Cottle Septum Elevator Graduated Double Ended, Septum and Periosteal Elevator

What the Cottle septum elevator graduated is

The Cottle septum elevator graduated is a hand instrument used to separate soft tissue from cartilage and bone inside the nose. Surgeons also call it a graduated Cottle elevator, a Cottle graduated elevator or a Cottle septum and periosteal elevator. It is made by Adas Instruments in high quality medical grade stainless steel, and it is reusable and fully autoclavable.

It is supplied in two graduated builds, a 21 cm with 3 mm and 2.1 mm tips and a 23 cm with two 5 mm tips, so the tip width is chosen with the length.

The work an elevator does is always the same in principle. A layer of soft tissue is stuck to the cartilage or bone under it, and it has to come off in one sheet without a hole in it. Get that right and the rest of the operation has a dry field and a flap that will lie back down. Get it wrong and you are repairing a tear for the next ten minutes. That is why the shape of the working end, the stiffness of the blade and the length of the shaft are the three things that decide which pattern a surgeon picks up.

Key design features of the Cottle septum elevator graduated

• Two graduated builds, chosen at the point of order
• 21 cm build with a 3 mm tip and a 2.1 mm tip
• 23 cm build with a 5 mm tip at each end
• Double ended, a working blade at each side of the shaft
• Used for septal flap elevation and for periosteal elevation
• High quality medical grade stainless steel, reusable and autoclavable

The handle is flat and knurled rather than round. A flat handle tells you where the blade is facing without looking at it, and the knurling holds when a glove is wet. The shaft runs straight into the blade with no step, so there is no shoulder to catch on the rim of a nostril and nothing for protein to sit in after a case.

Cottle elevator sizes and build options

Every size below is a size we actually ship. Imperial figures are given beside the metric because United States buyers search in inches.

The shaft is etched for depth, usually a millimeter scale and on some runs a single reference line. Nothing is listed above that we do not hold. If a length you need is not in the table, ask, because a pattern like this is often made to order for an OEM run and a different length is a tooling change rather than a new instrument.

Uses of the Cottle septum elevator graduated by specialty

The Cottle septum elevator graduated appears on the same trays across these specialties because the job is the same one each time, lifting a tissue plane cleanly off what lies under it.

The specialty name and the procedure name are both worth knowing when you order, because catalogues file this pattern under whichever of the two the buyer used. An operating room manager searches by procedure and a purchasing office searches by specialty, and they are looking for the same instrument.

Tissue planes the Cottle septum elevator graduated works in

An elevator handles no suture and no needle. What decides the choice of pattern is the plane it has to open and how much force that plane takes.

Force is the part nobody writes down. Perichondrium on young cartilage lifts with almost nothing. Mucoperiosteum on the bony septum needs a firm push and a stiff blade behind it. Scarred tissue in a revision case needs more again, and that is the point at which a light blade starts to flex and the plane is lost. Match the blade to the plane and the instrument does the work instead of your wrist.

How the Cottle septum elevator graduated compares with other patterns

These four sit next to each other on a nasal tray and they are not interchangeable.

Surgeons who use this pattern usually also hold the McKenty nasal septum elevator double ended, the Gorney septum suction elevator and the Freer septum elevator. The closest relative in the range is the Cottle septum elevator.

On the same tray you will usually also find the Joseph Masing septum elevator.

If you are building a nasal tray from scratch, the usual answer is two elevators rather than one. Something light for cartilage and something stiffer for bone covers almost every case, and the third and fourth patterns get added for the particular operations a unit does often.

Materials and finish

The instrument is made in high quality medical grade stainless steel. The steel itself is made to a German specification. The blade is flat ground and satin finished, which cuts glare under the lights in an operating room and keeps the working end readable against wet tissue. There is no coating to chip and nothing on the shaft to trap protein.

Stainless steel is chosen here for a reason that has nothing to do with appearance. An elevator is levered, and a levered instrument that is too hard will crack at the neck while one that is too soft will take a set and stay bent. The grade used for this pattern sits between the two, which is why the blade can be thinned at the working end without losing the shaft.

Cottle septum elevator graduated care and sterilization

Rinse the instrument in cool water straight after use so blood does not dry on the blade. Clean it with a soft brush and a neutral pH enzymatic detergent, rinse in deionized water, then dry it completely. Steam autoclave at 134 degrees Celsius. Lay it in the tray so the blades do not rest against other instruments, because a bruised edge on an elevator is what tears a flap.

Look at the working end against the light before every case. A blunt end should be smooth with no flat spot and no nick, and a sharp end should still take a clean line. An elevator that has been dropped on a tiled floor is the one that buttonholes a flap two cases later, and it costs nothing to check.

Ordering and wholesale

This pattern is supplied by Adas Instruments to hospitals, surgical distributors and OEM buyers, in single units and in bulk. The item code is AN-69.04 and it is printed in the size table above so a procurement search finds it. Backorder items dispatch in 10 to 12 working days. Every instrument carries a three year replacement against manufacturing defects.

For wholesale and OEM orders, instruments ship unpackaged in bulk or individually poly bagged, and laser marking with a distributor code or a hospital asset number is available on the shaft. Tell us the quantity and the marking you need and the quotation comes back with the lead time for that run rather than a stock figure.

Production is controlled under an ISO 13485 quality management system.

Frequently asked questions

What is a graduated Cottle elevator used for?

It raises the mucoperichondrial and mucoperiosteal flaps off the nasal septum, and the graduated builds let the tip width be chosen with the length. Surgeons reach for it when the same case needs a narrow tip at the caudal septum and a wider one further back.

How is the graduated Cottle different from the plain Cottle septum elevator?

The plain pattern is one build, 23 cm, spatulate at both ends. The graduated pattern is supplied in two builds, a 21 cm with 3 mm and 2.1 mm tips and a 23 cm with two 5 mm tips, so the tip width is part of the choice. Both carry etched depth marks, a millimeter scale or a single line.

What tip widths does it come in?

The 21 cm build has a 3 mm tip and a 2.1 mm tip. The 23 cm build has a 5 mm tip at each end. Both are double ended.

Is it a septum elevator or a periosteal elevator?

Both, and that is why it is listed under both names. The same blade raises mucoperichondrium off cartilage and mucoperiosteum off bone.

How do you care for a graduated Cottle elevator?

Rinse in cool water immediately after use, clean with a soft brush and a neutral pH enzymatic detergent, rinse in deionized water and dry fully before steam autoclaving at 134 degrees Celsius.

Related products and categories

Surgeons who work with the Cottle septum elevator graduated usually compare it against the McKenty nasal septum elevator double ended, the Gorney septum suction elevator and the Freer septum elevator. The whole family sits in dissectors and elevators, and this pattern is also listed under rhinoplasty instruments.