The Notch-and-Key Technique for Caudal Septal Deviation in Rhinoplasty: A Novel Approach

Sunnetci G, Yenigun A, Kucuk RB, Ozdemir E, Arslanoglu A, Ozturan O.

PubMed 41922621 Publisher (DOI)Free full text (PMC)

What this paper says

Cutting interlocking notches into a deviated caudal septum and a supporting graft so they lock together at the midline corrected 86-100% of the deviation angle with no complications or revisions at 12 months.

Overview

The front (caudal) part of the septum, when bent, blocks airflow and tilts the columella. Scoring, swinging-door and batten-graft methods can be unstable or need wide dissection. The Turkish authors describe a "lock-and-key" method in which matching notches are cut in the septum and in a septal or rib cartilage graft, so the two interlock and hold the septum straight. It was used through an open approach in primary rhinoplasty; patient numbers are not given in the abstract.

Sections of note

Angular correction 86-100% for anterior-posterior deviation and 89-100% for caudal deviation, rated "Good" to "Excellent."
Patient satisfaction on VAS improved by 4-7 points.
No complications and no revisions during 12-month follow-up.
Grafts were autologous septal or costal cartilage.
Level of Evidence IV.

What it means for a patient

A bent front septum can be mechanically locked straight rather than relying on sutures alone.
In this series the correction held for a year with no complications.
The abstract does not state how many patients were treated, so the strength of the evidence is unclear.

Why this paper matters

It adds a mechanical fixation concept to caudal septal surgery, where recurrence is a known problem. Limits: patient numbers absent from the abstract, no comparison group, 12-month follow-up.

Terms

Caudal septum: the front edge of the septal cartilage, just behind the columella.
Swinging door: a technique that frees the caudal septum and swings it back to the midline.
Batten graft: a cartilage strip sutured alongside the septum as a splint.
Anterior nasal spine: the bony point the caudal septum rests on.
VAS: visual analogue scale, 0-10.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Caudal septal deviation poses a significant challenge in rhinoplasty, affecting both nasal airflow and aesthetic balance. While various techniques such as scoring, swinging door, and batten grafting have been used, many fail to ensure sufficient stabilization or involve extensive dissection, especially in revision cases or in patients with limited septal support.

Technique: The notch-and-key technique involves creating interlocking notches in both the deviated caudal septum and a supporting graft. This configuration achieves mechanical fixation through a "lock-and-key" principle, securing the caudal septum at the midline without compromising anatomical integrity. The procedure was performed using an open approach in primary rhinoplasty cases. Autologous septal or costal cartilage was used for grafting.

Results: Objective angular analysis demonstrated correction rates of 86-100% for anterior-posterior deviation and 89-100% for caudal deviation, corresponding to "Good" to "Excellent" outcomes. Patient satisfaction on the VAS scale improved by 4-7 points.No complications occurred, and revisions were not necessary during the 12-month follow-up period.

Conclusions: The notch-and-key technique offers a safe, reproducible, and structurally sound alternative for caudal septal stabilization. By minimizing dissection and providing strong midline fixation, it facilitates both functional and aesthetic goals of rhinoplasty, especially in cases with isolated caudal deviation.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).