personal techniques for septoplasty

2.  Preserving L-strut to stabilize nasal dorsum
 Removal of surplus cartilage with boomerang excision
 Scoring or cross-hatching: Removal of internal stress and to
trigger regrowth of chondrocyte
As most of you know
these concepts cannot be applied to
every septal deviation

3.  There are too different type of NSD
 The effect of scoring or crosshatching is inconsistent
according to age or history of previous trauma
 Deviation often involves L-strut, which is better to be fixed
together at the time of septoplasty
Limitation with conventional
surgery

4.  External warping factor
• Factors which warps cartilaginous septum from outside
• ANS-Cartilage, bone-cartilage at Keystone area
: wrong connection at these area might cause deviation
• More important in young patients with less calcification and soft
cartilage

5.  Internal Stress
• As people grow older, calcification progresses in cartilage. In
these population, cartilaginous deviation can’t be fixed with
removing external warping factor only. Direct manipulation is
needed
 Fix Ext. factor first, then Int. factor if there is remaining deviation

6.  Release and Fixation
: Septal deviation might be fixed as a whole,
If we
① release external warping factor (ANS-caudal
septum or Keystone area) and make it
moveable
② Correction of most deviated portion.
: removal of surplus cartilage & suture
technique
③ Then fix it at correct position.
Septal Deviation

7. H O W ?
 Today I will show you…
• Caudal wedge excision with FO8 suture
• Müstarde suture
• Anterior sliding technique
• Keystone suture

8.  Mainly used for dorsoventral
deviation in caudal septum
 After evaluation of surplus
cartilage, wedge shape excision of
Surplus cartilage is done
 Then sutured with fig. of 8 shape
 More effective with
scoreing/Müstarde suture
 Should be incremental!: Possibility
of saddle nose with over-resection

9.  Principle: Using perpendicular direction vector with Horizontal
mattress suture
 More effective with partial thickness scoring
 Merit: can control the degree of correction with adjusting suture
strength
 Cautious for possible buckling in Weak cartilage  Add batten graft

10. • Theory: Straightening results in lengthening
Conversely lengthening causes straightening
• Tech: Freeing the septum from ANS
 advance the septum anteriorly  FO8 suture
Caution: this technique weakens septal support by freeing
ligamentous connection. So be cautious for stability with using this
tech.
Anterior sliding

11.  It should be incremental: don’t be ambitious!!
Male/18yo

12. • Male/22 YO
• Suture: Vicryl 4.0 for 4wks

13. Mustarde suture,
Scoring-DV
Caudal wedge exc.
Ant. Sliding
FO8 suture

14.  About 1/3 of Septoplasty cases in my hospital has high
dorsal deviation at bony-cart. junction to some degree
 assumption: if we apply horizontal mattress suture to this
area, it will fix the dorsal deviation

15.  Using double-armed vicryl 4.0
 Drilling two holes at bony septum
 Green stick fracture at bony septum above the holes
 Applying horizontal mattress suture through the holes
 Move the bony septum at midline with skin hook, & suture
(Kang JM et al,
AJRA 2012)
Conceptually it is similar with mustarde suture

17. (Kang JM et al,
AJRA 2012)

18.  We usually divide the septum as caudal, dorsal, bony or
cartilaginous septum, septal deviation is not confined to a
single area.
 To fix the deviated septum, first align the connection btw
ANS/Keystone area and cartilaginous septum
 Various techniques can be used to fix the NSD including
scoring, mustarde suture, Keystone suture, caudal wedge
excision and FO8 suture, ant. Sliding and so on.