Killian Septum Gouge

What the Killian septum gouge is

The Killian septum gouge is an ENT instrument for the bony part of the nasal septum. It scores, reshapes and takes out small segments of septal bone, and it is used in septoplasty, in rhinoplasty where the septum is being straightened, and in submucous resection.

Its blade is a concave trough, 5mm across, ground to a sharp edge along the front. A trough behaves differently from a flat blade: it runs under the plane rather than through it, so a strip of bone or cartilage can be freed at its base and lifted out in one piece instead of being broken up. That is why this pattern is the one usually picked when septal bone is being harvested as graft material rather than simply removed.

The instrument is 159mm long on a bayonet shaft, with a flat platform at the end of the handle for a mallet. Adas Instruments makes it as a single piece. Surgeons also search for it as a septum gouge or a septal gouge, and as a bone gouge instrument, and all of those describe this same tool.

Key design features of the concave septum gouge

The 5mm concave trough edge

The edge is a smooth curve, not a notch. It gives the blade a wide bearing surface against flat bone, which is what lets it take a shallow even cut across a broad crest instead of digging a groove in it. The trough also cups the fragment as it comes free, so the piece stays on the blade rather than dropping into the airway.

A bayonet shaft, so the view stays open

The shaft is offset twice and returns parallel, putting the handle out to one side. Down a nostril the surgeon has one narrow line of sight and this is what keeps it clear. It is the same geometry used on the Claus version of this instrument and on most nasal chisels for the same reason.

A flat impact platform for the mallet

The handle finishes in a true flat face. Bone in the posterior septum can be dense enough that hand pressure alone would need the surgeon to lean on the instrument, which is exactly when control is lost. Short mallet taps against a flat face move the blade a known distance each time.

A textured grip that holds when wet

The handle carries horizontal serrations along a solid section. Blood and irrigation make a smooth handle turn in the hand, and a gouge that rotates between taps stops cutting where it was aimed.

Killian septum gouge sizes and what they are for

One width and one length are stocked, because 5mm is the width that suits the septum and 159mm is the reach needed from outside the nostril. The wider 6mm and 8mm concave patterns exist in the trade but they are mastoid and general bone widths rather than septal ones.

If the job is taking a ridge down rather than lifting a strip out, the Claus version of this gouge with a V notch in the edge is the better instrument, because the notch aims itself and this smooth trough does not.

Where the Killian septum gouge is used

These are the procedures this gouge is bought for. It is a nasal instrument. The word gouge is shared with woodworking and the word chisel is shared with dentistry, and neither of those is what this is.

In each of these the mucoperiosteum is lifted off the bone first, normally with a Freer elevator, and the gouge then works on bare bone with the lining held aside.

What it cuts, and what it has to leave alone

What a septum gouge leaves alone is as much the point as what it removes. The concave edge and the offset shaft exist so that bone is taken while the lining on the far side of it stays intact.

The last row is the one that matters clinically. Bone can be replaced by a graft; septal mucosa torn on both sides in the same place cannot, and that is how a perforation happens.

How it compares with the rest of the septum family

Five septum instruments sit beside each other in this range and the two Killians are the pair most often mixed up. The plain Killian is this instrument. The Killian-Claus is the same tool with a notch cut into the edge.

So the choice between the two Killians is not about one being better made than the other, it is about the edge. A trough lifts. A notch aims. A set that does septal grafting regularly usually carries both.

Killian septum gouge materials and finish

The gouge is ground from high quality medical grade stainless steel, hardened through the blade so the edge holds after repeated mallet work, and left a little softer along the shaft so a tap that lands badly bends nothing permanently. The steel itself is made to a German specification.

The finish is satin rather than mirror bright. Under a headlamp a polished blade reflects light back up the nostril at the surgeon; a satin surface scatters it. Satin also shows bone dust and dried blood plainly, which is what you want when an instrument is being inspected between cases.

Caring for a Killian septum gouge

Rinse the trough under cool running water before anything dries in it. A concave blade holds bone paste along its length and it is far quicker to brush out at the sink than after it has set.

Ultrasonic clean in a neutral pH enzymatic solution, rinse in deionized water, then dry completely. Tap water left to dry on a blade is the ordinary cause of pitting on an instrument that has otherwise been cared for.

Autoclave at 134 degrees Celsius. Store with the edge protected and not touching other blades. The edge is the whole instrument on a gouge, and the commonest way it gets blunted is contact with another instrument in a tray, not use in a patient.

Ordering a Killian septum gouge, and wholesale

The Killian septum gouge is supplied as a single instrument, item code AM-81.05, 5mm concave blade on a 159mm bayonet shaft. It is made in our own workshop, so it can be ordered to match the finish and handle pattern of the rest of the septum instruments in a tray.

Distributor and wholesale pricing is available on quantity, and larger orders can be laser marked with a hospital or practice reference with no separate tooling charge. Send the quantity and the marking text and we will quote both together.

Item code AM-81.05. Every instrument carries a three year replacement warranty against manufacturing defects. Stock items ship from our own workshop. Backorder items take 10 to 12 working days to make. Production is controlled under an ISO 13485 quality management system.

Frequently asked questions

What is a Killian septum gouge used for

It scores, reshapes and removes small segments of the bony nasal septum in septoplasty, rhinoplasty and submucous resection. Because the blade is a concave trough it is also the pattern usually chosen when septal bone or cartilage is being lifted out whole as graft material.

What are the uses of a bone gouge instrument

A bone gouge removes bone by scooping rather than splitting. In the nose that means taking down a crest or a spur and freeing graft material. Elsewhere in surgery the same principle is used on the mastoid and on long bone, but the blade widths and shaft lengths are different and a septum gouge is not interchangeable with them.

How is a Killian septum gouge different from the Killian-Claus

The edge. This one is a smooth concave trough. The Claus has a V notch cut into that edge so it centers itself on a bony ridge. Use the trough to lift a strip out in one piece; use the notch to take a ridge down without the blade sliding off it.

What blade width does the Killian septum gouge use

This instrument is 5mm across the concave edge and 159mm overall. Wider concave gouges are made in the trade at 6mm and 8mm, but those widths belong to mastoid and general bone work rather than to the septum.

What is the tool surgeons use to cut nasal bone

Three instruments cover most of it. A gouge scoops, a chisel splits along a line, and an osteotome is heavier and used on the nasal bones rather than the septum. For septal bone the gouge and the chisel are the two that get picked up.

Related products and categories

• Freer septum gouge
• Freer septum chisel
• Ballenger Hajek septum chisel

Browse the full range of osteotomes, chisels and gouges, or see the wider set of rhinoplasty instruments this instrument belongs to.