Excision of Cartilage 
in Nasal Obstruction due to 
Deviated Septum. 
By JOHN B. ROBERTS, M. D., 
Philadelphia. 
[Reprinted from Transactions of Pennsylvania State Medical Society.] 
Philadelphia : 
Press of the Times Printing House, 
725 and 727 Chestnut St. 
1882. EXCISION OF CARTILAGE IN NASAL OBSTRUC- 
TION DUE TO DEVIATED SEPTUM. 
By JOHN B. ROBERTS, M. D,, 
PHILADELPHIA. 
I desire to call the attention of the Society to this method of 
treating lateral deviation of the septum, causing nasal obstruc- 
tion, since the general teaching has been such as to induce the 
profession to look upon these cases as usually irremediable. There 
is prevalent a traditional notion that the cartilaginous partition 
between the nostrils must not be perforated in efforts to render 
the occluded nostril patulous. Hence patients with a nostril 
entirely closed by a deflected triangular cartilage are often told 
that nothing can be done to relieve the nasal and throat symp- 
toms due to the abnormal respiration. 
Sometimes attempts are made to alleviate the trouble by 
dilating the narrowed orifice, or by paring away a portion of 
the surface of the cartilage. In the latter method, care should 
be taken, it is said, to avoid perforating the septum. This cau- 
tion is a mistake, and frequently prevents sufficient removal of 
the obstructing cartilage. 
When the deviation is not very marked, relief can sometimes 
be afforded by making a crucial or stellate incision through the 
septum at the point of greatest deflection, and pressing the 
weakened cartilage away from the outer wall of the nostril. It 
can be kept in this improved position by a nasal bougie until the 
wound has cicatrized, if a tendency to assume the original con- 
dition is exhibited. 
In very many cases, however, the most satisfactory treatment, 
because the most radical and efficacious, is to cut out a disk of 
cartilage at the point where deviation causes obstruction by EXCISION OF CARTILAGE IN NASAL OBSTRUCTION, 
approximation of the septum to the external wall of the nasal 
cavity. This is best clone by the nasal punch, or cutting forceps, 
here exhibited by me. 
The opening left between the nostrils is no objection to the 
procedure, because it does not weaken the support of the 
nasal cartilages materially, and is not small enough to produce 
whistling sounds during respiration. It is invisible unless the 
nasal cavities are illuminated or examined with a speculum, 
and hence it is not objectionable on cosmetic grounds. 
The deflected and occluding portion of cartilage can be cut 
out by a scalpel or gouge ; but this is a crude operation, difficult 
of performance when the obstruction occurs far back in the 
nares, and is not applicable when the deformity requires a disk 
of the bony septum to be removed. 
The fenestrated cutting forceps, which I have had made, are 
an improvement over others intended for the purpose, because 
the mucous membrane on both sides of the septum is more 
cleanly cut, the disk is more likely to be removed by the forceps 
on their withdrawal, and the instrument retains its keen edge 
longer. 'When the forceps has been forcibly closed upon the 
deviated part of the cartilaginous or bony septum, it should be 
rocked from side to side a little, to ensure entire division of the 
tissues. After an opening in the septum has thus been made, 
any remaining obstruction can usually be remedied by enlarging 
the orifice by cutting out additional pieces.