Standard septoplasty was performed with the mucoperichondrial flap
These procedures were performed through hemitransfixion, full-transfixion, and transcartilaginous (high-transfixion) incisions, with unilateral or bilateral mucoperichondrial flap
Once the septum has been cared for, the cartilage attached to the mucoperichondrial flap is incised in an ovoid or circular manner, roughly like the cartilage defect in the perforation.
The cartilage attached to the mucoperichondrial flap may need to be trimmed a bit at this stage.
A patient with mild tip depression and an excessively long caudal septum can be treated with a simple excision of the caudal septum, with or without a hemi- or complete transfixion incision of the excess mucoperichondrial flap
Countertraction is provided during placement by having a surgical assistant retract the mucoperichondrial flap
laterally with a tiny double-pronged hook.
The mucoperichondrial flaps
are then placed back into original position and secured to the neoseptum with a quilting suture (4-0 Chromic), thereby further securing the reimplanted septum, closing dead space, and reapproximating the nasal mucosa.
Nasal splints and intranasal packing applied at the time of incision and drainage will help to coapt the mucoperichondrial flaps
and reduce the risk of reaccumulation of the abscess.
Using a standard hemitransfixion incision, mucoperichondrial flaps were elevated on either side of the septum.
2) First, when elevating septal mucoperichondrial flaps, advancing the elevator forceps superiorly too far beyond the limits of the ethmoid roof may lead to perforation of the cribiform plate.
The left and right margins where the lesion encountered the mucous mucoperichondrial flaps
were not assessable.
Bilateral mucoperichondrial flaps
were raised, and an AlloDerm graft was placed on the left side between the flap and the cartilage (figure 2, B).