목적: Endoscopic endonasal dacryocystorhinostomy (DCR) is superior to external DCR shorter surgical time and a lack of an external scar, while having equivalent success rates with external DCR for the treatment of primary acquired nasolacrimal duct obstruction. Some patients still undergo, however, external DCR due to narrow surgical corridor caused by high septal deviation. The authors devised limited nasal septal carving so that these patients can undergo endoscopic endonasal DCR. Here, we present the efficiency and safety of our technique. 방법:Surgical techniques of limited nasal septal carving were as follows. First, mucoperichondrial flap was elevated via modified Killian incision on the convex side. Then, protruded quadrangular cartilage and perpendicular plate of the ethmoid bone were cautiously reduced using a high-speed drill. After evaluating the width of surgical corridor, septal mucosa was further reduced using a microdebrider, if needed. A total nine patients with significant high septal deviation successfully underwent endoscopic endonasal DCR by the aid of this technique. Patients were postoperatively followed up for potential sequalae including nasal stuffiness, nasal pain or discomfort, saddling, smell loss and synechia formation. 결과:Mean follow-up periods were 16.2 5.5 months. No patients suffered from nasal stuffiness, nasal pain or discomfort, nasal saddling or smell loss. Mean pre- and post-operative olfactory thresholds were 7.5 1.7 and 7.9 1.5 (p = 0.59). Mean pre- and post-operative olfactory identification scores were 9.0 1.7 and 9.1 3.0 (p = 0.86). At lastest follow-up, all patients showed patent surgical corridor. Synechia occurred in two patients, but they were free of symptoms such as epiphora. 결론:Limited nasal septal carving using powered instruments is believed to be a safe and efficient surgical technique allowing for endoscopic endonasal DCR in patients with significant high nasal septal deviation.