Brief overview of septoplasty.
Reading File
Finding Sources
Searching PubMed
septoplasty outcomes
Reading File
Reading File
Reading File
Reading File
Reading File
Reading File
Here is a concise overview of septoplasty, drawn from Scott-Brown's Otorhinolaryngology Head & Neck Surgery and Cummings Otolaryngology Head and Neck Surgery:
Septoplasty - Overview
Definition and Goal
Septoplasty is surgery to correct a deviated nasal septum, aiming to maximise symptomatic improvement of nasal obstruction while minimising surgical risk. Unlike older submucous resection (SMR), modern septoplasty emphasises reconstruction over excision, preserving the structural L-strut that supports nasal shape.
Indications
- Nasal airway obstruction caused by septal deviation (especially involving the caudal or dorsal L-strut)
- Failure of conservative/medical management
- Symptomatic correlation is key - treatment must be individualised, as some patients with large deviations are asymptomatic and vice versa
Anatomical Basis
The L-strut (the caudal and dorsal arms of the quadrilateral cartilage) is involved in most clinically significant deviations. SMR is limited to non-L-strut deviations; septoplasty is required whenever the L-strut is affected.
Surgical Approach and Technique
Incision:
- Hemitransfixion incision - placed at the caudal edge of the septum; provides access to the entire septum including the caudal L-strut. A partial, full, or extended hemitransfixion is chosen based on required access.
- Killian incision - placed ~1 cm cephalad from the caudal end; used for SMR when the L-strut is not involved.
Flap elevation:
- Mucoperiochondrial flap is raised at the subperichondrial plane, typically on the concave side first.
- Bilateral flaps are raised for S-shaped deformities or when sutures are placed in the mucosal envelope.
Techniques for correction (used alone or in combination):
| Technique | Mechanism |
|---|---|
| Cutting/scoring | Scoring the concave side releases intrinsic cartilage tension; splinting with a batten graft improves reliability |
| Grafting | Harvested septal cartilage/bone is used as a batten or spreader graft to straighten and splint deformed segments |
| Suturing | Quilting sutures, mattress sutures; the "Wright suture" stabilises fractured segments to the mucoperichondrial flap |
| Relocating | The "swinging door" technique - caudal excess cartilage is excised and the septum is re-anchored to the anterior nasal spine with absorbable suture (4-0 PDS) |
Osseocartilaginous junction: The junction between the quadrilateral cartilage and perpendicular plate of ethmoid is frequently disarticulated to allow realignment; this does not cause septal collapse as long as the upper lateral cartilage attachments are intact.
Variants
- Endoscopic septoplasty - Improved visualisation, especially posteriorly; useful for posterior deviations and spurs
- External (open) approach septoplasty - Used when combined rhinoplasty access is needed
- Extracorporeal septoplasty - The deviated cartilage is removed, reshaped or scored on the back table, and reinserted; used for severe deformities
- Paediatric septoplasty - Generally deferred until skeletal maturity (unless severe obstruction); conservative resection is even more critical in children to avoid growth disturbance
Complications
- Persistent obstruction - Most common; often due to inadequate attention to posterior bony deviations/spurs
- Septal haematoma - Prevented by quilting sutures
- Septal perforation - From contiguous bilateral mucosal tears or failure to reskeletonize the flap
- Nasal shape changes (tip ptosis, dorsal saddling) - From over-resection of the caudal septum or loss of dorsal support
- Synechiae - Between septum and turbinate/lateral nasal wall
- Infection - Rare
- Post-op bleeding/rhinorrhoea - Common in early period, especially if turbinoplasty is concurrent
Recent Evidence
A 2025 systematic review and meta-analysis (PMID 39230606) found septoplasty superior to non-surgical management for deviated nasal septum in RCTs. A 2024 systematic review (PMID 37991145) examining long-term outcomes noted that concurrent turbinoplasty may provide additional benefit in appropriately selected patients.
Sources: Scott-Brown's Otorhinolaryngology Head & Neck Surgery, Vol 1 (Ch. 103) | Cummings Otolaryngology Head and Neck Surgery (Ch. 29)
This is a shared conversation. Sign in to Orris to start your own chat.