A modification of the 'maxilla-premaxilla' approach for nasal septum surgery is described. With this modification the mucosal elevation in the area of the two inferior tunnels is performed from above along the crests of the vomer, maxillary and premaxillary bones, instead of from below through the undermined base of the nose as in the 'maxilla-premaxilla' approach. This mucosal elevation is performed under direct vision in the intraseptal area instead of by blind elevation as in the 'maxilla-premaxilla' approach where the progress of the elevator beneath the nasal mucosa is followed through the nasal chambers. It gives the surgeon the increased advantage of working under the perichondrium and periosteum and of overcoming any difficulty arising from malformations in the anterior (caudal) area of the septal cartilage, premaxillary wings and maxillary crest. With this modification, extensive undermining of the base of the nose is also avoided. Finally the septal framework is fully exposed as in the 'maxilla-premaxilla' approach but in a more easy and safe way while all the advantages of the 'maxilla-premaxilla' approach are preserved.