In this video, we're going to be demonstrating some adjunctive techniques for septal correction, particularly useful for septal deviation. Cartilage scoring is very common. It's done on the concave side, perpendicular to the axis of deviation. It can be done with a septal knife, or it can be done with a 15 blade. Notice that when we're using a 15 blade, we're not cutting completely through the cartilage, only gently, lightly, so as to get the degree of flexibility we want to achieve. We can support this with a graft, like thin perpendicular plate, or a spreader graft. Next, a clocking suture is done. A clocking suture is placed on the side the dorsal septum is deviated away from. It's placed first through stable upper lateral cartilage near the junction with the nasal bones. Then it's going to be placed more caudally through the more flexible septum, cartilaginous septum. Then it'll be placed as a horizontal mattress coming back through the cartilaginous septum, and then back up next to the first suture, which is again approximately near the stable nasal bone. As this is tied, it's going to pull the septum toward the stable nasal bone, you see? So even certain high septal deviations can be corrected with this technique, differentially tied sutures, or horizontal mattress clocking sutures. Another type of horizontal mattress suture can be placed in the body of the septum, more caudal along the L-strut. This could also be done to correct deviations. This is a horizontal mattress that's again going to be placed opposite the side of the deviation described by Ron Gruber. As this suture is tied, you'll see that it will create a curvature as the septum's pulled toward the side at which it's tied. And so those maneuvers can be done to correct septal deviations.

septal deviation

cartilage scoring

suture techniques

grafts

nasal correction