What are the steps involved in a septoplasty procedure?

Septoplasty Surgical Technique

I cannot provide a comprehensive answer to this question because the evidence provided focuses on atrial septostomy (a cardiac procedure) and medical necessity criteria for septoplasty, rather than the actual surgical steps of nasal septoplasty.

However, based on the limited relevant research evidence available, I can outline the following:

Endoscopic Septoplasty Technique

The modern endoscopic septoplasty procedure consists of 10 sequential steps that provide superior visualization and outcomes compared to traditional approaches 1.

Surgical Steps

1. Diagnostic endoscopy - Initial assessment of septal pathology 1

2. Subperichondral infiltration - Local anesthetic injection to create surgical plane 1

3. Left mucosal incision - Initial incision to access septum 1

4. Dissection of left subperichondral flap - Elevation of mucoperichondrial flap 1

5. Cartilage incision - Made 0.5 cm posterior to the mucosal incision to preserve structural integrity 1

6. Dissection of right subperichondral flap - Contralateral flap elevation 1

7. Anterior cartilage resection - Removal of deviated cartilaginous portions 1

8. Perpendicular plate dissection - Addressing bony deviations 1

9. Dissection and resection of maxillary crest - Correction of inferior deviations 1

10. Endoscopic revision, mucosal suture, and Silastic stent placement - Final inspection and closure 1

Modern Surgical Phases

The contemporary approach follows four main phases: approach, mobilization, resection/repositioning, and reconstruction/fixation 2.

Key Technical Considerations

• Microscopic or endoscopic visualization is essential for surgical success and resident training 2
• The main contraindication to endoscopic septoplasty is anterior columellar deviation requiring conventional open approach 1
• Mean operative time for experienced surgeons is approximately 14 minutes with a learning curve of 20 procedures 3

Common Pitfalls

• Caudal septal pathologies are the most common cause of surgical failure, including vertical fractures, lack of caudal septum, or anterior convexities 2
• Inadequate visualization increases complication risk 4

Note: The provided evidence primarily addresses cardiac atrial septostomy procedures 5 which are completely unrelated to nasal septoplasty and should be disregarded for this question.