ENT Surgery: Septoplasty
High-Yield Revision for NEET PG
Septoplasty is the definitive conservative surgical treatment for a Deviated Nasal Septum (DNS) causing obstruction, chronic sinusitis, or recurring epistaxis.
1. Surgical Principles
- Goal: Remove/reposition only the obstructing portion of the septum while preserving structural integrity.
- Unlike SMR (submucous resection), septoplasty involves minimal removal of cartilage/bone.
- Maintains the “L-strut” (dorsal and caudal support) to prevent nasal tip ptosis and saddle nose deformity.
2. Comparative Highlights
| Feature | SMR | Septoplasty |
|---|---|---|
| Extent | Radical resection. | Conservative repositioning. |
| Complications | Higher risk of perforation/flail septum. | Lower risk. |
3. NEET PG High-Yield Pearls
- Cottle’s Maneuver: Used to assess nasal valve obstruction. Retracting the cheek laterally improves breathing if the problem is at the nasal valve.
- Septal Hematoma: The most important early postoperative complication. Requires immediate drainage to prevent cartilage necrosis and subsequent saddle nose deformity.
- Incision Site: A Hemitransfixion incision is commonly used for septoplasty.
- Perforation Management: Often results from opposing tears in the mucoperichondrial flaps. Small perforations are often asymptomatic; large ones cause whistling and crusting.