Septoplasty

R1

; Septoplasty; Current Concept and Technique ,

Approach
Open Closed

Open septoplasty 1
Deviated nose septum septum Augmentation rhinoplasty 2 rhinoplasty Septal perforation Rhinoplasty

Open septoplasty 2
. Septum implant .

Open septoplasty 3
. Columella Tip support

Incision
Hemi-transfixion incision Transfixion Inter-cartilaginous incision Marginal incision Trans-columellar incision

Hemi-transfixion incision
Caudal septum incision caudal septal edge vestibular skin incision . incision caudal margin 1mm cephalic . incision membranous septum

septum .

Practical Rhinoplasty 96

Endoscopic Surgery of the Paranasal Sinuses and Anterior Skull Base (alte Wigand

Transfixion
Septal cartilage caudal border columella membranous septum incision septum . incision intercartilaginous incision intracartilaginous incision septum caudal margin membranous septum medial crura . Complete transfixion incision posterior nasal spine . incision

medial crura nasal septum tip

major tip support mechanism .

Surgical Approaches in Otorhinolaryngology Walter F. Thumfart

Complete transfixion incision

Inter-cartilaginous incision
Upper lateral cartilage lower lateral cartilage incision Incision alar rim double hook 15 blade medial lateral incision . . Unilateral complete transfixion incision scar skin hook medial crural footplate . tip surgery lateral crura eversion retrograde approach marginal incision delivery approach .

incision septal angle medial transfixion incision

osseocartilaginous vault

Practical Rhinoplasty 89

Atlas of Head and Neck Surgery -- Otolaryngology (): Byron J. Bailey,Karen H. Calhoun,Norman Friedm an,Shawn Newlands,Jeffrey T. Vrabec

Marginal incision
Infracartilaginous incision lower lateral cartilage caudal border . Lateral medial delivery approach . dome area incision lateral limb . Lateral crus lateral border nostril rim 15mm caudal border lateral component . lateral crus alar rim caudal margin . Medial limb . Medial limb lower lateral cartilage caudal border columella 1/3 . Intercartilaginous incision delivery approach . marginal incision open approach .

Atlas of Head and Neck Surgery -- Otolaryngology (): Byron J. Bailey,Karen H. Calhoun,Norman Friedman,Shawn Newlands,Jeffrey T. Vrabec

Pre-Op examination
Deviation to [R, L]

Approach
Killian Modified Killian Transfixion Dorsal Medial crural

Killian
Modified Killian incision(septum caudal 2~3mm hemitransfixion incision), Killian incision(septum caudal 10~15mm hemitransfixion incision)

septum isolated deformites, mid-septum, floor,

vomer, ethmoid caudal septum . modified Killian incision septum approach .

Modified Killian
Septum caudal 2~3mm . concave

incision
.

; Septoplasty; Current Concept and Technique ,

Dorsal
Open rhinoplasty approach dorsal deviation , medial crural approach caudal, dorsal deviation approach . membranous septum dorsal deviation septal reconstruction medial crural approach .

Flap elevation
Concave Convex Both

Tunnel
Ant : Rt, Lt, Both Post : Rt, Lt, Both Inf. : Rt, Lt, Both

Anterior tunneling
Vomer perpendicular plate dissection .

Inferior tunneling
Maxillary crest periosteum flap subperiosteal dissection .

Removal of deviated portion

Perpendicular palate of ethmoidal bone Quadrangular cartilage Maxillary crest Vomer

Cartilage
L-strut : drosum caudal portin 1~1.5cm tip dorsum support Anterior segment
Rhinon ant. nasal spine

; Septoplasty; Current Concept and Technique ,

Correction of caudal septum

Cut and suture Scoring and Batten Caudal resection Swing door technique Cross-hatching incision Full thickness vertical chondrotomy Full thickness horizontal chondrotomy

Swing door technique

; .

Atlas of Head and Neck Surgery -- Otolaryngology Byron J. Bailey,Karen H. Calhoun,Norman Friedman,Shawn Newlands,J effrey T. Vrabec

Correction of dorsal septum

Batten Discontinuation Wedge technique

Rhinoplastic techniques for the nasal valve for the p atient with sleep apnea, Andrew R. Golde, 2006

Extracorporeal technique

Closing of wound
Figure of eight Quilting suture Silastic sheet Packing

Rhinoplastic techniques for the nasal valve for the p atient with sleep apnea, Andrew R. Golde, 2006

Silastic sheet
silastic sheet , crusting

.
.

; .

Packing & Quilting suture

vs. (nasal packing vs. quilting suture):

4-0 5-0 catgut (absorbable suture) 5-7 .

,
. Yildirim(2005) (nasopulmonary reflex) .
; .