--- title: "Septoplasty Instruments" description: "ENT notes on Septoplasty Instruments - Identification, Uses, Advantages & Disadvantages." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/septoplasty-instruments" categories: ["Instruments in ENT"] video: "https://www.youtube.com/watch?v=iEA-86SBIww" image: "https://media.theentresident.com/og-images/septoplasty-instruments.png" --- # Septoplasty Instruments ENT notes on Septoplasty Instruments - Identification, Uses, Advantages & Disadvantages. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=iEA-86SBIww ## 🔧 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** --- ## About This Note This free ENT note on Septoplasty Instruments was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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