The "Maxilla-Premaxilla" Approach to Extensive Nasal Septum Surgery

The total submucosal removal of the nasal septum and all less extensive operations present a common technical difficulty. This is the elevation of the mucosa over obstructing and impacting cartilage and bony ridges and spines, especially if these are in the anterior area about the caudal end of the septal cartilage, the premaxillary wings, and the maxillary crests. Failure to identify and include in the elevation the whole of the periosteal and perichondrial layers makes further separation of the mucosa uncertain and difficult and leads to incomplete correction and early or late perforation formation. Correction of the anterior (caudal) portion of the septum is very frequently of prime consideration and its preservation or replacement is particularly essential in septum operations combined with pyramid surgery and when a careful reconstruction or reorganization of the os internum is necessary.

Anatomical Considerations

The septum cartilage in the white adult averages 3-4 mm. in