Conservative/Simple Septoplasty

The Problem

Severely deviated nasal septum.

The Background

Nasal septal deviation is one of the leading causes of nasal obstruction. Literature demonstrated over 75% of 2000 cadaveric subjects to have some degree of septal deviation. Approximately 33% of patients who visit an otolaryngologist report nasal obstruction, with up to a quarter of these patents seeking surgical intervention. Septoplasty is one of the three most common otolaryngologic surgery procedures performed in the United States. A total of 340,000 septoplasty cases were reported in the United States in 2006 alone.

In cases classified as severe, septal deviation may cause an asymmetric and unaesthetic nasal profile, which leads to dissatisfaction with appearance and poor self-esteem.

The term “septoplasty” describes any technique that aims to correct a deviated septum. Septoplasty techniques may vary in terms of complexity and electiveness. It is possible to provide an access to the septum for septoplasty through various techniques. Each of these techniques has been developed by different surgeons over time, and each has its own advantages and disadvantages. Bosworth, Asch, Freer, Killian, Metzenbaum, Peer, and Cottle are among those who have developed their own septoplasty techniques. In addition to different techniques, it should be noted that there are various approaches for incision. These include Killian's incision, hemitransfixion incision, full transfixion incision, high and low transfixion incision, and open rhinoplasty incision.

A fundamental index for decision making on the technique used to correct anomalies is the Cottle line. It is a vertical line between the nasal process of the frontal bone and the nasal spine of the maxillary crest. It divides the septum into anterior and posterior segments. Deviations anterior to it can be treated by septoplasty only, whereas deviations posterior to it can be treated by submucous resection (SMR) or septoplasty.