In this technique there is no need for incisions, flaps or sutures. We call this method the septal manipulation technique (SMT).
The septum is assessed, as in any other technique, and the side of deviation is noted. The SMT is suitable for both anterior and posterior deviations. However, it would not be appropriate for septal spurs and caudal dislocations of the septum. The procedure is divided into two stages.
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This stage involves the insertion of the Killian’s speculum into the narrower nasal cavity (i.e. the side the septum is deviated towards) against the deviated septum and along the floor of the nose with the handles held superiorly above the nares. The Killian’s speculum is opened as wide as possible. This action should begin to correct the deviation and the operating surgeon should feel the crunching of bone or cartilage being reduced. The Killian’s speculum is removed and the nasal cavity re-assessed again. The tips of Killian’s speculum will need to be angled superiorly to deal with high deviations.
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An assistant is required for this stage to hold the head in place. Once initial mobilisation of the septum has been achieved in stage 1, further mobilisation of the septum is required to establish it in the new position.
With the speculum still in an open position, the wrist is then flexed to apply pressure with the tip medially. With the speculum still open, the wrist is extended to apply pressure with the tip laterally. These movements should be repeated at least three times and each time the pressure should be sustained at the most lateral or most medial angle for at least three seconds. The medial movement is the most important as this works on the septum. Lateral movements work mainly on the anterior septum but may also out fracture the turbinate. The improved airway is inspected.
The SMT is a sound alternative technique to the Killian’s and Cottle’s septoplasty. It is particularly useful in situations where time efficiency is highly desired. E.g. when the septoplasty is required to improve access, but also equally useful in stand-alone septoplasty.
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