Septoplasty Instruments

🔧 Septoplasty Instruments

In this post, we'll discuss the important instruments used during Septoplasty, focusing on:

• Identification
• Parts of the instrument
• Uses
• Advantages
• Disadvantages
• Viva questions

1- Thudicum's Nasal Speculum

👨‍⚕️ Eponym

Named after Johann Ludwig Wilhelm Thudicum.

🔧 Parts

• U-shaped handle
• Two curved blunt blades, at right angles to the U-shaped handle

✅ Uses of Thudicum's Nasal Speculum

Diagnostic Use

• Anterior rhinoscopy

Therapeutic Uses

• Nasal packing (insertion and removal)
• Removal of foreign body from the nose
• Cauterization of a bleeding point
• Application of medications
• Nasal surgeries - SMR, Septoplasty, Polypectomy
• Local infiltration
• Antral wash

What are the structures Seen on Anterior Rhinoscopy?

Which structure cannot be seen on Anterior Rhinoscopy?

🩺 Use in Septoplasty

• Anterior rhinoscopy before surgery
• Local infiltration of the septal flaps and nasal cavity

How will you hold Thudicum's Nasal Speculum?

2- Tilley's Nasal Dressing Forceps

🔧 Parts

• Two ring shaped finger grip handles
• Two long slender blades with transverse serrations
• Flat and straight tip
• Box joint
• A bend

What is the importance of the bend in Tilley's Nasal Dressing Forceps?

✅ Uses of Tilley's Forceps

1- Anterior Nasal Packing

Indications:

• Post operatively, for hemostasis
• Epistaxis with an anterior bleed
• Fracture of the nasal bone, for fixing

2- Introduction of cotton pledgets soaked in adrenaline for local anaesthesia

3- Removal of foreign body from the nose

How will you differentiate between Tilley's Forceps vs Hartmann's Forceps?

3- Freer's Elevator

🔧 Parts

• Long central handle or shaft
• Two ends - one sharp, one blunt
• Concave bend at the end

✅ Uses of Freer's Elevator

In Septoplasty

1- Elevation of the mucoperichondrial or mucoperiosteal flap in septoplasty and SMR

2- Bony cartilaginous dysjunction - separating the septal cartilage from the bony septum

Other Uses

• Displacement of the inferior turbinate in antrostomy
• Fracturing the inferior turbinate
• Uncinectomy in FESS
• Harvesting a temporalis fascia graft during myringoplasty or tympanoplasty

How will you reduce the chances of a flap tear while doing flap elevation with Freer's elevator during Septoplasty?

What are the steps of septoplasty?

4- Killian's Long Bladed Self Retaining Nasal Speculum

🔧 Parts

• Two long blades, which enter the nasal cavity
• Handle, to open and close the blades
• Spring hinge / plier mechanism
• Locking screw with a self-retaining lock

⭐ Blades are available in different sizes, and the distance between them can be adjusted and fixed with the locking screw.

✅ Uses of Killian's Speculum

In Septoplasty & SMR

1- Retraction of the mucoperiosteal flaps away from each other, fixed with the screw to increase visibility

2- Anterior nasal packing

Other Uses

• Removal of nasal foreign body or rhinolith
• Polypectomy
• Turbinate reduction surgeries
• Taking biopsies

How will you hold Killian's Long Bladed Self Retaining Nasal Speculum?

What are the advantages of Killian's Long Bladed Self Retaining Nasal Speculum?

5- Luc's Forceps

🔧 Parts

• Ring handles
• Screw joint
• Two fenestrated sharp ended blades

✅ Uses of Luc's Forceps

In Septoplasty & SMR

👉 Removal of the deviated part of the cartilage or bone, and removal of the spur

Other Uses

• Caldwell Luc operation
• Removal of polyp
• Punch biopsy
• Substitute for tonsil holding forceps in tonsillectomy
• Turbinectomy
• Removal of adenoid tags after adenoidectomy

What are the Advantages of Luc's Forceps?

6- Killian's Nasal Gouge

🔧 Features

• Bayonet shaped, allowing adequate visualization inside the nasal cavity
• V-shaped edge, for a better grip on the bone

⭐ Used along with a mallet or hammer.

What are the uses of Killian's Nasal Gouge?

7- Heath's Mallet

🔧 Parts

• Heavy cylindrical striking head
• Neck
• Handle or shaft

✅ Uses of Heath's Mallet

1- Used with Killian's nasal gouge in SMR and septoplasty to remove a spur and the maxillary crest

2- Opening into the canine fossa in the Caldwell-Luc operation

3- Used with an osteotome for nasal bone work

8- Heymann's Turbinectomy Scissors

🔧 Features

• Bend
• Blunt tip
• Narrow stout blades

✅ Uses of Heyman's Scissors

1- Turbinectomy, especially of the inferior turbinate

2- Cutting a deviated part of the septal cartilage

What are the Advantages of Heymann's Turbinectomy Scissors?

🔧 Other Instruments Used in Septoplasty

Nasal Suction Cannula

Used to remove blood, mucus and secretions during surgery.

BP Handle with No. 15 Blade

Used to give the incision.

• Septoplasty → Freer's incision
• SMR → Killian's incision

What are the different incisions used in septoplasty?

Describe Freer's incision. What is the other name of Freer's incision.

Describe Killian's incision.

What are the differences between SMR and Septoplasty.

Septal Suction Elevator

• Sometimes used instead of Freer's elevator
• Has a dual function - acts as an elevator and a suction tip at the same time
• Gives a much clearer view of the septal flap region during flap elevation

Merocel Nasal Pack

• Inserted at the end of septoplasty
• Gives support to the corrected nasal septum
• Removed after about 48 hours
• Easily removed with the help of the threads tied at its edge

⭐ Exam Pearls

• Killian's speculum → Self-retaining with adjustable blade distance
• Luc's forceps → Fenestrated jaws prevent tissue crushing
• Killian's nasal gouge → Bayonet shaped with a V-shaped edge
• Heath's mallet is used along with Killian's nasal gouge
• Heymann's Turbinectomy xqscissors → Blunt tip prevents trauma to septal flaps
• Merocel nasal pack is removed after 48 hours

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