Maxilla-premaxilla approach to septal surgery in the cosmetic patient.

The maxillary-premaxillary approach to septal deformity developed by Cottle and Loring in 1958 is presented. The method is examined in terms of not only its role in repairing nasal function but also its advantages in controlling the septum for better cosmetic results. Excellent results were achieved using this approach in 350 patients with concomitant functional and cosmetic complaints. The method allows step-by-step diagnosis and treatment for all septal deformities and preserves excellent blood supply to the mucoperichondrial flaps, allowing a water-tight closure for repositioning as grafts, septal bone, and cartilage. It was discovered in most patients that curvature of the septum anteriorly and at the nasal dorsum was due to deformities at more posterior locations. As a result of scarring and overgrowth of the septum after trauma, stresses developed that caused the septum to assume a curved position. Once the stresses were relieved, the cartilaginous septum returned to the midline without further manipulation. The practice of removing curved portions of anterior cartilaginous septum, as with most forms of submucous operations, is unnecessary.