Endoscopic Nasal Septoplasty

This patient presented with a sharp septal spur on the left side protruding underneath the left middle terminate.

After an incision over the end of the spur was made with a sickle knife, a fur elevator was used to gently raise the mucopericondrium and mucoperiosteum.

Notice how the mucosa and the pericondrium is being elevated on the superior surface. And then the lower surface of the sharp edge of the spur has its mucopericondrium elevated by working underneath the septal spur.

This spur presented with a very sharp keel-like edge and was being removed both for access to the nasal cavity and to relieve obstruction. The sub-pericondrial dissection is continued superiorly and inferiorly until enough of the spur is exposed to enable a straight chisel to be inserted.

The surgeon guides the chisel along the base of the spur while the assistant gently taps using a two-tap light heavy light heavy technique. You can see after a few taps the spur is now become freed

anteriorly, but there is still a superior and posterior attachment to the vulmar which must be divided. The chisel is angled slightly and

continued to be used to free the spur from its attachment to the vulmar. Once the spur has been freed it was grabbed with cup foresups and gently removed from the nasal cavity.

Notice the spur extending above and the flat thin plate of vulmar.

You can see how this spur would cause nasal obstruction as well as prevent access to the middle mucus. At the end of the procedure the flaps are simply placed back in position and held there with temporary packing.