--- title: "Septoplasty Incisions | Killian's Incision, Freer's (Hemitransfixion) Incision & Transfixion Incision" description: "Septoplasty incisions: sites, indications, advantages, and limitations of Killian, Freer hemitransfixion, and transfixion approaches, with viva points." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/septoplasty-incisions-killian-freer-hemitransfixion-transfixion" categories: ["Rhinology", "Surgery"] video: "https://www.youtube.com/watch?v=sBroZGR85O8" image: "https://media.theentresident.com/og-images/septoplasty-incisions-killian-freer-hemitransfixion-transfixion.png" --- # Septoplasty Incisions | Killian's Incision, Freer's (Hemitransfixion) Incision & Transfixion Incision Septoplasty incisions: sites, indications, advantages, and limitations of Killian, Freer hemitransfixion, and transfixion approaches, with viva points. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=sBroZGR85O8 ## 👃 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 | Feature | Killian's Incision | Freer's (Hemitransfixion) Incision | Transfixion Incision | | --- | --- | --- | --- | | Site | 1 cm behind caudal border of septal cartilage | At caudal border of septal cartilage | Around caudal border, from one mucocutaneous junction to the other | | Side | One side (usually concave) | One side | Both sides | | Classical Use | SMR | Septoplasty | Septorhinoplasty | | Access to Caudal Septum | Not possible | Possible | Possible | | Combination with Rhinoplasty | Not possible | Can be converted to transfixion incision | Essential | | Main Disadvantage | Cannot access caudal deviation | Risk to L-strut, columellar retraction | Loss of tip support, scarring | --- ### 🧠 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. --- ## About This Note This free ENT note on Septoplasty Incisions | Killian's Incision, Freer's (Hemitransfixion) Incision & Transfixion Incision was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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