Septoplasty ent

Septoplasty

Definition: A conservative septal surgery where as much of the septal framework as possible is retained. A mucoperichondrial flap is generally raised only on one side. It has almost replaced the SMR (Submucous Resection) operation.

Indications & Contraindications

Indications:
  • Deviated Nasal Septum (DNS) causing obstruction.
  • Recurrent Epistaxis (from spur).
  • Sinusitis due to deviation.
  • Septal deviation causing Headaches (contact with lateral wall).
  • Part of Septorhinoplasty (Cosmetic).
  • Access for:
    • Endoscopic Sinus Surgery (ESS).
    • Endoscopic DCR.
    • Trans-sphenoidal Hypophysectomy (Pituitary).
  • Sleep Apnoea / Hypopnoea syndrome.
Contraindications:
  • Acute nasal or sinus infection.
  • Untreated Diabetes or Hypertension.
  • Bleeding Diathesis.

Technique

  • Anaesthesia: Local or General.
  • Position: Reclining (Same as SMR).

1. Incision

Type Location / Description Indication
Killian’s 2-3 mm above caudal end of cartilage. Standard Deviated Septum.
Hemitransfixion Septocolumellar incision (one side). Caudal Dislocation.
Transfixion Through and through septocolumellar incision. Caudal Dislocation.
Horizontal On the spur. Endoscopic Spurectomy.

2. Procedure Steps

Infiltration (1% Lignocaine + Adrenaline)
↓
Raise Mucoperichondrial Flap (One Side Only)
↓
Separate Cartilage from Vomer/Ethmoid Plate
↓
Correct Deformity (Bony/Cartilaginous)
↓
Suture Flaps & Pack Nose

3. Methods to Correct Cartilage

  • Scoring: On the concave side.
  • Cross-hatching or Morselizing.
  • Shaving or Wedge Excision.
  • Realignment of nasal spine or implantation of cartilage strip may be required.

Postoperative Care

  • Daycare Surgery: Patient discharged after recovery (Monitor Sleep Apnoea patients overnight).
  • Avoid: Strenuous exercise, nose blowing, hard sneezing.
  • Pack Removal: Next day.
  • Nasal Hygiene: Saline spray/Steam inhalation.
  • Splints: Removed on 4th–8th day (if used).

Complications

  • Immediate: Bleeding.
  • Septal: Haematoma, Abscess, Perforation.
  • Deformity: Supratip depression, Saddle nose, Columellar retraction, External deformity.
  • Rare/Severe:
    • CSF Rhinorrhoea (Avulsion of ethmoid plate).
    • Toxic Shock Syndrome.
📚 Source: ENT Dhingra | Chapter 88

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