The Endoscopic Septal Spur Pushback Technique

The septoplasty has been an essential and longstanding operation in otolaryngological practice, however, the elevation of a mucosal flap over a mixed bony/cartilaginous spur remains a challenging prospect. The apex of a spur has very thin and friable mucosa, and tensioning during dissection places it at significant risk of injury. The septal spur pushback technique is a stepwise endoscopic approach to the dissection of large and complex septal spurs. The procedure leverages the technical advantages of the endoscope to minimise mucosal tension, thereby reducing the rate of iatrogenic laceration and subsequent complications. A series of 493 consecutive patients undergoing the septal spur pushback technique resulted in only 15 iatrogenic flap lacerations (3.0%), all less than 1 cm in length and none resulting in any mucosal defect when re-apposed during suturing. There were no post-operative haematomas or perforations.