Killian’s Nasal Gouge

This instrument is part of the septoplasty set.

The Killian’s nasal gouge is bayonet shaped – that is, its shaft is bent so that the tip lies on a higher plane than the handle. This feature ensures that the hand holding the instrument does not obstruct vision and the surgeon can visualize the tip of the instrument inside the nasal cavity.

The tip of the instrument is V-shaped and very sharp. This feature helps remove spurs and sharp projections during septal surgeries.

This is a mallet (or hammer) used along with the gouge.

Uses

The instrument is used in septoplasty to remove spurs. It is especially useful to remove a deviated maxillary crest.

The wedge-shaped tip is placed at the beginning of the spur or bony projection in the septum. With the instrument in place, its handle is tapped gently with the mallet as the gouge cuts through the bony projection which is then removed with nasal dressing forceps.

More information

• Spurs are horizontal projections in the septum often formed at bony cartilaginous junctions that may cause nasal obstruction.
• The maxillary crest lies at the floor of the nasal cavity. It is sometimes deviated resulting in a large spur near the floor of the nasal cavity.
• Another type of gouge in ENT is the mastoid gouge. Before the introduction of the surgical drill, the mastoid gouge and hammer were used to perform mastoidectomy.

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Freer’s Elevator

This instrument is an important part of the septoplasty set.

Uses of the Freer’s elevator:

• Elevation of mucoperichondrial/mucoperiosteal flaps in septoplasty or SMR
• Separation of the septal cartilage from bone during septoplasty
• To perform uncinectomy during endoscopic sinus surgery
• For mucoperiosteal flap elevation in endonasal DCR

Identifying the septal elevator

This is a thin and long instrument with small flattened blades at either end. Most elevators are straight at one end and slightly curved at the other.

This is a close up of one end of the septal elevator.

Differentiating it from the tonsillar dissector

The tonsillar dissector is also a long and thin instrument, one end of which looks very much like the Freer’s elevator. Here’s how to tell the two instruments apart.

• The tonsillar dissector is slightly longer and stouter than the septal elevator.
• It has a blade on one end that is similar to the ones on the Freer’s elevator, but slightly larger.
• But the other end is bent and serrated with a comb like appearance.

How to use the Freer’s elevator

The straight end may be used for elevation of flaps. The curved end may be used in septoplasty to separate the quadrilateral cartilage from bone and elevate the mucoperiosteal flap on the opposite side.

The curved end may also be used to make an incision at the attachment of the uncinate process to the lateral wall of the nose during uncinectomy. (This is one method of performing uncinectomy, there are several others.) Both ends of the instrument are usually sharp, a feature that helps flap elevation and sharp dissection. 

If you look closely at the blade, you will find that one surface is flat and the other is gently curved. During flap elevation in septoplasty, make sure the flat surface and the sharp end rest on the cartilage or bone, while the smooth, curved side faces the flap. This will help you apply pressure on the septum without tearing the flap.

More information:

The elevator is used even in endoscopic septoplasty.

Modifications of the elevator with provision for suction are available. Bleeding during flap elevation is common and this instrument helps provide a clear field.

This instrument is also handy in any procedure that involves dissecting soft tissue off cartilage or bone.

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