Extracorporeal septoplasty is a valuable tool in the armamentarium of the nasal surgeon for the reconstruction of the severely deviated noses. Extracorporeal septoplasty offers the surgeon the opportunity to correct the septum under direct visualization, shape the nasal vault and address the nasal dorsum with the ultimate goal of providing both form and function for the patient with a complex septal deviation. Severe gross septal deviations present big surgical challenges for operating surgeon. Septal deviations have direct effect on aesthetic and functional part of nose. Correcting septal deviations during rhinoplasty is basic procedure. Extreme deviations of septum especially on dorsal and caudal end of cartilaginous septum are difficult to treat. The classical septoplasty approach becomes unsuitable for such severe deviations.

Extracorporeal septoplasty is a newer, rapidly evolving technique. It was first discussed in the 1950s by King and Ashley. In 1995, Gubisch described his series of 1012 extracorporeal septoplasties, performed via an endonasal approach; he sutured the pieces of cartilage back together and reimplanted them without any graft for support. By 2005, Gubisch was also excising the entire bony and cartilaginous septum, and would occasionally use PDS foil for support. He describes various techniques to create a straight septum, including excision of redundant cartilage and resuturing, releasing incisions on one side of the cartilage, or smoothing both the cartilaginous and bony septum with a drill. Senyuva in 1997 reported removal of the entire cartilaginous and bony septum via an external rhinoplasty approach. The dorsal and caudal septal edges are then reconstructed with an “L”-shaped strut cut from the quadrilateral cartilage.

Many authors are critical about this technique about the stability in Keystone area and difficulty in performing this procedure. Surgical treatment of the nasal septum in the form of submucous resection of the deviated bony and cartilaginous septum to relieve nasal airway obstruction was first described by Ingals in 1882 and later modified in 1902 by Freer and in 1904 by Killian. Attention to increased cartilage preservation and selectively raising mucoperichondrial flaps was the focus of studies by Metzenbaum, Cottle, Goldman and Converse with their descriptions of septoplasty. Since these descriptions of septoplasty in the middle of the 20th century, multiple variations have been proposed. More recently, a modified extracorporeal septoplasty technique has been described in which a small remnant of dorsal cartilage is preserved at the keystone area to increase stability.