OtoRhinoLaryngology Portal

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Bipolar Cautery of Little's Area Abnormal Vessels

 Abnormal dilated, tortuous and branching abnormal vessels of right Little's area which had caused repeated nose bleeds.



Bipolar cautery being use with excess uncovered tip protected with snug fit suction tubing to avoid thermal effect to unintended area.  Endoscopic-assisted procedure is preferred for accurate targeting of the abnormal vessels to be ablated. 



An endoscopic view taken immediately after bipolar cautery performed.




Excision of Septal Mass

Mass lesion arising from right Little's area with recent evidence of bleeding (circle).  Differential diagnoses include pyogenic granuloma and haemangioma. 

[V - vestibule, IT - inferior turbinate, S - nasal septum]


Endoscopic view after the mass was completely excised.

[IT - inferior turbinate, S -nasal septum]

Septoplasty for Deviated Nasal Septum

Septal Deviation to The Right      Initial Incision on The Septum

              Raising Subperichondrial Flap               The Contralateral

                                                 Subperichondrial Flap Separated

                                                with Septal Cartilage seen

                                                Between The Nasal Speculum


[Credit of these images to Dr AW Chong

from University of Malaya Medical Centre]

Fragments and pieces of cartilage and bones removed from a patient with severe nasal septum deviation.

Endoscopic Septoplasty


An example of suction elevator used to separate mucoperichondrium from cartilage or bony segment of nasal septum whilst achieving a blood-free operating field.

Suction elevator in used during septoplasty.  Noted dry field achieved with improved visualization of surgical anatomy while right mucoperichondrial flap being raised.  (F - mucoperichondrial flap, SC - septal cartilage, SE - suction elevation with the hollow end facing medially)

 The incision (convex side of the deviated septum).  [C - nasal septum cartilage, V - vestibule]

[C - nasal septum cartilage, P- perichondrium of the contralateral side (concave side of the deviated septum)]

Septal Sutures in Septoplasty

Absorbable septal sutures secured at incision line of nasal septum to appose the wound edges.  Alternatively, an absorbable suture stapler can be used.  Arrows - vicryl sutures (top left - view from right nasal cavity, top right - view from left nasal cavity), S - nasal septum (after cartilage removed), IT - inferior turbinate.

Septal deviation with spurring to right in another patient.


Absorbable septal sutures in-situ at completion of surgery.

Nasal Septum Post-Septoplasty: A CT-Scan Finding

Coronal view CT-scan.

Axial view CT-scan.

Rhinoplasty: Conchal Cartilage Harvest


[Credit of this image to Dr AW Chong

from University of Malaya Medical Centre]