Septoplasty Incisions | Killian's Incision, Freer's (Hemitransfixion) Incision & Transfixion Incision

👃 Septoplasty Incisions

In this post, we will discuss about the different incisions used in Septoplasty:

• Killian's Incision
• Freer's Incision (Hemitransfixion Incision)
• Transfixion Incision

Killian's Incision

📍 Site of Killian's Incision

Placed about 1 cm behind the caudal border of the septal cartilage.

What is the Depth of Killian's Incision?

📍 Side of Incision

Usually made on the Concave side of the deviated nasal septum.

⭐ It can also be made on the convex side, depending on the surgeon's preference.

Why is it made on the concave side of the deviated septum?

📌 Indications of Killian's Incision

• Classical incision for SMR (Submucous Resection)
• Posterior deviation of the septum
• No plan for rhinoplasty

✅ Advantages of Killian's Incision

• Preserves the caudal septum
• Preserves the L-strut

❌ Disadvantages of Killian's Incision

• Caudal septal deviation cannot be accessed
• Cannot be combined with rhinoplasty

Freer's Incision (Hemitransfixion Incision)

📌 Also known as Hemitransfixion Incision.

📍 Site of Freer's Incision

Made at the caudal border of the septal cartilage, on one side only.

Why is Freer's incision also called Hemitransfixion Incision?

⭐ Freer's incision is the most commonly used septoplasty incision in present practice.

⭐ Gives access to the entire septum, including the caudal septum.

Types of Hemitransfixion Incision

The length of the incision varies depending on the access required.

1- Partial (Limited) Hemitransfixion Incision

Used when access to the posterior septum is not required.

2- Full Hemitransfixion Incision

• Extends along the entire caudal margin of the septal cartilage

3- Extended Hemitransfixion Incision

• Extended further towards the nasal floor

What is the indication of Full Hemitransfixion Incision?

What is the indication of Extended Hemitransfixion Incision?

❌ Disadvantages of Freer's Incision

• Slightly higher risk to the L-strut if not careful
• Risk of columellar retraction if closure is not meticulous

What is Columellar Retraction?

What are the Advantages of Freer's Incision?

Transfixion Incision

📍 Site of Transfixion Incision

• Made on both sides of the caudal septum

• Separates the caudal septum from the columella

What is the Depth of Transfixion Incision?

📌 Indication of Transfixion Incision

👉 Rhinoplasty combined with septoplasty

❌ Disadvantages of Transfixion Incision

• Cuts through the septocolumellar ligament

• More tissue disruption → Higher chance of post-operative scarring

What are the Advantages of Transfixion Incision?

What is the Septocolumellar Ligament?

What are the tip support mechanisms of the nose?

⭐ High Yield Rapid Revision Table

🧠 Viva Pearls

• Killian's incision is placed 1 cm behind the caudal border of the septal cartilage.
• Killian's incision is the classical incision for SMR.
• Killian's incision is usually made on the concave side of the deviated septum.
• Killian's incision preserves the caudal septum and L-strut.
• Caudal septal deviation cannot be accessed through Killian's incision.
• Freer's incision is also known as hemitransfixion incision.
• Freer's incision is made at the caudal border of the septal cartilage on one side only.
• Freer's incision is the most commonly used septoplasty incision today.
• Advantages of Freer's incision were described by Bernstein.
• Hemitransfixion incision can be partial, full or extended.
• Transfixion incision is made on both sides of the caudal septum.
• Transfixion incision is the incision of choice when rhinoplasty is combined with septoplasty.

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