[Modern corrective nasoseptal surgery]

Inner nose surgery should be addressed to normalize the geometry of the nasal cavities in order to restore physiologic nasal resistance. As the nasal septum plays a key role in the form and the function of the nose, a successful rhinosurgeon must be able to deal with all septal problems ranging from localized spurs to severely traumatized or surgically damaged nasal septa. Nasal airway obstruction due to septal derangements cannot be successfully solved simply by submucous resections of septal window(s) but does often require a range of corrective maneuvers on the anatomic sub-units constituting the septum. Septal surgery is systematically performed by the Authors using the maxilla-premaxilla approach (MPA) which allows access to and manipulation of the entire nasal septum including the caudal and anterior septal margins, columella, upper lateral cartilages, inferior nasal spine as well as floor of the nasal cavities and maxillary crest areas. Correction of the septum combines mobilization and/or removal of any deranged portion of the bony and/or cartilaginous septum, followed by reconstruction of the septum support, preferably using autogenous septal grafts. Reconstruction procedures are designed to reconstitute a stable medial wall and at the same time minimize scar tissue formation. Reconstruction is indispensable to avoid septal flapping occurring when the medial wall consists of muco-periosteal tissue only without firm intermediary support. When reconstructing the medial wall, great care must be taken with the most important portion of the septum, i.e. the dorso-caudal margin and the cartilaginous elements. However, many common nasal problems require procedures to correct the inside of the nose and the external pyramid at the same time. To effectively and efficiently address the challenge posed by the combination of internal and external nasal problems, a thorough understanding of respiratory rhinology as well a familiarity with the many procedures involved in both extensive septal surgery and external nasal pyramid surgery are imperative for the modern-day rhinosurgeon.