor, making the approach useful in a teaching setting. Nasal endoscopy is a valuable tool for initial assessment of the relationship of the septum to the middle turbinates, which allows the surgeon to judge whether or not the position of the septum will limit access during ESS. Even in the absence of subjective nasal obstruction or gross septal deviation, septoplasty may be necessary to maximize access to the middle meatus during ESS, such as in the setting of a narrow nasal cavity with a prominent septal body (Fig. 1). Nasal endoscopy is an excellent tool for outpatient surveillance following septoplasty during the initial postoperative healing period and …show more content…
In most cases, the bony or cartilaginous septum deviates to some degree from the midline. Such deviations may be congenital or acquired. Septal deviations may be broad and convex (often termed bowing) or sharp and acute (often termed spurring). The septal mucosa often becomes very thin over the apex of a spur, which is an important consideration during septoplasty. The cartilaginous septum is formed by the quadrangular cartilage anteriorly, while the bony septum comprises vomer posteriorly and the perpendicular plate of the ethmoid posterosuperiorly. The septum sits atop the midline crest of the maxilla anteriorly and the palatine bone posteriorly. The septum is bordered anterosuperiorly by the paired nasal bones and upper/lower lateral nasal cartilages, superiorly by the cribriform plate and floor of the frontal sinus, and posterosuperiorly by the face of the sphenoid. The vomer thickens considerably at the posterior aspect of the septum, where it terminates at the junction with the

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