Septal surgery in rhinoplasty.

In general, septoplasty precedes all other procedures in rhinoplasty because a straight, stable septum dictates profoundly the aesthetic and functional outcome. The patient's history and expectations, proper preoperative analysis, and the surgeon's skills determine the way to proceed in septum correction. As a rule of thumb, slight deviations (e.g., single vomer spurs, maxillary crests, the septal tilt, and simple C-shaped deformities) may be managed endonasally using the hemitransfixion incision and procedures such as the swinging door technique, scoring incisions, batten grafts, or caudal septal replacement grafts. By contrast, for S-shaped and severe wavelike deviations, the cleft nose, the multiple fractured septum, and for most revisional cases, the open approach with extracorporeal septum reconstruction has been found to be the method of choice. After initial general remarks on the basic procedures, this article focuses on current concepts of septum correction that have to be adapted to the individual pathologic condition.