Traumatic Caudal or Anterior Septal Discolation and Treatment Difficulties

Caudal or Anterior Nasal Septum Deviation



What Is The Nasal Septum?

The nasal septum is a structure that separates the nasal cavity vertically and consists of bone-cartilage, both sides covered by the nasal mucosa, and you can find detailed information on the definition, description, treatment and deviation surgery of nasal septum deviations at the links below.

Nasal Septum Deviation Definition and Causes

Normally, septum deviations may also occur in cases of inherited genetic causes, trauma to the nasal region during birth or at any time in human life after birth. Unlike genetic nasal septum deviations, septum deviations can occur by traumatic causes (nasal bone fracture and septum fracture do not confuse!). Unfortunately, the curvature of the cartilage in the nose in some of patients with nasal septum deviation caused by trauma rather than a simple deviation surgery is becoming a problem for the operations to be performed much more careful and attentive. When the caudal part of the nasal septum, that is, the lowest part of the nasal septum, deviates from the midline to one side, "caudal septum deviation" or "anterior septal dislocation" occurs, which can also cause asymmetry in the nostrils and curvature at the tip of the nose. It usually occurs after trauma from front to back at the tip of the nose.

Treatment Difficulties For Nasal Septum Deviations

Depending on the traumatized areas of the nasal septum and the severity of the trauma, septum deviations and associated problems can occur with traumatic reasons as follows.

•  Caudal or Anterior Nasal Septum Deviation

deviations, dislocations, fractures and nasal drops can occur at the bottom of the nasal septum (caudal septum) as traverses approaching the nasal tip. In such deviations, simple removal of the curved cartilage area can result in severe loss of support and droop at the nose tip. In caudal septum deviations, unlike normal closed and intranasal deviations, it may be necessary to perform open technique nose surgery and reconstruct cartilage support tissue at the nose tip.


Traumatic septum deviation treatment difficulties - Traumatic caudal septum deviation - Anterior septum deviation - Traumatic septum deviation - Caudal septum deviation treatment - Anterior septal dislocation - Traumatic nasal septum fracture - Nasal septum deviation operation - Septoplasty operation - Caudal septoplasty operation - Nasal septum deviation correction surgery


•  Traumatic Nasal Septum Deviation

In the above photograph, it is seen that after the trauma from front to back to the tip of the nose, the bottom part of the septum cartilage is displaced to the left. Taking this curved cartilage area alone can cause loss of support at the tip of the nose and nose tip droop. For this reason, open technique similar to nasal aesthetic surgery, open septoplasty operation is suitable.


Traumatic septum deviation - Traumatic nasal septum fracture - Nasal septum deviation operation - Septoplasty operation - Nasal septum deviation correction surgery - Bone spur formation

• During normal simple septoplasty operation, cartilage is dissected and curved septal cartilage sites are removed with minimal traumatic techniques (submucous dissection, submucous removal ...). As seen in the photographs above, it is seen that if the septum is broken in the anterior part and two separate cartilaginous lines are formed traumatically, and the cartilage of each cartilage is followed, the septum seems to be punctured. Care should be taken when cartilage membranes are lifted in patients with such folded cartilage laminas with different angulations.

• in the case of traumatic cartilage flexion, ossified needle-like protrusions (bone spur formations) extending laterally from fracture lines may occur after fractures at the back of the septum.


Traumatic septum deviation treatment difficulties - Traumatic caudal septum deviation - Anterior septum deviation - Traumatic septum deviation - Caudal septum deviation treatment - Anterior septal dislocation - Traumatic nasal septum fracture - Nasal septum deviation operation - Septoplasty operation - Caudal septoplasty operation - Nasal septum deviation correction surgery

• The traumatic cartilaginous curvatures that develop during childhood, especially when nasal development continues, can be expected to accompany the deformations of the nasal bone with time, such as "c nose" and "curved nose" (as in the photo above).

• Deviation surgery is normally performed within the nose and an average of 10-15 minutes of operation is available. Patients suffering from nasal drops, advanced deviation in the nose, patients with advanced degrees of caudal septum deviation narrowing the nasal breath may need to reconstruct the cartilaginous curvature and nasal support of the cartilaginous side in the form of open technical nasal aesthetics. In some patients, reconstruction of the septum cartilage entirely (total septal reconstruction operation) may be required. In this way, the process time is between 45-120 min. Below you can watch the animation of the deviation surgery and the nasal septum deviation animation.

