Septal and Periosteal Elevators: Freer, Cottle and Raspatory Types
Instrument guides
Septal and Periosteal Elevators: Freer, Cottle and Raspatory Types
How septal and periosteal elevators differ, from the Freer and Cottle to suction elevators and raspatories, and which one suits each layer.
An elevator slides under a layer of tissue and lifts it off the bone or cartilage underneath. In septoplasty and rhinoplasty that means raising the mucoperichondrium off the septum and the periosteum off the nasal bones. Most patterns are double ended, with a sharp end to start the plane and a blunt end to widen it. The Freer is the classic septal elevator, the Cottle family covers septal and dorsal work, raspatories strip periosteum, and suction elevators keep the field clear as they work.
Where does the Freer elevator come from?
Otto Freer was a Chicago laryngologist who, with Gustav Killian, made submucous resection of the septum a standard operation in the early 1900s. Killian devised the operation, and Freer's changes to it became widely known, as The Journal of Laryngology and Otology recorded. Raising the lining of the septum without tearing it needs a thin, double ended elevator, and the Freer pattern is still the first one most surgeons reach for. A history of submucous resection covers how the operation developed.
Which elevators and raspatories do we make?
| Group | Patterns | Choose it when |
|---|---|---|
| Septal elevators | Freer, 5 and 6.5 mm, Cottle 23 cm, Cottle 2.5 mm, Masing, Pennington, Tebbetts, Kistner ball end | Raising the septal lining |
| Suction elevators | Gorney, Haraldsson, Negus, Gubisch suction raspatory | Bleeding obscures the plane |
| Periosteal elevators and raspatories | Cottle double ended, Converse, Dingman, McKenty, Lempert 2 to 6 mm, Williger | Lifting periosteum off the nasal bones and face |
| Perichondrium instruments | Daniel Cakir elevator, raspatory, Cottle Daniel raspatory | Preserving the perichondrium in structural rhinoplasty |
| Tunnelling and skin | Cottle tunnelling, Cottle skin elevator, Cottle periosteal file | Making a tunnel or raising skin over the dorsum |
| Fracture and bone | Boies nasal fracture elevator, Goldman displacer, Langenbeck bone elevator, Doyen rib raspatory, rib raspatory | Reducing a fracture or harvesting rib cartilage |
How do you choose between a sharp and a blunt elevator?
- Sharp ends cut into the right plane under the perichondrium or periosteum. Use them to start.
- Blunt ends extend the plane once you are in it, with less risk of tearing the flap.
- Width follows the space: 2 to 4 mm for the narrow septum, 5 mm and wider for broad bone surfaces.
- Suction saves a hand: a suction elevator lifts and clears blood at once, so you can see the plane.
How should elevators be cleaned?
Brush tissue off both ends straight after use. Flush suction elevators until the water runs clear, then brush the bore. Check sharp ends for burrs, because a burred edge tears the flap. Never leave instruments in saline, because it causes corrosion. Our instrument care guide gives the full routine, and the CDC guidance on cleaning instruments before sterilization explains why cleaning comes before the autoclave.
Frequently asked questions
What is a Freer elevator used for?
Raising the mucoperichondrium off the septal cartilage in septoplasty, and other fine elevation in the nose and face.
What is the difference between an elevator and a raspatory?
An elevator lifts tissue with a smooth edge. A raspatory has a sharp or roughened edge that scrapes periosteum off bone.
Why use a suction elevator?
It lifts and clears blood at the same time, so the plane stays visible without a separate suction tube.
Can suction elevators be autoclaved?
Yes, after the bore has been flushed and brushed.
Related instrument guides
- Rhinoplasty osteotomes and chisels
- Septal forceps and cartilage instruments
- Killian vs Cottle nasal speculum
- Surgical suction tubes
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