With recent exception, the history of septal surgery has predominantly been characterized by a slow progression toward conservatism. The earliest techniques used transmucosal reductions of deviations. As with all new surgical approaches, long-term complication rates and failures began to emerge. The resulting problems of septal perforation and nasal collapse prompted the development of the submucous resection technique by Freer1 and Killian,2 which was less radical in nature, preserving a mucoperichondrial cover.1-2 This allowed for manipulation of the cartilaginous and bony septal framework without violating the integrity of the septal mucosa. Although this was a significant advance for intranasal surgery, limitations existed and long-term results were unsatisfactory in selected cases. In severely deviated and externally deviated noses, the submucous resection was unable to address the most dorsal component of the quadrangular plate.
Intraoperative view of the technique. A, Mucosal leaf elevated on concave side of septal deviation from maxillary crest to nasal dorsum. B, Full-thickness vertical incisions on the concave side extending through the dorsal septum. C, Removal of cartilaginous compartment to compensate for lengthening and prevent postoperative telescoping of columns.
Deviation of the nose off the midline to the side of facial skeletal hypoplasia. Marked curvilinear deviation of the dorsal and caudal septum is present. A and B, Preoperative frontal and lateral views, respectively. C and D, One-year postoperative frontal and lateral views after fan septoplasty, modified Goldman septoplasty, double dome-binding suture, medial osteotomies, lateral osteotomies, and left perforating double lateral osteotomy, respectively.
Marked midseptal curvilinear deviation involving the bony and cartilaginous dorsum. A and B, Preoperative frontal and lateral views, respectively. C and D, One-year postoperative frontal and lateral views after fan septoplasty, medial osteotomies, lateral osteotomies, and medial crura binding suture, respectively.
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