Traumatic septum deviation treatment difficulties - Traumatic caudal septum deviation - Anterior septum deviation - Traumatic septum deviation - Caudal septum deviation treatment - Anterior septal dislocation - Traumatic nasal septum fracture - Nasal septum deviation operation - Septoplasty operation - Caudal septoplasty operation - Nasal septum deviation correction surgery

Treatment of Caudal Septum Deviation

In 1929, Dr. Metzenbaum is one of the first to describe a procedure addressing the problem of caudal septum deviation. Anterior attention was drawn to the difficulty in recognizing strength in the treatment of septal deviation and the minimal effect of correction of anterior deviation of posterior (posterior) septum resection. It also emphasized the importance of preserving the caudal septum for nasal support. On the outward side, the caudal septum defines a "swinging door technique" in which a vertical wedge is removed and emphasizes that the caudal septum must be repositioned in the middle line after the procedure. Several variations of this technique have been reported, including the technique of securing the caudal septum by suturing the nasal support tissues (source: Treating the caudal septal deflection).

Dr. Pastorek and Dr. Becker shared his experience with a modified swinging door technique, and in modified technique, septal cartilage, maxillary is torn from the crest and turned over the nasal floor, which acts as a "door stopper", and fixes the caudal septum in the midline position. To fix the caudal septum piece, the lower seam is placed. The authors emphasize that a swinging door technique can be applied so as not to lose support of the tip of the nose so as not to unduly weaken the caudal septum (source >>    Caudal septoplasty for treatment of septal deviation: aesthetic and functional correction of the nasal base).

There are many different surgical techniques that have been described for correcting the caudal septum deviation without attenuating the nasal support (source >> Nasal Septal Deviations: A Systematic Review of Classification Systems).

Normally, in a classic deviation surgery or septoplasty operation, the procedure is performed within the nose and there is no visible cut or trail change from the outside. Above, photographs of the nose after the open technique septoplasty, with advanced septum deviations with caudal septum deviation and in contact with the inferior turbinate at the posterior and before the procedure are seen. Since there is no operation on the nasal bone in general, only the silicone nasal pad is inserted into the nose and the procedure is terminated.

Caudal Septoplasty - Open Technique Septoplasty

In the photos and videos below, an open technique caudal septoplasty operation was performed on the patient who had caudal septum dislocation after previous trauma and a "dislocated part of the caudal septum" was seen inside the right nostril. You can find the patient's before and after photos and videos below.

Caudal Septoplasty - Open Technique Septoplasty

Caudal Septoplasty - Open Technique Septoplasty

Caudal Septoplasty - Open Technique Septoplasty

Caudal Septoplasty - Open Technique Septoplasty

Caudal Septoplasty - Open Technique Septoplasty

Caudal Septoplasty - Open Technique Septoplasty





Operation details: The operation started under general anesthesia. After local anesthetic infiltration, a columellar reverse vee incision was made. The caudal part of the nasal septum was resected. The straight graft obtained from the posterior side of the nasal septum was sutured to the septum and inner legs of the alar cartilage in the caudal septum section. Other deviated parts of the nasal septum were resected. Upon the patient's request, alar cephalic resection was performed and a cap graft was placed to additionally create a partial narrowing effect at the tip of the nose. 5/0 and 4/0 PDS were used to suture the grafts. The skin incision was sutured with 5/0 rapid Vicryl. Left alar base resection was performed. The piece of skin hanging inside the right nostril was resected. The operation was terminated by controlling bleeding. No hump resection or classical rhinoplasty was performed upon the patient's request.

Below are photographs of intranasal endoscopic examinations before and after surgery in a few patients who have undergone nasal septum deviation therapy with deviation surgery. Postoperative air passages increase and septum flat appearance.
 
Septoplasty Operation Before and After
 
Septoplasty Operation Before and After

Link group where you can read the articles about caudal septum deviation that I have previously prepared and published on this website >> https://www.ent-istanbul.com/search?q=caudal+septum+deviation

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
E-Mail: muratenoz@gmail.com
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47


 

Comments