The Laryngoscope Lippincott Williams & Wilkins © 2008 The American Laryngological, Rhinological and Otological Society, Inc. How I Do It Modified Nasal Specula and Flexible Holder for Endoscopic Nasal Surgery Munetaka Ushio, MD; Muneo Nakaya, MD; Kenji Kondo, MD; Mitsuya Suzuki, MD; Tatsuya Yamasoba, MD The use of an endoscope in nasal surgery has now extended to surgery on the nasal septum as well as to sinus surgery. We devised the use of the modified nasal specula with Yasargil’s flexible holder to resolve the technical prob- lems in using an endoscope for septal surgery. One nasal speculum has two plates for connecting to the Yasargil’s flexible holder. This speculum allows the surgeon to use both hands freely and also functions as a guide for stabiliz- ing an endoscope. Another nasal speculum has two long adjustable wings. This speculum can widen the working space between the cartilage or bone of the nasal septum and detached mucosa. Our modified nasal specula are readily applicable to resolve the problems such as unstable endo- scope and narrow working space in septal surgery under endoscopic view. Key Words: Nasal speculum, nasal septoplasty, endoscopy. Laryngoscope, 118:1293–1294, 2008 INTRODUCTION The use of an endoscope in nasal surgery has now extended to surgery on the nasal septum 1–3 as well as to sinus surgery. Septal surgery under endoscopic view has advantages over the conventional macroscopic septal sur- gery. Endoscopic procedure offers a magnified and wide an- gled view of the surgical field to both the surgeon and assis- tants, and it also enables video recording of the surgical procedure. There are, however, several technical problems in using an endoscope for septal surgery. First, it is difficult to stabilize an endoscope during surgery on the anterior part of the nasal septum. In endoscopic surgery on the middle nasal meatus or posterior part of the sinonasal cavity, the nasal vestibule can be a guide for stabilizing an endoscope. In contrast, handling of an endoscope in the most anterior part of the nasal cavity is often difficult because of the lack of a stable guide. Second, the space between the cartilage or bone of the nasal septum and the detached mucosa is often nar- row, which makes it difficult to use an endoscope together with surgical instruments. In macroscopic surgery, a nasal speculum is used to widen the working space for handling the instruments. When we use a speculum in a similar way in endoscopic surgery, however, an assistant must hold the speculum. We thus devised the use of the modified nasal specula with Yasargil’s flexible holder, which is usually used for ear surgery such as stapedotomy, as a readily applicable way to resolve such problems. MATERIALS AND METHODS We designed two types of nasal specula (types A and B) based on the Mile’s nasal speculum (manufactured by Nagashima Medical Instruments Co. Ltd., Tokyo, Japan). In the original Mile’s nasal speculum, the distance between the two wings can be adjusted and held with a screw. Our type A nasal speculum has two plates for connecting to the Yasargil’s flexible holder (Fig. 1A). In our type B nasal speculum, the two original short wings of the type A speculum are replaced by two long adjustable wings (Fig. 1B). Yasargil’s flex- ible holder is a flexible rod with two holders on each end (Fig. 1C). Its shape can be changed and fixed in various positions. At surgery, each of the two ends of Yasargil’s holder are fixed to the surgical bed (Fig. 2A) and the nasal speculum (Fig. 2B), respectively. For surgery on the anterior part of the nasal cavity (e.g., the first half of Cottle’s nasal septoplasty or resection of nasal vestibule tumor), type A nasal speculum is used. This speculum allows the surgeon to use both hands freely and also functions as a guide for stabilizing an endoscope. As shown in Figure 3A, the type A nasal speculum facilitates the exposure of the anterior end of the septal cartilage in the initial step of Cottle’s nasal septoplasty. For surgery on the middle or posterior part of the nasal septum, the type B nasal speculum is used. As shown in Figure 3B, this speculum can widen the working space between the cartilage or bone of the nasal septum and detached mucosa by holding the mucosa laterally, and therefore prevent iatrogenic injury of the mucosa. DISCUSSION The advantages of our new nasal specula are threefold. First, for surgery on the anterior part of the nasal cavity, our From the Department of Otolaryngology (M.U., K.K., M.S., T.Y.), Grad- uate School of Medicine, University of Tokyo, and the Department of Otolaryngology (M.N.), Tokyo Metropolitan Fuchu Hospital, Tokyo, Japan. Editor’s Note: This Manuscript was accepted for publication Febru- ary 11, 2008. Send correspondence to Munetaka Ushio, MD, Department of Oto- laryngology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. E-mail: IZT01356@nifty.ne.jp DOI: 10.1097/MLG.0b013e31816d1db4 Laryngoscope 118: July 2008 Ushio et al.: Modified Nasal Speculum 1293