The severely deviated septum--the way I solve the problem

Surgical correction of severely deviated or "saddle" noses poses specific problems that are often difficult to resolve because of the complexity of the deformities, particularly those of the septum. Four steps are necessary: (1) the deformations must be skeletonized and visualized by a perfect extramucosal dissection and maxillary-premaxillary approaches; (2) the septum must be mobilized by resection of the osteocartilaginous chondrovomerine callus, after which it is possible to carry out the septum as long as the mucosa is not torn; (3) the angulations must be corrected carrying out discontinuous cartilaginous incisions; and (4) the structures must be stiffened. Polydioxanone (PDS) struts provide a neat solution to the issue of the reconstruction of a plane and sufficiently stiff septum.