THE ADVOCATION OF A NEW METHOD OF 
OPERATION FOR MARKED DIFFUSE 
CARTILAGINOUS DEFLECTION 
OF THE NASAL SEPTUM. 
BY 
SEYMOUR OPPENHEIMER, M. D., 
OF' NEW YORK. 
REPRINTED FROM 
ANNALS OF OPHTHALMOLOGY AND OTOLOGY, Vol. IV, No. 4, 
October, 1895. [Reprinted from the Annals or Ophthalmology and Otology, October, 1895.] 
THE ADVOCATION OF A NEW METHOD OF OPERA- 
TION FOR MARKED DIFFUSE CARTILAGINOUS 
DEFLECTION OF THE NASAL SEPTUM.* 
By Seymour Oppenheimer, M. D., 
OF NEW YORK. 
THE subject of septum deviation is such an important one 
that I could not do it justice in the few moments allotted 
me for its resume and discussion, and particularly as it is 
more or less a specialistic topic, it might be somewhat out of 
place at a meeting of this kind. I will therefore confine 
myself very briefly to those points, directly advancing the 
method of operation under discussion. 
During the past few years, innumerable orthopedic and 
operative methods for the correction of cartilaginous devia- 
tions of the septum of a high degree have been advocated by 
various operators and authors. The general results of these 
various methods have been, as far as I learn, far from satis- 
factory . 
In the last year I have operated upon six cases of marked 
deflection, all due to trauma, in which the greatest portion of 
the cartilaginous septum was involved. In one I endeavored 
to correct the deformity by gradual dilatation with bougies, but 
after several months of perseverance without accomplishing 
much, the patient became discouraged and passed from under 
my observation. In three other cases I refractured the septum, 
and by means of splints held it in position. The immediate 
results appeared to be very satisfactory, but upon seeing the 
patients, some eight months subsequent to the operation, I 
* Read at Ihe eleventh annual meeting of the Fifth District Branch of 
the New York State Medical Association, Brooklyn, May 28, 1895. 2 
found that there was a decided tendency for the deformity to 
return. In the remaining two cases I made a crucial incision, 
followed by forcible correction of the deflection, and although 
this procedure did not accomplish all that might be desired, 
much improvement was derived. 
Recently, while in Vienna, I had the opportunity of observ- 
ing eleven cases of septal deformity operated upon by a 
method proposed by Dr. Hajek. The results were very 
encouraging. In all the cases, nasal respiration was estab- 
lished and no external deformity occurred. 
During the fall of 1892 and spring of 1893 fourteen cases 
had been operated upon. In none of these cases had there 
been any return of the nasal deflection up to the time of 
examination, December, 1894. 
Upon March 24, 1895, A. H., 38 years of age, consulted me, giving 
the following history : One year previously she was struck upon the 
nose very forcibly by a baseball. Her physician ordered cold appli- 
cations and lead and opium solution, under the influence of which 
the inflammation rapidly subsided, and, excepting for the discomfort 
of obstructed nasal breathing, she felt comparatively well. For the 
following six months she bad repeated attacks of rhinitis, accom- 
panied with profuse secretion. Consulting a specialist, he made six 
distinct applications of the galvano-cautery to the right inferior 
turbinated body at various sittings. His opinion, and also that of 
a consultant, as to the amount of benefit to be derived from opera- 
tive interference upon the deflected septum was so dubious, that 
she decided to postpone it until some future time. Following the 
cauterization, the nose, which formerly secreted so profusely, assumed 
a dry condition, with a gradual increasing amount of scab formation, 
which gave rise to a very disagreeable odor. For this she was again 
treated, and by the regular use of the spray the nose is kept in a 
fairly clean state. Upon examination, 1 find upon the right side an 
enormous concavity with a marked atrophic condition of the turbi- 
nated bodies. Upon the left, the septum is pushed so much laterally 
that it impinges upon the turbinated bodies, having caused a degen- 
eration of their structure. The entrance of air into this side is 
practically impossible. 
A similar condition of atrophic degeneration was present in the 
post-nasal space and upon the posterior pharyngeal wall. The 
patient requesting that something be done for the relief of the nasal 
obstiuclion which was developing most unpleasant symptoms, par- 3 
ticularly those referable to aural disturbance, I decided to interfere 
operatively, but being particularly cautious to inform the patient 
that I could not forsay the amount of good to be derived. 
Upon the following day I operated upon her, the various steps in 
the procedure being as follows : The nose was disinfected with a 
spray of a weak creolin solution, also saturating several pieces of 
cotton with it, which were allowed to remain in position for several 
minutes. After their removal the posterior nares were plugged, so 
that there would be no possibility of the blood flowing back into the 
pharynx during the operation; the patient's attempts at expectora- 
tion would have retarded the progress of the operation considerably. 
Pledgets of cotton saturated with a 10% solution of cocain were 
then introduced into both nostrils, pressing them firmly against the 
septum. After ten minutes they were removed, and the parts were 
found to be thoroughly anesthetized. 
Fig. 1. 
, Segittal section of the nose {diagrammatic). A, B, C, lines of incision: J,vomer; 2, ethmoidal 
plate; 3, nasal bone: 4, superior maxillary bone; 5, frontal sinus; G, sphenoidal cells. 
An incision (a) was then made with a slender sharp-pointed knife 
through the antero-inferior border of the cartilaginous septum 
(through its extire thickness). The incision was continued hori- 
zontally backwards and slightly upwards, with a blunt knife, along 
the juncture of the lower cartilaginous septal border with the spina 
nasalis of the superior maxilla as far back as the articulation of 
the vomer. 4 
A right-angular knife was then substituted for the straight one, 
and the incision prolonged upwards and slightly forwards for about 
cm. (6). Then the incision is made from the starting point of 
the first incision, i. e., ahtero-inferior septal border, and carried 
upwards parallel with the external contour of the nose until the 
lower edge of the ethmoidal plate is reached (c). 
These three incisions having been made, the cartilaginous portion 
of the septum is now converted into a movable fragment, attached 
only at the upper part. 
By using a little pressure the septum can now be dislocated from 
the convex to the concave side, and held in its new position by some 
form of splint. The tampons in the posterior nares now being 
removed, the operation is complete. 
Hajek1 made use of iodoform gauze tampons, which I have 
replaced by splints, as reccommended by Berens 2 
Little pain was experienced by the patient and the hemorrhage, 
although considerable, stopped of its own accord. The splints were 
left undisturbed for one week, when they were removed and the 
nares thoroughly cleansed and the splints re-introduced, being 
allowed to remain in position one week longer, after which they 
were discarded. 
On April 12, three weeks after operation, the wounds had entirely 
healed. There was some obstruction due to redundant tissue, occu- 
pying the inferior meatus. This was removed by means of the saw. 
The patient could then breathe freely through the nostril, and the 
symptoms of aural disturbance, i. e., pain, tinnitus, deafness, which 
previously existed, have entirely disappeared. The knives used for 
the operation were made after the models of Prof. Jurasz,3of Heidel- 
berg, their original intention being for resection of the septum. 
1 Hajek, International Klinische Rundschau, No. 38. 
2 Manhattan Eye and Ear Hospital Reports, 1894. 
3 Die Krankheiten der oberen Luftivege, page 70. 
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