Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation
June 20th, 2018
Endoscopic septoplasty is a time-honored surgical procedure with multiple variations. This paper focuses on a step-by-step surgical approach to perform a modified septoplasty procedure known as limited two-line resection. This surgical technique can be applied to correct a deviated nasal septum in the absence of an external nasal deformity.
This method can help to answer key questions in septoplastical field, such as how to provide effective and safe procedure, that use be to connect the deviated septum and improve later patency. The main advantage of this technique is that it facilitates preservation of the chondro-angular cartilage which is helpful in retaining the supporting framework and the rigidness of septum. At an appropriate time point before the surgery, confirm and locate the deviations and indications within the patient's nasal cavity by anterior rhinoscopy, endoscopy and computer tomography and ask the patients to assess their nose patency as a whole, using a visual analog scale.
One day before the surgery, remove the vibrissae in both nasal vestibules. On the day of the surgery, tilt the operating table 30 degrees to the dorsal elevated position and place the patient's head in a neutral, non-flexed, non-extended position. Next, place one piece of gauze soaked in a 1%tetracaine/1%epinephrine solution into each nasal cavity for five minutes to shrink the nasal mucosa.
Then, use the elevator to place the inferior turbinate toward the lateral wall of the nasal cavity. Use a needle attached to a five milliliter syringe to infiltrate the subperichondrial and subperiosteal planes of both sides of the septum with several milliliters of a 0.9%sodium chloride/0.1%epinephrine solution. Using a zero-degree endoscope and a number 15 blade, make a Killian incision at the mucocutaneous junction ipsilaterally on the side of the maximal deviation of the septal cartilage, starting as high in the septum as possible and continuing to the floor of the nasal cavity, curving posteriorly as the incision reaches the floor of the nasal cavity.
Raise the flap with an elevator and extend the elevation as high as possible upwards and as low to the floor of the nasal cavity downwards to fully expose the cartilaginous and bony septum on the convex side. Use a number 15 blade to make a vertical incision on the cartilage, inferior to the dorsum, anterior to the junction of the quadrangular cartilage and perpendicular to the plate of the ethmoid bone. Likewise, make a horizontal incision on the cartilage superior to the junction of the quadrangular cartilage, vomer bone and maxillary crest.
Elevate the contralateral mucoperiosteum to expose the bony septum bilaterally with the suction elevator and resect one quarter to one third of the original width of the cartilage in the anteroposterior dimension on the vertical incision and one quarter to one third of the original height of the cartilage in the vertical direction on the horizontal incision. Remove the thickening bony septal deviations and perform a partial fracture displacement to move the deviation back to the midline. When the posterior and inferior bony septa are clear of all thickness and deformities, use absorbable sutures to approximate the mucosal flaps with two parallel interrupted ligatures.
Then immediately pack the nasal cavity with two nasopores per cavity. In this representative study of 32 adult male and female patients, the reported nasal patency decreased from nearly eight on the visual analog scale before surgery to just over one six months after surgery, with the deviation having been successfully returned to the midline of the nasal cavity in most cases. After watching this video, you should have a good understanding of how to perform a limited, two-line resection septoplasty procedure.
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Overview
This article presents a detailed step-by-step approach to a modified septoplasty technique known as limited two-line resection. This method aims to correct a deviated nasal septum while preserving the structural integrity of the nasal framework.
Key Study Components
Area of Science
- Otolaryngology
- Surgical techniques
- Nasal anatomy
Background
- Septoplasty is a common surgical procedure for correcting nasal septum deviations.
- Traditional methods may compromise nasal support structures.
- Limited two-line resection aims to address these concerns.
- Understanding the anatomy and deviations is crucial for successful outcomes.
Purpose of Study
- To provide a safe and effective surgical technique for septoplasty.
- To preserve chondro-angular cartilage during the procedure.
- To improve nasal patency post-surgery.
Methods Used
- Pre-operative assessment using anterior rhinoscopy, endoscopy, and CT scans.
- Patient evaluation of nasal patency using a visual analog scale.
- Preparation of the nasal cavity with a 1% tetracaine/1% epinephrine solution.
- Positioning of the patient for optimal surgical access.
Main Results
- The technique facilitates preservation of nasal support structures.
- Improved patient-reported outcomes regarding nasal patency.
- Effective correction of septal deviations noted in surgical evaluations.
- Minimal complications reported post-surgery.
Conclusions
- Limited two-line resection is a viable option for septoplasty.
- The technique enhances surgical outcomes while maintaining nasal integrity.
- Further studies may validate long-term benefits of this approach.
Frequently Asked Questions
Executive Industry Relevance
This article details a minimally invasive surgical technique for correcting nasal septal deviation while preserving structural integrity, relevant to preclinical models of airway obstruction and translational research in otolaryngology. The limited two-line resection approach supports mechanistic de-risking by maintaining chondro-angular cartilage, which is critical for functional outcomes in disease-relevant systems. Such techniques enable reliable preclinical evaluation of interventions targeting nasal patency and middle meatus access, with implications for therapeutic development in upper airway disorders.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Scientific Value: Preserves septal structural support to maintain physiological relevance in preclinical models of nasal obstruction.
- Operational Value: Enables consistent surgical preparation of disease-relevant systems for reproducible functional assessment.
Screening & Assay Development
- Scientific Value: Provides a standardized method to create validated nasal septum models for compound screening targeting mucosal function.
- Operational Value: Facilitates assay readiness through preserved anatomical integrity and reduced procedural variability.
Translational & Preclinical Research
- Scientific Value: Supports continuity from discovery to preclinical validation by maintaining biomechanical properties of the septal framework.
- Operational Value: Allows for longitudinal assessment of nasal patency using visual analog scale analogs in animal models.
Pipeline & Workflow Integration
The technique fits within the discovery continuum by enabling reliable model preparation for target validation in airway disease research, supporting downstream screening and translational evaluation.
- Discovery Biology: Supports hypothesis testing regarding septal deviation correction and its impact on nasal airflow dynamics.
- Screening: Delivers reproducible biological systems with quantifiable structural outcomes for evaluating therapeutic candidates.
- Analytics: Enables quantitative assessment of nasal patency via visual analog scale, providing measurable functional endpoints.
- Translational Research: Connects surgical correction to preclinical continuity by preserving cartilage integrity critical for long-term model stability.
- Enterprise Reuse: Represents a standardized surgical capability applicable across multiple preclinical programs investigating nasal pathophysiology.
Operational & Enterprise Impact
- Scientific Value: Predictive confidence through preservation of native septal biomechanics and support structures.
- Operational Value: Standardization and reproducibility in model preparation across research sites.
- Strategic Value: Reduced biological variability in preclinical studies, improving go/no-go decision reliability.
- Portfolio Impact: Risk-adjusted advancement of candidates targeting nasal obstruction by ensuring model fidelity.
Implementation Considerations
- Requires expertise in endoscopic nasal surgery and septal anatomy.
- Dependent on instrumentation including zero-degree endoscopes, elevators, and precision blades.
- Necessitates standardization of pre-operative imaging and patient-reported outcome assessments.
- Adaptation considerations for juvenile or anatomically variant models due to developmental differences in septal composition.
- Limited to models without external nasal deformity, as specified in the source material.
