elevation was performed under direct endoscopic visualisation (Fig.
Then a mucoperichondrial flap
was elevated from this part of septum up to the perpendicular plate of ethmoid.
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.
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
. Suture septocolumellar fixation can be performed via this approach in patients with laxity in the ligaments connecting the medial crural footplate to the septum.
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.
As the post-op discomfort is significant in nasal packing we recommend quilting of the mucoperichondrial flaps
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.
The left and right margins where the lesion encountered the mucous mucoperichondrial flaps
were not assessable.