Simplifying the management of caudal septal deviation in rhinoplasty

Overview

A crooked nose usually presents as both a breathing problem and an appearance problem, and the two have to be addressed together. Deviation of the caudal septum, the front edge nearest the nostrils, is common in patients presenting for rhinoplasty. The authors set out a graduated approach and describe what to do when the usual manoeuvres fail.

Sections of note

• This is a descriptive technique article, not a patient series. No patient numbers, follow-up length or complication rates are given in the abstract.
• The authors state that accurate assessment before surgery and correct diagnosis during surgery drive the result.
• The approach is graduated, meaning simpler standard manoeuvres are tried first.
• If deviation persists, the caudal part of the anterior septum is cut free at its junction with the anterior nasal spine and maxillary crest.
• The freed cartilage is then sutured to the periosteum of the anterior nasal spine using 5-0 polydioxanone.
• The authors describe the method as safe and effective in the majority of cases, without supporting figures.

What it means for a patient

• A bent front septum is a common cause of blockage and of a nose that looks off centre, and it can be corrected during the same operation that changes the shape.
• The abstract reports no outcome data, so there is no measured success rate, revision rate or complication rate to weigh.
• A technique description reflects one group's practice and is not evidence that the method beats alternatives.

Why this paper matters

Caudal septal deviation is one of the harder parts of correcting a crooked nose, and clear stepwise descriptions shape what surgeons do. What remains unanswered is how this method performs against other caudal septal techniques over time.

Terms

• Caudal septum: the front lower edge of the wall dividing the two nostrils.
• Anterior nasal spine: the small bony point at the base of the nose above the front teeth.
• Maxillary crest: the ridge of upper jaw bone the septum sits on.
• Periosteum: the tough membrane covering bone, strong enough to hold stitches.
• Polydioxanone: a slowly absorbing suture material.