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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Lack's Tongue Depressor

This is a very commonly used OPD instrument.

It has two blades at right angles to each other. One of them is slightly wider than the other and is completely flat. This is the part of the tongue depressor that is inserted into the oral cavity. The other blade is narrower and has a slight curve at its free end, like a handle. This is the part of the instrument that is held in your hand.

Uses of the tongue depressor:

Examination of the oral cavity – vestibule, buccal mucosa, gums, floor of the mouth

Examination of the oropharynx and posterior pharyngeal wall

Used in posterior rhinoscopy, along with the postnasal mirror

For the ‘cold spatula test’ –  to assess (approximately) the nasal airway/ patency in the OPD

To perform minor procedures in the oral cavity

To take a throat swab or a swab from the tonsil

How to use the tongue depressor:

Hold the instrument by the narrower blade that acts as a handle.

Insert the other blade into the oral cavity.

First retract the cheek so you can examine the vestibule, buccal mucosa and gums and repeat the same on the other side.

Then place the blade flatly on the dorsum of the tongue and press it down – this will allow you to examine the palate, tonsillar pillars, the tonsils and the posterior pharyngeal wall.

Take care to depress only the anterior two-thirds of the tongue with this instrument. Touching the posterior third of the tongue will elicit the gag reflex.

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