Strategies for the Previously Operated Septum.

In a standard septoplasty, most of the quadrangular cartilage is resected while preserving an L-strut to maintain structure of the nose. Deviation may recur due to contractile forces causing flexure or torsion of the L-strut, which may be reduced by modifying the shape of the L-strut chondrotomy. Alternatively, deviations may have been insufficiently addressed by the initial septoplasty. Grafting techniques are often used to address deviations of the L-strut, and repositioning of the posterior septal angle may be required when displaced off the anterior nasal spine. With certain severe sepal deformities, extracorporeal septoplasty may be a more effective option.